search for




 

Efficacy of Mouthrinsing in Reducing Aerosol Contamination in the Dental Environment: A Systematic Review
J Dent Hyg Sci 2024;24:221-30
Published online December 31, 2024;  https://doi.org/10.17135/jdhs.2024.24.4.221
© 2024 Korean Society of Dental Hygiene Science.

Eun-Mi Choi1 and Eun-Bi Sim2,†

1Apple Tree Institute of Biomedical Science, Apple Tree Medical Foundation, Goyang 10387, 2Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju 26493, Korea
Correspondence to: Eun-Bi Sim, https://orcid.org/0000-0002-1014-4273
Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, 1 Yonseidae-gil, Wonju 26493, Korea
Tel: +82-0504-461-2489, Fax: +82-0504-461-2489, E-mail: simeunbi@yonsei.ac.kr
Received September 3, 2024; Revised November 4, 2024; Accepted November 8, 2024.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Aerosols generated during dental procedures can contaminate dental devices and trigger microbial and pathogenic propagation in dental clinics. Pre-procedural use of chlorhexidine gluconate, essential oils, or povidone-iodine can reduce the number of oral microorganisms in aerosols and the splatter produced during dental procedures. This study provides an update on aerosol-mediated respiratory infections and evaluates the efficacy of pre-procedural mouth rinsing at different landing distances.
Methods: We searched relevant articles in the MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases in December 2020. The eligible studies provided clear and sufficient information on aerosol and splatter reduction during dental procedures. We performed a systematic review of the effectiveness of pre-procedural mouth rinses in reducing the number of colony-forming units (CFUs) in dental aerosols.
Results: In this review, 9 of the 23 selected studies showed positive effects of pre-procedural mouth rinse intervention. The analysis of the landing distances of aerosols originating from the patient’s mouth revealed microorganisms in the aerosols at a minimum distance of one foot to a maximum distance of three feet or more. The experimental group that used pre-procedural antimicrobial mouth rinses showed a statistically significant mean CFU reduction of 33.33∼94.33% in the experimental group compared with the control group.
Conclusion: We recommend the use of mouthwash solutions to reduce the production of contaminated aerosols during dental procedures.
Keywords : Aerosols, Mouthwashes, Respiratory tract infections
Introduction

1. Background

Dental healthcare personnel (DHCP) are at risk of cross-contamination with aerosols and droplets during treatment procedures1). The occupational group with the highest risk of coronavirus disease 2019 (COVID-19) comprised dental hygienists, followed by respiratory therapy technicians, dental assistants, and dentists2). Therefore, the risk of infectious diseases in patients with DHCP cannot be ignored. The World Health Organization, Centers for Disease Control and Prevention (CDC), Occupational Safety and Health Administration, and Korea Centers for Disease Control and Prevention have emphasized the importance of hand hygiene, personal protective equipment, and environmental management. Patients diagnosed with or suspected of having infectious diseases were recommended to postpone aerosol-producing procedures that required the use of handpieces, three-way syringes, and ultrasonic scalers3-6).

Additional 30 sources of human activities, interventions, and daily cleaning in the hospital also generated aerosols. Fifty-five bacterial species, 45 fungal genera and ten viruses were identified in the hospital setting, and 16 bacterial and 23 fungal species were identified in the dental environment7). Aerosols generated during dental procedures may contaminate dental devices and trigger microbial and pathogenic propagation in dental clinics8,9). For example, an ultrasonic scaler can produce aerosols at >300 colony forming unit (CFU)/feet2,10). Thus, DHCP may be exposed to large amounts of microorganisms, such as bacteria and viruses, as well as body fluids, such as blood and saliva11). Aerosols can linger in the air for long periods12), thereby increasing the risk of infectious diseases such as chickenpox, measles, tuberculosis, smallpox, and influenza13).

The CDC recommends the use of rubber dams and high-volume suction to reduce the production of aerosols during dental procedures4). Mouth rinsing and use of air filters have also been recommended8,14-17). Rubber dams isolate the treatment sites during dental procedures, thereby reducing air pollution. However, rubber dams are generally not used during periodontal or surgical operations, or during orthodontic treatment18). In contrast, mouth rinses can be used for any dental procedure. Pre-procedural use of chlorhexidine gluconate, essential oils, or povidone-iodine can reduce the number of oral microorganisms in aerosols and the splatter produced during dental procedures. This can reduce the number of microorganisms entering the bloodstream during invasive dental procedures19). There is a risk of exposure to cross-infection by aerosols landing at distances >2 feet14). However, only a few studies have reported the reduction intervention effect of aerosols and the impact of landing distances on the possibility of aerosol contamination. Moreover, the results and conclusions differed between studies. This might be due to differences in sampling methods, strategies, and microorganism culturing.

2. Objectives

The purpose of this systematic review was to compare the number of microorganisms in aerosols by landing distance based on the presence or absence of mouth rinsing during dental procedures. We addressed the following question: Prior to the COVID-19 pandemic, in patients without oral diseases undergoing dental procedures that generate aerosols, does the use of a pre-procedural mouth rinse reduce the number of microorganisms compared with the use of sterile water rinse or no mouth rinse?

Materials and Methods

1. Protocol registration

The study protocol was registered with the PROSPERO International Prospective Register of Systematic Reviews (CRD42020157282).

2. Search strategy

This systematic review was prepared and presented in accordance with the Cochrane Handbook for Systematic Reviews of Interventions (ver 5.1)20). We performed a systematic literature search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to search the MEDLINE (via PubMed), EMBASE (via Ovid), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. The last search of all databases was performed in December 2020 No restrictions were imposed on language or publication year. The details of the search strategy using the MEDLINE (via PubMed) database are shown in Table 1. The same search formula was applied to all five databases. Search results were exported to EndNote version X7 (Clarivate Analytics, Philadelphia, PA, USA).

Ovid MEDLINE Search Strategy

[(exp Oral Hygiene/) OR (Oral Hygiene.tw.) OR (Dental Hygiene.tw.) OR (((oral or mouth or dental) adj2 (care or hygiene or health)).tw.) OR ((plaque adj2 (control* or remove*)).tw.) OR (exp Mouthwashes/) OR (((oral or dental or mouth) adj3 (wash* or rinse*)).tw.) OR ((mouthrinse* or mouth rinse* or mouthwash* or mouth wash*).tw.)] AND [(exp Aerosols/) OR ((Aerosol or bioaerosol or Aerosolization or airborne bacteria or airborne).tw.) AND [(randomized controlled trial) OR (controlled clinical trial) OR (randomized) OR (placebo) OR (drug therapy) OR (randomly) OR (trial) OR (groups) NOT (("animals" [Mesh]) not humans)]


3. Inclusion and exclusion criteria

As per the population, intervention, comparison, outcome (PICO) strategy, our population consisted of people without oral diseases; the intervention being any type of antimicrobial mouthrinse compared to sterile water rinse or no mouthrinse (comparison), and the outcome was the total number of CFUs of microorganisms by landing distance.

The inclusion criteria were as follows: 1) randomized controlled trials (RCTs) or clinical controlled trials on 2) any type of mouth rinse intervention and 3) experimental studies with controls regarding 4) aerosols generated during dental procedures. The exclusion criteria were 1) absence of an experimental or control group, 2) absence of any type of mouth rinse intervention, 3) studies that did not report outcomes of the intervention, 4) reviews, case reports, letters, or conference papers, and 5) articles with no available abstract. The Rayyan web-based platform was used to screen the titles and abstracts of the records for systematic reviews21).

4. Primary outcomes

The primary objective was to compare the number of microorganisms in the aerosols by landing distance, based on the presence or absence of mouth rinsing during dental procedures.

5. Screening and selection

Reference management software (EndNote) was used to identify and eliminate duplicate records. Two authors (EM and EB) independently reviewed the abstracts or titles (or both) of the remaining records to determine which studies should be included for further assessment (Table 2)17,22-43); they also investigated the full texts of all potentially relevant records, mapped the records to the studies, and classified the studies as included, excluded, and ongoing. Fig. 1 shows an adapted PRISMA flow diagram for study selection. No discrepancies were observed when the two authors evaluated the risk of bias.

Fig. 1. PRISMA flow diagram for study selection.

Characteristics of the Included Studies

Participants age (y) Procedure of collection Location of collection site (microbial analysis) Outcomes Year
72 (NR) High-speed handpiece NR (CFU count) Antibacterial mouthwash rinse vs. sterile water, 89.3% reduction 197022)
NR (NR) Ultrasonic scaler Dental chair, front of clinic, floor (CFU count) Aerobic bacteria, 33.82% reduction; anaerobic bacteria, 68.75% reduction 197823)
18 (NR) Ultrasonic scaler 2 inches (CFU count) Antiseptic mouthwash vs. 5% hydroalcohol control rinse, 85.36% reduction 199224)
18 (NR) Ultrasonic scaler 2 inches (CFU count) Cool Mint Listerine vs. 5% hydroalcohol control, 94.33% reduction 199325)
18 (NR) Ultrasonic scaler 2 inches (CFU count) Listerine vs. control, 85.71% reduction 199326)
18 (25∼54) Air abrasive polisher 2, 3, 5, 6, 9 feet, operator’s mask (CFU count) CHX vs. control, 93.1% reduction
EO vs. control, 1% reduction
199527)
15 (21∼63) Ultrasonic scaler 6 inches, 2 feet (CFU count) CHX vs. control, 51.43% reduction 200128)
50 (NR) Ultrasonic scaler 24 inches (CFU count) CHX vs. control, 59.57% reduction 200629)
60 (30∼70) Ultrasonic scaler Support board, participant’s chest, examiner’s forehead (CFU count) CHX vs. no rinse, 78% reduction
CPC vs. no rinse, 77% reduction
CHX vs. water, 70% reduction
CPC vs. water, 68% reduction
201030)
30 (NR) Ultrasonic scaler 4 feet (CFU count) Water, 19.34% reduction
0.2% chlorhexidine, 83.24% reduction
0.2% tempered chlorhexidine, 90.10% reduction
201231)
80 (42.74±12.38) Ultrasonic scaler Dentist’s mask (CFU count) CHX vs. water, 45.4% reduction 201332)
60 (25∼45) Ultrasonic scaler 6 inches from the operator’s nose, 6 inches from the dental assistant’s nose, 12 inches from the patients’ chest (CFU count) CHX vs. water, 93.3% reduction 201333)
24 (25∼55) Ultrasonic scaler Patient’s chest, doctor’s chest area, assistant’s chest area (CFU count) 0.2% CHX vs. herbal mouthwash, 56.43% reduction
0.2% CHX vs. water, 72.05% reduction
HRB vs. water, 35.85% reduction
201434)
23 (10∼40) Dental prophylaxis Clinician’s face, 10 cm from the clinician’s mouth, 15 cm from the patient’s oral cavity (CFU count) Distilled water vs. 0.12% chlorhexidine, 38.45% reduction 201435)
30 (8∼50) Ultrasonic scaler 1, 2, 3 feet (CFU count) Saline vs. 0.2% chlorhexidine, 99.91% reduction
Saline vs. herbal mouthwash, 58.27% reduction
201436)
15 (35∼50) Ultrasonic scaler 10 inches, 2 feet (CFU count) Saline vs. 0.2% CHX, 33.33% reduction
Saline vs. CHX+H2O2, 73.11% reduction
CHX vs. CHX+H2O2, 59.67% reduction
201537)
30 (25∼55) Ultrasonic scaler 12 inches (CFU count) 0.2% CHX pre-procedure rinse vs. control, 64.33% reduction 201543)
60 (25∼54) Ultrasonic scaler 6 inches, right and left side of the chair where the patient was seated (CFU count) Without suction: water vs. CHX, 45% reduction
Water vs. Listerine, 25% reduction
CHX vs. Listerine, 20% reduction
With suction: water vs. CHX, 55.5% reduction
Water vs. Listerine, 30% reduction
CHX vs. Listerine, 25.5% reduction
201517)
18 (NR) Slow-speed handpiece 30 cm (CFU count) CXH vs. no rinse, 77% increase
CHX vs. water, 25.3% increase
201638)
20 (25∼40) Ultrasonic scaler 3 feet (CFU count) Saline vs. 0.2% chlorhexidine, 75% reduction 201639)
45 (NR) Oral prophylaxis Four corners and the middle of the closed room (CFU count) Without pre-procedure rinse vs. with pre-procedure rinse, 61.35% reduction
Without high-volume evacuator+pre-procedure rinse vs with high-volume evacuator+pre-procedure rinse, 86.04% reduction
201640)
60 (18∼70) Ultrasonic scaler Support board, participant’s chest, clinician’s forehead (CFU count) CHX vs. no rinsing, 77% reduction
CPC+Zn+F vs. no rinsing, 70% reduction
CHX vs. water, 70% reduction
CPC+Zn+F vs. water, 61% reduction
201741)
30 (NR) Prophylactic scaling Face shield (CFU count) CHX vs. control, 91.23% reduction 201942)

NR: not reported in the study; location of collection site: radius from the patient’s mouth, CFU: colony-forming unit, CPC+Zn+F: cetylpyridinium chloride+zinc lactate+fluoride, CHX: chlorhexidine, EO: essential oils, HRB: herbal mouthwash.



6. Data extraction

Two authors (EM and EB) independently extracted information on the participant sample size, age, sex, procedure, aerosol collection method, microbial analysis, control and intervention, outcome sample size, and primary outcome (Table 2)17,22-43) from studies that met the inclusion criteria. The sum of the amount of aerosols orally collected from the participants and the associated landing distances (feet) were categorized.

7. Assessment of the risk of bias among the included studies

Two authors (EM and EB) independently assessed the risk of bias of each included study using Cochrane’s “Risk of Bias Version 2 (RoB 2)44),” which assesses the randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of the reported result. A summary of the “risk of bias domains” is presented in Fig. 217,22-43) to illustrate these findings. We used Excel to implement RoB 2.

Fig. 2. Risk of bias summary: review of authors’ judgments regarding each risk of bias item for each included study.
Results

1. Search and selection results

The electronic database search identified 321 studies. A total of 73 overlapping studies were excluded. The titles and abstracts of the remaining 248 studies were reviewed using EndNote and Rayyan software (Rayyan). Subsequently, the entire contents of the 29 studies that met the literature selection criteria based on PICO were reviewed, and six studies were excluded (Fig. 1). The analysis included 23 studies that were also assessed for risk of bias17,22-42).

2. Study characteristics

All 23 studies were RCTs. The study characteristics and primary outcome results are summarized in Table 217,22-43).

3. Risk of bias of the included studies

The overall risk of bias was identified as high in one study, concerning in seventeen studies, and low in five studies (Fig. 2)17,22-43). The randomization process of one study showed a high risk due to allocation by the judgment of the clinician, and some concerns were considered, as 17 studies did not provide enough information in the method of random sequence generation.

4. Primary outcome

Five studies that collected CFU measurements by using air monitors and vacuum pumps were excluded from the systematic review22-26,38,44). The studies included in the present analysis applied antimicrobial mouthrinses, including chlorhexidine (CHX), Listerine (three studies), herbal (two studies), cetylpyridinium chloride, zinc lactate, and fluoride (CPC+Zn+F) (one study), 1.5% hydrogen peroxide (one study), and 5% hydro-alcohol (one study). CHX was the most frequently used mouth rinse (18 studies).

In the present study, the analysis of the landing distances of aerosols originating from the patient’s mouth revealed microorganisms in the aerosols at a minimum distance of two inches to a maximum distance of nine feet. The experimental group that used pre-procedural antimicrobial mouth rinses showed a statistically significant mean CFU decrease of 33.33∼94.33% in the experimental group compared with that in the control group. The findings of this study demonstrated a significant effect of using pre-procedural mouthrinse on aerosols within nine feet.

Discussion

1. Key results and comparison with previous studies

The transmission of certain respiratory infectious diseases via aerosols or droplets is highly sensitive to the distance between individuals. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), shed by COVID-19 carriers through aerosols or droplets, can infect others within the six-feet radius45). Therefore, during the COVID-19 pandemic, the CDC advised social distancing of at least six feet in the public waiting rooms of dental clinics4). Aerosols produced during dental procedures can contaminate the surfaces of three feet or more from the source27,32,40,45). Aerosol splashing with an increased contamination risk is concentrated within 30 cm of the patient46). Most pre-procedural mouth rinses decreased the level of bacterial contamination in aerosols to some extent, with nine17,25,26,28,31,33,35,37,38) out of 23 studies reporting results within one foot of the patient, where CFU levels decreased by at least 33.33∼93.3%. A systematic review by Kumbargere Nagraj et al. (2022)47) also investigated the effects of pre-procedural mouth rinses on the reduction of CFUs in dental aerosols. The outcome of these studies was a reduction in the level of bacterial contamination measured as CFUs at distances of <2 m and ≥2 m. The mean reduction in the level of contamination was 20.9∼87.5 CFUs. As DHCP generally perform dental procedures within the patient’s mouth, they are at a risk of aerosol-mediated infections. Preventing the spread of infection may help reduce the number of microorganisms present in these aerosols. Hence, routine pre-procedural antimicrobial mouth rinsing is recommended to reduce this risk. Notably, studies that reported the effects of pre-rinsing with CHX showed a 90% or greater decrease in CFUs compared with groups that used distilled water for pre-rinsing or did not use any pre-rinse24,27,33,36,42). Similarly, a meta-analysis of 12 studies showed that mouth rinsing with CHX, essential oils, and CPC significantly reduced the percentage of CFU reduction48).

In the dental environment, the DHCP and patients are at a risk of exposure to disease-causing organisms via aerosols. The spread of COVID-19 has been verified in dental clinics; however, the exact route of infection remains controversial. Recently, SARS-CoV-2 RNA was detected in aerosols during ultrasonic scaling and tooth preparation in the clinical environment49); healthcare workers, patients, and visitors with specific risk factors may be particularly susceptible to infections. Importantly, Legionella species in aerosols can cause septic shock7,50). The basis of aerosol-mediated diseases could not be presented as the present study did not include data on aerosol-mediated respiratory infections. A systematic review found that none of the included studies reported on the incidence of infection among dental healthcare providers47). However, because aerosols can contain viruses and microorganisms that pose a potential risk of cross-infection, stringent infection control measures in the dental environment are necessary. This includes the use of pre-procedural mouth rinse to reduce aerosol concentration.

2. Limitations and suggestions for further studies

Our study had several limitations. Although several of the included studies exhibited a low risk of bias, the possibility of bias still remained. Based on the studies included in this systematic review, we compared and systematically analyzed the mean CFUs in aerosols at different distances between the groups using pre-procedural mouthrinses and those who either did not use mouthrinses or rinsed with water and systematically analyze. Furthermore, by conducting a literature review of studies published before the COVID-19 pandemic, bias related to status of respiratory disease in participants was excluded.

Acknowledgements

None.

Notes

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Ethical approval

The study protocol was registered with the PROSPERO International prospective register of systematic reviews (number CRD42020157282).

Author contributions

Conceptualization: Eun-Mi Choi. Data acquisition: Eun-Mi Choi and Eun-Bi Sim. Formal analysis: Eun-Mi Choi and Eun-Bi Sim. Supervision: Eun-Mi Choi. Writing-original draft: Eun-Mi Choi and Eun-Bi Sim. Writing-review & editing: Eun-Mi Choi and Eun-Bi Sim.

Funding

None.

Data availability

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

References
  1. Volgenant CMC, de Soet JJ: Cross-transmission in the dental office: does this make you ill?. Curr Oral Health Rep 5: 221-228, 2018. https://doi.org/10.1007/s40496-018-0201-3
    Pubmed KoreaMed CrossRef
  2. Lu M: The front line: visualizing the occupations with the highest COVID-19 risk. Retrieved June 25, 2024, from https://www.visualcapitalist.com/the-front-line-visualizing-the-occupations-with-the-highest-covid-19-risk/(April 15, 2020)
  3. World Health Organization: Coronavirus disease (COVID-19) outbreak: rights, roles and responsibilities of health workers, including key considerations for occupational safety and health: interim guidance, 19 March 2020. Geneva: World Health Organization; 2000.
  4. Centers for Disease Control and Prevention: Guidance for dental settings : interim infection prevention and control guidance for dental settings during the COVID-19 response. Retrieved July 30, 2024, from https://stacks.cdc.gov/view/cdc/88256(May 19, 2020)
  5. Occupational Safety and Health Administration: Recommended practices for safety and health programs: hazard prevention and control. Retrieved June 25, 2024, from https://www.osha.gov/safety-management/hazard-prevention(October 2016)
  6. Korea Centers for Disease Control and Prevention: Prevention, and management of COVID-19 infection in dental clinics. Retrieved July 30, 2024, from https://dportal.kdca.go.kr//pot/bbs/BD_selectBbs.do?q_bbsSn=1011&q_bbsDocNo=20200820800621685&q_clsfNo=0(August 20, 2020)
  7. Zemouri C, de Soet H, Crielaard W, Laheij A: A scoping review on bio-aerosols in healthcare and the dental environment. PLoS One 12: e0178007, 2017. https://doi.org/10.1371/journal.pone.0178007
    Pubmed KoreaMed CrossRef
  8. Pelleu GB, Jr., Shreve WB, Wachtel LW: Reduction of microbial concentration in the air of dental operating rooms. I. High-efficiency particulate air filters. J Dent Res 49: 315-319, 1970. https://doi.org/10.1177/00220345700490022001
    Pubmed CrossRef
  9. Acharya S, Priya H, Purohit B, Bhat M: Aerosol contamination in a rural university dental clinic in South India. Int J Infect Control 6, 2009. https://doi.org/10.3396/ijic.v6i1.3399
    CrossRef
  10. Veena HR, Mahantesha S, Joseph PA, Patil SR, Patil SH: Dissemination of aerosol and splatter during ultrasonic scaling: a pilot study. J Infect Public Health 8: 260-265, 2015. https://doi.org/10.1016/j.jiph.2014.11.004
    Pubmed CrossRef
  11. Jones RM, Brosseau LM: Aerosol transmission of infectious disease. J Occup Environ Med 57: 501-508, 2015. https://doi.org/10.1097/jom.0000000000000448
    Pubmed CrossRef
  12. Tellier R, Li Y, Cowling BJ, Tang JW: Recognition of aerosol transmission of infectious agents: a commentary. BMC Infect Dis 19: 101, 2019. https://doi.org/10.1186/s12879-019-3707-y
    Pubmed KoreaMed CrossRef
  13. Micik RE, Miller RL, Mazzarella MA, Ryge G: Studies on dental aerobiology. I. Bacterial aerosols generated during dental procedures. J Dent Res 48: 49-56, 1969. https://doi.org/10.1177/00220345690480012401
    Pubmed CrossRef
  14. Bentley CD, Burkhart NW, Crawford JJ: Evaluating spatter and aerosol contamination during dental procedures. J Am Dent Assoc 125: 579-584, 1994. https://doi.org/10.14219/jada.archive.1994.0093
    Pubmed CrossRef
  15. Harrel SK, Barnes JB, Rivera-Hidalgo F: Reduction of aerosols produced by ultrasonic scalers. J Periodontol 67: 28-32, 1996. https://doi.org/10.1902/jop.1996.67.1.28
    Pubmed CrossRef
  16. Sawhney A, Venugopal S, Babu GR, et al: Aerosols how dangerous they are in clinical practice. J Clin Diagn Res 9: Zc52-57, 2015. https://doi.org/10.7860/jcdr/2015/12038.5835
    Pubmed KoreaMed CrossRef
  17. Morawska L, Milton DK: It is time to address airborne transmission of Coronavirus Disease 2019 (COVID-19). Clin Infect Dis 71: 2311-2313, 2020. https://doi.org/10.1093/cid/ciaa939
    Pubmed KoreaMed CrossRef
  18. Retrieved July 30, 2024, from https://www.cdc.gov/mmwr/pdf/rr/rr5217.pdf(December 19, 2003)
  19. Higgins JPT, Green S: Cochrane handbook for systematic reviews of interventions version 5.1.0. Retrieved July 30, 2024, from https://training.cochrane.org/handbook/archive/v5.1/(March 2011)
  20. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A: Rayyan-a web and mobile app for systematic reviews. Syst Rev 5: 210, 2016. https://doi.org/10.1186/s13643-016-0384-4
    Pubmed KoreaMed CrossRef
  21. Litsky BY, Mascis JD, Litsky W: Use of an antimicrobial mouthwash to minimize the bacterial aerosol contamination generated by the high-speed drill. Oral Surg Oral Med Oral Pathol 29: 25-30, 1970. https://doi.org/10.1016/0030-4220(70)90407-x
    Pubmed CrossRef
  22. Muir KF, Ross PW, MacPhee IT, Holbrook WP, Kowolik MJ: Reduction of microbial contamination from ultrasonic scalers. Br Dent J 145: 76-78, 1978. https://doi.org/10.1038/sj.bdj.4804123
    Pubmed CrossRef
  23. Fine DH, Mendieta C, Barnett ML, et al: Efficacy of preprocedural rinsing with an antiseptic in reducing viable bacteria in dental aerosols. J Periodontol 63: 821-824, 1992. https://doi.org/10.1902/jop.1992.63.10.821
    Pubmed CrossRef
  24. Fine DH, Furgang D, Korik I, Olshan A, Barnett ML, Vincent JW: Reduction of viable bacteria in dental aerosols by preprocedural rinsing with an antiseptic mouthrinse. Am J Dent 6: 219-221, 1993.
  25. Fine DH, Yip J, Furgang D, Barnett ML, Olshan AM, Vincent J: Reducing bacteria in dental aerosols: pre-procedural use of an antiseptic mouthrinse. J Am Dent Assoc 124: 56-58, 1993. https://doi.org/10.14219/jada.archive.1993.0122
    Pubmed CrossRef
  26. Logothetis DD, Martinez-Welles JM: Reducing bacterial aerosol contamination with a chlorhexidine gluconate pre-rinse. J Am Dent Assoc 126: 1634-1639, 1995. https://doi.org/10.14219/jada.archive.1995.0111
    Pubmed CrossRef
  27. Klyn SL, Cummings DE, Richardson BW, Davis RD: Reduction of bacteria-containing spray produced during ultrasonic scaling. Gen Dent 49: 648-652, 2001.
  28. Wirthlin MR, Choi JH, Kye SB: Use of chlorine dioxide mouthrinse as the ultrasonic scaling lavage reduces the viable bacteria in the generated aerosols. J West Soc Periodontol Periodontal Abstr 54: 35-44, 2006.
  29. Feres M, Figueiredo LC, Faveri M, Stewart B, de Vizio W: The effectiveness of a preprocedural mouthrinse containing cetylpyridinium chloride in reducing bacteria in the dental office. J Am Dent Assoc 141: 415-422, 2010. https://doi.org/10.14219/jada.archive.2010.0193
    Pubmed CrossRef
  30. Reddy S, Prasad MG, Kaul S, Satish K, Kakarala S, Bhowmik N: Efficacy of 0.2% tempered chlorhexidine as a pre-procedural mouth rinse: a clinical study. J Indian Soc Periodontol 16: 213-217, 2012. https://doi.org/10.4103/0972-124x.99264
    Pubmed KoreaMed CrossRef
  31. Serban D, Banu A, Serban C, Tuţă-Sas I, Vlaicu B: Predictors of quantitative microbiological analysis of spatter and aerosolization during scaling. Rev Med Chir Soc Med Nat Iasi 117: 503-508, 2013.
  32. Shetty SK, Sharath K, Shenoy S, Sreekumar C, Shetty RN, Biju T: Compare the effcacy of two commercially available mouthrinses in reducing viable bacterial count in dental aerosol produced during ultrasonic scaling when used as a preprocedural rinse. J Contemp Dent Pract 14: 848-851, 2013. https://doi.org/10.5005/jp-journals-10024-1414
    Pubmed CrossRef
  33. Gupta G, Mitra D, Ashok KP, et al: Efficacy of preprocedural mouth rinsing in reducing aerosol contamination produced by ultrasonic scaler: a pilot study. J Periodontol 85: 562-568, 2014. https://doi.org/10.1902/jop.2013.120616
    Pubmed CrossRef
  34. Santos IR, Moreira AC, Costa MG, Castellucci e Barbosa M: Effect of 0.12% chlorhexidine in reducing microorganisms found in aerosol used for dental prophylaxis of patients submitted to fixed orthodontic treatment. Dental Press J Orthod 19: 95-101, 2014. https://doi.org/10.1590/2176-9451.19.3.095-101.oar
    Pubmed KoreaMed CrossRef
  35. Swaminathan Y, Toby Thomas J, Muralidharan NP: The efficacy of preprocedural mouth rinse of 0.2% chlorhexidine and commercially available herbal mouth containing salvadora persica in reducing the bacterial load in saliva and aerosol produced during scaling. Asian J Pharm Clin Res 7: 71-74, 2014.
  36. Ramesh A, Thomas JT, Muralidharan NP, Varghese SS: Efficacy of adjunctive usage of hydrogen peroxide with chlorhexidine as preprocedural mouthrinse on dental aerosol. Natl J Physiol Pharm Pharmacol 5: 431-435, 2015. https://doi.org/10.5455/njppp.2015.5.3006201559
    CrossRef
  37. Dawson M, Soro V, Dymock D, et al: Microbiological assessment of aerosol generated during debond of fixed orthodontic appliances. Am J Orthod Dentofacial Orthop 150: 831-838, 2016. https://doi.org/10.1016/j.ajodo.2016.04.022
    Pubmed CrossRef
  38. Mohan M, Jagannathan N: The efficacy of pre-procedural mouth rinse on bacterial count in dental aerosol following oral prophylaxis. Dent Med Probl 53: 78-82, 2016. https://doi.org/10.17219/dmp/60694
    CrossRef
  39. Narayana TV, Mohanty L, Sreenath G, Vidhyadhari P: Role of preprocedural rinse and high volume evacuator in reducing bacterial contamination in bioaerosols. J Oral Maxillofac Pathol 20: 59-65, 2016. https://doi.org/10.4103/0973-029x.180931
    Pubmed KoreaMed CrossRef
  40. Retamal-Valdes B, Soares GM, Stewart B, et al: Effectiveness of a pre-procedural mouthwash in reducing bacteria in dental aerosols: randomized clinical trial. Braz Oral Res 31: e21, 2017. https://doi.org/10.1590/1807-3107BOR-2017.vol31.0021
    Pubmed CrossRef
  41. Choi JO: A convergence study on waterline management of unit chair in dental hygiene laboratory. J Korea Conv Soc 10: 27-31, 2019. https://doi.org/10.15207/JKCS.2019.10.10.027
  42. Rao RM, Shenoy N, Shetty V: Determination of efficacy of pre-procedural mouth rinsing in reducing aerosol contamination produced by ultrasonic scalers. Nitte University J Health Sci 5: 52-56, 2015.
  43. Sterne JAC, Savović J, Page MJ, et al: RoB 2: a revised tool for assessing risk of bias in randomised trials. Bmj 366: l4898, 2019. https://doi.org/10.1136/bmj.l4898
    Pubmed CrossRef
  44. Grenier D: Quantitative analysis of bacterial aerosols in two different dental clinic environments. Appl Environ Microbiol 61: 3165-3168, 1995. https://doi.org/10.1128/aem.61.8.3165-3168.1995
    Pubmed KoreaMed CrossRef
  45. Yu Y, Wu X, Sun Y: Precise control of digital dental unit to reduce aerosol and splatter production: new challenges for future epidemics. BMC Oral Health 24: 213, 2024. https://doi.org/10.1186/s12903-024-03980-w
    Pubmed KoreaMed CrossRef
  46. Kumbargere Nagraj S, Eachempati P, Paisi M, et al: Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental healthcare providers. Cochrane Database Syst Rev 8: Cd013826, 2022. https://doi.org/10.1002/14651858.CD013826.pub2
    Pubmed KoreaMed CrossRef
  47. Marui VC, Souto MLS, Rovai ES, Romito GA, Chambrone L, Pannuti CM: Efficacy of preprocedural mouthrinses in the reduction of microorganisms in aerosol: a systematic review. J Am Dent Assoc 150: 1015-1026.e1011, 2019. https://doi.org/10.1016/j.adaj.2019.06.024
    Pubmed CrossRef
  48. Akin H, Karabay O, Toptan H, et al: Investigation of the presence of SARS-CoV-2 in aerosol after dental treatment. Int Dent J 72: 211-215, 2022. https://doi.org/10.1016/j.identj.2021.05.002
    Pubmed KoreaMed CrossRef
  49. Ricci ML, Fontana S, Pinci F, et al: Pneumonia associated with a dental unit waterline. Lancet 379: 684, 2012. https://doi.org/10.1016/s0140-6736(12)60074-9
    Pubmed CrossRef


December 2024, 24 (4)
Full Text(PDF) Free

Social Network Service

Cited By Articles
  • CrossRef (0)
  • Download (78)

Author ORCID Information