Abstract
Introduction Dental procedures produce splatter and aerosol which have potential to spread pathogens such as SARS-CoV-2. Mixed evidence exists on the aerosol-generating potential of orthodontic procedures. The aim of this study was to evaluate splatter and/or settled aerosol contamination during orthodontic debonding.
Material and methods Fluorescein dye was introduced into the oral cavity of a mannequin. Orthodontic debonding was undertaken with surrounding samples collected. Composite bonding cement was removed using a speed-increasing handpiece with dental suction. A positive control condition included a water-cooled, high-speed air-turbine crown preparation. Samples were analysed using digital image analysis and spectrofluorometric analysis.
Results Contamination across the eight-metre experimental rig was 3% of the positive control on spectrofluorometric analysis and 0% on image analysis. Contamination of the operator, assistant and mannequin was 8%, 25% and 28% of the positive control, respectively.
Discussion Splatter and settled aerosol from orthodontic debonding is distributed mainly within the immediate locality of the mannequin. Widespread contamination was not observed.
Conclusions Orthodontic debonding is unlikely to produce widespread contamination via splatter and settled aerosol, but localised contamination is likely. This highlights the importance of personal protective equipment for the operator, assistant and patient. Further work is required to examine suspended aerosol.
Key points
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Orthodontic debonding, including removal of composite using a slow-speed handpiece with dental suction, appears to pose little risk of widespread distribution of settled contamination.
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Splatter and settled aerosol was produced during the debonding procedure; however, this was mainly localised to the patient, operator and assistant.
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Further work is required to examine aerosol which remains suspended in the air.
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Acknowledgements
This study was supported by research grants from the British Endodontic Society and the Royal College of Surgeons of Edinburgh, and by the School of Dental Sciences, Newcastle University. Richard Holliday is funded by a National Institute for Health Research (NIHR) Clinical Lectureship. Charlotte Currie is funded by an NIHR Doctoral Research Fellowship. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Nadia Rostami was funded during this period by the Dunhill Medical Trust (RPGF1810/101) who kindly extended her funding to support this urgent COVID-19-related research. We would like to thank Kimberley Pickering, Ekaterina Kozhevnikova, Jamie Coulter and Chris Nile for their wider support on this project.
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H. Llandro and J. R. Allison are joint first authors. H. Llandro, J. R. Allison, C. C. Currie, D. Edwards, J. Durham, N. Jakubovics and R. Holliday contributed to the conception and design of the study. H. Llandro, J. R. Allison, C. C. Currie, D. Edwards, C. Bowes, N. Rostami and R. Holliday contributed to the acquisition, analysis and interpretation of data. All authors were involved in drafting and critically revising the manuscript, and have given final approval for publication. All authors agree to be accountable for all aspects of the work.
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Llandro, H., Allison, J., Currie, C. et al. Evaluating splatter and settled aerosol during orthodontic debonding: implications for the COVID-19 pandemic. Br Dent J (2021). https://doi.org/10.1038/s41415-020-2503-9
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DOI: https://doi.org/10.1038/s41415-020-2503-9
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