Is Standard Personal Protective Equipment Effective Enough To Prevent COVID-19 Transmission During Aerosol Generating Dental, Oral and Maxillofacial Procedures ? A Systematic Review

  1. Essam Ahmed Al-Moraissi
  2. Marwan Mohamed Abood
  3. Nasser A. Alasseri
  4. Frank Günther
  5. Andreas Neff

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Abstract

A systematic review was performed to answer the following questions: 1) Do dental, oral and maxillofacial (OMF) surgical procedures generate bioaerosols (and if so, which ones), which can result in transmission of COVID-19?; 2) Are aerosolized airborne droplets (and to which extent is splatter) in dental and OMF procedures infective?; 3) Is enhanced personal protective equipment (PPE) an essential to prevent spreading of COVID-19 during dental and OMF aerosol generating procedures (AGPs)? Authors performed a systematic review to retrieve all pertinent literature that assessed effectiveness of surgical mask vs respirators for protecting dental health care workers during dental and OMF AGPs surgical procedures. Additionally, studies which assessed potential aerosolization during dental, OMF and orthopaedic surgeries were retrieved. There is moderate evidence showing that ultrasonic scaling and bone drilling using high speed rotary instruments produces respirable aerosols. Additionally, there is very weak/inconclusive evidence to support the creation of infectious aerosols during dental procedures. According to available very weak/inconclusive evidence, transmission of SARS-CoV-2 via infective aerosol during AGPS, so far, must remain speculative and controversial. As, however, this is a probable opportunistic way of transmission which at least cannot be sufficiently excluded and therefore should not be dismissed out of hand prematurely, proper and equally important properly applied protective equipment (i.e., N95 respirators or FFP-2 masksv or above regarding mouth and nose protection) should always be used during AGPs.

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  1. ScreenIT

    SciScore for 10.1101/2020.11.20.20235333: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    RandomizationFocused questions: Search strategy: Relevant randomized controlled trials (RCTs), regardless of language and publication date, were retrieved by a systematic search of MEDLINE, EMBASE, CINAHL, the Cochrane Central Registry of Controlled Trials (CENTRAL), and SCOPUS from the inception of each database to the end of May2020 (Additional file 1).
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Focused questions: Search strategy: Relevant randomized controlled trials (RCTs), regardless of language and publication date, were retrieved by a systematic search of MEDLINE, EMBASE, CINAHL, the Cochrane Central Registry of Controlled Trials (CENTRAL), and SCOPUS from the inception of each database to the end of May2020 (Additional file 1).
    MEDLINE
    suggested: (MEDLINE, RRID:SCR_002185)
    EMBASE
    suggested: (EMBASE, RRID:SCR_001650)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.11.20.20235333v1 on medRxiv