As Evidence Mounts, Is NOW The Time To Relax COVID Dental Restrictions?
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- Published: Monday, 05 July 2021 07:39
- Written by Chris Tapper
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The results of a new UK-based study should bolster the argument for an urgent relaxation of COVID-19 restrictions in dentistry.
Research carried out by Cambridge University Hospitals Foundation Trust has shown that wearing high-grade FFP3 masks can provide up to 100% protection against coronavirus infection in health workers.
Although the Cambridge research hasn’t yet been peer-reviewed, it has been released early because of the urgent need to share information relating to the pandemic.
“It was found that when Addenbrooke’s Hospital upgraded its face masks for staff working on COVID-19 wards to filtering face piece 3 (FFP3) respirators, it saw a dramatic fall – up to 100% – in hospital-acquired SARS-CoV-2 infections among these staff” Dr Mark Ferris wrote on the Cambridge University website.
“The Cambridge trust is among 17 across the UK known to have decided to upgrade PPE regardless of national policy,” according to the BBC’s Science Correspondent David Shukman.
A call by the British Dental Association on the four UK Chief Dental Officers to commission the Scottish Dental Clinical Effectiveness Programme (SDCEP) to develop a strategy in order to relax the restrictions, was answered by the four CDO’s a few weeks ago.
In a joint statement, they said “All four UK chief dental officers share their profession’s ambition for increasing access which needs to be done safely and effectively, which is why there is now going to be a further review of the UK-wide infection control guidance in the light of the current science and prevalence.”
There has been no statement made so far, on the progress made towards the relaxation of restrictions, although the BDA News website has said that the Chief Dental Officer for England Sara Hurley told a meeting this week that she "Stressed that officials are now looking on emerging evidence on airborne transmission, and how this might underpin a relaxation of current restrictions."
But the latest research from Cambridge closely follows another UK study which concluded that many of the common procedures carried out by dentists have a very low risk of increasing the aerosol spread of COVID-19.
The study carried out at the University of Bristol also found that some procedures, such as ultrasonic scaling, were not shown to generate aerosol other than from the clean instrument itself.
The Bristol University website reported that the study is the largest which has been carried out to date, to specifically measure aerosol generation from dental instruments in “real-patient clinical scenarios.”
Although also yet to be peer-reviewed, the research mirrors the conclusions of recent other studies which strongly suggest that aerosol generating dental procedures don’t increase the risk of contracting COVID-19.
A study carried out at Ohio University found that when the genetic makeup of organisms detected in samples of aerosols were analysed, researchers found that the watery solution from irrigation tools, and not saliva, was the main source of any bacteria or viruses present in the spatter and spurts from patients’ mouths.
Dr Simon Thackeray told the annual Local Dental Committee Conference back in June, that the risk to dental staff from aerosol generating procedures is “between zero and negligible.” Dr Thackeray was speaking to a motion calling for an urgent review into the need for enhanced PPE in the dental clinical setting.
The Bristol University website said the latest research, is part of the Aerosolisation And Transmission Of SARS-CoV-2 in Healthcare Settings (AERATOR) study, set out to measure the amount of aerosol produced from a wide range of dental procedures carried out on patients.
“Where aerosol was detected in patient procedures, the research team compared the size distributions of this aerosol to the aerosol produced from the dental instrument itself when used in a (non-patient) phantom head control.”
“The study found the ultrasonic instrument, commonly used for dental scaling, produced much lower aerosol concentrations than the high-speed dental drill despite the two instruments currently requiring the same precautions.”
“Also, aerosol produced during the ultrasonic scaling procedure was consistent with the clean aerosol produced from the instrument itself and did not show additional aerosol is produced that could potentially spread COVID-19.”
Dr Tom Dudding is a Restorative Dentistry Specialty Trainee at Bristol Dental School and is a joint first author of the study. He said: "Our study confirms much of the guidance around dental procedures deemed as low risk of spreading COVID-19 is correct, but suggests that the ultrasonic instrument could be seen as lower risk than it currently is.
"Our findings could allow the expansion of dental, hygiene and therapy work as it would reduce the need for additional precautions such as additional personal protective equipment (PPE) and fallow times when using this instrument."
Dr Mark Gormley, Consultant Senior Lecturer in the Bristol Dental School and joint senior author of the study, added "Our study provides strong evidence to confirm many of the common dental procedures have very low risk of increasing the aerosol spread of COVID-19.”
“We also found that some other procedures, such as ultrasonic scaling, do not appear to generate additional aerosol above that of the instrument itself and do not increase the risk to dentists, relative to the risk of being near the patient."
“For procedures such as the high and slow speed drilling commonly used for dental fillings, crown preparations and polishing, the next step for the research team would be to repeat these experiments with instruments which can further differentiate between aerosol produced by the dental instrument and aerosol which has been contaminated by bodily fluids, such as saliva.”
“If no contaminated aerosol is identified, these instruments would also be safe for use without additional precautions.”
In answer to the BDA’s call for a relaxation of restrictions, the CDO’s issued a joint statement saying, “All four UK chief dental officers share their profession’s ambition for increasing access which needs to be done safely and effectively, which is why there is now going to be a further review of the UK-wide infection control guidance in the light of the current science and prevalence.”
The Bristol research paper can be found by clicking ’A clinical observational analysis of aerosol emissions from dental procedures.’
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