What can I do to reduce the amount of spatter created during prophylaxis?
Since the onset of the pandemic, the United States Centers for Disease Control and Prevention (CDC) and American Dental Hygienists’ Association (ADHA) have published guidance recommending the avoidance of aerosol-generating procedures whenever possible.1,2 Many revisions have subsequently been released over the past year. Each revision has continued to recommend avoiding aerosol-generating procedures whenever possible. Many dental offices, however, have returned to business as usual, including the use of aerosol-generating procedures. New research indicates that the prevalence of COVID-19 infections among US dental hygienists was very low (3.1%).3 This study found that 99.1% of the dental hygienists surveyed noted that their offices implemented enhanced infection control procedures. As we begin to learn more about COVID-19, adherence to good infection control practices remains necessary.
Aerosols are thought to be small particles less than 50 micrometers (µm) in diameter with the ability to stay suspended in the air for a prolonged period of time, whereas spatter is particles (droplets) larger than 50 µm that are forcefully ejected and either fall to the floor or land on surfaces, remaining suspended in the air only momentarily.4 Harrel and Molinari4 suggest a layered approach to ensuring protection from aerosols. The first layer includes use of proper personal protective equipment, the second layer focuses on implementing an antiseptic preprocedural mouthrinse, and the third layer is the routine use of high-volume evacuation (HVE) either with an assistant or a device. HVE devices must have at least an 8 mm opening that can remove a large volume of air (up to 100 cubic feet of air per minute). A fourth layer is incorporating high-efficiency particulate air filtration in the operatory.4
These layered recommendations are aligned with current CDC recommendations, with the exception of preprocedural mouthrinsing (PPMR). The CDC maintains there is not enough evidence to support PPMR at this time.1 The CDC does state that PPMRs with antimicrobial properties, such as chlorhexidine, essential oils, povidone iodine, and cetylpyridinium chloride, may reduce the levels of oral microorganisms in aerosols.1 As such, PPMRs may be helpful as a “best practice” especially in open floor plan layouts or practices with high volumes of patients. The most recent CDC guidance recommends all of these layered practices as well as the use of N95 respirators, filtering facepiece respirators, powered air-purifying respirators, or elastomeric respirators when performing aerosol-generating procedures. In addition, the CDC recommends clinicians don a face shield or goggles to reduce spatter.1 A combination of proper devices and behaviors is the best approach to limiting aerosols.
If a clinician believes coronal polishing is necessary, some precautions to limit spatter include: N95 or other respirator, face shield, or goggles; HVE or four-handed dentistry with an assistant; selective polishing only where needed; low-spatter polishing paste; limiting the amount of polishing paste; frequently wiping the rubber cup with a 2×2 gauze; and maintaining a dry field as much as possible.
- United States Centers for Disease Control and Prevention. Guidance for Dental Settings Interim Infection Prevention and Control Guidance for Dental Settings During the Coronavirus Disease 2019 (COVID-19) Pandemic. Accessed at: cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html. Accessed June 11, 2021.
- American Dental Hygienists’ Association. ADHA Interim Guidance on Returning to Work. Available at: adha.org/resources-docs/ADHA_TaskForceReport.pdf. Accessed June 11, 2021.
- Estrich C, Gurenlian J, Battrell A, et al. COVID-19 prevalence and related practices among dental hygienists in the United States. J Dent Hyg. 2021;95:6–16.
- Harrel S, Molinari J. Aerosols and spatter in dentistry: a brief review of the literature and infection control implications. J Am Dent Assoc. 2004;135:429-437.
From Dimensions of Dental Hygiene. July 2021;19(7):46.