As we have all learned during our heightened state of pandemic awareness, a healthy indoor air quality is a medical necessity. Especially for first responders and other medical workers. But when it comes to the risk of harm from infectious disease, there are other industries that are considered high-risk; such as the dental profession.
There are occupational health risks that threaten the well-being of dentists, their staff, and the patients they serve. The main risk dental office workers face is contracting illness which is caused by the aerosols created during patient treatment. Contamination of the indoor medical environment occurs when germs from an infected patient become airborne and linger. (1)
DENTAL AEROSOLS DEFINED
The human mouth contains innumerable germs/microbes that can spread through casual contact. But the greatest risk is through aerosolization such as a cough or a sneeze. But germs may also be spread during routine dental procedures and oral surgery that generate their own aerosols.
Dental aerosols are defined as the splatters, mists, and droplets created from the use of certain dental instruments. These fine sprays and particles include saliva, blood, plaque, and oral debris and can travel distances up to 20 feet and linger in the air and on surfaces long after the patient has left the office.
To illustrate the significant threat that aerosols pose to the dental community, consider the information from a recent article published about contamination longevity for the COVID 19 virus (7).
Coronavirus germ life:
• On plastic and stainless-steel surfaces, the virus is viable up to 72 hours.
• On cardboard surfaces, up to 24 hours.
• On copper surfaces, up to nine hours.
• Suspending in the environment, up to three hours.
The chain of infection refers to the series of events that allow pathogens to cause infection in a person. This chain begins with an infectious agent, or pathogen, finding an instantaneous means of exit (sneeze, cough, or dental procedure).
A typical manner of transmission is when germ-laden saliva is projected via a cough or sneeze. But in a dental setting, this aerosolization is created by even standard procedures such as ultrasonic scaling, tooth abrasion or polishing, or operating an air-water syringe. The use of high-speed equipment such as scalers and drills in the presence of bodily fluids allow pathogens the opportunity to spread rapidly, making even routine dental procedures a potential threat. (2)
Add oral surgery to the list of procedures performed and there are a lot of aerosols emitted into the breathing space of the dental workers and other patients. (3)
Once an infected patient coughs or aerosols from a dental procedure are emitted, the time and distance traveled will depend on the size of the particles. Droplets are heavier and tend to fall and land at closer distances. As the droplets begin to evaporate, they diminish in size and float in the atmosphere where they become airborne vehicles of infectious transmission. (4) See chart of transmission, below.
Every day pathogens are transmitted within a given community. Oftentimes, transmission happens between members who are either asymptomatic or who do not recognize their illness or understand that it is contagious. Therefore, dental practices should treat all patients as if they can transmit disease.
The health risks vary from viruses such as the common flu or coronavirus to bacteria such as Streptococcus and Staphylococcus. The number of microbes at large will vary as will the severity of illness they can cause due to time, location, and the health and vulnerability of the individual who contracts the illness. For example, viruses, such as COVID 19, are smaller than even the most minuscule of bacterial germs, are rapid reproducers, and are much more likely to cause illness (5) which drives home the importance of eliminating the possibility that germs are spread within a dental office.
To keep workers and patients safe, the goal should be to eliminate the vehicle of germ transmission by stopping it before it can become a problem. To do this, multiple precautionary strategies will need to be employed. No one defense against infection will work on its own. Only multiple strategies, working in tandem, will create a safe and healthy indoor air quality.
In addition to basic medical hygiene practices such as handwashing and the use of antimicrobial hand sanitizers, (6) dental practices should adopt the following four-step method for the most complete means of keeping illness at bay: (4)
Proper safety protocol should always include:
1.PPE, personal protective equipment including gloves and facemasks
2.Antiseptic mouth rinse before and after a procedure
3.HVE, High-velocity air evacuation unit
4.Portable HEPA air filtration system
Following these control guidelines is the first step in preventing illness from taking hold of dental practitioners, hygienists, and patients. The second step is to contact an experienced indoor air quality specialist to find out what product makes sense for your practice.
At Air Impurities Removal Systems, Inc., we provide our dental industry customers with our 30 plus years of indoor environmental experience as well as our high-quality air cleaning products. Contact us today and ask about our Extract-All 987 Dental Clean Air systems.