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Protective eyewear. Important in preventing splatter droplets from contacting the eyes, eyewear lenses should be large enough to offer effective protection, and must include side shields, as required by the Occupational Safety and Health Administration’s (OSHA’s) bloodborne pathogens standard. Detachable sideshields are available on the market for prescription eyeglass. Face shields may be worn in place of eyeglasses/goggles, if desired.

Protective clothing. This category includes gowns, uniforms and jackets that guard the skin and underlying garments from contact with splatter and its microbes. OSHA’s bloodborne pathogens standard requires the protective garment’s sleeves to be long enough to protect the forearms when it is worn as PPE.

Gloves. These not only protect the patient from any microbes on the skin of the workers, but they also protect the wearer from any direct contact with patient oral microbes. Moreover, gloves shield the worker from contacting any microbes on operatory surfaces.

Evacuators and ejectors. High-velocity evacuators (HVEs) and saliva ejectors reduce the level of oral fluids, thereby minimizing the number of microbes that can escape from the patient’s mouth in aerosols and splatter.

Pre-procedural mouthrinsing. This step functions like HVEs and saliva ejectors to reduce the number of microbes in the patient’s mouth that can exit in aerosols and splatter.11 Note: When attempting to maintain a reduced level of salivary microbes throughout the dental procedure, it is important to use an antimicrobial mouthrinse because non-antimicrobial rinses only temporarily reduce microbial levels.

Rubber dams. These are used to isolate teeth to be worked on from the saliva and its microbes. Although this seal is not always perfect, using the rubber dam does greatly reduce the exit of patients’ microbes from their mouths.10 Nonetheless, note that any microbes already existing in dental unit water, even when used with a rubber dam in place (for example, the water generated by highspeed handpieces), can and do exit the mouth.

Barriers. Environmental barriers made of water-impermeable materials can prevent operatory and other surfaces from becoming contaminated from splatter or from being touched with contaminated hands. These barriers are to be changed between patients.7

Surface disinfection. Surface cleaning and disinfection is another way (besides using surface barriers) to manage operatory and other surfaces contaminated with splatter. The cleaning and disinfection process is accomplished using the spray-wipe-spray technique; or when using disinfectant wipes, the wipe-discard-wipe technique.12 In both cases, the initial application or wiping is to clean the surface, and the final application with a second spray and/or second wipe is to disinfect the surface.

Common contamination
Aerosols and splatter are generated from the oral cavity during the care of almost every dental patient. These particles of oral fluids contain microbes that contaminate office personnel through droplet and airborne spread and operatory surfaces through droplet spread. Asepsis procedures and products that prevent these modes of spread include PPE, HVE, saliva ejectors, pre-procedural mouthrinsing, rubber dams, surface barriers and surface cleaning and disinfection.

modes of disease spread

01 Direct contact Example: Performing intraoral procedures without wearing gloves. Potential outcome: Herpes infection of the fingers, which could be transferred to other patients.	02 Indirect contact Example: Contacting a contaminated object or receiving a contaminated sharps injury. Potential outcome: Contracting hepatitis B from a sharps injury.
03 Droplet spread Example: Having larger droplets from the patient’s oral splatter contact your eye or the mucous membranes of your nose or mouth. Potential outcome: Herpes infection of the eye.	04 Airborne spread Example: Inhalation of very small aerosolized particles of the patient’s oral fluids, called droplet nuclei. Potential outcomes: Measles, TB, chickenpox, SARS or influenza.

Photos: DKAR Images/Jeffrey Hamilton/Dan Dalton/Image Source/Getty Images

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References

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