SPATTER CONTAMINATION IN DENTAL PRACTICES – HOW CAN IT BE PREVENTED?

Authors

  • C. GRAETZ University of Kiel, Germany
  • Jule BIELFELDT University of Kiel, Germany
  • Anica TILLNER University of Kiel, Germany
  • Anna PLAUMANN University of Kiel, Germany
  • C. E. DÖRFER University of Kiel, Germany

Abstract

Infectious diseases endanger all dental personnel during treatment, especially when spatter and aerosols are produced. Therefore, there is a strong need for better infection control principles during all treatments. The purpose of this in-vitro pilot study was to measure the environmental spatter contamination through a fluorescence technique. Scaling was performed using different power-driven devices and high-volume evacuation combined with a newly developed cannula (PS), standard suction cannulas (STS) and saliva ejectors (CDS). Material and methods: One sonic (AIR) and two ultrasonic devices (TIG, VEC) were utilized to remove biofilm from 168 artificial teeth in a manikin head. Teeth were scaled for 120s supra- or subgingivally. The spatter contamination of an area of 1.5m2 around the manikin head was assessed. Results and conclusions: The contaminated area (%) was significantly different for the AIR (median [25th; 75th percentiles]: 2.5 [1.16; 6.05]) versus TIG (0.25 [0.18; 0.88]) and VEC (0.08 [0.06; 0.1]) (p < 0.001). Irrespective of the instrument, subgingival scaling led to a less contaminated area (0.18 [0.07; 1.05]) than supragingival scaling (0.34 [0.1; 2.24]) (p < 0.001). High-volume evacuation combined with STS (0.17 [0.07; 1.04]) and PS (0.18 [0.07; 1.14]) reduced the contamination similarly (p=0.302) and was more effective compared to CDS (1.01 [0.12-5.78]) (p<0.001; p=0.002). Beside the limitation of an in-vitro investigation, it can be conclude that only high-volume evacuation with an adequately calibrated cannula is capable of significantly reducing the amount of spatter contamination produced during power-driven scaling.

Author Biographies

  • C. GRAETZ, University of Kiel, Germany

    School of Dental Medicine
    Clinic of Conservative Dentistry and Periodontology

  • Jule BIELFELDT, University of Kiel, Germany

    School of Dental Medicine
    Clinic of Conservative Dentistry and Periodontology

  • Anica TILLNER, University of Kiel, Germany

    School of Dental Medicine
    Clinic of Conservative Dentistry and Periodontology

  • Anna PLAUMANN, University of Kiel, Germany

    School of Dental Medicine
    Clinic of Conservative Dentistry and Periodontology

  • C. E. DÖRFER, University of Kiel, Germany

    School of Dental Medicine
    Clinic of Conservative Dentistry and Periodontology

References

1. Petersilka GJ, Ehmke B, Flemmig TF. Antimicrobial effects of mechanical debridement. Periodontol 2000 2002; 28: 56-71.
2. Westfelt E. Rationale of mechanical plaque control. J Clin Periodontol 1996; 23: 263-267.
3. Legnani P, Checchi L, Pelliccioni GA, D'Achille C. Atmospheric contamination during dental procedures. Quintessence Int 1994; 25: 435-439.
4. Bentley CD, Burkhart NW, Crawford JJ. Evaluating spatter and aerosol contamination during dental procedures. J Am Dent Assoc 1994; 125: 579-584.
5. Lu DP, Zambito RF. Aerosols and cross infection in dental practice--a historic view. Gen Dent 1981; 29: 136-142.
6. Leggat PA, Kedjarune U. Bacterial aerosols in the dental clinic: a review. Int Dent J 2001; 51: 39-44.
7. Szymanska J. Dental bioaerosol as an occupational hazard in a dentist's workplace. Ann Agric Environ Med 2007; 14: 203-207.
8. Gross KB, Overman PR, Cobb C, Brockmann S. Aerosol generation by two ultrasonic scalers and one sonic scaler. A comparative study. J Dent Hyg 1992; 66: 314-318.
9. Palakuru SK, Lakshman VK, Bhat KG. Microbiological analysis of oral samples for detection of Mycobacterium tuberculosis by nested polymerase chain reaction in tuberculosis patients with periodontitis. Dent Res J (Isfahan) 2012; 9: 688-693.
10. Faecher RS, Thomas JE, Bender BS. Tuberculosis: a growing concern for dentistry? J Am Dent Assoc 1993; 124: 94-104.
11. Harrel SK, Barnes JB, Rivera-Hidalgo F. Reduction of aerosols produced by ultrasonic scalers. J Periodontol 1996; 67: 28-32.
12. Cottone JA, Molinari JA. State-of-the-art infection control in dentistry. J Am Dent Assoc 1991; 122: 33-41.
13. Harrel SK. Clinical use of an aerosol-reduction device with an ultrasonic scaler. Compend Contin Educ Dent 1996; 17: 1185-1193; quiz 1194.
14. Serban D, Banu A, Serban C, Tuta-Sas I, Vlaicu B. Predictors of quantitative microbiological analysis of spatter and aerosolization during scaling. Rev Med Chir Soc Med Nat Iasi 2013; 117: 503-508.
15. Badersten A, Nilveus R, Egelberg J. Effect of nonsurgical periodontal therapy. II. Severely advanced periodontitis. J Clin Periodontol 1984; 11: 63-76.
16. Rühling A, Schlemme H, Konig J, Kocher T, Schwahn C, Plagmann HC. Learning root debridement with curettes and power-driven instruments. Part I: a training program to increase effectivity. J Clin Periodontol 2002; 29: 622-629.
17. Kocher T, Plagmann HC. Heat propagation in dentin during instrumentation with different sonic scaler tips. Quintessence Int 1996; 27: 259-264.
18. Tunkel J, Heinecke A, Flemmig TF. A systematic review of efficacy of machine-driven and manual subgingival debridement in the treatment of chronic periodontitis. J Clin Periodontol 2002; 29 Suppl 3: 72-81; discussion 90-71.
19. Walmsley AD, Lea SC, Landini G, Moses AJ. Advances in power driven pocket/root instrumentation. J Clin Periodontol 2008; 35: 22-28.
20. Larato DC, Ruskin PF, Martin A. Effect of an ultrasonic scaler on bacterial counts in air. J Periodontol 1967; 38: 550-554.
21. Walmsley AD. Potential hazards of the dental ultrasonic descaler. Ultrasound Med Biol 1988; 14: 15-20.
22. Dutil S, Meriaux A, de Latremoille MC, Lazure L, Barbeau J, Duchaine C. Measurement of airborne bacteria and endotoxin generated during dental cleaning. J Occup Environ Hyg 2009; 6: 121-130.
23. Day CJ, Sandy JR, Ireland AJ. Aerosols and splatter in dentistry--a neglected menace? Dent Update 2006; 33: 601-602, 604-606.
24. Holbrook WP, Muir KF, Macphee IT, Ross PW. Bacteriological investigation of the aerosol from ultrasonic scalers. Br Dent J 1978; 144: 245-247.
25. Goldman HS, Hartman KS. Infectious diseases. Their disease, our unease: infectious diseases and dental practice. Va Dent J 1986; 63: 10-19.
26. Macher J, Willek K, Martinez KF, Morey PR, Martyny J. Bioaerosols: Assessment and Control. Cincinnati, Ohio: ACGIH, 1999.
27. Basu MK, Browne RM, Potts AJ, Harrington JM. A survey of aerosol-related symptoms in dental hygienists. J Soc Occup Med 1988; 38: 23-25.
28. Glenwright HD, Knibbs PJ, Burdon DW. Atmospheric contamination during use of an air polisher. Br Dent J 1985; 159: 294-297.
29. Bennett AM, Fulford MR, Walker JT, Bradshaw DJ, Martin MV, Marsh PD. Microbial aerosols in general dental practice. Br Dent J 2000; 189: 664-667.
30. Nejatidanesh F, Khosravi Z, Goroohi H, Badrian H, Savabi O. Risk of Contamination of Different Areas of Dentist's Face During Dental Practices. Int J Prev Med 2013; 4: 611-615.
31. Jacks ME. A laboratory comparison of evacuation devices on aerosol reduction. J Dent Hyg 2002; 76: 202-206.
32. Harrel SK, Barnes JB, Rivera-Hidalgo F. Aerosol reduction during air polishing. Quintessence Int 1999; 30: 623-628.
33. Harrel SK. Airborne spread of disease--the implications for dentistry. J Calif Dent Assoc 2004; 32: 901-906.
34. Timmerman MF, Menso L, Steinfort J, van Winkelhoff AJ, van der Weijden GA. Atmospheric contamination during ultrasonic scaling. J Clin Periodontol 2004; 31: 458-462.
35. Flemmig TF, Petersilka GJ, Mehl A, Hickel R, Klaiber B. The effect of working parameters on root substance removal using a piezoelectric ultrasonic scaler in vitro. J Clin Periodontol 1998; 25: 158-163.
36. Flemmig TF, Petersilka GJ, Mehl A, Rudiger S, Hickel R, Klaiber B. Working parameters of a sonic scaler influencing root substance removal in vitro. Clin Oral Investig 1997; 1: 55-60.
37. Harrel SK, Barnes JB, Rivera-Hidalgo F. Aerosol and splatter contamination from the operative site during ultrasonic scaling. J Am Dent Assoc 1998; 129: 1241-1249.
38. Barnes JB, Harrel SK, Rivera-Hidalgo F. Blood contamination of the aerosols produced by in vivo use of ultrasonic scalers. J Periodontol 1998; 69: 434-438.
39. Nicoll BK, Peters RJ. Heat generation during ultrasonic instrumentation of dentin as affected by different irrigation methods. J Periodontol 1998; 69: 884-888.
40. Plagmann HC. [Textbook of periodontology]. München; Wien: Hanser Verlag, 1998. [Book in German]
41. Reitemeier B, Jatzwauk L, Jesinghaus S, Reitemeier C, Neumann K. [Effective reduction of aerosol - possibilities and limitations]. ZMK 2010; 26: 662-673.
42. Checchi L, Matarasso S, Pirro P, D'Achille C. Topographical analysis of the facial areas most susceptible to infection with transmissible diseases in dentists. Int J Periodontics Restorative Dent 1991; 11: 164-172.
43. Gupta DG, Mitra DD, K PD et al. Comparison of Efficacy of Pre-Procedural Mouth Rinsing in Reducing Aerosol Contamination Produced by Ultrasonic Scaler: A Pilot Study. J Periodontol 2013.
44. Veksler AE, Kayrouz GA, Newman MG. Reduction of salivary bacteria by pre-procedural rinses with chlorhexidine 0.12%. J Periodontol 1991; 62: 649-651.
45. Fine DH, Mendieta C, Barnett ML et al. Efficacy of preprocedural rinsing with an antiseptic in reducing viable bacteria in dental aerosols. J Periodontol 1992; 63: 821-824.
46. Drisko CL, Cochran DL, Blieden T et al. Position paper: sonic and ultrasonic scalers in periodontics. Research, Science and Therapy Committee of the American Academy of Periodontology. J Periodontol 2000; 71: 1792-1801.
47. Fine DH, Furgang D, Korik I, Olshan A, Barnett ML, Vincent JW. Reduction of viable bacteria in dental aerosols by preprocedural rinsing with an antiseptic mouthrinse. Am J Dent 1993; 6: 219-221.
48. Feres M, Figueiredo LC, Faveri M, Stewart B, de Vizio W. The effectiveness of a preprocedural mouthrinse containing cetylpyridinium chloride in reducing bacteria in the dental office. J Am Dent Assoc 2010; 141: 415-422.

Additional Files

Published

2018-04-26