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      Do exposures to aerosols pose a risk to dental professionals?

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          Abstract

          Background

          Dental care professionals are exposed to aerosols from the oral cavity of patients containing several pathogenic microorganisms. Bioaerosols generated during dental treatment are a potential hazard to dental staff, and there have been growing concerns about their role in transmission of various airborne infections and about reducing the risk of contamination.

          Aims

          To investigate qualitatively and quantitatively the bacterial and fungal aerosols before and during clinical sessions in two dental offices compared with controls.

          Methods

          An extra-oral evacuator system was used to measure bacterial and fungal aerosols. Macroscopic and microscopic analysis of bacterial species and fungal strains was performed and strains of bacteria and fungi were identified based on their metabolic properties using biochemical tests.

          Results

          Thirty-three bioaerosol samples were obtained. Quantitative and qualitative evaluation showed that during treatment, there is a significant increase in airborne concentration of bacteria and fungi. The microflora included mainly gram-positive organisms ( Staphylococcus epidermidis and Micrococcus spp.), gram-positive rod-shaped bacteria and those creating endospores as well as non-porous bacteria and mould fungi ( Cladosporium and Penicillium).

          Conclusions

          Exposure to the microorganisms identified is not a significant occupational hazard for dental care professionals; however, evidence-based prevention measures are recommended.

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          Most cited references20

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          A scoping review on bio-aerosols in healthcare and the dental environment

          Background Bio-aerosols originate from different sources and their potentially pathogenic nature may form a hazard to healthcare workers and patients. So far no extensive review on existing evidence regarding bio-aerosols is available. Objectives This study aimed to review evidence on bio-aerosols in healthcare and the dental setting. The objectives were 1) What are the sources that generate bio-aerosols?; 2) What is the microbial load and composition of bio-aerosols and how were they measured?; and 3) What is the hazard posed by pathogenic micro-organisms transported via the aerosol route of transmission? Methods Systematic scoping review design. Searched in PubMed and EMBASE from inception to 09-03-2016. References were screened and selected based on abstract and full text according to eligibility criteria. Full text articles were assessed for inclusion and summarized. The results are presented in three separate objectives and summarized for an overview of evidence. Results The search yielded 5,823 studies, of which 62 were included. Dental hand pieces were found to generate aerosols in the dental settings. Another 30 sources from human activities, interventions and daily cleaning performances in the hospital also generate aerosols. Fifty-five bacterial species, 45 fungi genera and ten viruses were identified in a hospital setting and 16 bacterial and 23 fungal species in the dental environment. Patients with certain risk factors had a higher chance to acquire Legionella in hospitals. Such infections can lead to irreversible septic shock and death. Only a few studies found that bio-aerosol generating procedures resulted in transmission of infectious diseases or allergic reactions. Conclusion Bio-aerosols are generated via multiple sources such as different interventions, instruments and human activity. Bio-aerosols compositions reported are heterogeneous in their microbiological composition dependent on the setting and methodology. Legionella species were found to be a bio-aerosol dependent hazard to elderly and patients with respiratory complaints. But all aerosols can be can be hazardous to both patients and healthcare workers.
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            Dental bioaerosol as an occupational hazard in a dentist's workplace.

            Many-year studies on aerosols as an infection vector, despite their wide range, ignored dental aerosol. All procedures performed with the use of dental unit handpieces cause the formation of aerosol and splatter which are commonly contaminated with bacteria, viruses, fungi, often also with blood. Aerosols are liquid and solid particles, 50 microm or less in diameter, suspended in air. Splatter is usually described as a mixture of air, water and/or solid substances; water droplets in splatter are from 50 microm to several millimetres in diameter and are visible to the naked eye. The most intensive aerosol and splatter emission occurs during the work of an ultrasonic scaler tip and a bur on a high-speed handpiece. Air-water aerosol produced during dental treatment procedures emerges from a patient's mouth and mixes with the surrounding air, thus influencing its composition. Because air contained in this space is the air breathed by both dentist and patient, its composition is extremely important as a potential threat to the dentist's health. According to the author, insufficient awareness of health risk, working habits, and economic factors are the reasons why dentists do not apply the available and recommended methods of protection against the influence of bioaerosol and splatter. Behaviour protecting a dentist and an assistant from the threat resulting from the influence of dental aerosol cannot be limited to isolated actions. The author, on the basis of the literature and own research, characterizes bioaerosol and splatter in a dental surgery and reviews a full range of protective measures against these risk factors.
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              A pilot study of bioaerosol reduction using an air cleaning system during dental procedures

              Key Points Dental procedures create bioaerosols that are a potential vector for transmission of infection in the dental surgery. The use of an air cleaning system both before and during dental treatment can reduce the size of bioaerosols and therefore reduce the risk of spread of infection. Air cleaning systems may have a useful role to play in the treatment of patients, in particular those who may be immune-compromised.
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                Author and article information

                Journal
                Occup Med (Lond)
                Occup Med (Lond)
                occmed
                Occupational Medicine (Oxford, England)
                Oxford University Press (UK )
                0962-7480
                1471-8405
                September 2018
                20 June 2018
                20 June 2018
                : 68
                : 7
                : 454-458
                Affiliations
                [1 ]Medical University of Silesia in Katowice, School of Public Health in Bytom, Bytom, Poland
                [2 ]Silesian University of Technology, Chair of Air Protection, Centre of New Technologies, Gliwice, Poland
                [3 ]Institute of Occupational Medicine & Environmental Health, Sosnowiec, Poland
                Author notes
                Correspondence to: J. Kobza, Medical University of Silesia in Katowice, School of Public Health in Bytom, Piekarska 18, 41-902 Bytom, Poland. Tel: +48 601389984; e-mail: koga1@ 123456poczta.onet.pl
                Article
                kqy095
                10.1093/occmed/kqy095
                6135984
                29931138
                387a6b03-7f2b-4088-9386-e75076fb74b8
                © The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Occupational Medicine.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Page count
                Pages: 5
                Categories
                Original Papers

                Occupational & Environmental medicine
                bioaerosols,dental care professionals,health risk,indoor control,occupational hazard

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