Introduction

The oral clinical environment is vulnerable to bioaerosol contamination due to extensive use of medical instruments. The aerosols have an easy entry in the respiratory tract during oral procedures and may increase certain health risks, including mucosal irritation, conges­tion, edema, bleeding, and ulceration. According to the World Health Organization reports, 14 out of 41 major infectious diseases worldwide are transmitted through microbial aerosols, nearly 20% of these cases globally, are attributed to respiratory infections due to aerosols. Various methods such as high-volume suction systems, air disinfection machines, and dental electric suction machines, are used to manage dental aero­sols. Nevertheless, the most effective combination of techniques that would reduce air­borne endotoxins and microbial aerosols in dental clini­cal environments has not yet been identified.

Aim

To ascertain the effectiveness of various cleaning methods for reducing airborne endotoxin and microbial aerosols during oral cleaning procedures.

Patient Profile

• Patients undergoing oral cleaning procedures (n=40)

  Methods

  Study Design

• An observational study.

  Treatment Strategy

• The study subjects were randomly assigned to one of the following four groups (n =10 per group):
  • Group A: Received strong suction alone
  • Group B: Received strong suction combined with an air disinfection machine
  • Group C: Received strong suction combined with a dental electric suction machine
  • Group D: Received strong suction combined with both an air disinfection machine and a dental electric suction machine

  Assessments

• Aerosol content was assessed using natural sedimentation method, at distances of 20 cm, 60 cm, and 1 m from the patient’s mouth at four time-points: 0 min before treatment, 30 min after treatment initiation, immediately after the treatment completion, and 60 min after treatment ended.
• Airborne endotoxin was sampled using an air microbio­logical sampler.

Results

• A significant increase was observed in airborne endotoxins and microbial aerosols levels during treatment, as compared to before treatment. The highest levels were observed at 20 cm from the patient’s mouth (P <0.05). The highest airborne endotoxins and microbial aerosols production were also observed at 20 cm after treatment (P < 0.05).
• During treatment, groups with additional cleaning methods (groups B, C, and D) showed higher levels of airborne endotoxins and microbial aerosols as compared to group A (strong suction alone).
• Group D exhibited the highest levels of endotoxins and microbial aerosols among all groups during treatment but the same was lowest after treatment, while group A had the highest post-treatment levels (P < 0.05) (Table 1).

Table 1: Distribution of airborne endotoxins and microbial aerosols in the oral clinical environment in the study groups

a Compared with before treatment, P-value < 0.05; b Compared with during treatment, P-value < 0.05; c Compared with Group A, P-value < 0.05; d Compared with Group B, P-value < 0.05; e Compared with Group C, P-value < 0.05

• As compared to the surface sampling method, the natural settling method captured significantly lower concentra­tions of airborne endotoxins and microbial aerosols at 20 cm (P-value < 0.05), indicating its superior accuracy in terms of reflecting airborne contamination.

Conclusions

• Implementing effective aerosol management strategies during dental procedures may significantly reduce aerosol dispersion in the oral clinical environment.
• Continuous monitoring of aerosol concentrations and the application of appropriate control measures are critical to minimize the risk of infections for both patients and healthcare providers during oral cleaning procedures.

BMC Oral Health. 2024;24:1147. Doi: 10.1186/s12903-024-04885-4.