AEROSOLS AND AIRBORNE INFECTION CONTROL IN THE

DENTAL OFFICE
An overview on the importance of size of aerosolized particles and nanotechnology
Author: S Bordin-Aykroyd
as an essential foundation in the control of airborne disease. admin@aaofh.org
Abstract Control ID#: 3577546

TABLE 1. CLASSIFICATION OF BIOAEROSOL PARTICLES

BACKGROUND The size of particles is a Classification of particles Particle size Sites found
according to size type
determinant factor in aerosol behavior and plays an coarse 2.5 10 µm spatter > 50 floor, countertop, sink, bracket,
essential role in the spread and mitigation of fine < 2.5 µm µm table, computer, patient or operator
airborne diseases. They are influenced by ultrafine < 0.1 µm droplet Air suspension until evaporation
Corona Virus SARS-CoV-2 0.06 to 0.14 µm or µm
environmental conditions such as temperature, droplet 5 µm Contains microorganisms. Can
~120 nm
humidity, and airflow distribution12. Due to their size, Crown spikes of Corona Virus 9 - 12 nm nuclei contaminate surfaces within 3 feet
SARS-CoV-2 and remain airborne for hours
composition, ability to remain suspended and travel
long distances, small, infected aerosolized particles The risk of cross-infection by SARS-CoV-2 in the dental office is confirmed by research showing positive salivary tests,
pose a considerable health risk12, especially in the indicating the possibility of transmission through the spread of saliva as respiratory viruses usually spread via direct
dental operatory. contact or splatter and aerosol production from mouth and nose22. More than 700 microbial species have been identified in
saliva. Studies suggest that the transmission of virus can be closely connected with saliva and salivary glands may
AIM To provide an overview on the importance of
become a potential source cross-infection by the SARS-CoV-2 virus23.
particle size and nanotechnology as an essential
Some viral aerosolized particles, can potentially travel up to 20 feet18 and aerosolized droplet nuclei, containing significant
foundation in the control of airborne disease.
amounts of viruses can remain suspended in the air and capable of contamination for many days 12,15,2.

METHOD Literature review 2010 - 2020

Airborne transmission has often been attributed to infectious droplet nuclei produced by the desiccation of suspended
Bioaerosol
Type of procedure Size of particle
classification 3, where there is a predominance of pathogens. Those can be produced by coughing and
Ultrasonic aerosol particles 0.001 to 100 µm aerosol + splatter
sneezing and be immediately respirable3. Most particles in exhaled breath are smaller than 4 m, with an average size
90 % of general dental
procedures
< 5 µm aerosols between 0.7 and m 49.
95% laser plume water water
bioaerosols, Small particle aerosols are associated with most respiratory infections3.
including cellular
Infected
5 % laser plume debris, blood
droplets Entry size Body part
fragments, and The capacity of particles to be deposited in different parts of
bacteria. capacity
the body is also determined by their sizes11,12,13,17,18. Nose 6 12 Upper respiratory system
INTRODUCTION - Devices utilized in dental filtering
operatories, such as high-speed handpieces, Nasal filtration of particles smaller than 0.5 microns is low, so 0.25 0.1 µm Alveoli / lungs
ultrasonic devices, and some types of lasers, can smaller particles can pass easily into the lower respiratory tract < 0.1 µm Bloodstream, organs, heart &
brain
generate aerosol, splatter, or droplets, which to infect the lungs.

contains small contaminant particles associated with
the devices, with ultrasonics and high- speed
handpieces producing more airborne contamination
than any other dental device. Ultrasonic
instrumentation can transmit 100,000 microbes per
cubic ft. 3,19,20,21.
This can be of clinical significance, since the
Fine particles (< 2.5 microns), capable of infecting the lower
average size of the corona virus is 120 nm1 and it
respiratory system, contain 8.8 times more virus than coarse
can be present in very small droplets that may
particles and can be found on exhaled breath4.
not be picket-up by HEPA filters that operate on
Particles smaller than 0.1 microns can access and travel the a micron scale
bloodstream and directly infect organs, heart and brain11,12,13.

One of the most effective methods of reducing aerosols in dentistry are high-volume evacuators (HVE), however, recently, ASHRAE recommends the inclusion of extra room
equipment to air conditioning filters and HVEs, such as stand-alone air-purifiers, UV light devices, etc., requiring additional technological solutions for this and future pandemics.

Advanced Oxidation Processes (AOPs) Photocatalytic disinfection Use nano-particles such as Titanium dioxide (TiO2) or zinc oxide (ZnO) as photosensitizing agents
and ultra-violet (UV) radiation as the activator of excitation24.
RESULTS
In this review, we explored the implication of particle size in airborne infection viability and the importance of a good filtering system. We also found a 10 years review of supportive
evidence of the efficacy of up to 99.99% of -Cov family.
DISCUSSION REFERENCES
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numbers, one could assume that this may directly influence viral load and requires further investigation. 12. Siegel JD, Rhinehart E, Jackson M, Chiarello L, Health Care Infection. Control Practices Advisory Committee. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007; 35: S65 164.

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Also, if SARS-cov2 can be present in great numbers in particles smaller than < 0.1 µm and those particles can
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directly access the bloodstream, organs and brain, could there possibly be a relationship between the inhaled
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particle sizes, with its respective viral load, and COVID-19 symptoms severity and/or post-covid sequalae?
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CONCLUSION
In addition to managing environmental factors such as air dynamics, temperature and humidity that influence the size and transport mechanism of particles; using dental tools that
produce less contaminant aerosols and advanced airflow technology, this review indicates that nanotechnology photocatalytic filters may offer an effective additional solution to the
control of aerosols and transmission of airborne disease in the dental office.

Disclaimer: The author received no financial support and declares no conflict of interest