. 2020 Nov 24;6:25. doi: 10.1038/s41405-020-00053-2

Table 1.

Oral surgery: research methods.

Author, year (country)	AIMS	Methods
Ishihama et al., 2008 (Japan)	To evaluate the exposure of splattering contaminated with blood by the attending surgeon during outpatient surgery for an impacted mandibular third molar	1. Study setting: Hospital (not stated) 2. Environmental factors: Not stated	25 procedures (25 sets of PPE used by operators)	1. Cases: Surgical removal of the impacted tooth, alveoloplasty and transalveolar extraction (patients positioned at 45°, all treatments carried out by a single, right-handed surgeon) 2. Control: Control measures not used	1. Procedures: Recorded as <10, 10–20 or >20 min 2. Sampling: post procedure (duration not stated)	1. Instruments: Air motor handpiece (INTRAflex 2313 LN, KaVo, Germany) with steel round-bar at 12,000 r.p.m (standard); dental turbine handpiece (SUPERtorque LUX640, KaVo) with diamond point bar at 380,000 r.p.m. (standard); air motor handpiece with steel fissure bar 2. Irrigation: Water sprayed at 40–60 mL/min (standard) from the triple and single nozzles of the dental turbine handpiece and air motor handpiece 3. Mitigation: Suction at 80 L/min at 0.008 mpA standard setting by assistant 4. PPE: Surgical level PPE used	1. Type: Visible and imperceptible blood contamination on PPE 2. Sites: Operators: PPE used including operating gown and visor mask (areas covered: abdomen, femur, face shield, left arm, left forearm, mask, right forearm, right arm and thorax)	Visual check (with and without enhancers) of PPE used 1. Visible stains: visible check, count, location and size categorisation (small, 0.5 mm; large, 0.5 mm) 2. Imperceptible splatters: Leucomalachite green solution composed of 0.1 g of leucomalachite green (125660, Sigma-Aldrich, St. Louis, MO), 10 mL of acetic acid (017-00251, Wako, Japan), 0.5 mL of 30% hydrogen peroxide (081-04215, Wako) and 19.5 mL of distilled water (dilution experiment carried out to determine the sensitivity of the leucomalachite green solution to detect blood diluted up to 1:4000)
Ishihama et al., 2009 (Japan)	To assess the existence of floating blood-contaminated aerosols during outpatient surgery for a mandibular impacted third molar	1. Study setting: Hospital (Not stated) 2. Environmental factors: Not stated	132 procedures (100 procedures at 20 cm, 25 at 60 cm and 7 at 100 cm distances from the extraoral evacuator nozzle)	1. Cases: Impacted mandibular third molar surgery (patients positioned at 45°; operator not specified) 2. Control: Control measures not used	1. Procedures: 2–47.9 min of high-speed instrument use with a median time of 6.4 min in 79 cases 2. Sampling: post-procedure (duration not stated)	As per Ishihama et al., 2008 (see above) * An extraoral evacuator used at distances of 20, 60 and 100 cm	1. Type: Well-diluted and invisible blood stains 2. Sites: Environment: Aerosolised blood collected in the atmospheric samples collected by an extraoral high-volume evacuator system set at a distance of 20 cm for the first 100 cases, 60 cm for 25 cases and 100 cm for seven trial cases	Visual check (with enhancers) of filters placed on an air sampler Leucomalachite green solution composed of 0.1 g of leucomalachite green (125660, Sigma-Aldrich Inc., Missouri, MO, USA), 10 mL of acetic acid (017-00251, Wako Pure Chemical Industries Ltd, Osaka, Japan), 0.5 mL of 30% hydrogen peroxide (081-04215, Wako) and 19.5 mL of distilled water to test non-woven absorbable towel used as a filter on an extraoral high-volume evacuator system (3.0 m³/min at 5.0 kPa) (sensitivity of the filter towel determined as 96% of the American Society of Heating, Refrigerating and Air Conditioning Engineers (ASHRAE) test dust collection arrest under 430 Pa at initial pressure loss and 2.5 m/s of air velocity with a gravimetric method)
Wada et al., 2010 (Japan)	To evaluate the dissemination of blood and distribution of frequent contaminations, we investigated blood contamination on environmental surfaces of equipment in an outpatient procedure room	1. Study setting: Hospital (single-chair setting) 2. Environmental factors: Not stated	40 samples (sets of samples for light arm and bracket table arm from 20 cases)	1. Cases: Impacted mandibular third molar extraction (patients positioned at 45°; operator not specified) 2. Control: Control measures not used but surfaces disinfected with ethanol-based disinfectant cloths before each procedure	1. Procedures: Not stated 2. Sampling: post procedure (duration not stated)	As per Ishihama et al., 2008 (See above)	1. Type: Imperceptible blood contamination 2. Sites: Clinical subsites: Dental chair light arm and bracket table arm (described as low-touch areas)	Visual check (with enhancers) of absorbent wipes used for sampling Leucomalachite green solution composed of 0.1 g of leucomalachite green (125660, Sigmae Aldrich Inc., Missouri, MO, USA), 10 mL of acetic acid (017-00251, Wako Pure Chemical Industries Ltd, Osaka, Japan), 0.5 mL of 30% hydrogen peroxide (081-04215, Wako) and 19.5 mL of distilled water captured to test ethanol sterile absorbent cotton used to wipe down the environmental surfaces
Yamada et al., 2011 (Japan)	To clarify whether blood-contaminated aerosols were existent and floating in the air during dental procedures and to evaluate the effect of an extraoral evacuator system	1. Study setting: Hospital (Unclear but photograph included suggests multiple-chair setting) 2. Environmental factors: Not stated	226 procedures (52 impacted third molar extraction; 61 crown preparation; 47 inlay preparation; 66 scaling cases)	1. Cases Oral surgery procedure: Impacted third molar extraction Other treatment procedures: Full-crown preparation, black class II cavity preparation (in the proximal surfaces of molar and premolar) and scaling as cases that can induce bleeding. (patients positioned in a horizontal position, operator not specified) 2. Control: 19 inlay cavity preparation (black class I) conducted as bleeding is not induced	1. Procedures: Not stated 2. Sampling: During the procedure (duration not stated)	1. Instruments: High-speed rotating instrument and ultrasonic scaler 2. Irrigation: Not stated 3. Mitigation: Suction used but details unclear *An extraoral evacuator used for air sampling at distances of 50 and 100 cm PLUS a second extraoral evacuator at a distance of 100 cm 4. PPE: Unclear	1. Type: Blood-contaminated aerosol 2. Sites: Environment: 50 cm away from patient’s mouth and 100 cm away from patient’s mouth; and both 50 and 100 cm behind the patient’s mouth	Visual check (with enhancers) of filter on air sampler(s) Leucomalachite green solution (composition and dilution not stated) used to test filter placed on extraoral air evacuator (Free Arm FORTE-S, Tokyo Giken) 3.0 m³/min air at 5.0 kPa (sensitivity of the filter towel determined as 96% of the American Society of Heating, Refrigerating and Air Conditioning Engineers (ASHRAE) test dust collection arrest under 430 Pa at initial pressure loss and 2.5 m/s of air velocity with a gravimetric method)
Al-Eid et al., 2018 (Saudi Arabia)	To identify the extent of visually imperceptible blood contamination of the different surfaces of the oral surgery clinic and the PPE used therein, using forensic luminol	1. Study setting: Hospital (Unclear) 2. Environmental factors: Not stated	30 participants (details not provided)	1. Cases: Removal of one or both mandibular first molar (all treatments carried out by a single surgeon) 2. Control: Control measures not used but all clinical subsites disinfected before each procedure and tested	1. Procedures: 25–60 min (mean 40 min; SD 7.88; range 25–60 min) 20 procedures lasted >40 min out of 30 2. Sampling: Post-procedure (duration not stated)	1. Instruments: Rotary handpiece 2. Irrigation: Saline irrigation 3. Mitigation: Low-volume suction 4. PPE: Surgical level PPE used	1. Type: Imperceptible blood contamination 2. Sites: Operator and assistants: PPE included surgical gown, sterile gloves, face masks, eyewear, head cap and shoe cover Patients: PPE included head cap, eyewear and drape Clinical subsites: Tabletop for files and stationery; table for instruments and disposable; flooring behind the dental chair (including the operator’s and assistant’s chairs); instrument tray and handpiece unit; operating light and dental chair armrests; cuspidor and suction unit; and flooring in front of dental chair	Visual check (with enhancers) of PPE used and clinical subsites Luminol reagent spray (luminol blood detection reagent, TRITECH Forensics, Southport, North Carolina, USA) and isolation of the room from all light sources. Blacklight used to detect chemiluminescence to confirm the presence of traces of blood contamination (two calibrated investigators carried out a visual check for contamination)
Aguilar-Duran et al., 2020 (Spain)	Determining the prevalence of blood particles on masks with visors and surgical caps in oral surgery procedures and establishing the main risk factors for blood spatter	1. Study setting: Hospital (unclear) 2. Environmental factors: Not stated	216 samples (sets of caps and face masks used by surgeons and assistant for 108 procedures)	1. Cases: Extraction of impacted or erupted teeth, implant placement, extraction (non-surgical) (treatments carried out by multiple post-graduate trainees) 2. Control: Control measures not used	1. Procedures: Reported as ≥ or <30 min 2. Sampling: Post procedure (duration not stated)	1. Instruments: Tooth extraction: High-speed air-turbine handpiece or low-speed electric straight handpiece Implant placement: Electric contra-angled handpiece 2. Irrigation: Tooth extraction: Water cooling for high-speed air–water turbine and external cooling using a syringe for low-speed electric handpiece Implant placement: Saline cooling incorporated in the handpiece 3. Mitigation: Not stated 4. PPE: Surgical level PPE used	1. Type: Visible and invisible blood splatter 2. Sites: Operators and dental assistants: PPE used included facial masks with a visor (outer and inner sides) and surgical caps (outer side only)	Visual check (with and without enhancers) of PPE used 1. Visible blood contamination: Visual screening and count of blood splashes for each site 2. Imperceptible blood contamination: Kastle–Meyer reagent (two drops) plus two drops of 6% hydrogen peroxide added after 5 s (visual checks for contamination carried out by a single investigator)
Hallier et al., 2010 (UK)	To measure the levels of bioaerosol associated with dental procedures and to determine if these could be reduced in the local environment by use of the IQAir system both before and during certain types of dental procedure	1. Study setting: Hospital (single-chair setting for oral surgery and multiple-chair setting for other procedures) 2. Environmental factors: Clinic windows closed, no air conditioning systems, or fans on. Room temperature in all three clinical areas was between 21 and 24 °C	Eight participants [bioaerosol measured for each treatment (×4) for 2 cases (with without ACS) and plate change every 10 min. Between 5 and 9 bioaerosol samples collected. Fifteen separate bioaerosol samples at baseline] *Total number of samples = unclear	1. Cases: Oral surgery procedure: Extraction (non-surgical) Other treatment procedures: Cavity preparation, history and oral examination and ultrasonic scaling (all eight treatments carried out by eight different dental students) 2. Control: 15 baseline sampling performed during the weekend, with no dental treatment being undertaken	1. Procedures: Not stated 2. Sampling: During the procedure, plates replaced every 10 min	1. Instruments: Scaling: Ultrasonic Scaler (with high-volume aspiration) Cavity preparation: Air rotor high-speed dental handpiece Extraction: Not stated 2. Irrigation: Scaling: Not stated Cavity preparation: Not stated Extraction: Not stated 3. Mitigation: Scaling: High-volume aspiration Cavity preparation: Not stated Extraction: Not stated *Air cleaning system used for cases but not for controls PLUS an air sampling pump placed at a distance of 20 cm 4. PPE: Not stated but implied regular PPE used	1. Type: Bacterial 2. Sites: Environment: 20 cm away from the dental chair	Microbiological assessment of settle plates on an air sampler Sampling pump calibrated to 2.7 mm of water pressure at a flow rate of 100 L/min every 30 min for all procedures Blood agar plates incubated at 37 °C for 48 h under aerobic conditions (clinic windows closed, no air conditioning used during procedures, temperature maintained between 21 and 24 °C and air cleaning system used)
Jimson et al., 2015 (India)	To assess the bacterial composition of aerosols formed during surgical procedures	1. Study setting: Hospital (single-chair setting) 2. Environmental factors: Not stated	120 samples (4 samples for each of the 30 procedures)	1. Cases: Surgical removal of impacted mandibular third molar (treatments carried out by surgeon-unspecified) 2. Control: Two petri dishes exposed for 20 min before each procedure	1. Procedures: Not stated 2. Sampling: During the procedure for up to 20 min	1. Instruments: Surgical bur and handpiece 2. Irrigation: Not stated 3. Mitigation: Not stated 4. PPE: Not stated	1. Type: Bacterial 2. Sites: Operators and assistants: ‘Near surgeon,’ ‘near attendant’ Patients: Patient’s chest Clinical subsites: Instrument trolley	Microbiological assessment of settle plates Blood agar plates (20 min exposure during procedure) incubated at 37 °C for 24 h under aerobic conditions
Janani and Kumar et al., 2018 (India)	To determine the level and type of bacterial contamination presents on disposable surgical dental care clothing worn over scrubs of dental students to assess the risk of spread of nosocomial infection in a dental institution	Hospital (unclear) 2. Environmental factors: Not stated	135 samples (three swabs collected and cultured at the end of each of the 45 procedures) * Equivalent sites were swabbed at the beginning of each procedure but not reported	1. Cases: Surgical removal of impacted tooth, alveoloplasty, transalveolar extraction (treatments carried out by multiple post-graduate trainees) 2. Control: Samples collected at the beginning and at the end of each procedure	1. Procedures: Not stated 2. Sampling: Post-procedure (duration not stated)	1. Instruments: Not stated 2. Irrigation: Not stated 3. Mitigation: Not stated 4. PPE: Surgical level PPE used	1. Type: Bacterial 2. Sites: Operators: PPE used included surgical gown covering neck (collar), sleeve (cuff) and chest area	Microbiological assessment of swabs used for sampling Blood agar culture medium plate incubated at 37 °C under microaerophilic conditions (5% CO₂) for 24 h
Kobza et al., 2018 (Poland)	To analyse the number of colony-forming units (CFUs) in bioaerosols and assess whether exposure limits are exceeded. Objective: To measure the concentration of bacteria and fungi in aerosols, in rooms where oral surgery was performed using high-speed instruments	1. Study setting: General practice (single- plus multiple-chair setting) 2. Environmental factors: Not stated	Not stated	1. Cases: Oral surgery procedure not specified (treatments carried out by dentists- unspecified) 2. Control: Air samples taken outside the dental practice before and during the working day	1. Procedures: Not stated 2. Sampling: During the procedure (duration not stated)	1. Instruments: High-speed ‘instrument' 2. Irrigation: Not stated 3. Mitigation: Not stated *An extraoral evacuator used at a distance of 30–60 cm for air sampling 4. PPE: Not stated	1. Type: Bacterial and fungal 2. Sites: Environment: 30–60 cm from surgical site	Microbiological assessment of filter on an air sampler Filter placed on an extraoral air evacuator used for morphological and microscopic analysis Bacteria: Morphological analysis using Tryptic Soy Agar base with cycloheximide added to inhibit fungal growth and microscopic analysis Fungi: Morphological analysis using Malt Extract Agar base and microscopic analysis
Divya et al., 2019 (India)	To evaluate the aerosol and splatter contamination from various minor oral surgical procedures and to assess the risk of spread of nosocomial infection in our dental institution	1. Study setting: Hospital (multiple-chair setting) 2. Environmental factors: Not stated	180 samples (six agar plates for each of the 30 patients; 10 alveoplasty, 10 transalveolar extraction, 10 surgical removals of impacted tooth)	1. Cases: Surgical removal of impacted tooth, alveoloplasty, transalveolar extraction (treatments carried out by operators- unspecified) 2. Control: Control measures not used	1. Procedure: Not stated 2. Sampling: During the procedure for 30 min	1. Instruments: High-speed handpiece 2. Irrigation: Water spray 3. Mitigation: High-volume evacuation used PLUS pre-procedural mouth rinse with chlorhexidine used before each procedure 4. PPE: Surgical level PPE used	1. Type: Bacterial 2. Sites: Patients: ‘On patient’ Clinical subsites: Instrument trolley and areas of the dental cubicle, including right middle cubicle, left middle cubicle, right corner and left corner	Microbiological assessment of settle plates Nutrient agar plates (30 min exposure during procedure) incubated at 37 °C for 24 h

Author, year (country)

AIMS

Methods

Setting
1. Study setting (single- and/or multi-chair)
2. Environmental factors (humidity, temperature, air conditioning)

Sample size (participant and/or procedure and/or sample details)

Procedure(s)
1. Cases
2. Control

Duration
1. Clinical procedures
2. Sampling

Equipment detail
1. Instruments
2. Irrigation
3. Mitigation (types of suction/evacuation)
4. PPE

Contamination
1. Type(s)
2. Site(s)

Sampling method

Ishihama et al., 2008 (Japan)

To evaluate the exposure of splattering contaminated with blood by the attending surgeon during outpatient surgery for an impacted mandibular third molar

1. Study setting: Hospital (not stated)

2. Environmental factors: Not stated

25 procedures (25 sets of PPE used by operators)

1. Cases: Surgical removal of the impacted tooth, alveoloplasty and transalveolar extraction (patients positioned at 45°, all treatments carried out by a single, right-handed surgeon)

2. Control: Control measures not used

1. Procedures: Recorded as <10, 10–20 or >20 min

2. Sampling: post procedure (duration not stated)

1. Instruments: Air motor handpiece (INTRAflex 2313 LN, KaVo, Germany) with steel round-bar at 12,000 r.p.m (standard); dental turbine handpiece (SUPERtorque LUX640, KaVo) with diamond point bar at 380,000 r.p.m. (standard); air motor handpiece with steel fissure bar

2. Irrigation: Water sprayed at 40–60 mL/min (standard) from the triple and single nozzles of the dental turbine handpiece and air motor handpiece

3. Mitigation: Suction at 80 L/min at 0.008 mpA standard setting by assistant

4. PPE: Surgical level PPE used

1. Type: Visible and imperceptible blood contamination on PPE

2. Sites: Operators: PPE used including operating gown and visor mask (areas covered: abdomen, femur, face shield, left arm, left forearm, mask, right forearm, right arm and thorax)

Visual check (with and without enhancers) of PPE used

1. Visible stains: visible check, count, location and size categorisation (small, 0.5 mm; large, 0.5 mm)

2. Imperceptible splatters: Leucomalachite green solution composed of 0.1 g of leucomalachite green (125660, Sigma-Aldrich, St. Louis, MO), 10 mL of acetic acid (017-00251, Wako, Japan), 0.5 mL of 30% hydrogen peroxide (081-04215, Wako) and 19.5 mL of distilled water

(dilution experiment carried out to determine the sensitivity of the leucomalachite green solution to detect blood diluted up to 1:4000)

Ishihama et al., 2009 (Japan)

To assess the existence of floating blood-contaminated aerosols during outpatient surgery for a mandibular impacted third molar

1. Study setting: Hospital (Not stated)

2. Environmental factors: Not stated

132 procedures (100 procedures at 20 cm, 25 at 60 cm and 7 at 100 cm distances from the extraoral evacuator nozzle)

1. Cases: Impacted mandibular third molar surgery (patients positioned at 45°; operator not specified)

2. Control: Control measures not used

1. Procedures: 2–47.9 min of high-speed instrument use with a median time of 6.4 min in 79 cases

2. Sampling: post-procedure (duration not stated)

As per Ishihama et al., 2008 (see above)

* An extraoral evacuator used at distances of 20, 60 and 100 cm

1. Type: Well-diluted and invisible blood stains

2. Sites: Environment: Aerosolised blood collected in the atmospheric samples collected by an extraoral high-volume evacuator system set at a distance of 20 cm for the first 100 cases, 60 cm for 25 cases and 100 cm for seven trial cases

Visual check (with enhancers) of filters placed on an air sampler

Leucomalachite green solution composed of 0.1 g of leucomalachite green (125660, Sigma-Aldrich Inc., Missouri, MO, USA), 10 mL of acetic acid (017-00251, Wako Pure Chemical Industries Ltd, Osaka, Japan), 0.5 mL of 30% hydrogen peroxide (081-04215, Wako) and 19.5 mL of distilled water to test non-woven absorbable towel used as a filter on an extraoral high-volume evacuator system (3.0 m³/min at 5.0 kPa) (sensitivity of the filter towel determined as 96% of the American Society of Heating, Refrigerating and Air Conditioning Engineers (ASHRAE) test dust collection arrest under 430 Pa at initial pressure loss and 2.5 m/s of air velocity with a gravimetric method)

Wada et al., 2010 (Japan)

To evaluate the dissemination of blood and distribution of frequent contaminations, we investigated blood contamination on environmental surfaces of equipment in an outpatient procedure room

1. Study setting: Hospital (single-chair setting)

2. Environmental factors: Not stated

40 samples

(sets of samples for light arm and bracket table arm from 20 cases)

1. Cases: Impacted mandibular third molar extraction (patients positioned at 45°; operator not specified)

2. Control: Control measures not used but surfaces disinfected with ethanol-based disinfectant cloths before each procedure

1. Procedures: Not stated

2. Sampling: post procedure (duration not stated)

As per Ishihama et al., 2008 (See above)

1. Type: Imperceptible blood contamination

2. Sites: Clinical subsites: Dental chair light arm and bracket table arm (described as low-touch areas)

Visual check (with enhancers) of absorbent wipes used for sampling

Leucomalachite green solution composed of 0.1 g of leucomalachite green (125660, Sigmae Aldrich Inc., Missouri, MO, USA), 10 mL of acetic acid (017-00251, Wako Pure Chemical Industries Ltd, Osaka, Japan), 0.5 mL of 30% hydrogen peroxide (081-04215, Wako) and 19.5 mL of distilled water captured to test ethanol sterile absorbent cotton used to wipe down the environmental surfaces

Yamada et al., 2011 (Japan)

To clarify whether blood-contaminated aerosols were existent and floating in the air during dental procedures and to evaluate the effect of an extraoral evacuator system

1. Study setting: Hospital (Unclear but photograph included suggests multiple-chair setting)

2. Environmental factors: Not stated

226 procedures (52 impacted third molar extraction; 61 crown preparation; 47 inlay preparation; 66 scaling cases)

1. Cases Oral surgery procedure: Impacted third molar extraction

Other treatment procedures: Full-crown preparation, black class II cavity preparation (in the proximal surfaces of molar and premolar) and scaling as cases that can induce bleeding. (patients positioned in a horizontal position, operator not specified)

2. Control: 19 inlay cavity preparation (black class I) conducted as bleeding is not induced

1. Procedures: Not stated

2. Sampling: During the procedure (duration not stated)

1. Instruments: High-speed rotating instrument and ultrasonic scaler

2. Irrigation: Not stated

3. Mitigation: Suction used but details unclear

*An extraoral evacuator used for air sampling at distances of 50 and 100 cm PLUS a second extraoral evacuator at a distance of 100 cm

4. PPE: Unclear

1. Type: Blood-contaminated aerosol

2. Sites: Environment: 50 cm away from patient’s mouth and 100 cm away from patient’s mouth; and both 50 and 100 cm behind the patient’s mouth

Visual check (with enhancers) of filter on air sampler(s)

Leucomalachite green solution (composition and dilution not stated) used to test filter placed on extraoral air evacuator (Free Arm FORTE-S, Tokyo Giken) 3.0 m³/min air at 5.0 kPa (sensitivity of the filter towel determined as 96% of the American Society of Heating, Refrigerating and Air Conditioning Engineers (ASHRAE) test dust collection arrest under 430 Pa at initial pressure loss and 2.5 m/s of air velocity with a gravimetric method)

Al-Eid et al., 2018 (Saudi Arabia)

To identify the extent of visually imperceptible blood contamination of the different surfaces of the oral surgery clinic and the PPE used therein, using forensic luminol

1. Study setting: Hospital (Unclear)

2. Environmental factors: Not stated

30 participants (details not provided)

1. Cases: Removal of one or both mandibular first molar (all treatments carried out by a single surgeon)

2. Control: Control measures not used but all clinical subsites disinfected before each procedure and tested

1. Procedures: 25–60 min (mean 40 min; SD 7.88; range 25–60 min) 20 procedures lasted >40 min out of 30

2. Sampling: Post-procedure (duration not stated)

1. Instruments: Rotary handpiece

2. Irrigation: Saline irrigation

3. Mitigation: Low-volume suction

4. PPE: Surgical level PPE used

1. Type: Imperceptible blood contamination

2. Sites: Operator and assistants: PPE included surgical gown, sterile gloves, face masks, eyewear, head cap and shoe cover

Patients: PPE included head cap, eyewear and drape

Clinical subsites: Tabletop for files and stationery; table for instruments and disposable; flooring behind the dental chair (including the operator’s and assistant’s chairs); instrument tray and handpiece unit; operating light and dental chair armrests; cuspidor and suction unit; and flooring in front of dental chair

Visual check (with enhancers) of PPE used and clinical subsites

Luminol reagent spray (luminol blood detection reagent, TRITECH Forensics, Southport, North Carolina, USA) and isolation of the room from all light sources. Blacklight used to detect chemiluminescence to confirm the presence of traces of blood contamination

(two calibrated investigators carried out a visual check for contamination)

Aguilar-Duran et al., 2020 (Spain)

Determining the prevalence of blood particles on masks with visors and surgical caps in oral surgery procedures and establishing the main risk factors for blood spatter

1. Study setting: Hospital (unclear)

2. Environmental factors: Not stated

216 samples (sets of caps and face masks used by surgeons and assistant for 108 procedures)

1. Cases: Extraction of impacted or erupted teeth, implant placement, extraction (non-surgical) (treatments carried out by multiple post-graduate trainees)

2. Control: Control measures not used

1. Procedures: Reported as ≥ or <30 min

2. Sampling: Post procedure (duration not stated)

1. Instruments:

Tooth extraction: High-speed air-turbine handpiece or low-speed electric straight handpiece

Implant placement: Electric contra-angled handpiece

2. Irrigation:

Tooth extraction: Water cooling for high-speed air–water turbine and external cooling using a syringe for low-speed electric handpiece

Implant placement: Saline cooling incorporated in the handpiece

3. Mitigation: Not stated

4. PPE: Surgical level PPE used

1. Type: Visible and invisible blood splatter

2. Sites: Operators and dental assistants: PPE used included facial masks with a visor (outer and inner sides) and surgical caps (outer side only)

Visual check (with and without enhancers) of PPE used

1. Visible blood contamination: Visual screening and count of blood splashes for each site

2. Imperceptible blood contamination: Kastle–Meyer reagent (two drops) plus two drops of 6% hydrogen peroxide added after 5 s (visual checks for contamination carried out by a single investigator)

Hallier et al., 2010 (UK)

To measure the levels of bioaerosol associated with dental procedures and to determine if these could be reduced in the local environment by use of the IQAir system both before and during certain types of dental procedure

1. Study setting: Hospital (single-chair setting for oral surgery and multiple-chair setting for other procedures)

2. Environmental factors: Clinic windows closed, no air conditioning systems, or fans on. Room temperature in all three clinical areas was between 21 and 24 °C

Eight participants [bioaerosol measured for each treatment (×4) for 2 cases (with without ACS) and plate change every 10 min. Between 5 and 9 bioaerosol samples collected. Fifteen separate bioaerosol samples at baseline]

*Total number of samples = unclear

1. Cases: Oral surgery procedure: Extraction (non-surgical)

Other treatment procedures: Cavity preparation, history and oral examination and ultrasonic scaling (all eight treatments carried out by eight different dental students)

2. Control: 15 baseline sampling performed during the weekend, with no dental treatment being undertaken

1. Procedures: Not stated

2. Sampling: During the procedure, plates replaced every 10 min

1. Instruments: Scaling: Ultrasonic Scaler (with high-volume aspiration)

Cavity preparation: Air rotor high-speed dental handpiece

Extraction: Not stated

2. Irrigation:

Scaling: Not stated

Cavity preparation: Not stated

Extraction: Not stated

3. Mitigation:

Scaling: High-volume aspiration

Cavity preparation: Not stated

Extraction: Not stated

*Air cleaning system used for cases but not for controls PLUS an air sampling pump placed at a distance of 20 cm

4. PPE: Not stated but implied regular PPE used

1. Type: Bacterial

2. Sites:

Environment: 20 cm away from the dental chair

Microbiological assessment of settle plates on an air sampler

Sampling pump calibrated to 2.7 mm of water pressure at a flow rate of 100 L/min every 30 min for all procedures

Blood agar plates incubated at 37 °C for 48 h under aerobic conditions

(clinic windows closed, no air conditioning used during procedures, temperature maintained between 21 and 24 °C and air cleaning system used)

Jimson et al., 2015 (India)

To assess the bacterial composition of aerosols formed during surgical procedures

1. Study setting: Hospital (single-chair setting)

2. Environmental factors: Not stated

120 samples (4 samples for each of the 30 procedures)

1. Cases: Surgical removal of impacted mandibular third molar

(treatments carried out by surgeon-unspecified)

2. Control: Two petri dishes exposed for 20 min before each procedure

1. Procedures: Not stated

2. Sampling: During the procedure for up to 20 min

1. Instruments: Surgical bur and handpiece

2. Irrigation: Not stated

3. Mitigation: Not stated

4. PPE: Not stated

1. Type: Bacterial

2. Sites:

Operators and assistants: ‘Near surgeon,’ ‘near attendant’

Patients: Patient’s chest

Clinical subsites: Instrument trolley

Microbiological assessment of settle plates

Blood agar plates (20 min exposure during procedure) incubated at 37 °C for 24 h under aerobic conditions

Janani and Kumar et al., 2018 (India)

To determine the level and type of bacterial contamination presents on disposable surgical dental care clothing worn over scrubs of dental students to assess the risk of spread of nosocomial infection in a dental institution

Hospital (unclear)

2. Environmental factors: Not stated

135 samples (three swabs collected and cultured at the end of each of the 45 procedures)

* Equivalent sites were swabbed at the beginning of each procedure but not reported

1. Cases: Surgical removal of impacted tooth, alveoloplasty, transalveolar extraction

(treatments carried out by multiple post-graduate trainees)

2. Control: Samples collected at the beginning and at the end of each procedure

1. Procedures: Not stated

2. Sampling: Post-procedure (duration not stated)

1. Instruments: Not stated

2. Irrigation: Not stated

3. Mitigation: Not stated

4. PPE: Surgical level PPE used

1. Type: Bacterial

2. Sites:

Operators: PPE used included surgical gown covering neck (collar), sleeve (cuff) and chest area

Microbiological assessment of swabs used for sampling

Blood agar culture medium plate incubated at 37 °C under microaerophilic conditions (5% CO₂) for 24 h

Kobza et al., 2018 (Poland)

To analyse the number of colony-forming units (CFUs) in bioaerosols and assess whether exposure limits are exceeded. Objective: To measure the concentration of bacteria and fungi in aerosols, in rooms where oral surgery was performed using high-speed instruments

1. Study setting: General practice (single- plus multiple-chair setting)

2. Environmental factors: Not stated

Not stated

1. Cases: Oral surgery procedure not specified

(treatments carried out by dentists- unspecified)

2. Control: Air samples taken outside the dental practice before and during the working day

1. Procedures: Not stated

2. Sampling: During the procedure (duration not stated)

1. Instruments: High-speed ‘instrument'

2. Irrigation: Not stated

3. Mitigation: Not stated

*An extraoral evacuator used at a distance of 30–60 cm for air sampling

4. PPE: Not stated

1. Type: Bacterial and fungal

2. Sites:

Environment: 30–60 cm from surgical site

Microbiological assessment of filter on an air sampler

Filter placed on an extraoral air evacuator used for morphological and microscopic analysis

Bacteria: Morphological analysis using Tryptic Soy Agar base with cycloheximide added to inhibit fungal growth and microscopic analysis

Fungi: Morphological analysis using Malt Extract Agar base and microscopic analysis

Divya et al., 2019 (India)

To evaluate the aerosol and splatter contamination from various minor oral surgical procedures and to assess the risk of spread of nosocomial infection in our dental institution

1. Study setting: Hospital (multiple-chair setting)

2. Environmental factors: Not stated

180 samples (six agar plates for each of the 30 patients; 10 alveoplasty, 10 transalveolar extraction, 10 surgical removals of impacted tooth)

1. Cases: Surgical removal of impacted tooth, alveoloplasty, transalveolar extraction

(treatments carried out by operators- unspecified)

2. Control: Control measures not used

1. Procedure: Not stated

2. Sampling: During the procedure for 30 min

1. Instruments: High-speed handpiece

2. Irrigation: Water spray

3. Mitigation: High-volume evacuation used PLUS pre-procedural mouth rinse with chlorhexidine used before each procedure

4. PPE: Surgical level PPE used

1. Type: Bacterial

2. Sites:

Patients: ‘On patient’

Clinical subsites: Instrument trolley and areas of the dental cubicle, including right middle cubicle, left middle cubicle, right corner and left corner

Microbiological assessment of settle plates

Nutrient agar plates (30 min exposure during procedure) incubated at 37 °C for 24 h