TASK 1

Select an occupational health and safety concern in your

workplace

AEROSOLS and SPLATTER in the

DENTAL CLINIC

Despite safety measures taken by dental clinic staff to keep the clinic clean
and to practice environmental asepsis, the patient’s oral microbes must also
be considered.
The saliva of a healthy patient contains large
numbers of streptococci, staphylococci, and gram
negative bacteria. While many of these organisms
are relatively harmless for a healthy person, they
carry the possibility of infection for the increasing
number of people with compromised immune
systems.

Figure 1 saliva
Of more concern to Dental personnel are the
pathogenic bacteria and viruses originating from
nonsalivary and non-tooth origins. These include
organisms from the nasopharynx, phlegm
originating in the lungs, and blood routinely
encountered during scaling. These areas are
the sources of many pathogenic organisms such
as tuberculosis (TB), hepatitis, human
immunodeficiency virus (HIV), and severe acute
respiratory syndrome (SARS).

Splatter and aerosol droplets

A variety of intraoral equipment and dental procedures generate small particles
that may contain saliva, blood, water, microbes and oral debris. These
particles commonly exit the patient’s mouth and are propelled by high-speed
or low-speed handpieces, ultrasonic scalers or air-water syringes—anything that
creates salivary turbulence.
While large droplets contain potentially pathogenic organisms, they are usually
controlled by standard barrier techniques such as gloves, masks, and eye
protection.

Personal Protective Equipment

However, the ultrasonic scaler and the air polisher are the greatest producers
of small particle aerosol contamination in dentistry. The use of these
instruments places not only the Dentist and Dental Assistant at risk but also
places other patients at the forefront of risk for the airborne transmission of
infections; hence aerosols and splatter are an occupational health and safety
hazard in a dental clinic.

Figure 2) Visible coolant water aerosol Figure 3) the visible aerosol cloud, made up of
created by a straight style ultrasonic insert water and abrasive at the levels recommended
using the standard 17ml/min of coolant by the manufacturer, produced by an air polisher.
water

AEROSOLS & SPLATTER (the differentiation)

Splatter
The particles exiting patients’ mouths are divided into two categories based
upon size. Most particles are larger droplets referred to as splatter.
These droplets are more than 50 micrometers
in diameter.
Some are visible and can be noted as spots
on dental personnel’s eyewear
some even may be felt landing on the skin
Despite their size, splatter droplets may
settle out as far as 3 feet away from the
patient, contaminating nearby operatory
surfaces.

Aerosols

Consists of the smaller particles exiting a patient’s mouth.

Measuring less than 50 micrometers in diameter, aerosols tend to
evaporate quickly into even smaller invisible particles called droplet
nuclei that measure 1 to 5 micrometers in diameter and may contain
microbes.
These small particles can remain airborne for
minutes to hours and even longer in some
instances.
If any microbes in the nuclei remain viable
after the evaporation process, these nuclei
can serve as a source of airborne infection
if inhaled. They are small enough to be
inhaled into the alveoli of the lungs, which
have an exclusion limit of 5 micrometers.

TASK 2
 Develop a strategy (plan) focusing on improving this concern for
the safety of all team members and clients.

STRATEGY for reducing potential danger(S) from Dental Aerosols

and splatter

Protective eyewear
Important in preventing splatter droplets from contacting the eyes.
 Eyewear lenses should be large enough to offer effective protection,
and must include side shields
 Face shields may be worn in place of eyeglasses/goggles, if desired.

Protective clothing
This category includes:
 Gowns,
 Uniforms
 And jackets that guard the skin and underlying garments from contact
with splatter and its microbes.
 Gloves
These will not only protect the patient from any microbes on the skin of the
dental staff, but they also protect the dental staff from any direct contact with
patient oral microbes. Moreover, gloves shield the worker from contacting any
microbes on operatory surfaces.

Evacuators and ejectors
High-velocity evacuators (HVEs) and saliva ejectors reduce the level of oral
fluids, thereby minimising the number of microbes that can escape from the
patient’s mouth in aerosols and splatter.

Pre-procedural mouth-rinsing with antiseptic mouthwash

(such as chlorhexadine)
This step functions like HVEs and saliva ejectors to reduce the number of
microbes in the patient’s mouth that can exit in aerosols and splatter.

Rubber dams
Although this seal is not always perfect, rubber dam should be used, as this

greatly reduces the exit of patients’ microbes from their mouths.

Surface disinfection
 Surface cleaning and disinfection is another way (besides using surface
barriers) that dental staff should employ to manage operatory and other
surfaces contaminated with splatter.
It must be emphasised that no single approach can minimize the risk of infection
to dental personnel or other patients completely.

A single step will reduce the risk of infection by a certain percentage; another step
added to the first step will reduce the remaining risk, until such time as the risk is
minimal. This can be described as layering of the protective procedures  this
layering of infection control steps needs to be followed in reducing the potential
dangers of dental aerosols
 BIBLIOGRAPHY

Websites

 "Dimensions of Dental Hygiene Online." Welcome to Dimensions of

Dental Hygiene. Web. 17 Feb. 2011.
<http://www.dimensionsofdentalhygiene.com/ddhright.aspx?
id=123>.

 "Guidelines for Infection Control in Dental Health-Care

Settings --- 2003." Centers for Disease Control and
Prevention. Web. 18 Feb. 2011.
<http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm>.

 "Bloodborne Pathogens & Aerosols - FAQs - Infection Control in Dental

Settings - Oral Health."Centers for Disease Control and Prevention .
Web. 21 Feb. 2011.
<http://www.cdc.gov/oralhealth/infectioncontrol/faq/aerosols.htm>.

Journals
 "Aerosol Contamination Caused by Ultrasonic
Scalers." Dental Abstracts 50.1 (2005): 46-47. Print.
 Harrel, Stephen, and John Molinar. "Aerosol Contamination Caused by
Ultrasonic Scalers." Dental Abstracts." Aerosols and splatter in dentistry,
a brief review of the literature and infection control implications. The
Journal of the American Dental Association, n.d. Web. 20 Feb. 2011.
<"Aerosol Contamination Caused by Ultrasonic Scalers." Dental Abstracts
50.1 (2005): 46-47. Print.>.