Dental Aerosols and Spatter… What Precautions Are You Taking?

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It’s time to reevaluate the conversation around aerosol management in the dental office and begin taking serious measures to help control the risk for both dental professionals and our patients. According to a study done by Visual Capitalist, dentistry is classified in the “very –high –risk” category of occupations involved with aerosol production.

The production of aerosols and spatter in dentistry is one of the biggest concerns regarding the spread of potentially infectious material among both dental professionals and their patients. Now, more than ever, infection prevention is at the forefront of all our minds!

I know that those involved in dentistry understand that the oral cavity we work in can be a contaminated environment. Every standard dental procedure we provide, from a dental cleaning to ultrasonic scaling to preparation of a tooth for a filling or crown to even the basic operation of an air-water syringe, all produce aerosols and spatter. But is this really any new information to those of us in the industry? Isn’t this what we signed up to do? The reality is we work in an environment that revolves around the oral cavity that is laden with hundreds of different types of microbes.

Each dental patient we see presents the possible risk of exposure to harmful airborne contaminants and infectious diseases such as hepatitis B, hepatitis C, HIV, SARS, influenza, and tuberculosis – just to name a few. I clearly remember being told as a dental hygiene student, “All patients should be treated as infectious, and the same protective measures should be taken across the board.”

In the late 1980s, the Occupational Safety and Health Administration (OSHA) implemented rules to protect health-care workers against blood-borne pathogens resulting in the use of personal protective equipment (PPE). We wear gloves, masks, and eyewear, in addition to practicing with standard precautions and best practices to minimize our potential exposure.

COVID-19 has heightened our awareness of yet another potentially dangerous virus that dental professionals may be exposing themselves and their patients to. The difference with this virus is the asymptotic nature of an individual that may actually be infected and unknowingly spreading it. We also know that this virus has a transmission through aerosols, droplets, or direct contact with the respiratory fluids of an infected person making the delivery of dental treatment more complicated.

In an article on Today’s RDH, Michelle Strange, RDH, BHS, MSDH, defined an aerosol as a suspension of solid or liquid particles in a gas containing bacteria or viruses. Procedures that generate aerosols and spatter can present safety risks for both patients and dental professionals. We know that bacteria and viruses can rapidly spread through spatter and aerosols produced by a patient’s saliva. Exactly how long aerosol stays in the air depends on the size and weight of the suspended material as well as the room ventilation, but it can range from seconds to hours, certainly long enough to be inhaled or settle on nearby surfaces. It behooves all dental professionals to assess how to reduce aerosol production and take steps to protect themselves and their patients.

To boost patient and provider safety, dental professionals should abide by the latest Center for Disease Control (CDC) guidelines and recommendations. This includes using HVE or a HVE in combination with an isolation-and-evacuation device, providing preprocedural peroxide rinse, maintaining dental unit water quality, and wearing proper PPE. The CDC has released guidelines for preferred and acceptable PPE to be used when treating patients during this pandemic as well as recommendations surrounding aerosol production reduction. Like many of you, I foresee changes in PPE requirements that will become permanent as we navigate and move beyond this crisis. Dental professionals must be aware of the potential risks involved within the dental clinic, educate themselves to prevent contamination, and protect all people who enter their work environment.

Zirc Dental Products can help take some of that worry off your mind. Zirc has the most extensive and innovative line of isolation products in the industry. Today, I want to focus on three that have been combined to create the new Protection Pack – Mr. Thirsty® One-Step, Insti-Dam®, and Pink Petal®. The idea behind the Protection Pack is that one of these three devices should be used for every patient during their dental visit in order to offer the most protection available surrounding aerosol production/reduction.

With the recent news regarding COVID-19, the Protection Pack aligns with CDC and ADA recommendations to decrease aerosol production. While no way exists to eliminate 100% of aerosols, studies have shown that use of HVE and HVE with an attached device cuts aerosol production by greater than 90%. A reduction in aerosols means a reduction in potentially infectious materials in the air, making a safer environment for both you and your patients.

Mr. Thirsty® One-Step

Mr. Thirsty® One-Step is designed to have powerful, high-volume suction. Unlike other hands-free isolation devices, Mr. Thirsty® One-Step has wide chambers in the middle of the device to allow this powerful suction to occur. It comes completely pre-assembled and is disposable, so there is no risk of cross-contamination. With its built-in bite block, tongue retraction, and airway/cheek protection, it is the perfect solution for a practitioner to use when performing any procedures that produce an aerosol.

Insti-Dam®

Any dental dam will provide maximum effectiveness of aerosol protection by isolating the potential for aerosolization to only the surface of the tooth being worked on. Zirc’s Insti-Dam® has added feature that make it easier and more efficient to use than traditional dams. Both the Original Insti-Dam® and the Relaxed-Fit Insti-Dam® come pre-framed and pre-punched with a single hole. They are each pre-assembled on their own flexible frame that allows the dam to be folded to the side for taking radiographs. No more having to take the dam off to gain access to the oral cavity just to have to put the frame back on again! The flexible material of the Relaxed-Fit Insti-Dam® makes it perfect for posterior placement. Once placed, the material can be tightened on the frame to remove slack. The taught material of the Original Insti-Dam® is ideal for anterior teeth. The results of aerosol reduction and time savings is remarkable.

Pink Petal®

Pink Petal® is a disposable device that holds the saliva ejector in the back corner of the mouth near the retro-molar pad. It allows continuous hands-free isolation, protects and retracts the cheek, and allows patient to close around the suction with ease. Because the saliva ejector attaches to the low-volume suction, reduction of aerosols will not be achieved. Instead, Pink Petal® offers continuous removal of pooling water and saliva… which in turn helps control bacteria that could be released into the air. From start to finish, Pink Petal® is the perfect fit for any hand instrumentation and polish procedure.

Zirc understands it is difficult to completely eliminate the risk posed by dental aerosols, but it is possible to minimize the risk with relatively simple and inexpensive precautions like personal barrier protection, preprocedural mouth rinse, and the use of high-volume suction apparatus like Mr. Thirsty® One-Step or Insti-Dam® when applicable. The use of these precautions will minimize the risk of an aerosolized spreading of infection. The time will come when we are allowed to return to providing dental treatment beyond emergency cases – do what you can now to find the devices that can put your mind at ease. When your patients return, communicate with them about each additional process you are taking to ensure their safety!

Written by: Tina Punton, Zirc Clinical Account Executive, Special Markets. Tina spent 23 years as a practicing hygienist before joining the Zirc team. She specializes in helping DSOs and group practices become more efficient. As a consultant for our RESET program, Tina understands just how busy practices are on a day-to-day basis. She enjoys being able to help them get organized and make each day moving forward a happier one! Email Tina at tinap@zirc.com. Visit Zirc’s website at www.zirc.com.

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