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View Article Aerosols a Menace for the Dental Healthcarers JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL SCIENCES Ravleen Kaur, Inderjot Singh, Gina Singh, Anushi Mahajan. Aerosols a menace for the dental healthcarers. Journal of pharmaceutical and biomedical sciences (J Pharm Biomed Sci.) May(Supplement 1); 30(30):S58-S64. The online version of this article, along with updated information and services, is located on the World Wide Web at: www.jpbms.info Journal of Pharmaceutical and Biomedical Sciences (J Pharm Biomed Sci.), Member journal. Committee of Publication ethics (COPE) and Journal donation project (JDP). ISSN NO- 2230 – 7885 CODEN JPBSCT NLM Title: J Pharm Biomed Sci. Ravleen Kaur, Inderjot Singh, Gina Singh, Anushi Mahajan Review article Aerosols a menace for the dental healthcarers Ravleen Kaur1, Inderjot Singh2, Gina Singh3, Anushi Mahajan4 Affiliation:- 1Assistant Professor, Department of Periodontics, control by emphasizing seven major areas; aseptic Christian Dental College, Ludhiana, Punjab, India. technique, patient screening and evaluation, 2Associate Professor, Department of Oral & personal protection, instrument sterilization, Maxillofacial surgery, Christian Dental College, environmental surface disinfection, equipment Ludhiana, Punjab, India. asepsis and laboratory asepsis. Each infection 3Professor and Head, Department of Periodontics, control component contributes to minimizing the Christian Dental College, Ludhiana, Punjab, India. potential for cross-infection during provision of 4Assistant Professor, Department of Periodontics, dental treatment. Dental patients fall into several Christian Dental College, Ludhiana, Punjab, India. risk categories concerning the transmission of infection. Some patients will only suffer from *Correspondence to:- dental or oral diseases, others are infected, some Dr Ravleen Kaur are healthy carriers, and yet others are Assistant Professor, Department of Periodontics, symptomatic or asymptomatic carriers of a Christian Dental College, Ludhiana, Punjab, India transmissible disease at a contagious or Phone no:- +91-09781108811 noncontiguous stage. Abstract: Key words: Periodontal aerosol; dental aerosol; Dental professionals have addressed the increased bioaerosols. challenge of infectious disease and infection Article citation:- Ravleen Kaur, Inderjot Singh, Gina Singh, Anushi Mahajan. Aerosols a menace for the dental healthcarers. Journal of pharmaceutical and biomedical sciences (J Pharm Biomed Sci.) May(Supplement 1); 30(30):S58-S62. Available at http: //www.jpbms.info INTRODUCTION he increase in scientific data and the consideration for infection control and awareness of the problems concerning occupational health, since infectious agents could “indoor pollution” have led to many studies be transmitted via aerosols to patients or staff in T 2 aimed at identifying and measuring the different the confines of the dental unit . There is concern factors that can alter the quality of air in an that aerosols from dental procedures may be enclosed environment. The dental office must deal regulated by the Occupational Safety and Health with the inherent or specialized pollution Administration, or OSHA, as part of standards for produced by the daily professional activities indoor air quality3. performed. The various procedures performed Dental professionals have addressed the increased with aerosol-creating instruments, such as air- challenge of infectious disease and infection turbine handpieces, low-speed hand-pieces, control by emphasizing seven major areas; aseptic ultrasonic instruments, bicarbonate polishers, technique, patient screening and evaluation, polishing cups, and air-sprays, inside the oral personal protection, instrument sterilization, cavity, which is highly contaminated with wide and environmental surface disinfection, equipment still partially known range of bacterial flora1. asepsis and laboratory asepsis. Each infection Bioaerosols have been implicated in contributing control component contributes to minimizing the to indoor air-pollution and gained notoriety in potential for cross-infection during provision of association with various conditions, such as dental treatment4. Legionnaires’ disease and Sick building syndrome. Several studies document the dispersion of In the dental clinic, bioaerosols are an important infectious agents in aerosols and splatter during S58 ISSN NO- 2230 – 7885 CODEN JPBSCT NLM Title: J Pharm Biomed Sci. Ravleen Kaur, Inderjot Singh, Gina Singh, Anushi Mahajan dental treatments, especially when the water spray years, the theory of airborne infection has received is used5. Waterlines for the air-water syringe and much attention from all the areas of biomedical handpiece can become contaminated with activity10. Miller et al. 11 and Lorato et al.12 have bacteria6. Infectious agents also can be introduced documented the risks of airborne infection by into the handpiece water-supply from the previous dental aerosols. or current patient and can be aspirated into the waterline from the patient’s mouth when the water Defining aerosols is shut off, even when the hand piece is equipped There is concern that aerosols from dental with anti-retraction valves7. procedures may be regulated by the Occupational The patient’s mouth is also a source of infectious Safety and Health Administration, or OSHA, as part agents that can be dispersed by splatter from the of standards for indoor air quality. OSHA’s water spray5. The oral cavity provides a unique proposed indoor air-quality rule does not specify a ecosystem of moist environment, temperature, and size range in describing bioaerosols13. the existence of endogenous and exogenous There has been some confusion about the metabolic substrates, which makes it an ideal definition of an aerosol, which varies widely medium for bacterial growth8. About 150 billion according to the discipline describing it13. Micik microorganisms are found in 1g of material of the and colleagues defined dental aerosols as being gingival crevice of a patient with poor oral hygiene, particles smaller than 50 micrometers, with any and over 6 billion are present in 1ml of saliva9. particles larger than 50 µm being described as Modes of microbial transmission in the dental splatter14. Aerosols and splatters are generated by environment may be classified into three general the use of high speed hand-pieces, sonic and categories4: ultrasonic scalers etc15. The particle concentration was 10,000 colony-forming units (CFU)/sq ft up to Direct contact with infectious lesions, blood or 2 ft away, 1000 CFU/sq ft up to 4 ft away, and 100 saliva. CFU/sq ft upto 7 ft away. The results from a Indirect transmission via transfer of patient’s sneeze and from dental procedures were microorganisms by a contaminated comparable11. So, while dental healthcare workers intermediate object. may lean back to be out of the way as the patient Aerosolization via the airborne transfer of sneezes, resuming work at close quarters exposes infected blood, saliva or nasopharyngeal them to the same hazard15. secretion droplets, or all three. Aerosols generated by dentists in their work may contain solid particles and chemicals or gases, as Oral microflora and occupational risks: well as bacteria and viruses. One cannot easily The human mouth is an ideal incubator for a many separate gases and chemical from the aerosols, as potential microbial pathogens, offering multiple the gases and chemicals in the oral cavity may microenvironments, appropriate temperature and become dissolved in the droplets16. An air turbine an abundance of nutrients. Most adults have been high speed dental handpiece can generate nearly infected with herpes viruses (that is, herpes simplex 27 million particles of dental enamel <5 µm in virus, cytomegalovirus, Epstein-Barr virus), and diameter17. Air samples recovered after use of certain respiratory viruses such as Enteroviruses lubricated high speed handpieces contained 0.62 and Rhinoviruses4. mg/m3 oil, presenting some risk for Because of the particular features of the oral cavity oleogranuloma, pneumonia, or paraffinoma18. and the diagnostic and therapeutic procedures used in dentistry, dental surgeons are at high risk for developing infectious diseases. During the past Splatter 11 Aerosol 16 Squames15 Travel in a ballistic fashion, with a Droplet nuclei are those expelled from the Released from the skin of the surgical curved trajectory similar to that of an nose or mouth, which evaporate and team become airborne, adding to the air artillery shell, landing on the faces and become smaller. Nose and throat droplets hygiene burden and posing a risk to the clothing of the operator and assistant of mucous and saliva do not evaporate as patient. and on nearby surfaces. fast as water. They become droplet nuclei, buoyant in the air and called aerosols. S59 ISSN NO- 2230 – 7885 CODEN JPBSCT NLM Title: J Pharm Biomed Sci. Ravleen Kaur, Inderjot Singh, Gina Singh, Anushi Mahajan Aerosol particles, nominally under 50 m The human body produces an estimated 7 diameter, may contain one or more million skin squames per minute. microorganisms and may drift in the air for some time. The friction of clothes and bedding They do not settle readily on open agar increases their sloughing, and bodily are >50 µm diameter and may be visible plates, so they are sampled by vacuum movement crease a bellows effect, forcing devices that draw them into liquid culture squames out of the garment neck, sleeves, media or onto agar plates. and trouser cuffs. They do not settle readily on open agar Body heat creates convection
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