Novel use of riboflavin as a fluorescent tracer in the dissemination of aerosol and splatter in an open operatory dental clinic

Abstract

Objectives: The rapid spread of severe acute respiratory syndrome coronavirus 2 and the ensuing rise of the COVID-19 pandemic have impacted healthcare unprecedentedly. With the scarcity of available resources, including healthcare providers themselves, novel methods for tracking aerosol and splatter in real time are required to alleviate demand and increase safety. This study evaluates the utility of riboflavin (vitamin B₂ ) as a tracer for splatter/aerosol distribution from ultrasonic scaling in an open operatory clinic.

Material and methods: In two experimental designs, ultrasonic scaling was performed on 18 volunteers or simulated on a manikin. Riboflavin was introduced into the irrigation system, and aerosol and splatter dissemination were evaluated for both experimental designs.

Results: Ultrasonic scaling utilizing riboflavin solution, in volunteers and manikins, leads to observable particle fluorescence under UV light. Contamination distribution varied across the different suction methods and between the volunteer and manikin trials. Nearly all observed incidences of contamination occurred within the operatory in use.

Conclusions: Riboflavin can be used with minimal risk during dental procedures and allows for the detection of droplet spread in clinical settings in real time.

Keywords: COVID-19; dental; infection control; riboflavin.

Figure 1

Operatory set‐up diagram showing the further spread of splatter/aerosol measured by suction type.

Figure 2

Least squares means plots (and 95% confidence intervals) for the percentages of contaminated patients (the ratio of the number of contaminated patients divided by the total number of patients). Because the logit link function was used for the generalized linear mixed model assessment, these plots use log scales. No difference was demonstrated among groups (p = .92).

Figure 3

Box plots of raw data for percentages of contaminated patients. To better illustrate the distribution of the data points, they are spread horizontally to minimize their overlapping one another. The ends of the boxes are the 25th and 75th quantiles/quartiles/percentiles. The lines across the middle of the boxes are the medians. The interquartile range is the difference between the quartiles. The lines (whiskers) extend from the boxes to the outermost points that fall within the distance computed as 1.5 (interquartile range).

Figure 4

Least squares means plots (and 95% confidence intervals) for the percentages of contaminated manikins (the ratio of the number of contaminated patients divided by the total number of patients). Because the logit link function was used for the generalized linear mixed model assessment, these plots use log scales. No difference was demonstrated among groups (p = .42).