journal club on dental aerosols

1. Comparative evaluation of the
Chlorhexidine and Cinnamon
extract
as ultrasonic coolant for reduction
of
bacterial load in Dental Aerosols
Presented by- Dr Kumari Abhilasha
Moderated by – Dr Harini
Department Of Periodontics
M.R.Ambedkar Dental College, Bangalore

2. • INTRODUCTION
• AEROSOL
• TYPES OF AEROSOL
• BIOAEROSOL IN DENTISTRY
-About Bio-aerosol
-Composition
-Source and Distribution
-Diseases caused by aerosol
-Methods of Reduction of aerosols
-CDC Guidelines
• PREPROCEDURAL MOUTHRINSES
• EARLIER STUDIES
• ARTICLE
• REFERENCES
CONTENT

3. INTRODUCTION
• The microorganisms present in the environment
have evolved in many ways to enable their existence.
• Introduction of contaminants into the environment
can be one of the methods of transmission of these
organisms into the host.
• They can either be natural or synthetic particles and
can cause adverse effects and might be harmful to
the health.
• Example of one such particle is aerosol.

4. AEROSOL
• Frederick Donnan , first used the term aerosol during World
War I to describe an aero-solution, clouds of microscopic
particles in air.
• An aerosol is defined as a colloidal system of solid or liquid
particles in a gas. It includes both the particles and the
suspending gas, which is usually air.
• The size of the particle may vary from 0.001 mm to more than
100 μm.
• The smallest particle size (ranging between 0.5 μm and 10
μm) has the greatest potential to penetrate the respiratory
passages and the lungs, possessing the ability to transmit the
disease.

5. TYPES OF AEROSOL
 Aerosols are of 2 types
• i) Primary aerosols- contain particles introduced directly into
the gas
• ii) Secondary aerosols- form through gas-to-particle
conversion
 Aerosols are differentiated based on particle size:
1. Splatter (> 50 µm),
2. Droplet (≤ 50 µm), and
3. Droplet nuclei (≤ 10 µm)

6. BIOAEROSOL IN DENTISTRY
• Introduction of ultrasound in the field of dentistry by Catuna (1953) for
purpose of cutting teeth, a new direction was seen.
• This work was further carried forward and showed that ultrasound in the
form of ultrasonic can be beneficial to remove deposits from the teeth
• But as everything comes with its own sets of merits and demerits,
ultrasonic scalers were no exception.
• The aerosol produced by the ultrasonics were heavily contaminated with
bacteria termed as bioaerosol and hence a potential threat to the
operator, dental auxiliary and the patients,.
• Bioaerosol is a suspension of airborne particles that contain living
organisms or were released from living organisms.

7. • These particles are very small and range in size from less than
one micrometer (0.00004") to one hundred micrometers
(0.004").
• Droplets remain suspended in the air until they evaporate,
leaving droplet nuclei that contain bacteria related to
respiratory infections
• In dentistry, bioaerosols are important consideration for
infection control and occupational health, as infections can be
transmitted to patients or dental staff within the dental
confinement

8. Composition
• The composition of aerosol and splatter is of prime concern because it
affects the quality of air in a dental setup.
• Various factors affecting the composition of these aerosol particles are- its
size, shape, density, microflora of Dental Unit Water Lines (DUWL) , oral
flora of patient, type of treatment.
• Aerosols consist of water, saliva, blood, debris and microorganisms (e.g.,
bacteria, fungi, viruses and protozoa), along with their metabolites, such
as lipopolysaccharides/endotoxins and other toxins.
• The most predominant bacteria seen during aerosol emission in a dental
setup are Streptococcus at around 42% and Staphylococcus species around
41% of the total count.

9. Source and distribution
• Bioaerosols can arise from either a manmade or natural surfaces.
• These can be air systems, ceilings, carpets, operating room and aeration
tanks.
• In the dental clinic, aerosols may originate from various sources like
patients, staff, visitors, air conditioning system, DUWL.
• In addition to aerosols produced by coughing, dental procedures like
ultrasonic scaling, air-water syringe and even use of lasers can causes
aerosol production
• Sweeping of the floor can also cause suspension of bio-aerosols

10. Types of diseases caused by aerosols
• Numerous studies have shown that fine suspended particles
in the dental environment can lead to disease transmission
which can lead to severe health defects involving
cardiovascular, respiratory systems and also cause allergic
diseases.
• The types of disease caused by aerosol may vary among
different people.
• It depends on the immunity of the individual, composition
and types of organisms present in the aerosol

12. Methods to reduce Aerosols
The following principles should be followed in order to
reduce the risk resulting from the use of a dental unit
and exposure to aerosol.
1. Necessity for routine sterilization and disinfection.
2. Rinsing the oral cavity of a patient with an antiseptic,
e. g. chlorhexidine, before a procedure
3. A dental unit should be disinfected at the beginning of
a working day, and between patients
4. Use of devices reducing air contamination in a dental
surgery like Air Cleaning Systems, High volume
evacuators

13. 5. The quality of water should be monitored with the use of
commercial laboratory tests.
-The water line has to be flushed at the start of each clinical
day and between patients, for 30 seconds to 1 minute to
reduce microbial accumulation due to overnight waterline
stagnation
6. Valves must be used to prevent suckback of liquids into DUWL
7. Usage of personnel protective equipment like gloves, eye
wear, faceshields, apron and masks

14. CDC report in 2007 has released some of the fundamental
elements to prevent aerosol transmission and infection
control.
1) Adherence of health care personnel to recommended
guidelines.
2) Surveillance for healthcare-associated infections (HAIs).
3) Education of healthcare workers, patients.
4) Hand hygiene.
5) Personal protective equipment for healthcare personnel
like gloves, isolation gowns, and face protection: masks,
goggles, face shields.
6) Safe work practices to prevent exposure to bloodborne
pathogens
7) Proper waste disposal measures.

15. Pre Procedural Mouthrinses
The use of preprocedural antiseptic mouth rinses have
become a routine part of daily infection control procedures
They have been recommended in reducing the incidence of
bacteremia associated with dental procedures
Several preprocedural mouthrinses include chemical and
herbal formulations.
 Chemical include-
Cetyl pyridinium chloride,
stannous fluoride,
sodium fluoride.
 Herbal formulations
include- Aloe vera,
Grapefruit seed extract,
Neem ,
Peppermint,
Tea leaves,
White oak bark

16. CHLORHEXIDINE
• Gold Standard in chemical plaque control with both
bacteriostatic and bactericidal properties.
• Structure- Symmetrical molecule consisting of four
chlorophenyl rings and two bisguanide groups connected by a
central hexamethylene bridge.
• Strongly basic and dicationic compound
• Mechanism of action-
A)On bacterial cell membrane-
*low concentration- bacteriostatic
*high concentration- bactericidal

17. B)On the tooth surface-
*Prevents pellicle formation
*Prevents plaque formation
*Prevents binding of mature plaque
• Side effects-
-Staining of tooth
-Dryness of mouth
-Slight alteration in taste

18. Cinnamon
• Cinnamon (Cinnamomum zeylanicum) is a member of Lauraceae family
used in dry or ground form.
• Cinnamon bark is rich in cinnamaldehyde (50.5%), which is highly
electronegative and interferes in biological processes involving electron
transfer, and reacts with nitrogen-containing components, thereby
inhibiting the growth of the microorganisms
• Cinnamon possesses antibacterial, anti-inflammatory, and antifungal
property.
• Cinnamon has been historically used as a medicine for cold, flatulence,
diarrhea, and nausea

19. EARLIER STUDIES

22. ARTICLE

23. Aim of the Study

24. INTRODUCTION

25. • This was a single-center, placebo-controlled, randomized clinical trial with
a three-group parallel design.
SELECTION CRITERIA
The inclusion criteria of this study were as follows:
(i) participants having minimum of 20 permanent teeth,
(ii) participants diagnosed with moderate-to-severe gingivitis having a
gingival index (GI) score of 2–3,
(iii) systemically healthy patients,
(iv) participants indicated for full-mouth scaling in single sitting.
The exclusion criteria of this study were as follows:
(i) the presence of any systemic disease,
(ii) received antibiotics or NSAIDs in the past 9–11 weeks,
(iii) oral prophylaxis within the past 3 months,
(iv) pregnant and lactating mothers, and
(v) smokers.
MATERIALS AND METHOD

28. RESULTS

32. DISCUSSION

33. CONCLUSION
• Within the limitations of this study, both cinnamon and
chlorhexidine when used as an ultrasonic coolant effectively helped
in the reduction of bacterial contamination in dental aerosols which
was seen by reduction in the CFUs, after adding these agents in the
DUWL.
• Cinnamon extract can also be promoted to be used as a mouthwash
as it has no side effects.
• Moreover, its low cost may motivate the patients at especially
low socioeconomic strata for oral hygiene maintenance.
• This is an encouraging result which clearly favors the promotion of
cinnamon among the rural communities, especially belonging to
low socioeconomic strata, as cinnamon is easily available,
inexpensive, and a safe alternative to chlorhexidine.
• Furthermore, as the best line of action is prevention of the
disease-causing entity and thereby disease itself, these agents can
be promoted to be used through DUWLs

34. REFERENCES
• Textbook of Periodontology, Carranza 11th Ed
• Singh A, Manjunath RS, Singla D, Bhattacharya HS, Sarkar A,
Chandra N. Aerosol, a health hazard during ultrasonic scaling: A
clinico-microbiological study. Indian Journal of Dental Research.
2016 Mar 1;27(2):160.
• Rani KR, Ambati M, Prasanna JS, Pinnamaneni I, Reddy PV,
Rajashree D. Chemical vs. herbal formulations as pre-procedural
mouth rinses to combat aerosol production: A randomized
controlled study. Journal of Oral Research and Review. 2014 Jan
1;6(1):9.
• Sawhney A, Venugopal S, Babu GR, Garg A, Mathew M, Yadav M,
Gupta B, Tripathi S. Aerosols how dangerous they are in clinical
practice. Journal of clinical and diagnostic research: JCDR. 2015
Apr;9(4):ZC52.
• Pulluri P, Karibasappa SN, Mehta DS. Aerosol and splatter in
Dentistry-An Overview.