A Review of Aerosol Generation Mitigation in International Dental Guidance

Clare Robertson* (Corresponding Author), Janet E. Clarkson, Magaly Aceves Martins, Craig Ramsay, Derek Richards, Thibault Colloc, CoDER Working Group

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)
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Introduction: The coronavirus disease 2019 (COVID-19) led to the worldwide closure of dental practices or reduction of dental services. By the end of April 2020, governments and professional organisations were publishing recommendations or guidance for the reopening/restructuring of dental services. The aim of this study was to assess how dental aerosol-generating procedures (AGPs) were defined in international dental guidelines, what mitigation processes were advised, and whether they were linked to COVID-19 epidemiology.

Methods: Electronic searches of a broad range of databases, along with grey literature searches, without language restriction were conducted up to 13 July 2020. Recommendations for the use of face masks and fallow times with patients without COVID-19 were assessed against the deaths per 1 million population in the included countries and country income level using Pearson Chi-squared statistics.

Results: Sixty-three guidance documents were included. Most (98%) indicated that AGPs can be performed with patients without COVID-19 with caveats, including advice to restrict AGPs where possible, with 21% only recommending AGPs for dental emergencies. Face masks were recommended by most documents (94%), with 91% also specifying the use of goggles or face shields. Fallow periods for patients without COVID-19 were mentioned in 48% of documents, ranging from 2 to 180 minutes. There were no significant differences in recommendations for face masks or fallow time in patients without COVID-19 by country death rate (P = .463 and P = .901) or World Bank status (P = .504 and P = .835). Most documents
recommended procedural or environmental mitigations such as preprocedural
mouthwash (82%) and general ventilation (52%). Few documents provided underpinning evidence for their recommendations.

Conclusions: While the amount of high-quality direct evidence related to dentistry and COVID-19 remains limited, it is important to be explicit about the considered judgements for recommendations as well as generate new evidence to face this challenge.
Original languageEnglish
Pages (from-to)203-210
Number of pages8
JournalInternational Dental Journal
Issue number2
Early online date3 Jun 2021
Publication statusPublished - 1 Apr 2022

Bibliographical note

The COVID-19 Dental Services Evidence Review Working Group would like to thank and acknowledge the contribution of the following individuals for providing the advice and access to the international guidance documents necessary for this rapid review:

Colette Bridgman, Chief Dental Officer, Wales; Alonso Carrasco-Labra, Director, ADA Science & Research Institute; Riana Clarke, National Clinical Director Oral Health, New Zealand; Michael Donaldson, Chief Dental Officer, Northern Ireland; Tom Ferris, Chief Dental Officer, Scotland; Sara Hurley, Chief Dental Officer, England; Paulo Melo, COVID-19 Task Team Chair, FDI World Dental Federation; Timothy Ricks, Chief Dental Officer, US Public Health Service; James Taylor, Chief Dental Officer, Canada; Benoit Varenne, Dental Officer, World Health Organisation. Thanks also to Tif Qureshi for providing access to some international guidance documents.

The members of the COVID-19 Dental Services Evidence Review Working Group are grateful to for the help and support provided by Shona Floate, University of Glasgow; Anne Littlewood and Laura MacDonald from Cochrane Oral Health; David Felix, Postgraduate Dental Dean, NES; and colleagues from NES's Clinical Effectiveness workstream: Samantha Rutherford, Douglas Stirling, Michele West, and Linda Young.

All authors have approved the final article.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Data Availability Statement

Supplementary material associated with this article can be found in the online version at https://doi.org/10.1016/j. identj.2021.04.002.


  • Rapid review
  • Aerosol-generating procedures
  • Dental
  • international
  • guidelines
  • covid-19


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