Summary & conclusions
A careful and contextualized review of the currently available evidence on dental aerosols reveals the following:
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Viral shedding occurs in saliva during acute phases of all respiratory diseases, and influenza viruses have been reported in post‐recovery and asymptomatic patients.
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Respiratory bacterial pathogens are present in saliva of asymptomatic individuals; however, their relative abundances are very low.
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Aerosols are generated by all individuals during all times of the day during all types of activities.
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The microbial payload in physiological aerosols correlates with disease severity for respiratory diseases.
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Aerosols are created during most dental procedures. The four main aerosol emitting devices are ultrasonics, handpieces, air‐water syringes, and lasers.
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There is little evidence to definitively implicate saliva as the primary source of bacteria in these aerosols. Although absence of evidence is not evidence of absence, the available evidence currently points to environmental sources, particularly dental unit water lines, as a major basis of aerosol bacteria in the dental environment.
Large‐scale, multi center studies using atraumatic air harvesters and integrated data modeling that is superimposed on a geographic map of the physical space have enabled the medical community to identify patterns of aerosol spread, model disease transmission, and create human and instrument flow paths to reduce risk of infection. Similar studies to determine the creation and spread of aerosols during dental procedures and to estimate time and extent of spread are urgently needed.
AUTHOR CONTRIBUTIONS
Purnima S. Kumar and Kumar Subramanian contributed equally to the literature review, and writing and reviewing the manuscript.
Serial posts:
- Demystifying the mist: Sources of microbial bioload in dental aerosols
- Introduction : microbial bioload in dental aerosols
- The characteristics of aerosolized particle
- Methods to investigate aerosols
- The oral cavity as a reservoir for viruses in health and disease
- Aerosol generation during physiological activity
- The oral cavity as a host for respiratory bacterial pathogens
- Aerosol generating medical and dental procedures (AGMP & AGDP)
- Is saliva the primary source of pathogens in dental aerosols?
- Disease transmission to dental healthcare personnel & patients
- Summary & conclusions
- Aerosol generation during physiological activity