Creating a Clean Air in our Dental Office.
Benefits of Reducing Aerosols and Splatter in Dentistry to Create Clean Air Quality in Dental Offices:
Due to the recent health threat and the possibility of contracting a potentially life-threatening virus we all know as COVID-19, our office sought ways that we can reduce aerosols and splatter and provide clean air quality in our office.
So, what are the tactics that we can implement to help improve the management of aerosols in our office and create clean air quality for our patients and our team. Below is a list of everything that we have done to create clean air quality.
- Servicing and updating the existing building’s heating, ventilation, and air conditioning (HVAC) system
- Ultraviolet Light Air Purification
- Freestanding, commercial-grade air purification systems.
- HVE and the use of the HVE System for hygiene procedures.
- Use of a rubber dam.
- Use of an Isolite.
- Hydrogen peroxide or iodine rinse before any treatment or exam thereby decreasing loads of pathogens coming from patients’ mouths.
- Use of high Filtration, N95 masks.
#1. Servicing and Updating the Existing Building’s Heating, Ventilation, and Air Conditioning (HVAC) System
Dental teams may believe that they are protected from airborne contaminants and pathogens through a building’s heating, ventilation, and air conditioning (HVAC) system. In reality, air conditioning systems recirculate air, bacteria, viruses, and many other airborne particles. It is essential to service our HVAC system to ensure that it works properly and to its fullest capacity. It is also just as important for us to use high-quality filters and to replace them regularly
#2 Ultraviolet Light Air Purification System
An Ultraviolet Light Air Purification system was installed as part of our office’s central heating and cooling system. It is an Advanced Photocatalytic Oxidation In-Duct Air Purifier. The system cell absorbs contaminates and allows time for complete oxidation of these contaminates. Plus, the cell is regenerative, breaking down the captured impurities to simple carbon dioxide and water vapor. In addition this system uses proven shield UV-C lamp for airborne disinfection, not to mention irradiating the coil to eliminate system clogging with biological growth.
It uses germicidal UV light waves coupled with a catalytic process to attack germs and other particles while still in the air or on surfaces like doorknobs and countertops.
By helping rid your office of a wide variety of germs and allergens, air scrubbers can help reduce exposure to aerosols, too.
#3 Stand alone Air Purification Machine
A standard air purification machine (APM) plays a significant role in reducing the transmittable bio-aerosols and help remove harmful pathogens from the air.
#4 HVE and the Use of HVE Systems for Hygiene Procedures
High velocity evacuation, or HVE, used during all procedures, has made researchers aware of the potential effectiveness. HVE is effective in the control of aerosols when appropriately used. Some tests show a 95% reduction in aerosols with the use of HVE alone. Likewise, it is as effective when adjusted at optimal velocity and when positioned close to the operating site.
We looked at a few studies to find the answers:
Study #1: Aerosols and splatter in dentistry: A brief review of the literature and infection control implications. STEPHEN K. HARREL and JOHN MOLINARI J Am Dent Assoc 2004;135;429-437)
Study #2: Efficacy of High-volume Evacuator in Aerosol Reduction: Truth or Myth?
A Clinical and Microbiological Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4206761/
Conclusion of this study: The conclusion of the study is that to work properly, the placement of HVE devices should be approximately 6-15 mm away from the active ultrasonic tip or air polisher.
According to those studies, HVE works only when used properly. Consequently, it is easier to do so for dentists while working with a dental assistant. What about hygienists and collecting aerosols while they use ultrasonic instruments?
At Karrie Chu DDS Dental Care we use Isolite. The system is an innovative, hands-free HVE suction device that conveniently connects to existing dental vacuum systems. IsoLite assists with evacuation, retraction and maintaining a dry field during various dental and hygiene procedures, ultimately helping improve air quality in dental offices.
The use of an Isolite, from Zyris systems, is a versatile clinical option for dental isolation advantage and an ability to catch aerosols without using a rubber dam. We have incorporated an Isolite system in every operatory in our office at Karrie Chu DDS Dental Care.
https://youtu.be/UStZXDR7pHk
Isolite(R) Systems, Inc., from Zyris, is the industry leader in dental isolation technology. The newest member of the Isolite product line – the Isovac(TM) Dental Isolation Adapter, connects Isolite system to HVE.
The answer about HVE’s efficiency: By using HVE properly and using in conjunction with the Isolite system, the amounts of aerosols/ splatter can be dramatically reduced and making the air to be clean and free of pathogens.
#5 Use of a Rubber Dam
A rubber dam isolates the teeth that need to be treated from the saliva, soft tissues, and tongue of the oral cavity. Isolation with a rubber dam will reduce the number of microorganisms in the aerosols generated during treatment. This is in addition to the value of rubber dams in providing a dry area and increased access for visibility when performing restorative work.
#6 Hydrogen Peroxide Rinse Prior to Any Treatment or Exam Decreasing the Loads of Pathogens in Patients’ Mouths
The best mouthwash to kill coronavirus?The answer is not clear yet. But, an antimicrobial mouth rinse is thought to reduce the number of oral microbes. Listerine, commonly used as a mouth rinse, may not be effective in killing coronavirus. Additionally, since coronavirus is vulnerable to oxidation, any mouth rinse containing oxidative agents such as 1% hydrogen peroxide is recommended to reduce the salivary load of oral microbes, including potential coronavirus.
Learn more at:
Efficacy of Povidone-Iodine Gargle/Mouthwash Against Respiratory and Oral Tract Pathogens
#7 Use of N95 Masks
Q: How Big Are Coronavirus Particles and Can N95 masks protect?Scientists have used electron microscopes to measure how big the coronavirus is. Coronavirus particles (fancy scientific name “virions”) are spheres with diameters of approximately 0.125 microns (125 nm). The smallest particles are 0.06 microns, and the largest is 0.14 microns.
Q: Do N95 masks provide a 95% protection level against airborne viruses, and are they more efficient than traditional surgical masks?Answer: The results indicate that the penetration of particles, like virions, through the NIOSH-certified N95 masks (National Institute for Occupational Safety and Health), is significantly less than with surgical masks.
An N95 FFR is a type of mask which removes particles from the air breathed through it. These masks or respirators filter out at least 95% of very small (0.3 micron) particles. N95 FFRs are capable of filtering out all types of particles, including bacteria and viruses.
Q: What is the main difference between N95 and surgical masks?Answer: The fit of the mask is a major difference. Masks, especially N95 masks, should fit tightly while surgical masks do not provide a tight enough fit thereby allowing aerosols to sneak underneath.
N95 masks reduce the wearer’s exposure to airborne particles, from small particle aerosols to large droplets. N95 respirators are tight-fitting respirators that filter out at least 95% of particles in the air, including large and small particles.
When properly fitted and worn, minimal leakage occurs around edges of the respirator when the user inhales. This means almost all of the air is directed through the filter media.
Certainly, some surgical masks may let a significant portion of airborne viruses penetrate their filters, providing a meager amount of protection against aerosolized infectious agents when speaking in the size range of 10 to 80 nm. Therefore, it should also be noted that surgical masks are primarily designed to protect the environment from those wearing the masks. Respirators are supposed to protect the wearer from the environment.
All in all, the N95 masks do provide a level of protection that a standard mask does not offer.
Combining high infection control standards coupled with our methods for creating clean air, Karrie Chu DDS Dental Care can help keep team members and patients remain healthy and well.