Even though most countries have begun to allow the delivery of dental and medical services, providing safe oral healthcare routinely remains challenging due to the high transmissibility of the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus; coronavirus) and how easily it may be dispersed during aerosol-generating procedures. SARS-CoV-2 is present in salivary and nasopharyngeal secretions of infected patients, and spreads through respiratory droplets (droplet nuclei less <5 μm in size) as well as small viral particles that can linger in the air [2, 3].
Global Coronavirus disease (or COVID-19) cases have surpassed 115 millions. The COVID-19 pandemic is placing health care professionals performing aerosol-generating procedures in the oropharyngeal region at risk for becoming infected and subsequently, become vectors of infection . As such, patients, and especially vulnerable individuals for COVID-19 may hold off from obtaining dental care in view of the perceived risk of such visits and procedures . The Health Policy Institute of the American Dental Association showed a possible 38% decline in dental care spending in the U.S. in 2020 and 20% in 2021. In October, 2020 more than a half of dental practices were open with a lower patient volume (55.2%) than usual .
Poor access to dental care can lead to untreated dental decay or other oral health infections, leaving people with no viable options other than visiting hospital emergency rooms, where treatment is costly and disrupts more urgent care needs, particularly in a time of crisis such as the current COVID-19 pandemic . Additionally, missed routine dental visits represent failed opportunities to provide preventive oral health care and to identify oral manifestations of systemic diseases .
To reduce the spread of the infection, especially during aerosol generating procedures, we invented “The Cupola”, a shield that creates a mechanical barrier around the patient’s head and body, and allows health providers to perform their work unhindered (Fig.1 panel A). “The Cupola” includes a face shield on a cart (or anchored to the dental chair) and a disposable waterproof surgical utility drape with tape around the shield to cover the patient head and body (as an additional option). The shield can be reused after disinfection with an Environmental Protection Agency (EPA)-registered, hospital-grade disinfectant.
We hypothesized that the use of The Cupola during aerosol generating procedures in the oropharyngeal region decreases the spread of droplets and aerosols in dental offices, which could lead to safer dental practices. This has potential implications to decrease the spread of disease among dentists, maxillofacial surgeons, otolaryngologists and their patients. The aim of this pilot study is to assess the efficacy of The Cupola in decreasing the spread of droplets and aerosols during simulated aerosol generating dental procedures.