Breakthroughs in research on aerosol generating dental procedures

Research on the risk of aerosol generating procedures (AGPs) during the current pandemic has yielded first evidence of impact in the field.

Aerosol specialists from the Mechanical Engineering Department of Imperial College London (Professor Yannis Hardalupas, Dr Antonis Sergis) and medical specialists from Guy's and St Thomas' NHS Foundation Trust and Kings College London (Professors Owen Addison, William Wade, Jennifer Gallagher) are currently conducting aerosol measurements in multiple environments that represent closed and open dental surgery spaces at Guy’s Hospital. The research evaluates the infection risk from generated aerosols during routine dental procedures, and identifies ways to reduce the aerosols.

The findings of the consortium are disseminated to the four UK Chief dental officers, dental lead for Public Health England, General Dental Council, Royal Colleges of Surgeons, WHO and with educational providers, UK Dental Deaneries and Association of UK Dental Schools to inform decision-making and provide recommendations on policy and operational guidelines for dental practices.

Routine dental procedures represent one of the highest risks in healthcare for aerosol generation and potential viral transmission. Dental services must now integrate social distancing, enhanced personal protective equipment (PPE) and lengthy surgery decontamination periods between dental treatments. Current restrictions are a particular difficulty for NHS-supported treatments, since they reduce the number of patients who can be treated each day. However, the need for dental services remains, and during the current crisis approximately 80% of all non-respiratory calls to the 111 service in London were due to dental problems.

The collaborative work, which highlighted possible methods of spray and aerosol mitigation in dental operations, has informed the Scottish Dental Clinical Effectiveness Programme (SDCEP) for their “Rapid Review of Aerosol Generating Procedures in Dentistry” document. The purpose of the SDCEP document was to identify and appraise the evidence related to AGPs in dentistry and to reach agreed positions that may be used to inform policy and clinical guidance.

The project has also influenced the work of the Faculty of General Dental Practice (FGDP (UK)) and the College of General Dentistry, who have convened an expert task force to review the evidence base for dental practice during the Covid-19 outbreak. The risk categorisation for dental procedures included in their document "Implications of Covid-19 for the safe management of general dental practice: A practical guide" was heavily influenced by this work.

Instrumentation and software for aerosol visualisation was loaned from Photron (Europe) Ltd and LaVision UK Ltd. The research is funded by Guy’s and St Thomas NHS Foundation Trust, UKRI and the British Endodontic Society (BES).