First-of-its-kind splatter study examines infection control during oral surgery

infection control dental splatter
Photo: milkos 123rf

US researchers have examined the patterns of splatter contamination created by rotary instruments and irrigation during oral surgery. This study by a team at the University of Minnesota School of Dentistry is the first to examine rotary instrumentation splatter created during oral surgery procedures, and its findings provide several key suggestions for the future of oral surgery and improving safety measures for both providers and patients.

The study—published in Clinical Oral Investigations—involved an experiment on manikins (patient simulators). Researchers simulated the surgical extraction of four molars in different quadrants with one operator and one assistant with four combinations of operations: saline with a self-irrigating drill, hydrogen peroxide with a self-irrigating drill, saline with hand irrigation or hydrogen peroxide with hand irrigation.

A total of 52 procedures were completed and splatter was collected on glass fiber prefilters, which were allowed to dry before being photographed under UV Light.

The study found the most splatter occurred on the patient’s chest, followed by the assistant’s face shield. The operator’s face shield was also splattered, as were face masks and corner of the operatory.

The difference between assistant irrigation and self-irrigating drills was marginally significant, but the study found that using hydrogen peroxide as an irrigant instead of saline increased the area of droplet splatter.

“To finally have evidence on the impact of our use of irrigation is very important for the future of our field,” lead author Dr Rachel Uppgaard said. 

“We can’t do surgery without it, but now we know more about the patterns generated and can make decisions about our clinical practice that are evidence-based.”

While hydrogen peroxide rinses have been used throughout the COVID-19 pandemic as a pre-procedural rinse, this study is the first to report an enhancing effect of the hydrogen peroxide irrigant on the formation of splatter and suggest that hydrogen peroxide actually increases the risk of spreading droplets when it’s used as an irrigant.

“With the implication that hydrogen peroxide may not be a suitable solution as a pre-procedure rinse for dental procedures, it could change the pre-existing ideas about using hydrogen peroxide to prevent COVID-19 in patient clinics,” co-author Dr Boyen Huang said.

The study also offers important insights for the use of personal protective equipment in oral surgery—given the high level of splatter on the operator and assistant’s face shields, practitioners may consider continuing to use face shields.

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