As variants of the SARS-CoV-2 virus continue to emerge and bring a dark cloud of fear across the dental community, forecasts point to the underlying importance of diligence in the provision of infection control standards for the dental professional. In a world of “if aerosols were really infectious,” dental professionals have subsequently moved from a profound focus on blood-borne pathogens to focusing on the safety threats of airborne transmission and how this impacts successful, comprehensive patient care in the dental chair.
While mitigation strategies such as high-volume evacuation, patient screening, staggered dental appointments, and air purification have been adapted into dental practices across the United States, a pervasive and unending concentration on infection control strategies has been the employment of appropriate levels of personal protective equipment (PPE) aimed to reduce viral contamination and subsequent disease transmission. Most specifically, new research data has denoted that eye protection is an integral component for consideration in appropriate clinician protection, aerosol mitigation, and the safety guidelines that follow.
This article provides a “meteorology report” examining the previous climate around eye protection for the dental professional, as well as forecasting the best ways to prepare for the ever-changing “weather” that the dental community can anticipate regarding complete eye protection within the new normal.
Yesterday’s forecast: Cloudy with a chance of rain
Prior to the COVID-19 global health crisis, eye protection for the dental operator focused mainly on concerns of blood-borne pathogens and risk of trauma from foreign body spatter. Specifically, 87% of general dental practitioners reported wearing eye protection routinely; however, it was noted that the clinician’s choice of protection was not always appropriate for complete protection nor worn for all procedures. As a result, 48% of general dental practitioners reported they had experienced ocular trauma or infection while delivering dental procedures.1
Related reading: Eye spy: Exploring the mouth-eye connection
While wearing surgical loupes to optimize magnification and subsequent visualization has become commonplace across the dental profession, a 2020 study of dental students and dentists reported that only 12.25% of study participants were using magnification within their eye protection.2
This data clarified that most dental clinicians were approaching their clinical care with a “cloudy” vision and chance for aerosol contamination due to inadequate protection. Like the heavy air and gentle sprinkles before a rainstorm, this data became a warning that our profession would likely be faced with a need to evaluate and correct several of our preexisting PPE strategies, including adequate eye protection, to prepare for the storm ahead.
As the initial waves of the COVID-19 storm swept around the world, it became understood that the ocular mucous membrane could act as a portal of entry for aerosol-transmitted diseases, as the COVID-19 infection was readily detected through conjunctival swabs.3
In response, increased eye protection standards have been seen in about 68% of dentists who have employed a high-level eye protection program into their infection control practices as a means of occupational safety.4 However, research still has its eyes, so to speak, on what specific factors need to be considered in comprehensive eye protection aimed at optimal visualization and complete clinician protection.
Today’s forecast: Clear skies and sunshine
As research continues to unpack the importance of eye protection as a component of complete aerosol mitigation safety, dental professionals are beginning to adapt the use of specialized eye protection not only for ample magnification and visualization, but also specifically for aerosol protection. This viewpoint resulted from the Centers for Disease Control and Prevention5 guidelines encouraging dental professionals to don eye protection prior to entering a treatment area that might be contaminated with previously generated and residually present aerosols, and to continue donning eye protection throughout contact time in enclosed spaces with potential residual aerosols.
The innovation of aerosol protection loupes designed with soft silicone cups has provided optimal means for ocular protection against blood-borne pathogens, spatter from foreign bodies, and now, against aerosols. By creating a seal around the orbit, the clinician benefits from comprehensive aerosol protection, while the adjustable spring hinges and wire core temples offer a customizable, secure fit. Additionally, the magnetic silicone eye cups are removable and easily cleaned, which follows appropriate PPE hygiene guidelines.
Finally, the use of a touchless loupe light system delivers high-intensity illumination while reducing the risk of cross contamination often observed when a contaminated examination glove might activate or inactivate a loupe light button. With the integration of an intuitive response for hands-free operation, the clinician’s head movements initiate the lighting system or deactivate the loupe light, thus reducing the risk of cross contamination often observed when a button is required for activation.
With the use of optimal illumination and safe, clear magnification, aerosol-protection loupe systems provide a promising forecast for abundant light and clarity ahead!
Tomorrow’s forecast
While the conversation around aerosol mitigation seems to be focused deeply on SARS-CoV-2 contraction, it is well understood that, as a generalization, the dental community now has an opportunity to employ a comprehensive approach to aerosol mitigation. This focus particularly highlights the importance of considering the feasibility of other future aerosol-transmitted diseases of bacterial, viral, or even fungal origin. Clinicians who have adapted the use of safe eye protection during this global health crisis have also prepared themselves well for additional protection against other potential aerosol-transmitted infections.
As the climate of infection control standards continues to evolve, and as expert predictions about transmission rates continue to leave epidemiologists guessing, one thing is certain: an ounce of preparation is worth a pound of cure. Be prepared and stay dry out there; together, we will make it through this storm!
Editor's note: This article appeared in the March 2022 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.
References
- Farrier SL, Farrier JN, Gilmour ASM. Eye safety in operative dentistry—a study in general dental practice. Br Dent J. 2006;200(4):218-223. doi:10.1038/sj.bdj.4813257
- Aboalshamat K, Daoud O, Mahmoud LA, et al. Practices and attitudes of dental loupes and their relationship to musculoskeletal disorders among dental practitioners. Int J Dent. 2020:8828709. doi:1155/2020/8828709
- Qing H, Yang Z, Shi M, Zhang Z. New evidence of SARS-CoV-2 transmission through the ocular surface. Graefes Arch Clin Exp Ophthalmol. 2021;259(6):1661-1662. doi:1007/s00417-020-04726-4
- Al-Mohaimeed MM. Comprehensive profiling through a cross-sectional assessment on the awareness about eye protection safety among dental professionals in Saudi Arabia. Ophthalmic Epidemiol. 2021:1-8. doi:1080/09286586.2021.1966808
- Lu CW, Liu XF, Jia ZF. 2019-nCoV transmission through the ocular surface must not be ignored. Lancet. 2020;395(10224):e39. doi:1016/S0140-6736(20)30313-5
