A commentary on

Holliday R, Allison J R, Currie C C et al.

Evaluating contaminated dental aerosol and splatter in an open plan clinic environment: Implications for the COVID-19 pandemic. J Dent 2021; 105: 103565.

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GRADE rating

Commentary

The coronavirus disease (COVID-19) caused by the novel coronavirus (SARS-CoV-2) has had the most remarkable impact on delivery of clinical dental services and education in living memory. Following an initial period of fear and anxieties at the start of the pandemic, dental practices and institutions across the globe are now back in operation, albeit at lower efficiency levels due to additional precautions mandated by professional guidelines. One of the major concerns with clinical dentistry relates to the risks of SARS-CoV-2 contamination during aerosol generating procedures (AGPs). The virus is present in nasopharyngeal secretions, saliva and blood, and bioaerosols generated in the dental clinical environment may cause cross infection through inhalation, contact with eyes and contaminated work surfaces.1 Although there is no direct evidence to substantiate the spread of SARS-CoV-2 through dental aerosols, guidelines continue to advise additional precautions to reduce the risk of cross infection.2

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The COVID-19 pandemic has posed unique challenges for dental organisations with open plan clinics, particularly dental hospitals and universities.3 Dental teaching institutions have had to adopt a wide range of risk mitigation strategies for AGPs in open plan clinics since the start of the pandemic. These include: a combination of physical and temporal separation measures; compartmentalisation of open plan clinics to create self-contained pods for AGPs; use of high-volume intraoral and extraoral suction devices; use of speed-increasing handpieces; and installation of air exchange systems.4 In any case, these cross-infection control measures have impacted adversely on dental services, with significant resource and logistic implications for the providers. Clinical training of dental students is usually provided in open plan clinics. It has been immensely difficult for students to achieve their annual clinical targets since the start of the pandemic, which has impacted on their sign off for finals, and it continues to be a huge challenge for dental schools globally.

The current study by Holliday et al. provides new evidence regarding the pattern of aerosol spread in simulated open plan dental clinical environments. The authors have used a variety of standardised experimental conditions to quantify aerosol spread and its impact on fallow time for dental AGPs. The findings of this study are corroborated by a recent study by Ehtezazi et al.5 The evidence emerging from these studies indicates that with appropriate use of personal protective equipment (PPE), suction devices, air exchange systems and disinfection of the clinical environment, it may be possible to reduce the fallow time for AGPs to ten minutes in open plan clinics. Further studies in real-time open plan clinical settings are required to substantiate these findings to inform professional guidelines.

The ongoing COVID-19 vaccination campaigns provide a glimmer of hope that some degree of normality might be restored in the future. However, the rapid emergence of mutant strains of SARS-CoV-2 and lack of clarity regarding the longevity of immune protection imparted by vaccines add to the existing uncertainties related to COVID-19. In addition, fake propaganda on social media platforms fuelled by conspiracy theories is a barrier to widespread uptake of vaccines, particularly among some sections of society.6 With the third wave of COVID-19 already looming, it seems likely that COVID-19 is here to stay in some form and the dental profession must continue to adapt in light of emerging scientific evidence.