Aerosol Generating Procedures (AGPs)
Dental aerosols are generated with many procedures, as shown in Table 1. Aerosols that may contain Corona virus from an infected patient occur when saliva is aerosolized along with products of the procedure. This occurs with aerosol procedures, from the use of certain dental and hygiene instruments, where the saliva cannot be prevented from entering the procedure area and becoming aerosolized. If these procedures are required, they must be performed with measures to mitigate the impact of aerosols.
For many procedures, potentially infectious aerosols may be minimized with the following steps:
Have patients rinse with 1% hydrogen peroxide (H2O2) for 60s.
Apply a sealed rubber dam to isolate the procedure area, then swab exposed procedure area with H2O2 (hydrogen peroxide) prior to beginning treatment
Use of high-volume suction (HVE)
When the above steps are followed, and the treatment proceeds with use of high-speed instruments and other aerosolizing procedures, the aerosols created will only contain tooth debris and no infectious saliva, minimizing the risk of infectious aerosols. Using HVE will minimize risk of infectious aerosols and is expected to be suitable for patients in the low risk category for COVID-19. Research is currently underway to quantify the risks of this approach.
|Ultrasonic and Sonic Scalers
||Considered the greatest source of aerosol contamination; use of a high-volume evacuator will reduce the airborne contamination by more than 95%
||Bacterial counts indicate that airborne contamination is nearly equal to that of ultra-sonic scalers; high-volume evacuator will reduce airborne bacteria by nearly 99%
|Tooth Preparation with High Speed Handpiece
||Minimal airborne contamination if a rubber dam is used
|Tooth Preparation with Air Abrasion
||Bacterial contamination is unknown; extensive contamination with abrasive particles has been shown