Evaluating aerosol and splatter during orthodontic debonding: implications for the COVID-19 pandemic

Introduction Dental procedures often produce splatter and aerosol which have potential to spread pathogens such as SARS-CoV-2. Mixed guidance exists on the aerosol generating potential of orthodontic procedures. The aim of this study was to evaluate aerosol and/or splatter contamination during an orthodontic debonding procedure. Material and Methods Fluorescein dye was introduced into the oral cavity of a mannequin. Orthodontic debonding was carried out in triplicate with filter papers placed in the immediate environment. Composite bonding cement was removed using a slow-speed handpiece with dental suction. A positive control condition included a high-speed air-turbine crown preparation. Samples were analysed using digital image analysis and spectrofluorometric analysis. Results Contamination across the 8-metre experimental rig was 3% of the positive control on spectrofluorometric analysis and 0% on image analysis. There was contamination of the operator, assistant, and mannequin, representing 8%, 25%, and 28% of the positive control spectrofluorometric measurements, respectively. Discussion Orthodontic debonding produces splatter within the immediate locality of the patient. Widespread aerosol generation was not observed. Conclusions Orthodontic debonding procedures are low risk for aerosol generation, but localised splatter is likely. This highlights the importance of personal protective equipment for the operator, assistant, and patient. Three ‘In brief’ points Orthodontic debonding, including removal of composite using a slow speed handpiece with dental suction, appears to be a low risk procedure for aerosol generation. Splatter was produced during the debonding procedure, however this was mainly localised to the patient, operator and assistant. A single positive reading was identified 3.5 meters away from the patient, highlighting the need for suitable distancing and/or barriers in open clinical environments.