Cochrane · intervention · CD013686
Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious diseases
Kumbargere Nagraj, S, Eachempati, P, Paisi, M, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
39
current version
GRADE rated
23
No studies
9
Included studies
16
as reported
No studies 9 · 23.1%Ungraded 7 · 17.9%Very low 23 · 59%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Dental healthcare providers (dentist, dental surgery assistant, dental hygienist, dental technologist, dental laboratory staff, dental aide or dental trainee) and their patients undergoing a dental AGP | 425 participants across 16 studies; aged 5 to 69 years; two studies recruited only children, nine studies recruited adults only, four did not report age; one study female only |
| Intervention | Any method, procedure or policy that aimed to reduce contaminated aerosols in dental clinics compared to any other method including no treatment or combination of methods. Categories: methods to prevent contaminated aerosols escaping from the mouth; local ventilation; general ventilation; decontamination of aerosols in the air; combination of methods | High-volume evacuation/HVE (n=5); Combination system/Isolite (n=3); Rubber dam (n=4); Air cleaning system (n=1); Laminar air flow with HEPA filter (n=1); Antimicrobial coolants - chlorhexidine, povidone iodine, cinnamon (n=2) |
| Comparison | Any other method including no treatment or combination of methods | No HVE (n=5); Conventional dental suction/LVE (n=1); Saliva ejector (n=1); Rubber dam + HVE (n=1); HVE (n=1); No rubber dam (n=3); Cotton roll + HVE (n=1); No ACS (n=1); Without laminar flow or filter (n=1); Distilled water/control coolant (n=2); Antimicrobial coolant B (n=2) |
| Outcomes | Primary: Incidence of infection of dental staff or patients; Reduction in volume of contaminated aerosols in the operative environment; Reduction in level of contamination in aerosols in the operative environment. Secondary: Costs for the interventions used; Acceptability and feasibility of the intervention to patients and dentists | Reduction in level of contamination in aerosols measured as bacterial CFU (n=16); Reduction in volume of contaminated aerosols (n=2 measured, not analyzable); Incidence of infection (n=0); Costs (n=0); Acceptability/feasibility (n=0) |
| Study designs | RCTs and CCTs conducted in a dental environment, including randomized and pseudo-randomized (alternation) split-mouth studies; unit of randomization dental professionals, participants, quadrants (split-mouth), dental units or practices; excluded laboratory studies with mannequins not including real patients | RCT (n=11); CCT (n=5) |
| Timing | Not reported | Not reported |
Search date: 2020-09. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; WHO COVID-19 Global literature on coronavirus disease database; US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov); Cochrane COVID-19 Study Register
Questions and results
Current version onlyAny method, procedure or policy to reduce contaminated aerosols in dental clinics vs Any other method, no treatment or combination of methods
Population: Dental healthcare providers (dentist, dental surgery assistant, dental hygienist, dental technologist, dental laboratory staff, dental aide or dental trainee) and their patients undergoing a dental AGP
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Costs for the interventions used | no estimate extracted | 0 studies | No studies |
Acceptability and feasibility of the intervention to patients and dentists | no estimate extracted | 0 studies | No studies |
Reduction in volume of contaminated aerosols in the operative environment | Reduction in volume of contaminated aerosols in the operative environment: Not reported (row present in all Summary of findings tables) | 0 studies | No studies |
Incidence of infection of dental staff or patients | Rate of infection of dental staff or patients: Not reported (row present in all Summary of findings tables) | 0 studies | No studies |
High-volume evacuation (HVE) vs No HVE
Population: People undergoing aerosol-generating procedures (AGPs) in a dental setting
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in contamination of aerosols on operator's face shield/mask (RCTs) | MD -15.71 [-46.37, 14.95] | 2 studies · 42 participants | Ungraded |
Reduction in level of contamination in aerosols (CFU) at more than 1 foot from oral cavity (CCT) | MD -13.56 [-23.18, -3.94] | 1 study · 30 participants | Ungraded |
Reduction in level of contamination in aerosols (CFU) at less than 1 foot from oral cavity (CCTs) | MD -50.19 [-109.71, 9.33] | 2 studies · 45 participants | Ungraded |
Reduction in level of contamination in aerosols (CFU) during ultrasonic scaling and air polishing at more than 1 foot from oral cavity (RCT) | MD -1.00 [-2.56, 0.56] | 1 study · 80 participants | Very low Downgraded: risk of bias, imprecision |
Reduction in level of contamination in aerosols (CFU) during ultrasonic scaling and air polishing at less than 1 foot (~30 cm) from oral cavity (RCTs) | MD -47.41 [-92.76, -2.06] | 3 studies · 122 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
High-volume evacuation (HVE) vs Conventional dental suction (low-volume evacuator / saliva ejector)
Population: People undergoing aerosol-generating procedures (AGPs) in a dental setting
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in level of contamination in aerosols (CFU) during ultrasonic scaling at 40 cm from mouth | MD -2.30 [-5.32, 0.72] | 1 study · 6 participants | Very low Downgraded: risk of bias, imprecision |
Reduction in level of contamination in aerosols (CFU) during ultrasonic scaling at 150 cm from mouth | MD -2.20 [-14.01, 9.61] | 1 study · 6 participants | Very low Downgraded: risk of bias, imprecision |
Combination system (Isolite) vs Saliva ejector (low-volume evacuator)
Population: People undergoing aerosol-generating procedures (AGPs) in a dental setting
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in contamination of aerosols (CFU) after ultrasonic scaling / AGP After AGP | MD -0.35 [-0.99, 0.29] | 1 study · 50 participants | Very low Downgraded: risk of bias, imprecision |
Reduction in level of contamination in aerosols (CFU) during ultrasonic scaling / AGP During AGP | MD -0.31 [-0.82, 0.20] | 1 study · 50 participants | Very low Downgraded: risk of bias, imprecision |
Combination system (Isolite) vs Rubber dam + HVE
Population: People undergoing aerosol-generating procedures (AGPs) in a dental setting
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in level of contamination in aerosols (CFU) during water spray using high-speed handpiece | MD -125.20 [-174.02, -76.38] | 1 study · 1 participants | Very low Downgraded: risk of bias, imprecision |
Combination system (Isolite) vs HVE
Population: People undergoing aerosol-generating procedures (AGPs) in a dental setting
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in level of contamination in aerosols (CFU) during water spray using high-speed handpiece | MD -109.30 [-153.01, -65.59] | 1 study · 1 participants | Very low Downgraded: risk of bias, imprecision |
Rubber dam vs No rubber dam
Population: People undergoing aerosol-generating procedures (AGPs) in a dental setting
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in level of contamination in aerosols (CFU) during restorative procedures at operator's occiput (RCT) | MD 0.77 [-0.46, 2.00] | 1 study · 47 participants | Very low Downgraded: risk of bias, imprecision |
Reduction in level of contamination in aerosols (CFU) during restorative procedures at 2 metres from mouth (RCT) | MD -11.70 [-15.82, -7.58] | 1 study · 10 participants | Very low Downgraded: risk of bias, imprecision |
Reduction in level of contamination in aerosols (CFU) during restorative procedures at operator's left ear (RCT) | MD 0.96 [-0.08, 2.00] | 1 study · 47 participants | Ungraded |
Reduction in level of contamination in aerosols (CFU) during restorative procedures at 1 metre from mouth (CCT) | MD -10.10 [-19.72, -0.48] | 1 study · 20 participants | Ungraded |
Reduction in level of contamination in aerosols (CFU) during restorative procedures at operator's submental region (RCT) | MD 0.52 [-0.11, 1.16] | 1 study · 47 participants | Ungraded |
Reduction in level of contamination in aerosols (CFU) during restorative procedures at 2 metres from mouth (CCT) | MD -2.80 [-4.65, -0.95] | 1 study · 20 participants | Ungraded |
Reduction in level of contamination in aerosols (CFU) during restorative procedures at operator's forehead (RCT) | MD 0.98 [-0.73, 2.70] | 1 study · 47 participants | Very low Downgraded: risk of bias, imprecision |
Reduction in level of contamination in aerosols (CFU) during restorative procedures at 1 metre from mouth (RCT) | MD -16.20 [-19.36, -13.04] | 1 study · 10 participants | Very low Downgraded: risk of bias, imprecision |
Rubber dam + HVE vs Cotton roll + HVE
Population: People undergoing aerosol-generating procedures (AGPs) in a dental setting
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in level of contamination in aerosols (CFU) during restorative procedures at dental unit light | MD -12.70 [-12.85, -12.55] | 1 study · 21 participants | Very low Downgraded: risk of bias, imprecision |
Reduction in level of contamination in aerosols (CFU) during restorative procedures at participant's chest | MD -251.00 [-267.95, -234.05] | 1 study · 21 participants | Very low Downgraded: risk of bias, imprecision |
Air cleaning system (ACS) vs No air cleaning system
Population: People undergoing aerosol-generating procedures (AGPs) in a dental setting
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in level of contamination in aerosols (CFU) during ultrasonic scaling | MD -32.40 [-51.55, -13.25] | 1 study · 2 participants | Very low Downgraded: risk of bias, imprecision |
Reduction in level of contamination in aerosols (CFU) during cavity preparation | MD -66.70 [-120.15, -13.25] | 1 study · 2 participants | Very low Downgraded: risk of bias, imprecision |
Laminar air flow with HEPA filter vs Without laminar flow or filter
Population: People undergoing aerosol-generating procedures (AGPs) in a dental setting
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in level of contamination in aerosols (CFU per cubic feet/min/patient) using Reyniers slit sampler 30 inches (76 cm) from floor | MD -319.14 [-385.60, -252.68] | 1 study · 50 participants | Very low Downgraded: risk of bias, imprecision |
Reduction in level of contamination in aerosols (CFU per cubic feet/min/patient) using Andersen cascade sampler 20-30 cm from mouth | MD -483.56 [-550.02, -417.10] | 1 study · 50 participants | Very low Downgraded: risk of bias, imprecision |
Chlorhexidine coolant vs Distilled water coolant
Population: People undergoing aerosol-generating procedures (AGPs) in a dental setting
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in level of contamination in aerosols (CFU): chlorhexidine coolant vs distilled water during ultrasonic scaling | MD -124.00 [-135.78, -112.22] | 1 study · 20 participants | Very low Downgraded: risk of bias, imprecision |
Reduction in level of contamination in aerosols (CFU): povidone iodine coolant vs distilled water during ultrasonic scaling | MD -656.45 [-672.74, -640.16] | 1 study · 40 participants | Very low Downgraded: risk of bias, imprecision |
Reduction in level of contamination in aerosols (CFU): cinnamon extract coolant vs distilled water during ultrasonic scaling | MD -644.55 [-668.70, -620.40] | 1 study · 40 participants | Very low Downgraded: risk of bias, imprecision |
Antimicrobial coolant A (chlorhexidine) vs Antimicrobial coolant B (cinnamon extract)
Population: People undergoing aerosol-generating procedures (AGPs) in a dental setting
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in level of contamination in aerosols (CFU): chlorhexidine vs cinnamon extract coolant during ultrasonic scaling | MD -11.90 [-35.88, 12.08] | 1 study · 40 participants | Very low Downgraded: risk of bias, imprecision |
Reduction in level of contamination in aerosols (CFU): chlorhexidine vs povidone iodine coolant during ultrasonic scaling | MD -59.30 [-64.16, -54.44] | 1 study · 20 participants | Very low Downgraded: risk of bias, imprecision |
General ventilation (e.g. natural ventilation, exhaust fans, opening windows) vs No general ventilation / standard operatory
Population: Dental healthcare providers (dentist, dental surgery assistant, dental hygienist, dental technologist, dental laboratory staff, dental aide or dental trainee) and their patients undergoing a dental AGP
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Ionisation (ionic air purifier) vs No ionisation / standard operatory
Population: Dental healthcare providers (dentist, dental surgery assistant, dental hygienist, dental technologist, dental laboratory staff, dental aide or dental trainee) and their patients undergoing a dental AGP
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Ozonisation vs No ozonisation / standard operatory
Population: Dental healthcare providers (dentist, dental surgery assistant, dental hygienist, dental technologist, dental laboratory staff, dental aide or dental trainee) and their patients undergoing a dental AGP
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Ultraviolet (UV) light air decontamination vs No UV light / standard operatory
Population: Dental healthcare providers (dentist, dental surgery assistant, dental hygienist, dental technologist, dental laboratory staff, dental aide or dental trainee) and their patients undergoing a dental AGP
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Fumigation or fogging vs No fumigation or fogging / standard operatory
Population: Dental healthcare providers (dentist, dental surgery assistant, dental hygienist, dental technologist, dental laboratory staff, dental aide or dental trainee) and their patients undergoing a dental AGP
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Any method, procedure or policy to reduce contaminated aerosols in dental clinics vs Any other method or combination of methods
Population: Dental staff (dentist, dental surgery assistant, dental hygienist, dental technologist, dental laboratory staff or dental aide) and their patients undergoing a dental AGP
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Costs for the interventions used | no estimate extracted | NR | No studies |
Acceptability and feasibility of the intervention to patients and dentists | no estimate extracted | NR | No studies |
Incidence of infection of dental staff or patients | no estimate extracted | NR | No studies |
Reduction in level of contamination in aerosols in the operative environment | no estimate extracted | NR | No studies |
Reduction in volume of contaminated aerosols in the operative environment | no estimate extracted | NR | No studies |