By Thierry Rouleau, Doctor of Pharmacy
In the last 12 months, our life has changed. Colin Powell said “good judgment comes from experience, and experience comes from bad judgment”.
We will therefore analyse the various important points that have been well commented on for dental practices as we have come out of lockdown in order to give a quick overview.
SARS-CoV-2 is an enveloped virus belonging to the Coronavirus family that is easily destroyed by adding a lipophilic or oxidising disinfectant. If nothing is done, it is contagious and complicated, without mentioning its variants.
The virus is transmitted from people who are already infected, unwell or are asymptomatic carriers of the virus, by direct transmission of particles emitted when coughing, sneezing or simply talking, or by indirect transmission by contact via a contaminated inert surface1. This therefore creates a need for both “droplet” and “contact” prevention. Aerosol transmission is not the main route but should be considered in dental practices2.
The air in the surgery is therefore not the main problem. Neither is the air in general and it is not necessary to disinfect it.
We breathe thousands of cubic metres of air every day without any problems, otherwise we would all be dead. The lung mucus is simply doing its job.
The only hazardous airborne contamination is heavy metals, VOCs3 or toxic substances.
Airborne UV treatment using photocatalysis is of little scientific benefit in this case. Direct UV-C4 cannot be used in a dental surgery. A particle filter could be an interesting choice provided that the filters are changed very regularly, which comes with a non-negligible cost if you want to maintain good efficiency.
Filtration plants using photocatalysis have been the subject of a warning note published by the INRS classifying them as potentially dangerous.
Only physiological secretions, water and surfaces are responsible for contamination, epidemics or pandemics in general.
For water sprays, it is necessary to work chemically on the water and physically on the shape of the spray.
1. Chemically, through installing a spray water treatment device such as the IGN5, which, when used with a disinfectant such as Calbenium6, disinfects the spray water while also making it a disinfectant when it is deposited on the skin of the face.
Therefore, the drastic reduction in the SARS-CoV-2 viral load in spray water in contact with saliva will not allow contamination from a patient to a practitioner or assistant.
2. Physically, by asking the practitioner to carefully control their water consumption with the instruments, which should not exceed 50ml/min.
This can easily be checked with a measuring beaker. It is also important to reduce the spray air pressure (not the turbine rotation pressure) in order to obtain a heavy spray where the drops are no longer a fine spray but a spray where the droplets immediately undergo gravity in the mouth.
This avoids splashing outside of the mouth as much as possible.
The spray must then be trapped spray using surgical suction with permanent use of the saliva pump and the large cannula during the procedure, or even a surgical funnel to be placed on the large cannula and turned towards the operating field if there is no assistant or further if the dentist has 3 suction cannulas, which can happen.
Removing the spittoon, a receptor of saliva soiled by a viral protein load and soiling the environment because the patient often ends up spitting next to the spittoon.
The use of red counterangle turbine sprays is always preferable as counterangle sprays are less strong and create less mist than those of the turbines.
With this, it is possible to solve 95% of problems.
Think about the suction motor, which must have its exhaust air outlet on the outside, and check that if it is placed next to the compressor air intake it does not leak stale air that could enter the compressor. Remember to change the compressor filters and the bacteriological filter of the suction motor if it is equipped with one.
DSVA7, finally a solution to health problems.
The Nocotech8 concept, which combines a machine (Nocospray) and a hydrogen peroxide-based disinfectant (Nocolyse+), provides complete and perfect airborne disinfection of all inaccessible surfaces in the surgery. It complies with the NF T72-281 standard, and is therefore bactericidal, fungicidal, yeasticidal and virucidal (including the coronavirus family).
Placed in the centre of the room to be treated, the Nocotech concept consists of an ionising heating turbine that transforms a hydrogen peroxide-based disinfectant liquid into gas.
In this gaseous form, it will come into contact with 100% of the surfaces of everything in the dental surgery, including electronic surfaces, without causing any corrosion. The treatment is considered biodegradable because it decomposes into water and oxygen.
The metaphor is that a kitchen can be transformed into an operating theatre in two hours without leaving any surface residue.
In the surgery, when used regularly and working on two dental blocks, a block recovery time of 30 minutes is enough.
There will be a problem with air conditioning. Surgeries will find it difficult to function without it. In nursing homes and health care facilities with centralised air-conditioning, kitchens, restaurants and many others, contamination from these systems has been observed to the point of shutting them down.
This is not sustainable.
The Nocotech8 concept, which combines a machine (Nocospray) and a hydrogen peroxide-based disinfectant (Nocolyse+), provides complete and perfect airborne disinfection of all inaccessible surfaces in the surgery. It complies with the NF T72-281 standard, and is therefore bactericidal, fungicidal, yeasticidal and virucidal (including the coronavirus family).
Placed in the centre of the room to be treated, the Nocotech concept consists of an ionising heating turbine that transforms a hydrogen peroxide-based disinfectant liquid into gas.
In this gaseous form, it will come into contact with 100% of the surfaces of everything in the dental surgery, including electronic surfaces, without causing any corrosion. The treatment is considered biodegradable because it decomposes into water and oxygen.
The metaphor is that a kitchen can be transformed into an operating theatre in two hours without leaving any surface residue.
In the surgery, when used regularly and working on two dental blocks, a block recovery time of 30 minutes is enough.
There will be a problem with air conditioning. Surgeries will find it difficult to function without it. In nursing homes and health care facilities with centralised air-conditioning, kitchens, restaurants and many others, contamination from these systems has been observed to the point of shutting them down.
This is not sustainable.
Almost all dentists’ surgeries are equipped with independent air-conditioning with cooling plates and an independent compressor. Today, we treat a number of central air-conditioning systems with the Nocotech system, whether it is during ceiling work in hospitals where Aspergillus resurgence is common or in the P2 and P3 microbiological safety laboratories where strict treatment conditions apply.
Independent air conditioning systems are treated in the same way.
By leaving the air conditioners on during the treatment, the Nocotech concept can effectively disinfect an air conditioner in summer.
Large private practices, health centres and dental schools are equipped with either independent or separate boxes. On independent boxes, the problem is easily solved. In open spaces, it only takes one working unit to put the whole space at risk. In this case, a bacteriological reset is necessary in the evening with the Nocotech system, which will reduce the problem.
Logistics and stewardship of PPE9, patient management and nursing staff and dentists can do this very easily if given good instructions based on common sense.
For a protocol to work, it must fulfil 3 functions:
– Simple to use so that it can be implemented and repeated.
– Economical so as not to affect the dental work too much financially and be related to the practice’s activity.
-Progressive so that the practitioner can improve on what they have just learned in the future and not have it turn into an unnecessary act.
“The Nocotech concept is simple and easy to handle, which means that my assistants don’t find it tedious to use”
“As a dental surgeon and holder of a master’s degree in bacteriology and virology, I have implemented strong hygiene and prevention measures since I started.
As AIDS and hepatitis C were already being widely discussed, I decided to install an IGN / Calbenium system on my units in 1995 to treat the water in the sprays and its mist.
In 2003, I purchased a Nocotech concept that my assistant would use on a daily basis in my dental practices and before every surgery.
With the emergence of SARS-Cov-2 and the risk from its current variants, it seemed clear to me that a more comprehensive DSVA treatment on all surfaces was necessary in the practice including in the sterilisation room, waiting room and office.
The Nocotech concept is simple and easy to handle, which means that my assistants don’t find it tedious to use, so they use it and render an effective result of total disinfection, “ says Dr. Sophie Giromany.
According to an article in BioMed Research International10 entitled “Environmental disinfection of a dental practice during the Covid-19 pandemic: Presentation” and published in October 2020, the objective of this summary is to evaluate the scientific literature on non-contact disinfection procedures in dental practices aimed at limiting transmission through airborne particles or fomites, using non-contact procedures for environmental decontamination of dental practices.
The article is based on extensive documentary research (articles, studies, etc.) and compares different systems such as: manual spraying, UV-C, hydrogen peroxide vapour systems, pulsated Xenon, ozone gas and hydrogen peroxide-based airborne surface disinfection. The conclusions drawn state that “the decontamination technique best suited to the needs of dental practices is to use hydrogen peroxide […] which can be sprayed by means of a high-speed turbine device with the ability to produce small aerosol particles, also recommended due to its low cost. […] Dentists should consider the use of new disinfectants and non-contact decontamination technologies to improve disinfection of surfaces in dental practices. […] Manual cleaning and disinfection of environmental surfaces in health care facilities (daily and when patients are discharged) are essential components of infection control programmes, especially during the SARS-CoV-2 pandemic. .”
To conclude, we could ask if today we really have a choice? Given the variants of Covid-19, it goes without saying that the new virus is spreading rapidly around the world. The situation is expanding and, moreover, it suggests that health problems will persist if we do not adapt to the current context.