The Debate: What Are Aerosol-Generating Procedures in Dentistry? A Rapid Review

Abstract

Introduction: This article aims to review the current national and international dental guidance produced during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic to identify the level of consensus on aerosol-generating dental procedures (AGDPs). The outcomes intend to encourage increased collaboration with respect to dental guidelines in relation to the SARS-CoV-2 pandemic, as well as to improve decision making and safety for dental patients and staff.

Methods: This rapid review was conducted by 2 authors (MKV and KD), with the support of a third author (SD), to assess current guidelines related to dental AGDPs. This streamlined review approach allowed synthesis of data in an efficient manner in the rapidly evolving environment associated with the SARS-CoV-2 pandemic.

Results: The findings identified 1) a lack of consistency in reporting which procedures were deemed an AGDP; 2) that high-speed handpieces, air-water syringes, and mechanical scalers were consistently considered high-risk AGDPs; 3) a lack of consensus on the risk of coronavirus disease 2019 (COVID-19) transmission with the use of slow-speed handpieces; 4) a general agreement, when described, that rubber dam and high-volume evacuation can significantly reduce aerosol production; and 5) a lack of consistency in reporting whether procedures constitute a low, moderate, or high risk of COVID-19 transmission. The findings are discussed in relation to the guidance and future recommendations.

Conclusion: It is recommended that future published guidance should indicate the risk stratification (low/moderate/high) of each procedure/exposure in a standardized international approach.

Knowledge transfer statement: The results of this rapid review can be used by clinicians to increase their awareness of international guidance on aerosol-generating procedures in dentistry. It will also encourage those publishing future guidance to provide an internationally standardized, risk-stratified approach to describing aerosol-generating procedures. Currently, it allows clinicians to consider aerosol-generating procedures as a risk spectrum.

Keywords: coronavirus; coronavirus infections; dental equipment; dental research; evidence-based dentistry; occupational dentistry.

Figure.

Identification of relevant documents. A flowchart to outline the rapid review process undertaken to identify guidance and nonguidance documents relating to dental aerosol-generating dental procedures (AGDPs). The rapid review involved electronic database searches of Medline via Ovid, Embase, and the Cochrane Library. In total, 775 records were identified and screened for their appropriateness. Following removal of unrelated and duplicated articles, 57 articles were considered eligible for inclusion. Owing to the unavailability of 3 articles, 54 were ultimately included in the study. Twenty-six of these were guidance documents and/or position statements, while 28 were nonguidance published articles. The guidance documents were scrutinized and tabulated in the Table. Nonguidance articles were reviewed for relevant information on AGDPs, which was used for comparison with the guidance documents, in the discussion.