A clinical observational analysis of aerosol emissions from dental procedures

  1. Tom Dudding
  2. Sadiyah Sheikh
  3. Florence Gregson
  4. Jennifer Haworth
  5. Simon Haworth
  6. Barry G. Main
  7. Andrew J. Shrimpton
  8. Fergus W. Hamilton
  9. AERATOR group
  10. Anthony J. Ireland
  11. Nick A. Maskell
  12. Jonathan P. Reid
  13. Bryan R. Bzdek
  14. Mark Gormley

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Abstract

Aerosol generating procedures (AGPs) are defined as any procedure releasing airborne particles <5 μm in size from the respiratory tract. There remains uncertainty about which dental procedures constitute AGPs. We quantified the aerosol number concentration generated during a range of periodontal, oral surgery and orthodontic procedures using an aerodynamic particle sizer, which measures aerosol number concentrations and size distribution across the 0.5–20 μm diameter size range. Measurements were conducted in an environment with a sufficiently low background to detect a patient’s cough, enabling confident identification of aerosol. Phantom head control experiments for each procedure were performed under the same conditions as a comparison. Where aerosol was detected during a patient procedure, we assessed whether the size distribution could be explained by the non-salivary contaminated instrument source in the respective phantom head control procedure using a two-sided unpaired t-test (comparing the mode widths (log( σ )) and peak positions (D P,C )). The aerosol size distribution provided a robust fingerprint of aerosol emission from a source. 41 patients underwent fifteen different dental procedures. For nine procedures, no aerosol was detected above background. Where aerosol was detected, the percentage of procedure time that aerosol was observed above background ranged from 12.7% for ultrasonic scaling, to 42.9% for 3-in-1 air + water syringe. For ultrasonic scaling, 3-in-1 syringe use and surgical drilling, the aerosol size distribution matched the non-salivary contaminated instrument source, with no unexplained aerosol. High and slow speed drilling produced aerosol from patient procedures with different size distributions to those measured from the phantom head controls (mode widths log(σ)) and peaks (D P,C , p < 0.002) and, therefore, may pose a greater risk of salivary contamination. This study provides evidence for sources of aerosol generation during common dental procedures, enabling more informed evaluation of risk and appropriate mitigation strategies.

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  1. Version published to 10.1371/journal.pone.0265076
  2. Version published to 10.1101/2021.06.09.21258479v3 on medRxiv
  3. Version published to 10.1101/2021.06.09.21258479v2 on medRxiv
  4. ScreenIT

    SciScore for 10.1101/2021.06.09.21258479: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: Ethical approval and patient recruitment: This study obtained ethical approval as part of the AERosolisation And Transmission Of SARS-CoV-2 in Healthcare Settings (AERATOR) study via the Northwest Research Ethics Committee (Ref: 20/NW/0393) and was conducted in accordance with the STROBE guidelines (Strengthening the Reporting of Observational Studies in Epidemiology).
    Consent: Each patient was contacted via telephone, received an information leaflet via post, and provided written consent on the day of treatment.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    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.
    • Thank you for including a protocol registration statement.

    Results from scite Reference Check: We found no unreliable references.

    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.

  5. Version published to 10.1101/2021.06.09.21258479v1 on medRxiv