A study from the University of Minnesota School of Dentistry and published in Clinical Oral Investigations examined the patterns of splatter contamination created by rotary instruments and irrigation during oral surgery. This study 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 involved an experiment on manikins, otherwise known as patient simulators, in the University of Minnesota’s Oral and Maxillofacial Surgery operatories. 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 fibre prefilters, which were allowed to dry before being photographed under ultraviolet (UV) light. The study found that 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 corners of the operatory. Also, the difference between assistant irrigation and self-irrigating drills was marginally significant, but found that using hydrogen peroxide to irrigate instead of saline increased the area of droplet splatter.
While hydrogen peroxide rinses were used throughout the Covid-19 pandemic as a pre-procedural rinse, this study is the first to report an enhancing effect of irrigation using hydrogen peroxide on the formation of splatter, and suggests that hydrogen peroxide actually increases the risk of spreading droplets when it’s used to irrigate.
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.
The authors suggest further approaches could include additional studies of the effects of irrigants and irrigation methods on viral load and surface stability of viruses, and testing of frequently-touched locations.