Generating “virus-free aerosols” to minimize the virus spread (eg. SARS-CoV-2) in dental clinics
Dentists and dental patients are showing an ever-increasing concern about the generation of virus-containing aerosols through various dental procedures, and the resultant risk of infection spread. Povidone Iodine has shown to be effective against most of the viruses including coronavirus. Adding Povidone Iodine to the water bottle attached to the chair could be thought of as a possible solution. This is a hypothesis that can be developed further.
Droplet and aerosol transmission of 2019-nCoV are the most critical concerns in dental clinics because it is hard to avoid the generation of high quantities of aerosol and droplets mixed with patient’s saliva and even blood during dental procedures. Devices such as high-speed dental handpieces when used in the patient’s oral cavity can generate a large amount of aerosol and droplets mixed with the patient’s saliva or even blood. Particles of droplets and aerosols are small enough to stay airborne for an extended period before they settle on environmental surfaces or enter the respiratory tract. Thus, the 2019-nCoV has the potential to spread through droplets and aerosols from infected individuals in dental clinics and hospitals.
Article: Peng, X., Xu, X., Li, Y. et al. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci 12, 9 (2020).
Povidone Iodine antiseptic solutions have demonstrated > 99.99% activity against both enveloped and non-enveloped viruses including Ebola, MERS, SARS coronavirus, influenza and HFMD viruses (Enterovirus 71 and Coxsackievirus A16)
Article: Eggers, M. Infectious Disease Management and Control with Povidone Iodine. Infect Dis Ther 8, 581–593 (2019).
The rapid bactericidal and virucidal efficacy of povidone-iodine, including PVP-I gargle/mouthwash, against pathogens, causing oral and respiratory tract infections observed in other in vitro and in vivo studies and the established safety profile of PVP-I from over 60 years of use, provide a strong rationale for the use of PVP-I oral solution for protective oropharyngeal hygiene management for individuals at high risk of exposure to oral and respiratory pathogens.
Article: Eggers, Maren et al. “In Vitro Bactericidal and Virucidal Efficacy of Povidone-Iodine Gargle/Mouthwash Against Respiratory and Oral Tract Pathogens.” Infectious diseases and therapy vol. 7,2 (2018): 249-259.
PVP-I has higher virucidal activity than other commonly used antiseptic agents including chlorhexidine and benzalkonium chloride. It has been shown to be active in vitro against the coronaviruses that have caused epidemics in the last two decades, namely SARS-CoV causing the severe acute respiratory syndrome (SARS) epidemic of 2002–3 and MERS-CoV the agent responsible for causing the Middle East respiratory syndrome (MERS) epidemic of 2012–13.
Povidone-iodine (PVP-I) has better anti-viral activity than other antiseptics and has already been proven to be an effective virucide in vitro against severe acute respiratory syndrome and Middle East respiratory syndrome coronaviruses (SARS-CoV and MERS-CoV). Povidone-iodine has been shown to be a safe therapy when inhaled nasally or gargled. We propose that a protocolised nasal inhalation and oropharyngeal wash of PVP-I should be used in the current COVID-19 pandemic to limit the spread of SARS-CoV-2 from patients to healthcare workers (and vice versa) and thus reduce the incidence of COVID-19.
Kirk-Bayley, Justin and Challacombe, Stephen and Sunkaraneni, Vishnu and Combes, James, The Use of Povidone Iodine Nasal Spray and Mouthwash During the Current COVID-19 Pandemic May Protect Healthcare Workers and Reduce Cross Infection. (March 28, 2020).
A recommended irrigant in the ultrasonic scaler is 10% povidone-iodine diluted 1:9 with water.
A higher concentration can be used if the patient accepts it. Iodophors should not be used
In patients with sensitivity to iodine or are susceptible to hypothyroidism. Also to be avoided in pregnant women and nursing mothers because the fetus or infant could develop transient hypothyroidism.
Article: Slots J, Jorgensen MG. Efficient antimicrobial treatment in periodontal maintenance care. J Am Dent Assoc. 2000;131(9):1293–1304.
Conclusion: We should consider using Povidone-Iodine as an irrigant in high-speed handpieces too, as it has already been a recommended irrigant in the ultrasonic scaler. The recommendation is to use 10% povidone-iodine diluted 1:9 with water.
So if you have a half litre bottle attached to your chair: Put 50 ml of 10 % Povidone Iodine solution in the bottle and then add water to fill the bottle. So this dilution will be 50: 450 = 1:9
A few concerns will be how the devices will be able to cope up with this addition in the long run and what would be the maintenance protocols.