In the early years, dentists didn’t worry much about contamination in their practice, other than blood and saliva. The dental staff just needed a mask, a pair of gloves, and a lab coat.
Now, in the age of COVID-19, aerosol and splatter present new cause for concern. These substances may be smaller, but their impact is considerably stronger. They carry viruses such as the SARS-CoV-2. Exposure can easily affect patients and team members. Hence, the dental community exponentially increased the use of Personal Protective Equipment (PPE) in the practices and even started doing virtual consultations.
A recent webinar hosted by Benco Dental featured Dona Schulz, RDH, BS, MBA, as a consultant sharing expertise on this topic. Schulz is a former corporate national director of dental hygiene, certified technology mentor, clinical hygiene instructor, and Benco Dental practice coach. With a passion for helping people, she shared why dentists must be mindful of aerosol and splatter and how to keep practice safer than ever.
How aerosol and splatter can transmit coronavirus
A recent article from the International Journal of Environmental Research and Public Health noted that small particles carrying viruses may spread indoors. The particles can cover distances of up to 10 meters from the discharge sources.
Aerosols can generate from handpieces during dental procedures. The aerosol particles produced can serve as a potential path for the transmission of diseases, such as the coronavirus.
For this reason, advances in dentistry aim not to reduce reliance on handpieces. Technologies and solutions have been created and made available to reduce aerosols and splatter in the dental practice.
How to reduce aerosol and splatter
Accessibility to comprehensive information and advanced technologies now provide possibilities to reduce aerosol and splatter.
The following are some equipment and techniques available to reduce aerosol and splatter in the dental practice:
- Lasers. Dental aerosols are formed through water flow (mL/min) and air pressure (PSI). A handpiece produces 30 to 60 mL/min water flow and 38 PSI air pressure.
In contrast, lasers generate 10 mL/min (67 to 83 percent less water flow) and 10 PSI (74 percent less air pressure). Therefore, lasers produce fewer aerosols than high-speed handpieces.
- Extraoral Suction Systems. These portable devices lessen the possibility of bacterial and viral infections spread throughout dental procedures. They decrease the flow of aerosol particles through a high-speed filtration system, which kills viruses and bacteria and prohibits them from being reentered into the air.
- Air purification system. Most air purifiers use High-Efficiency Particulate Air filters (HEPA) for filtration. The efficiency of the HEPA filter is said to be 95 percent, which is sufficient to minimize the amount of aerosol and splatter in the air. This filtration system is affordable with a reasonably Clean Air Delivery Rate (CADR) and low electric power.
- Splatter Guard prophy angles. Hygienists use prophy angles to apply prophy paste to patient’s teeth during a dental hygiene session. However, a new product is now available with even more beneficial features: the Splatter Guard prophy angle. Unlike any other prophy angles, the Splatter Guard has an attached wiper-style blade under the prophy cup. It retains both saliva and prophy paste on the tooth surface, reducing more splatter efficiently. This newly-designed tool protects the hygienist and the patient from splatters.
- Piezo technology scalers. This ultrasonic scaler provides unique benefits not available with other scalers. Working at a slightly higher frequency, this scaler requires less water to regulate heat and causes fewer vibrations. It provides easier removal of plaque and calculus for patients. Since the power and water flow required is low, it produces less aerosol than other scalers.
- Isolation techniques. During the webinar session, two methods were presented:
Localized suction option (safety suction). This isolation technique is placed on the handpiece near the ultrasonic tips. This tool focuses on extracting all the aerosol particles in reverse. It claims to provide 90 percent effectiveness in managing the aerosols.
Laser Bacterial Reduction (LBR). This method is a painless and rapid way to prevent the spread of diseases during treatment. Laser light isolates the bacteria that reside in the hollows around the teeth. This procedure takes only about 5 to 10 minutes.
Several available technologies and solutions can reduce aerosol and splatter. Know and choose what is best for patient and practice.
Integrate risk management systems
With all the changes brought by the pandemic, dental teams need to complete a process inventory at their practices. Integrated risk management systems to keep dentist, team, your patients safe in this vulnerable time are featured below:
- Complete practice inventory pulse check. The checklist below allows dentists to monitor the movement and progress of their practices. Consider the following for regular review:
Know which methods and equipment work for the team.
Learn what still needs to be improved at the practice.
Ensure that all are on one page in terms of communicating with patients.
Focus on patients’ main concerns at each visit.
Ensure everyone has a role and skill set to contribute.
Provide training and resources.
Schedule strategic meetings with the team.
2. PPE considerations. Take note of all the necessary precautions to protect dentist and team. Equip the practice with the following:
Non-contact infrared thermometers
Infection control training and protocol
3. Prepreprocedural rinsing. This is a recommended approach in reducing the transmission of pathogenic microorganisms. Although there is no evidence that this method diminishes SARS-CoV-2, biological plausibility implies that hydrogen peroxide and POVIDONE-IODINE (PVP-I) may reduce SARS-CoV-2 viral load in dental aerosols.
4. Paperless practice. Studies show that the coronavirus can live up to five days on paper. Instead of giving a hardcopy of a document or sending out cards, do it via email, SMS, or chat.
As an alternative, use a digital database to gather all patient information. Make sure the system is HIPAA-compliant and fully compatible with mobile devices. The top dental software being used includes Eaglesoft, Open Dental, and Dentrix. These databases have a feature for practice management syncing, reducing the need to duplicate files. Each software mentioned can automatically transfer all the information over to a patient’s chart.
The future of dentistry
Besides the development of tools and solutions, teledentistry has come a long way in dental practices, bringing valuable advantages in a time of precautions and restrictions. Other benefits of teledentistry include:
- Total patient engagement.
- Removal of barriers (virtual consultations/interviews, transferring of images files, etc.)
- Lessening of PPE expense.
- Reservation of time spent with patients.
Aspects of clinical practice can never be replaced by technology. However, innovation allows opportunities not restricted to the four walls of a practice.
As the months pass, advanced technology and practical solutions have been developed amid the pandemic to support the dental industry. Through these approaches, it’s possible to further protect patients and team in this challenging environment.
To learn more about the most up-to-date technologies and solutions available, contact your Friendly Benco Rep.