Rapid Cochrane review of AGPs gives mixed messages

Rapid Cochrane review of AGPs gives mixed messages

A rapid review into aerosol generating procedures has been carried out by Cochrane Oral Health and covers 58 countries, with fallow times after procedures ranging from 2 to 180 minutes. It shows a wide variation in guidance, but warns that ‘there is a lack of evidence provided to support the majority of recommendations in the documents.’

Key Messages of the report

  • This review reports on national recommendation for AGPs and their mitigation from 58 countries.
  • There is a highly variable level of details provided across international resources.
  • Just over half of the documents (56%) provide a definition of AGPs.
  • 98% of countries state that AGPs can be provided for non-COVID patients.
  • 94% of countries recommend the use of a face mask and goggles or a face shield for non-COVID patients.
  • Surgical masks are advised by 21 countries (33%) for non-COVID patients while 44 countries (70%) recommend the use of FFP2/N95 masks and 12countries (19%) recommend the use of FFP3 masks.
  • 82% of documents recommend the use of a pre-procedural mouthwash for non-COVID patients.
  • 48% of documents suggest a fallow period after the providing AGP treatment for non-COVID patients, with times ranging from 2 to 180 minutes.
  • Most countries making recommendations for COVID patients advised the same mitigation as for non-COVID patients.
  • There is a lack of evidence provided to support the majority of recommendations in the documents.


The aim of this rapid review was to assess how dental aerosol generating procedures (AGPs) were defined in international dental guidelines, what mitigation processes were advised and whether they were linked to COVID-19 epidemiology.

The specific objectives were:

  • Assess how aerosol generating procedures (AGPs) are defined and classified in international guidelines
  • Identify what AGP mitigation is advised for both COVID and non-COVID patients
  • Report recommended time gaps (fallow periods) between treating COVID and non-COVID patients in the same surgery following provision of AGPs
  • Identify any mitigating factors that allow reductions in the length of fallow periods.
  • (Assess whether there is a relationship between COVID-19 epidemiology and World Bank income status with PPE provision–to be reported later).
  • (Assess the quality of linked evidence to recommendations –currently in progress to be reported later).

The review was undertaken to inform the Scottish Dental Clinical Effectiveness Programme (SDCEP) Aerosol Generating Procedures in Dental Practice Rapid Review.



Clarkson J, Ramsay C, Richards D, Robertson C, & Aceves-Martins M, on behalf of the CoDER Working Group.

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents -A Rapid Review



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