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Aerosols in the Dental Office: Best Practices for Patient and Practitioner Safety

Course Number: 619


A novel β-coronavirus (SARS-CoV-2) causing severe and potentially fatal pneumonia (COVID-19) originating from Wuhan city, Hubei province, China was introduced to the human population in 2019 and initiated a pandemic that caused worldwide suffering and countless deaths.1-3 Clinical symptoms of SARS-CoV-2 infection in a patient without immunity include fever, dry cough, myalgia, fatigue, and pneumonia with abnormal chest CT. Less commonly observed symptoms include sputum production, headache, hemoptysis, and diarrhea.4-6 A zoonotic origin for SARS-CoV-2 is presumed. SARS-CoV-2 demonstrates 96.2% of whole-genome identity to the horseshoe bat (Rhinolophus affinis) virus RaTG13 and SARS-CoV-2 demonstrates over 99% genetic similarity to β-CoV samples found in pangolins, (scaly anteaters).7,8 While approximately 70% of viruses become pathogenic in humans after moving from animals to humans, the exact source of this virus has not yet been well-established. The person-to-person transmission of SARS-CoV-2 include direct transmission, such as cough, sneeze, saliva and other droplet inhalation transmission, and contact transmission, such as the contact with oral, nasal, and eye mucous membranes.9-12

Dental health care personnel (DHCP) and their patients were presumed to be at increased occupational risk associated with aerosols in the dental office due to the frequency of close, personal face-to-face communication and exposure to saliva, blood, and other body fluids, and—indirectly—by the handling of sharp instruments and touching contaminated dental surfaces.13-16 Studies involving other, similarly sized viral particles have shown that microorganisms in the mouth and respiratory tract can be transported in aerosols, splash and spatter generated during dental procedures and can contaminate the skin and mucous membranes of the mouth, respiratory passages, and eyes of DHCP as well as environmental surfaces and materials exposed to such aerosols and droplets. As such, DHCP play an important role in preventing disease transmission within the dental practice.17-24 This course seeks to assess the risks posed by aerosols in the dental office and assess infection control measures that have been shown to be effective to significantly reduce occupational risk for DCHP and patients through standard and transmission-based precautions.25-27