EARN This course was written for dentists, 3 CE dental hygienists, CREDITS and dental assistants. © Matthieuclouis | Dreamstime.com COVID-19: Part 2— Is there something in the air? Aerosols and infection prevention/control in the dental office A peer-reviewed continuing education course written by Maria L. Geisinger, DDS, MS PUBLICATION DATE: OCTOBER 2020 EXPIRATION DATE: SEPTEMBER 2023 SUPPLEMENT TO ENDEAVOR PUBLICATIONS EARN 3 CE CREDITS COVID-19: Part 2—Is there something This continuing education (CE) activity was developed by Endeavor Business Media with no commercial support. in the air? Aerosols and infection This course was written for dentists, dental hygienists, and dental assistants, from novice to skilled. Educational methods: This course is a self-instructional journal and prevention/control in the dental office web activity. Provider disclosure: Endeavor Business Media neither has a leadership position nor a commercial interest in any products or services discussed or shared in this educational activity. No Abstract manufacturer or third party had any input in the development of the Dental procedures that employ handpieces, lasers, electrosurgery units, ultra- course content. Requirements for successful completion: To obtain three (3) CE sonic scalers, air polishers, prophy angles, hand instruments, and air/water credits for this educational activity, you must pay the required fee, syringes can create bioaerosols and spatter. Ultrasonic scalers and high-speed review the material, complete the course evaluation, and obtain an exam score of 70% or higher. handpieces produce more airborne contamination than any other instruments CE planner disclosure: Laura Winfield, Endeavor Business Media in dentistry, but much is still unknown about the nature and infectivity of such dental group CE coordinator, neither has a leadership nor commercial interest with the products or services discussed in this educational aerosols. As dental procedures and technologies have evolved, the incidence activity. Ms. Winfield can be reached at [email protected]. of aerosol-creating procedures has increased. Inhalation of airborne particles Educational disclaimer: Completing a single continuing education course does not provide enough information to result in the participant and aerosols produced during dental procedures may cause adverse respira- being an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that tory health effects, including high-consequence infectious diseases (HCIDs) allows the participant to develop skills and expertise. spread by airborne routes. While transmission-based precautions may mini- Image authenticity statement: The images in this educational mize risk to dental health-care providers, the evidence to support the most activity have not been altered. Scientific integrity statement: Information shared in this CE course effective interventions and the guidance for infection control and prevention in is developed from clinical research and represents the most current regard to airborne disease transmission is rapidly evolving. During the initial information available from evidence-based dentistry. Known benefits and limitations of the data: The information pandemic stages, limiting dental practice and minimizing aerosol-generating presented in this educational activity is derived from the data and procedures was critical, but as the current pandemic evolves, it has highlighted information contained in the reference section. Registration: The cost of this CE course is $59 for three (3) our understanding of potential modes of airobone disease transmission in the CE credits. dental office and effective methods to mitigate such risks. Going forward, den- Cancellation and refund policy: Any participant who is not 100% satisfied with this course can request a full refund by contacting tal health-care providers should be aware of invisible risks within their opera- Endeavor Business Media in writing. tories and stay abreast of evolving infection prevention protocols before, during, Provider information: Dental Board of California: Provider RP5933. Course registration and after patient care. This course seeks to review up-to-date infection control number CA code: 03-5933-20001. Expires 7/31/2022. “This course recommendations and emerging evidence for ongoing infection control when meets the Dental Board of California’s requirements for three (3) units of continuing education.” delivering dental care, particularly in relation to the COVID-19 pandemic. Endeavor Business Media is a nationally approved PACE program Educational objectives provider for FAGD/MAGD credit. Approval does not imply acceptance Upon completion of this course, the dental professional should be able to: by any regulatory authority or AGD • Explain the risk factors and basic properties of aerosols generated during endorsement. 11/1/2019 to 10/31/2022. routine dental procedures Provider ID# 320452 • Describe what types of dental procedures result in significant dental aero- AGD code: 148 sol production • Understand the types of pathogens and resultant illnesses associated with such aerosols Endeavor Business Media is designated as an approved provider by the American • Differentiate between standard and transmission-based precautions and Academy of Dental Hygiene Inc. #AADHPNW (January 1, 2019–December 31, 2020). Approval does not imply acceptance by a state or provincial board of dentistry. Licensee their utility in the dental office for safe delivery of care should maintain this document in the event of an audit. • List infection control and aerosol mitigation techniques that may reduce the risk of cross-contamination to patients and providers Endeavor Business Media is an ADA CERP–recognized provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of dental continuing education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at ada.org/goto/cerp. Go online to take this course. DentalAcademyofCE.com QUICK ACCESS code 20001 DENTAL ACADEMY OF CONTINUING EDUCATION Introduction infection control measures that can be Airborne droplets: aerosols A novel β-coronavirus (SARS-CoV-2), pur- implemented during dental practice to versus spatter portedly originating in a seafood market block the person-to-person transmission Aerosols are defined as liquid or solid par- in Wuhan, Hubei province, China, is caus- routes through standard, transmission- ticles less than 50 micrometers in diam- ing severe and potentially fatal pneumo- based, and potentially novel precautions.21 eter.16,17,26,27 Particles of this size are small nia (COVID-19) and has demonstrated enough to stay airborne for an extended pandemic spread throughout the globe.1–3 Aerosols in the dental office: period before they settle on environmen- The World Health Organization (WHO) has What are the risks associated tal surfaces or enter the respiratory tract stated that modes of transmission include with dental procedures? after inhalation.16,17 Smaller particles of contact, droplet, airborne, and fomite Airborne transmission of various an aerosol (0.5 to 10 μm in diameter) have routes. The US Centers for Disease Control pathogens, including tuberculosis and the potential to enter the lungs and settle and Prevention (CDC) further states that measles, has been reported in various within the bronchial passages, reaching most cases are spread by close person-to- health-care and community settings.22,23 as far as the pulmonary alveoli.16,17 These peson interaction within six feet through air- Furthermore, viral transmission of droplets, due to their capacity to remain borne respiratory particles produced during common infections after airborne droplets/ in the air, may prompt a shift in infection many common activities including cough- particles have settled on surfaces has also prevention and control practices employed ing, sneezing, speaking, and even breath- been shown.22,23 Air quality evaluation in the dental office.26,27 ing.4-8 Additionally, while an airborne route within dental operatories has revealed the Spatter describes airborne particles, of transmission is suspected for SARS-CoV-2, the exact nature and conditions necessary to allow for this kind of transmission are cur- Average rently unknown. Given these transmission bacterial size routes, there has been a renewed interest 0.2 μm in aerosols in the practice of dentistry and Human hair Particles may their risk to dental practitioners and den- 70–100 μm penetrate the lower tal patients, as well as mitigation strate- respiratory tract gies for risks associated with reducing 1 μm viral contamination and infection due Aerosol to dental procedures. threshold Currently, dental practitioners, 50 μm Visible threshold members of the dental team, and their 30–40 μm patients are exposed to risks associated Fine aerosol with aerosols in the dental office due to the (may remain frequency of face-to-face communication, suspended in air) exposure to saliva, blood, and other body 5 µm fluids, and—indirectly—by the touching of instruments and other surfaces that may FIGURE 1: Relative sizes of airborne droplets serve as fomites (any inanimate object that if contaminated with or exposed to an infectious agent can then transfer