A dental aerosol is an aerosol that is produced from

dental instrument Dental instruments are tools that dental professionals use to provide dental treatment. They include tools to examine, manipulate, treat, restore, and remove teeth and surrounding oral structures. Examination instruments These tools allow dental ...

, dental handpieces, three-way syringes, and other high-speed instruments. These aerosols may remain suspended in the clinical environment. Dental aerosols can pose risks to the clinician, staff, and other patients. The heavier

particle In the physical sciences, a particle (or corpuscule in older texts) is a small localized object which can be described by several physical or chemical properties, such as volume, density, or mass. They vary greatly in size or quantity, from ...

s (e.g., >50 µm ) contained within the aerosols are likely to remain suspended in the air for relatively short period and settle quickly onto surfaces, however, the lighter

s may remain suspended for longer periods and may travel some distance from the source. These smaller particles are capable of becoming deposited in the lungs when inhaled and provide a route of

disease A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...

s transmission. Different dental instruments produce varying quantities of aerosol, and therefore are likely to pose differing risks of dispersing microbes from the mouth. Air turbine dental handpieces generally produce more aerosol, with electric micromotor handpieces producing less, although this depends on the configuration of water coolant used by the handpiece.

Composition

These dental aerosols are bioaerosols which may be contaminated with

bacteria Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one Cell (biology), biological cell. They constitute a large domain (biology), domain of prokaryotic microorganisms. Typically a few micrometr ...

fungi A fungus ( : fungi or funguses) is any member of the group of eukaryotic organisms that includes microorganisms such as yeasts and molds, as well as the more familiar mushrooms. These organisms are classified as a kingdom, separately from ...

, and

virus A virus is a submicroscopic infectious agent that replicates only inside the living cells of an organism. Viruses infect all life forms, from animals and plants to microorganisms, including bacteria and archaea. Since Dmitri Ivanovsk ...

es from the oral cavity,

skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different de ...

, and the

water Water (chemical formula ) is an Inorganic compound, inorganic, transparent, tasteless, odorless, and Color of water, nearly colorless chemical substance, which is the main constituent of Earth's hydrosphere and the fluids of all known living ...

used in dental units. Dental aerosols also have micro-particles from dental burs, and silica particles which are one of the components of

dental filling Dental restoration, dental fillings, or simply fillings are treatments used to restore the function, integrity, and morphology of missing tooth structure resulting from caries or external trauma as well as to the replacement of such structure sup ...

materials like

dental composite Dental composite resins (better referred to as "resin-based composites" or simply "filled resins") are dental cements made of synthetic resins. Synthetic resins evolved as restorative materials since they were insoluble, of good tooth-like appea ...

. Depending upon the procedure and site, the aerosol composition may change from patient to patient. Apart from

microorganism A microorganism, or microbe,, ''mikros'', "small") and ''organism'' from the el, ὀργανισμός, ''organismós'', "organism"). It is usually written as a single word but is sometimes hyphenated (''micro-organism''), especially in olde ...

s, these aerosols may consist of particles from saliva, gingival crevicular fluid,

blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the cir ...

dental plaque Dental plaque is a biofilm of microorganisms (mostly bacteria, but also fungi) that grows on surfaces within the mouth. It is a sticky colorless deposit at first, but when it forms tartar, it is often brown or pale yellow. It is commonly found be ...

calculus Calculus, originally called infinitesimal calculus or "the calculus of infinitesimals", is the mathematical study of continuous change, in the same way that geometry is the study of shape, and algebra is the study of generalizations of arithm ...

, tooth debris, oronasal secretions, oil from dental handpieces, and micro-particles from grinding of the

teeth A tooth ( : teeth) is a hard, calcified structure found in the jaws (or mouths) of many vertebrates and used to break down food. Some animals, particularly carnivores and omnivores, also use teeth to help with capturing or wounding prey, t ...

and dental materials. They may also consist of

abrasive An abrasive is a material, often a mineral, that is used to shape or finish a workpiece through rubbing which leads to part of the workpiece being worn away by friction. While finishing a material often means polishing it to gain a smooth, reflec ...

particles that are expelled during

air abrasion Air abrasion is a dental technique that uses compressed air to propel a thin stream of abrasive particles—often aluminum oxide or silica—through a specialized hand-piece to remove tooth tissue and decay before being suctioned away, similar to s ...

and polishing methods.

Size

Dental aerosols contain a wide range of particles with the majority being less than 50 µm. The smaller particles with size between 0.5 µm -10 µm are more likely to be inhaled and have the potential to transmit the

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dis ...

s. Smaller particles ar elikely to remain suspended for longer periods of time, and may travel further from the source. Settling time of particles is described by Stokes' law in part as a function of their aerodynamic diameter.

Potential hazards and mitigation

The

used in the dental units may be contaminated with ''

Legionella ''Legionella'' is a genus of pathogenic gram-negative bacteria that includes the species '' L. pneumophila'', causing legionellosis (all illnesses caused by ''Legionella'') including a pneumonia-type illness called Legionnaires' disease and a mil ...

'', and the aerosols produced by dental handpieces may contribute to the spread of the ''

'' in the environment; there is therefore a risk of inhalation by the dentist, staff and patients. The dental unit water lines (DUWLs) may also be

contaminated Contamination is the presence of a constituent, impurity, or some other undesirable element that spoils, corrupts, infects, makes unfit, or makes inferior a material, physical body, natural environment, workplace, etc. Types of contamination ...

with other

like ''Mycobacterium'' spp and ''

Pseudomonas aeruginosa ''Pseudomonas aeruginosa'' is a common encapsulated, gram-negative, aerobic–facultatively anaerobic, rod-shaped bacterium that can cause disease in plants and animals, including humans. A species of considerable medical importance, ''P. aerug ...

''. Infection from ''Legionella'' species causes infections like

Legionellosis Legionnaires' disease is a form of atypical pneumonia caused by any species of '' Legionella'' bacteria, quite often ''Legionella pneumophila''. Signs and symptoms include cough, shortness of breath, high fever, muscle pains, and headaches. Na ...

and several

pneumonia Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severi ...

like diseases. However, still there is no strong evidence that suggests the dentists are at greater occupational risk from ''Legionella''. Transmission of

tuberculosis Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, i ...

also occurs from the

cough A cough is a sudden expulsion of air through the large breathing passages that can help clear them of fluids, irritants, foreign particles and microbes. As a protective reflex, coughing can be repetitive with the cough reflex following three ph ...

producing procedures on the patients with

that involve production of aerosols. '' Mycobacterium tuberculosis'' is transmitted in the form of droplet nuclei which are smaller than 5 µm which stay suspended in the environment for longer duration. The development of active tuberculosis in Dental Health Care Workers (DHCWs) is less likely than the rest of the other Health Care Workers (HCWs). There are lacking evidences to prove the active tuberculosis development resulting from this transmission in Dental health care Workers (DHCWs). The

that caused the

COVID-19 Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was identified in Wuhan, China, in December 2019. The disease quickly ...

pandemic is named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the

International Committee on Taxonomy of Viruses The International Committee on Taxonomy of Viruses (ICTV) authorizes and organizes the taxonomic classification of and the nomenclatures for viruses. The ICTV has developed a universal taxonomic scheme for viruses, and thus has the means to ap ...

(ICTV) on 11 February 2020. SARS-CoV-2 remains stable in aerosols for several hours. The virus is viable for hours in aerosols and for few days on surfaces, hence the transmission of SARS-CoV-2 is feasible through aerosols and also shows

fomite A fomite () or fomes () is any inanimate object that, when contaminated with or exposed to infectious agents (such as pathogenic bacteria, viruses or fungi), can transfer disease to a new host. Transfer of pathogens by fomites A fomite is any ...

transmission. Dentists have previously been described as one of the top of the working groups with high risk of exposure to SARS-CoV-2. Due to the close proximity of the dental health care workers to the patients, dental procedures involving aerosol production is not advisable in patients who tested positive for COVID-19 except for emergency dental treatment. On 16 March 2020, the American Dental Association (

ADA Ada may refer to: Places Africa * Ada Foah, a town in Ghana * Ada (Ghana parliament constituency) * Ada, Osun, a town in Nigeria Asia * Ada, Urmia, a village in West Azerbaijan Province, Iran * Ada, Karaman, a village in Karaman Province, ...

) has advised dentists to postpone all elective procedures.

also developed guidance specific to address dental services during the

COVID-19 pandemic The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The novel virus was first identi ...

. Elements like calcium, aluminium, silica and phosphorus can also be found in the dental aerosols produced during the procedures like debonding of orthodontic appliances. These particles may range from 2 to 30 µm in diameter and there are chances of inhaling them. A number of methods have been proposed, and are widely used, to control dental aerosols and reduce risk of disease transmission. For example, dental aerosols can be controlled or reduced using dental suction, rubber dam, alternative handpieces, and local exhaust ventilation (extra-oral suction).

References

External links

* {{cite web , url = https://success.ada.org/en/practice-management/patients/infectious-diseases-2019-novel-coronavirus , publisher = American Dental Association (ADA) , title = Coronavirus Resource Center for Dentists Aerosols aerosol Occupational hazards Occupational safety and health

Composition

Size

Potential hazards and mitigation

See also

References

Further reading

External links