OBJECTIVES. Many dental procedures are responsible for the creation of an aerosol capable of transporting bacteria, virus and infected particles into the surrounding environment. The use of handpieces and/or ultrasonic devices creates an aerosol of particles with different diameters that present a severe risk for nasal and tracheobronchial cavities. This deposition of particles occurs on different levels, depending on their dimensions: particles with larger diameter stops in the nasal cavities, while the smaller ones end up in lung alveoli. These aerosol particles have their own movement, partly caused by the displacement of air masses and by the Brownian motions produced by the impact of the gaseous particles against the aerosol ones. Since these droplets are able to persist continuously for long time in environments where patients and procedures follow and overlap over the course of a day, it is essential for dental clinicians to adopt personal protective equipment, among which the choice of an appropriate mask. The aim of this literature overview is to clarify the terminology, the criteria for the construction of a mask, to illustrate the differences between masks and oral respirators. and to provide practical support for personal and patient protection, choosing the device suitable for each clinical situation. MATERIALS AND METHODS. This work is a literature review of the national and international literature on this topic: the scientific data published since mask introduction to date have been collected, and the characteristics, differences and clinical indications for the use of masks and oral respirators in dentistry have been analyzed. CONCLUSIONS. The surgical mask and the respirator are individual devices that meet specific standards and whose use must always be combined with other PPE such as screens and protective glasses, headgear, gloves, disposable gowns and of course a careful personal hygiene. The importance of examining the technical data sheet referring to the devices used, in order to check the necessary strict adherence to the reference protocols, must always be underlined. To date there are still conflicting opinions on what the correct indication may be on the type of respirator to be used to prevent contagion from Sars-CoV-2. Respirators without a filter-valve seem to be the devices capable of providing the highest protection to the operator and patient but, precisely because of their high filtering capacity, they make breathing difficult if worn for a long time continuously. To improve respiratory capacity and therefore to seek greater comfort, the use of a high filter respirator with exhalation valve, in association with a surgical mask to be applied on it, is conceivable. However, surgical masks remain valid devices for all those services that do not involve the creation of highly infected aerosols and the consequent dispersion of potentially contaminated particles in the air. Finally, to limit the spread of Covid-19 as much as possible, anyone should wear a surgical mask, so that an infected person cannot contaminate the surrounding environment and people nearby. CLINICAL SIGNIFICANCE. This work highlights the characteristics of surgical masks and oral respirators, providing practical indications on the most suitable devices for protection from Covid-19 infection.

OBIETTIVI. Sono numerose le procedure odontoiatriche in grado di creare un aerosol capace di trasportare batteri, virus e particelle inquinate nell’ambiente circostante. L’utilizzo di una turbina o di uno strumento ultrasonico va a creare una sospensione di particelle di vario diametro che presenta un serio rischio infettivo per le cavità nasali e tracheo-bronchiali. Questa deposizione di particelle avviene su differenti livelli a seconda delle loro dimensioni, dove le più grosse vengono fermate nelle cavità nasali, mentre le più piccole finiscono negli alveoli polmonari. Queste particelle aerosoliche hanno un proprio movimento, anche di alcuni metri, in parte causato dallo spostamento di masse d’aria e dai moti browniani prodotti dall’urto delle particelle gassose contro quelle aerosoliche. Poiché questa nube aerosolica persiste e si alimenta continuativamente in ambienti dove pazienti e procedure si susseguono e si sovrappongono nell’arco di una giornata, è fondamentale da parte degli operatori l’utilizzo di dispositivi di protezione individuale, fra i quali appare preminente la scelta di una mascherina appropriata. L’obiettivo di questo lavoro è di chiarire la terminologia,i criteri di costruzione di una mascherina, di illustrare le differenze tra mascherine e respiratori orali e di fornire un supporto pratico per la protezione propria e dei pazienti, scegliendo il dispositivo adatto a ogni situazione clinica. MATERIALI E METODI. In questo lavoro è stata condotta una revisione della letteratura nazionale e internazionale sull’argomento, sono stati raccolti i dati scientifici pubblicati dall’introduzione delle mascherine fino a oggi e vengono descritte le caratteristiche, le differenze e le indicazioni cliniche all’uso di mascherine e respiratori orali nel contesto odontoiatrico. CONCLUSIONI. La mascherina chirurgica e il respiratore sono presidi individuali che soddisfano standard specifici e il cui utilizzo va sempre abbinato ad altri DPI quali schermi e occhiali protettivi, copricapo, guanti, camici monouso e naturalmente a un’attenta igiene personale. Va sempre sottolineata l’importanza di esaminare la scheda tecnica riferita ai dispositivi utilizzati, al fine di controllare la necessaria stretta aderenza ai protocolli di riferimento. Ad oggi vi sono ancora pareri discordanti su quale possa essere l’indicazione corretta sulla tipologia di respiratore da utilizzare per prevenire il contagio da Sars-CoV-2. I respiratori senza filtro-valvola sembrano i dispositivi in grado di fornire la protezione più alta a operatore e paziente, ma proprio per la loro alta capaci-tà di filtraggio rendono difficile la respirazione se portati per lungo tempo continuativamente. Per migliorare la capacità respiratoria e quindi per ricercare un maggior comfort è ipotizzabile l’utilizzo di un respiratore ad alto filtraggio con valvola di esalazione, in associazione a una mascherina chirurgica da applicarvi sopra. Le mascherine chirurgiche rimangono comunque dei validi presidi per tutte quelle prestazioni che non comportano creazione di aerosol altamente infetti e conseguente dispersione di particelle potenzialmente contaminate nell’aria. Infine, per limitare il più possibile la diffusione del Covid-19, chiunque dovrebbe indossare una mascherina chirurgica, in modo tale che un soggetto infetto non possa contaminare l’ambiente circostante e le persone vicine. SIGNIFICATO CLINICO. Questo contributo mette in evidenza le caratteristiche di mascherine chirurgiche e respiratori orali, fornendo indicazioni pratiche sui dispositivi più idonei alla protezione da infezione da Covid-19.

Surgical masks vs respirators: properties and indications for use / Checchi, V; Checchi, L. - In: DENTAL CADMOS. - ISSN 0011-8524. - 88:7(2020), pp. 436-447. [10.19256/d.cadmos.07.2020.06]

Surgical masks vs respirators: properties and indications for use

Checchi, V
;
2020

Abstract

OBJECTIVES. Many dental procedures are responsible for the creation of an aerosol capable of transporting bacteria, virus and infected particles into the surrounding environment. The use of handpieces and/or ultrasonic devices creates an aerosol of particles with different diameters that present a severe risk for nasal and tracheobronchial cavities. This deposition of particles occurs on different levels, depending on their dimensions: particles with larger diameter stops in the nasal cavities, while the smaller ones end up in lung alveoli. These aerosol particles have their own movement, partly caused by the displacement of air masses and by the Brownian motions produced by the impact of the gaseous particles against the aerosol ones. Since these droplets are able to persist continuously for long time in environments where patients and procedures follow and overlap over the course of a day, it is essential for dental clinicians to adopt personal protective equipment, among which the choice of an appropriate mask. The aim of this literature overview is to clarify the terminology, the criteria for the construction of a mask, to illustrate the differences between masks and oral respirators. and to provide practical support for personal and patient protection, choosing the device suitable for each clinical situation. MATERIALS AND METHODS. This work is a literature review of the national and international literature on this topic: the scientific data published since mask introduction to date have been collected, and the characteristics, differences and clinical indications for the use of masks and oral respirators in dentistry have been analyzed. CONCLUSIONS. The surgical mask and the respirator are individual devices that meet specific standards and whose use must always be combined with other PPE such as screens and protective glasses, headgear, gloves, disposable gowns and of course a careful personal hygiene. The importance of examining the technical data sheet referring to the devices used, in order to check the necessary strict adherence to the reference protocols, must always be underlined. To date there are still conflicting opinions on what the correct indication may be on the type of respirator to be used to prevent contagion from Sars-CoV-2. Respirators without a filter-valve seem to be the devices capable of providing the highest protection to the operator and patient but, precisely because of their high filtering capacity, they make breathing difficult if worn for a long time continuously. To improve respiratory capacity and therefore to seek greater comfort, the use of a high filter respirator with exhalation valve, in association with a surgical mask to be applied on it, is conceivable. However, surgical masks remain valid devices for all those services that do not involve the creation of highly infected aerosols and the consequent dispersion of potentially contaminated particles in the air. Finally, to limit the spread of Covid-19 as much as possible, anyone should wear a surgical mask, so that an infected person cannot contaminate the surrounding environment and people nearby. CLINICAL SIGNIFICANCE. This work highlights the characteristics of surgical masks and oral respirators, providing practical indications on the most suitable devices for protection from Covid-19 infection.
2020
88
7
436
447
Surgical masks vs respirators: properties and indications for use / Checchi, V; Checchi, L. - In: DENTAL CADMOS. - ISSN 0011-8524. - 88:7(2020), pp. 436-447. [10.19256/d.cadmos.07.2020.06]
Checchi, V; Checchi, L
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1211645
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