Aerosol anguish in dentistry in COVID-19 pandemic: A hypotheses or reality?

Impact of COVID-19 pandemic has been appalling and calamitous, affecting the economic, psychosocial, and social lives of all. The causal virus SARS-CoV-2 is a highly infectious contagion with multiple modes of transmission, including droplets and aerosols, where it may persist up to 3 h [1] Aerosol-generating procedures, widely performed in varied health care settings, particularly in dentistry, pose a high biologic risk of SARS-CoV-2 inhalation as well as fomite transmission. Dental aerosols include droplets and droplet nuclei that may contaminate surfaces up to 3 feet and may remain airborne for 30 min to 2 h [2].

Globally, dental practices have started adhering to the standard precautions along with transmission-based precautions that include use of protective barriers, particulate respirators (equivalent to US National Institute for Occupational Safety and Health (NIOSH)-certified N95 or European Union (EU) standard FFP2) and additional amendments such as the use of dental handpieces with anti-retractive or anti-reflux valves, high-volume surgical aspirators, rubber dam, etc [3], [4].

However, routinely updating guidelines have caused a precariousness to dominate the clinical decision-making process. On one hand, the authorities are trying to issue regulations to limit dental services to emergency procedures only, in lieu of the pandemic, while on the other, dentists contemplate whether dental aersols are equivalent to those produced during anesthesia or intubation procedures. Secondly, they question whether dental aersols even contain infectious virus. Moreover, they ask whether evidence exists for spread of respiratory viruses in dental settings while adhering to the current standard precautions. Another doubt is the increased risk of COVID-19 infection for dental practitioners [5]. Also, when 90% of dental aerosols produced are extremely small (<5 µm), their potential to transport SARS-CoV2 and virulence in dental clinical settings is yet to be validated. Consequently, as aerosols in dental practice remain a clinical conundrum, further research should be done to come to a definite conclusion.