“Within samples where SARS-CoV-2 RNA was found, the quantity of RNA detected was in extremely low numbers in large volumes of air and one study that found SARSCoV-2 RNA in air samples reported inability to iden-tify viable virus.” 31 Tran also stated, “While other proce-dures, including tracheotomy, non-invasive ventilation, and manual ventilation before intubation were associated with an increased risk of SARS infection, given the paucity of studies and lack of robustness, these findings were considered difficult to interpret with respect to drawing firm conclusions. There were no other proce-dures which were found to be significantly associated with a risk of SARS transmission.” 44 Davies et al in a review of the risks and disease trans-mission associated with aerosol generating medical procedures found the following conclusion “while there is compelling evidence that procedures such as broncho-scopies generate aerosols, the potential for aerosol gener-ation from some procedures may have been overstated. Clearly, nosocomial transmission from infected patients to health care workers has taken place, but whether it is the AGP that is the primary source is difficult to clarify. Without further quantitative research to establish defini-tively the presence/absence of aerosols from these proce-dures it will be difficult to lay to rest the uncertainty that surrounds these procedures.” 45 It is vital for the pediatric, orthodontic and overall dental community to determine the risk of dental aerosols and determine the extent to which all measures must be taken to minimize the risk. Given the points and counterpoints above regarding the danger of dental aerosol, we make the following sugges-tions that must be studied in order for the dental commu-nity to be able to definitively answer the question about safety of dental treatment during the COVID-19 pandemic and possibly future respiratory disease pandemics: 2. Centers for Disease Control and Prevention. Information for Pediatric Healthcare Providers. https://www.cdc.gov/coron-avirus/2019-ncov/hcp/pediatric-hcp.html. 3. Raza I, Zaman Z, Waseem Y. MISC: A Kawasaki-like hyperin-flammation syndrome in COVID-19. https://www.authorea.com/users/331540/articles/458186-misc-a-kawasakilike-hyperinflammation-syndrome-in-covid19?commit=a54714f5dbded447036cf331847a2820351d e94e. Published 2020. 4. Meng L, Hua F, Bian Z. Coronavirus Disease 2019 (COVID-19): Emerging and Future Challenges for Dental and Oral Medicine. J Dent Res. 2020. doi:10.1177/0022034520914246 5. Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci. 2020. doi:10.1038/s41368-020-0075-9 6. Mair A, Kome P. Decoding Dental Aerosols.; 2020. 7. Azzi L, Carcano G, Gianfagna F, et al. Saliva is a reliable tool to detect SARS-CoV-2. J Infect. 2020. doi:10.1016/j.jinf.2020.04.005 8. To KKW, Tsang OTY, Leung WS, et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARSCoV-2: an observational cohort study. Lancet Infect Dis. 2020. doi:10.1016/S14733099(20)30196-1 9. To KKW, Tsang OTY, Chik-Yan Yip C, et al. Consistent detec-tion of 2019 novel coronavirus in saliva. Clin Infect Dis. 2020. doi:10.1093/cid/ciaa149 10. Organization WH. Transmission of SARS-CoV-2: Implica-tions for Infection Prevention Precautions.; 2020. 11. Gandhi M, Yokoe DS, Havlir D V. Asymptomatic transmis-sion, the achilles’ heel of current strategies to control Covid-19. N Engl J Med. 2020. doi:10.1056/NEJMe2009758 12. Morawska L, Milton DK. It Is Time to Address Airborne Transmission of Coronavirus Disease 2019 (COVID-19). Clin Infect Dis. 2020. doi:10.1093/cid/ciaa939 13. Asadi S, Bouvier N, Wexler AS, Ristenpart WD. The coron-avirus pandemic and aerosols: Does COVID-19 transmit via expiratory particles? Aerosol Sci Technol. 2020. doi:10.1080/02786826.2020.1749229 14. Judson SD, Munster VJ. Nosocomial transmission of emerg-ing viruses via aerosol generating medical procedures. Viruses. 2019. doi:10.3390/v11100940 15. Weber TP, Stilianakis NI. Inactivation of influenza A viruses in the environment and modes of transmission: A critical review. J Infect. 2008. doi:10.1016/j.jinf.2008.08.013 16. Fowler RA, Guest CB, Lapinsky SE, et al. Transmission of severe acute respiratory syndrome during intubation and mechanical ventilation. Am J Respir Crit Care Med. 2004. doi:10.1164/rccm.200305-715oc 17. Centers for Disease Control and Prevention. People with Developmental and Behavioral Disorders. https://www.cdc.gov/coronavirus/2019 -ncov/need-extra-precautions/peoplewith-developmental-behavioral-disabilities.html. Published 2020. 18. Dentistry TAA of P. Management of Patients with Special Health Care Needs. https://www.aapd.org/research/oral-health-policies--recommendations/management-of-dental-patients-with-special-health-care-needs/. ᕡ Repeat the study by Bidra et al using waterline treated water with iodine and silver compounds. ᕢ Use air sampling technology to best assess the effects of suctioning equipment including HVE, isolite, and other auxiliary systems to assess the spread of aerosol in a typical dental setting. ᕣ Using air sampling or aerosol evaluation technol-ogy, assess the makeup of dental aerosol – how much is saliva and how much is waterline water. ᕤ Sample pharyngeal secretion in infected, symp-tomatic patients and compare to saliva of pre-symptomatic but COVID-19 positive patients to determine the difference in the viral loads. The findings of such studies could help the pediatric and overall dental community determine the relative risk of dental treatment with dental aerosol of a typical pre-symptomatic COVID-19 positive patients. References 1. Barnett ML, Grabowski DC. Nursing Homes Are Ground Zero for COVID-19 Pandemic. JAMA Heal Forum. 2020. doi:10.1001/jamahealthforum.2020.0369 36 Spring 2021 JAOS
Journal of the American Orthodontic Society Spring 2021: Page 36
