Dentists have a much higher risk of exposure to coronavirus disease (COVID-19) than other healthcare workers. The virus is transmitted primarily through respiratory droplets and close/direct contact. The propagation of aerosols is also possible in the event of prolonged exposure to high concentrations in a relatively closed environment. In this report, we describe the use of an aerosol box design to prevent aerosol generation during dental procedures. This report serves to inform clinicians of the potential effectiveness of this palliative measure in cases where aerosol-generating procedures are unavoidable and where medical supplies and personal protective equipment are in short supply.
The coronavirus disease (COVID-19) has been declared an international emergency global pandemic. Its spread is particularly difficult to manage given that infected people may be asymptomatic . The virus is transmitted primarily through respiratory droplets and close/direct contact. The spread of aerosols is also possible in the event of prolonged exposure to high concentrations in a relatively closed environment. . Once generated, the aerosols remain suspended in the air for approximately three hours. On March 15, 2020, The New York Times published an article titled “Workers Who Face Greatest Coronavirus Risk,” in which a schematic figure demonstrated that dentists have a much higher risk of exposure to COVID-19. than other healthcare workers, such as as nurses and general practitioners . Indeed, dental care is often performed in an enclosed space, which requires the dentist to be close to the patient. Additionally, it has been established that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be present in the saliva of asymptomatic individuals, suggesting that aerosol-generating dental procedures may be a source of infection. .
Dental infection is likely to cause secondary infections in uninfected people. The inability to receive adequate dental care has many adverse effects on general health. Therefore, it is essential to ensure that satisfactory measures are in place to facilitate the safe and effective delivery of dental care. It is essential that this care is not in itself a source of infection to protect public health.
In this report, we describe a new technique for preventing infections during dental treatment. This technique involves an aerosol can and an endoscope. We proposed that the new technique would be effective for routine clinical work after the pandemic.
Researchers recently reported the concept of using an aerosol can to prevent aerosol generation during intubation . Later modifications produced more convenient and practical devices . Using this model of an aerosol box, we devised a method to suppress aerosol generation using a surgical endoscope suitable for oral examination, called an “oroscope” (Video 1).
The dentist places a plastic bag over the chest and face of the patient, who is seated in the dental chair, and the dental instruments to be used in the procedure. Therefore, all aerosols generated by dental procedures remain in the plastic bag. This will prevent infection of dentists and dental hygienists and reduce contamination of the clinical environment. However, the deposition of aerosol particles on the inner surface of the plastic bag causes progressive deterioration of the surgical field of vision. Therefore, the “oroscope” is used to secure the field of view. In this case, we inserted an endoscope (LTF-s190-10, Olympus, Japan), specifically designed for laparoscopy, through a small opening in the plastic bag, limiting aerosol transmission (Figure 1). We have called this infection prevention approach the “Kojima/Sugimura Dental Treatment System” (KS System).
Verification of the effectiveness of this device in containing all aerosols generated by typical dental procedures is ongoing. However, it appears to be effective as a palliative measure in cases where aerosol-generating procedures are unavoidable and medical supplies and personal protective equipment are in short supply. It can be effective in areas where personal protective equipment is scarce. Dentists can use an “oroscope” for patients undergoing any type of dental procedure; this would be particularly beneficial in cases where the status of the infection is uncertain. Some patients may find the placement of the vinyl cover over their face awkward. However, there is no immediate harm to the patient. Since dentists typically focus on the visual display of the “oroscope,” which provides a narrow field of view, they may need to regularly shift their focus to assess the larger operating field. Previous studies have suggested that videoscopes may be effective for periodontal surgery and implant therapy, and no major complications have been reported. [7,8].
Although the concept of using a ventilation system to remove aerosols generated during dental procedures has recently been proposed, such a system would have potential drawbacks, including difficulties in large-scale manufacturing and the inability to prevent the transmission of infections completely. . The endoscope used in this report was based on a previously established design and adapted for use in the oral cavity and pharynx. We haven’t had any problems using it and it seems to provide enough field of vision for routine dental work. As aerosols cannot be transmitted through the vinyl cover, the proposed device can theoretically contain aerosols generated by infected patients. The clinical efficacy of the “KS system” must be confirmed by additional studies.
Given the current lack of a robust COVID-19 vaccine, the only viable option for healthcare providers is to prevent transmission of the disease from infected individuals. Since aerosols are often generated during dental procedures, the “KS System” may be able to significantly reduce the spread of COVID-19 to dental professionals. Even after a permanent vaccine and treatment for COVID-19 is in place, the use of an “oroscope” may remain essential to prevent other forms of aerosol infections; in addition, it can also reduce the consumption of personal protective equipment by healthcare workers.
In the context of the current COVID-19 pandemic, dental care is stressful for both patients and dental professionals [10-12]. By using the “KS System”, dentists can reduce the transmission of aerosol infections and reduce the stress and anxiety associated with the possibility of contracting an infection during dental procedures. This method can be applied even after the pandemic and used as one of the infection control methods in the future. Additionally, an oroscope can be effective in securing the visual field when treating molars, which are difficult to treat. It is necessary to continue to examine the effectiveness of this method.
We have devised a method to prevent aerosol infection and contamination of the clinical environment in dental practices by using an oroscope and a plastic bag placed over the patient’s chest and face. This method can be applied even after the pandemic and can be used as one of the infection control methods in the future. In addition, an oroscope can be effective in securing the visual field.