Table 4.
Main findings of the included studies.
| Author(s) | Summary of aerosol reduction | Conclusions |
|---|---|---|
| Al-Amad et al 2017 | The number of bacteria: Using a rubber dam > not using a rubber dam | The rubber dam seems to result in significantly higher aerosol levels on various areas of the dentist’s head, requiring that dentists cover their heads with suitable protective wear. |
| Ashokkumar et al 2023 | The number of bacteria: distilled water (control) > herbal formulation (test) > CHX (tTest) | The addition of antiseptic agents to the water source contributed to a significant reduction of the cultivable microbial counts in the aerosol and hence can be used to reduce the risk of cross-infection during ultrasonic scaling. |
| Barrett et al 2022 | The number of particles: HVE only > HVE and EOSD | The reduction of aerosols is enhanced when the EOSD is used in combination with traditional HVE. However, the increased noise level when using the device can have a negative impact on patients’ dental experience. |
| Capparè et al. 2022 | The test group on pollution abatement was 83% more than the control group. | The addition of PAC equipment to the already existing safety measures was found to be significantly effective in further microbiological risk reduction. |
| Choudhary et al., 2022a, Choudhary et al., 2022b | The bacteria identified were most consistent with either environmental or oral microbiota. | Aerosols generating from dental procedures pose a low health risk for bacterial and likely viral pathogens when common aerosol mitigation interventions. |
| Choudhary et al., 2022a, Choudhary et al., 2022b | The number of particles: tip HVE > Conical HVE tip HVE > ISOVAC HVE |
Dentists should consider using HVE rather than standard-tip evacuators to reduce aerosols generated during routine clinical practice. |
| Das et al 2022 | The number of bacteria: no rinse group (control) > water (test) > 0.2% Chlorhexidine gluconate (test) > herbal mouthwash (test) | 0.2% Chlorhexidine gluconate is superior in reducing the microbial load in aerosols produced during ultrasonic scaling. |
| Demirkol et al 2023 | The number of particles: only SE > ventilated room > SE and HEOS |
As the particle size increases, the rate of spread away from the dentist’s working area decreases. The HEPA filtered extra-oral suction unit is more effective on particles smaller than 0.5 µm. |
| Desarda et al 2014 | The number of bacteria: with HVE: 11.08 ± 2.25 without HVE: 12.14 ± 1.93 |
It was concluded that HVE, when used as a separate unit without any modification, is not effective in reducing aerosol counts and environmental contamination. |
| Devker et al 2012 | The number of bacteria: 0.2% CHX gluconate > HVE > 0.2% CHX gluconate and HVE |
Preprocedural rinse and high volume suction were effective when used alone as well as together in reducing the microbial load of the aerosols produced during ultrasonic scaling. |
| Dudding et al 2022 | The number of particles: Background: 12.7% 3-in-1 air + water syringe: 42.9% |
This study provides evidence for sources of aerosol generation during common dental procedures, enabling more informed evaluation of risk and appropriate mitigation strategies. |
| Emery et al 2023 | The percentages of contaminated: slow suction > high suction > in‐line funnel |
Riboflavin can be used with minimal risk during dental procedures and allows for the detection of droplet spread in clinical settings in real time. |
| Feres et al 2010 | The number of bacteria: water (conrol) > CPC (test), CHX (test); no rinsing (control) > CPC (test), CHX (test) | A commercial mouthrinse containing 0.05 percent CPC when used as a preprocedural mouthrinse was equally effective as CHX in reducing the levels of spatter bacteria generated during ultrasonic scaling. |
| Fine et al 1992 | The number of bacteria: 5% hydroalcohol (control) > antiseptic mouthwash (test) | This study indicates that preprocedural rinsing with an antiseptic mouthwash can significantly reduce the microbial content of aerosols generated during ultrasonic scaling and may have potential in-office use as part of an infection control regimen. |
| Fine et al 1993 | The number of bacteria: control > antimicrobial mouthrinse |
The pre-procedural use of an antimicrobial mouth rinse produces a significant reduction in number of viable bacteria in a dental aerosol produced by ultrasonic scaling 40 min later. |
| Gupta et al 2014 | The number of bacteria: group C > group B > group A |
A routine preprocedural mouth rinse could eliminate the majority of bacterial aerosols generated by the use of an ultrasonic unit, and that 0.2% CHX gluconate is more effective than herbal mouthwash. |
| Hallier et al 2010 | The number of bacteria: Without ACS > with ACS |
Potentially hazardous bioaerosols created during dental procedures can be significantly reduced using an air cleaning system. |
| Holloman et al 2015 | The number of bacteria: control group: 3.61(0.95) > test group: 3.30(0.88) | Neither device reduced aerosols and spatter effectively, and there was no significant difference in reduction between the 2 devices. Additional measures should be taken with these devices to reduce the likelihood of disease transmission. |
| Jawade et al 2016 | The number of bacteria: CHX gluconate: 27.17 ± 12.5 CFU distilled water: 124.5 ± 30.08 CFU povidone iodine: 60.43 ± 33.33 CFU |
CHX gluconate is more effective in reducing dental aerosols when compared to povidone iodine and distilled water. Povidone iodine showed better CFU reduction when compared with distilled water. |
| King et al 1997 | The number of bacteria: the ultrasonic sealer without the aerosol reduction device: 45.1 ± 28.9; the ultrasonic sealer with the aerosol reduction device: 2.6 ± 3.6 | An aerosol reduction device is effective in reducing the number of microorganisms generated during ultrasonic scaling, therefore decreasing the risk of disease transmission. |
| Lahdentausta et al 2022 | The number of particles: different dental procedures > background air turbine handpiece was highest |
Air turbine handpieces produced the highest levels of < 1 μm aerosols and total particle number concentrations. High- and low-speed dental handpieces and ultrasonic scalers elevated the aerosol concentration levels compared to the aerosol levels measured during oral examination. |
| Liu et al 2023 | The bioaerosol concentration: Without OSSM > with OSSM |
OSSM use in dental clinics can reduce the exposure concentrations of bioaerosols for healthcare workers during dental treatment and is beneficial for minimizing the risk of infectious diseases such as COVID-19. |
| Logothetis and Martinez-Welles, 1995 | The number of bacteria: water (conrol) > chlorhexidine (test); dantiseptic mouthwash (test) > chlorhexidine (test) | Bacterial counts collected during the treatment indicate that the chlorhexidine pretreatment rinse was significantly more effective than the other solutions in reducing bacterial aerosols. |
| Makhsous et al 2021 | The bioaerosol concentration: HEPA > EOSD |
The data collected found a slight reduction in particle count when EOSD units were turned on. |
| Mamajiwala et al 2018 | The number of bacteria: distilled water (conrol) > chlorhexidine (test); distilled water (control) > cinnamon (test) | Both CIN and CHX used as an irrigant through DUWL effectively helped in the reduction of bacterial count in dental aerosols. |
| Muzzin et al 1999 | The number of bacteria: without the aerosol reduction device (control) > with the aerosol reduction device (test) | The data suggest that the aerosol reduction device is effective in reducing the number of microorganisms generated during air polishing. |
| Nayak et al 2020 | The number of bacteria: water > Befresh™ (Sagar Pharmaceuticals) mouthwash > the CHX group |
This study proves that a regular preprocedural mouth rinse could significantly reduce the majority bacteria present in aerosols generated by the use of an ultrasonic unit, and Befresh™ mouth rinse was found to be equally effective in reducing the aerosol contamination to 0.2% CHX gluconate. |
| Nisha et al 2021 | The number of bacteria: group A > group B > group C |
Routine use of preprocedural mouthrinse could be a measure to reduce bacterial aerosols generated during ultrasonic scaling and 0.12% CHX gluconate is more effective than 0.75% BA mouthwash in reducing CFUs count. |
| Nisha et al 2022 | The number of bacteria: distilled water (control) > 1.5% hydrogen peroxide (test) > 0.12% chlorhexidine (test) | Preprocedural rinse using HP can effectively be used as a method to reduce dental aerosols generated during ultrasonic scaling. |
| Noordien et al 2021 | DASD + LV: in a 62% reduction HV + LV compared to LV alone: in a 53% reduction |
The DASD in conjunction with LV was more effective in reducing aerosol, droplets and splatter than HV plus LV. |
| Paul et al 2020 | The number of bacteria: PVP-1 > AV > CHX |
94.5% AV as a preprocedural rinse is better than 1% PVP–I and comparable to 0.2% CHX in reducing CFU count. |
| Prasanth et al 2010 | The number of colonies: stage 1 > stage 2 | The use of high volume suction apparatus and 0.5 percent sodium hypochlorite solution was significantly effective in reducing the microbial load. |
| Reddy et al 2012 | The number of bacteria: sterile water (control) > non tempered chlorhexidine (test) > tempered chlorhexidine (test) | Pre-procedural rinse can significantly reduce the viable microbial content of dental aerosols and tempered chlorhexidine was more effective than non-tempered chlorhexidine. |
| Retamal-Valdes et al 2017 | The number of bacteria: did not rinse or rinse with water > CPC + Zn + F or CHX | The mouthwash containing CPC + Zn + F, is effective in reducing viable bacteria in oral aerosol after a dental prophylaxis with ultrasonic scaler. |
| Santa et al 2022 | The number of bacteria: Without IBCD > with IBCD |
The use of the biosafety device is an effective means to reduce air contamination by more than 99% of bacterial contamination around the main droplet/aerosol source. |
| Santos et al 2014 | The number of bacteria: distilled water (control) > 0.12% chlorhexidine (test) | The prior use of 0.12% chlorhexidine as mouthwash significantly reduced contamination caused by aerosolized sodium bicarbonate during dental prophylaxis in the orthodontic clinic. |
| Sethi et al 2019 | The number of bacteria: distilled water (conrol) > chlorhexidine (test); distilled water (control) > cinnamon extract (test) | Both cinnamon and chlorhexidine used as an ultrasonic device coolant through DUWLs effectively helped in the reduction of bacterial count in dental aerosols. |
| Shetty et al 2013 | The number of bacteria: distilled water > tea tree oil > Chlorhexidine digluconate | This study showed that all the antiseptic mouthwashes significantly reduced the bacterial CFUs in aerosol samples. Chlorhexidine rinses were found to be superior to tea tree when used preprocedurally in reducing aerolized bacteria. |
| Suprono et al 2021 | The number of bacteria: HVE > HVE and intraoral suction device |
Significant reductions were founded in the amount of microbial aerosols when both HVE and an intraoral suction device were used. |
| Takenaka et al 2022 | The number of bacteria: With the eHVE 20 cm away > With the eHVE 10 cm away; No rinsing > mouth rinsing | Preprocedural mouth rinsing can reduce bacterial contamination where the extraoral HVE is positioned away from the mouth, depending on the procedure. Combining an extraoral HVE with preprocedural mouth rinsing can reduce bacterial contamination in dental offices. |
| Toroğlu et al 2001 | The number of bacteria: Debonding > Baseline Without CHX rinse > with CHX rinse (P > 0.05) |
Preprocedural CHX gluconate mouth rinse appears to be ineffective in decreasing the exposure to infectious agents. Therefore, barrier equipment should be used to prevent aerosol contamination. |
| Yang et al 2021 | the number of particles: SE + HSS > SE + HSS + HVS |
The increase of the level of aerosol with size less than 10 µm was minimal during dental procedures when using SE and HSS. Use of HVS further reduced aerosol levels below the ambient levels. |
AV: aloe vera; BA: boric acid; CCT: controlled clinical trials; CFUs: colony‑forming units; CHX: chlorhexidine; CPC: cetylpyridinium chloride; DASD: dental aerosol suction device; DUWLs: dental unit waterlines; EOSD: extra-oral suction device; HEPA: high-efficiency particulate air; HSS: high-speed suction; HVE: high-volume evacuators; IBCD: individual biosafety capsule in dentistry; LV: low-volume; PVP‑I: povidone‑iodine; RCT: randomized controlled trials; SE: saliva ejector.