COVID-19 and the Problem with Dental Aerosols
The COVID-19 pandemic has reshaped the way we look at infection control — especially in dental practices where aerosol generation is common. Dental aerosols pose a significant challenge when it comes to virus transmission, including SARS-CoV-2, the virus responsible for COVID-19.
1. What Are Dental Aerosols?
Dental aerosols are tiny particles or droplets that become airborne during procedures involving:
- High-speed handpieces
- Ultrasonic scalers
- Air-water syringes
These aerosols can remain suspended in the air for extended periods and travel across the room, potentially carrying viruses, bacteria, and other pathogens.
2. Why Are Aerosols a Concern During COVID-19?
SARS-CoV-2 spreads primarily through respiratory droplets, and aerosols can carry the virus over longer distances and durations — especially in poorly ventilated areas. In dental settings:
- The patient’s mouth is open.
- Tools often create a spray of saliva, blood, and fluid.
- Close proximity between patient and dental staff increases exposure risk.
This makes dental clinics a high-risk environment for airborne transmission if proper precautions aren’t taken.
3. Which Dental Procedures Generate the Most Aerosols?
- Tooth preparation with high-speed drills
- Ultrasonic scaling
- Air polishing
- Surgical extractions
- Endodontic procedures
These procedures require special attention and safety protocols during and after the COVID-19 pandemic.
4. How Can Dental Practices Reduce Aerosol Risks?
Here are some effective strategies:
a) Use of High-Volume Evacuation (HVE)
HVE systems can capture up to 90–95% of aerosols at the source, significantly reducing airborne contamination.
b) Pre-procedural Mouth Rinses
Using antimicrobial rinses like hydrogen peroxide or povidone-iodine can reduce the microbial load in the mouth before treatment begins.
c) Personal Protective Equipment (PPE)
Dentists and staff should wear:
- N95 or equivalent respirators
- Face shields
- Gowns and gloves
- Hair covers
d) Rubber Dam Isolation
Rubber dams can isolate the treatment area and minimize the exposure of oral fluids to the surrounding air.
e) Air Filtration and Ventilation
HEPA filters, UV light purification, and improved air exchange systems help clean the air in operatories.
f) Scheduling and Disinfection Protocols
- Space out appointments to allow disinfection between patients.
- Use EPA-approved disinfectants on all surfaces.
- Allow time for aerosol “settling” before cleaning the room.
5. How Has COVID-19 Changed Dental Practice Protocols?
Post-COVID, dental clinics now follow stricter sterilization and ventilation protocols, and many have redesigned patient flow, check-in procedures, and waiting areas to minimize exposure.
Some practices now:
- Screen patients for symptoms or travel history.
- Take temperatures upon arrival.
- Limit companions.
- Offer teledentistry for consultations.
6. What Should Patients Know and Do?
- Don’t delay dental care — but be informed.
- Choose a dental clinic that clearly follows COVID-19 safety protocols.
- Wear masks, sanitize hands, and follow pre-visit instructions.
Conclusion
COVID-19 brought the issue of dental aerosols to the forefront — and rightly so. With the right precautions, the dental profession can continue to provide safe, effective care while minimizing the risks associated with aerosol transmission. It’s a shared responsibility between dental teams and patients to stay informed, cautious, and committed to health and safety.
