Aerosol concentrations and size distributions during clinical dental procedures

Laura Lahdentausta; Enni Sanmark; Saku Lauretsalo; Verneri Korkee; Sini Nyman; Nina Atanasova; Lotta Oksanen; Jiangyue Zhao; Tareq Hussein; Antti Hyvärinen; Susanna Paju

doi:10.1016/j.heliyon.2022.e11074

Aerosol concentrations and size distributions during clinical dental procedures

Heliyon. 2022 Oct 18;8(10):e11074. doi: 10.1016/j.heliyon.2022.e11074. eCollection 2022 Oct.

Authors

Laura Lahdentausta¹, Enni Sanmark², Saku Lauretsalo¹, Verneri Korkee¹, Sini Nyman¹, Nina Atanasova^{3

4}, Lotta Oksanen², Jiangyue Zhao⁵, Tareq Hussein^{6

7}, Antti Hyvärinen⁴, Susanna Paju¹

Affiliations

¹ Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, FI-00014 Helsinki, Finland.
² Department of Otorhinolaryngology and Phoniatrics-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, FI-00029 Helsinki, Finland.
³ Faculty of Biological and Environmental Sciences, Molecular and Integrative Biosciences, University of Helsinki, Helsinki, Finland.
⁴ Finnish Meteorological Institute, Helsinki, Finland.
⁵ Fraunhofer WKI, Material Analysis and Indoor Chemistry, Braunschweig, Germany.
⁶ Environmental and Atmospheric Research Laboratory (EARL), Department of Physics, School of Science, The University of Jordan, 11942 Amman, Jordan.
⁷ Institute for Atmospheric and Earth System Research (INAR/Physics), University of Helsinki, UHEL FI-00014 Helsinki, Finland.

Abstract

Background: Suspected aerosol-generating dental instruments may cause risks for operators by transmitting pathogens, such as the SARS-CoV-2 virus. The aim of our study was to measure aerosol generation in various dental procedures in clinical settings.

Methods: The study population comprised of 84 patients who underwent 253 different dental procedures measured with Optical Particle Sizer in a dental office setting. Aerosol particles from 0.3 to 10 μm in diameter were measured. Dental procedures included oral examinations (N = 52), restorative procedures with air turbine handpiece (N = 8), high-speed (N = 6) and low-speed (N = 30) handpieces, ultrasonic scaling (N = 31), periodontal treatment using hand instruments (N = 60), endodontic treatment (N = 12), intraoral radiographs (N = 24), and dental local anesthesia (N = 31).

Results: Air turbine handpieces significantly elevated <1 μm particle median (p = 0.013) and maximum (p = 0.016) aerosol number concentrations as well as aerosol particle mass concentrations (p = 0.046 and p = 0.006) compared to the background aerosol levels preceding the operation. Low-speed dental handpieces elevated >5 μm median (p = 0.023), maximum (p = 0.013) particle number concentrations,> 5 μm particle mass concentrations (p = 0.021) and maximum total particle mass concentrations (p = 0.022). High-speed dental handpieces elevated aerosol concentration levels compared to the levels produced during oral examination.

Conclusions: Air turbine handpieces produced the highest levels of <1 μm aerosols and total particle number concentrations when compared to the other commonly used instruments. In addition, high- and low-speed dental handpieces and ultrasonic scalers elevated the aerosol concentration levels compared to the aerosol levels measured during oral examination. These aerosol-generating procedures, involving air turbine, high- and low-speed handpiece, and ultrasonic scaler, should be performed with caution.

Clinical significance: Aerosol generating dental instruments, especially air turbine, should be used with adequate precautions (rubber dam, high-volume evacuation, FFP-respirators), because aerosols can cause a potential risk for operators and substitution of air turbine for high-speed dental handpiece in poor epidemic situations should be considered to reduce the risk of aerosol transmission.

Keywords: Air turbine handpiece; Dental aerosol; High- and low-speed dental handpiece; Optical particle sizer; Ultrasonic scaler.