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产生气溶胶的牙科、口腔颌面和骨科手术会导致疾病传播吗?对当前新冠疫情的启示。

Can aerosols-generating dental, oral and maxillofacial, and orthopedic surgical procedures lead to disease transmission? An implication on the current COVID-19 pandemic.

作者信息

Al-Moraissi Essam Ahmed, Kaur Amanjot, Günther Frank, Neff Andreas, Christidis Nikolaos

机构信息

Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Dhamar, Yemen.

Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, India.

出版信息

Front Oral Health. 2022 Aug 1;3:974644. doi: 10.3389/froh.2022.974644. eCollection 2022.

Abstract

Various dental, maxillofacial, and orthopedic surgical procedures (DMOSP) have been known to produce bioaerosols, that can lead to the transmission of various infectious diseases. Hence, a systematic review (SR) aimed at generating evidence of aerosols generating DMOSP that can result in the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), further investigating their infectivity and assessing the role of enhanced personal protective equipment (PPE) an essential to preventing the spreading of SARS-CoV-2 during aerosol-generating procedures (AGPs). This SR was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) guidelines based on a well-designed Population, Intervention, Comparison, Outcomes and Study (PICOS) framework, and various databases were searched to retrieve the studies which assessed potential aerosolization during DMOSP. This SR included 80 studies (59 dental and 21 orthopedic) with 7 SR, 47 humans, 5 cadaveric, 16 experimental, and 5 animal studies that confirmed the generation of small-sized < 5 μm particles in DMOSP. One study confirmed that HIV could be transmitted by aerosolized blood generated by an electric saw and bur. There is sufficient evidence that DMOSP generates an ample amount of bioaerosols, but the infectivity of these bioaerosols to transmit diseases like SARS-CoV-2 generates very weak evidence but still, this should be considered. Confirmation through isolation and culture of viable virus in the clinical environment should be pursued. An evidence provided by the current review was gathered by extrapolation from available experimental and empirical evidence not based on SARS-CoV-2. The results of the present review, therefore, should be interpreted with great caution.

摘要

已知各种牙科、颌面和整形外科手术(DMOSP)会产生生物气溶胶,这可能导致各种传染病的传播。因此,一项系统评价(SR)旨在提供产生气溶胶的DMOSP的证据,这些手术可能导致严重急性呼吸综合征冠状病毒2(SARS-CoV-2)的传播,进一步研究其传染性,并评估增强个人防护装备(PPE)在气溶胶产生手术(AGP)期间预防SARS-CoV-2传播中的作用。本系统评价是根据系统评价和Meta分析的首选报告项目声明(PRISMA)指南,基于精心设计的人群、干预措施、对照、结局和研究(PICOS)框架进行的,并检索了各种数据库以获取评估DMOSP期间潜在气溶胶化的研究。本系统评价纳入了80项研究(59项牙科研究和21项骨科研究),其中包括7项系统评价、47项人体研究、5项尸体研究、16项实验研究和5项动物研究,这些研究证实了DMOSP中会产生小于5μm的小颗粒。一项研究证实,HIV可通过电锯和牙钻产生的雾化血液传播。有充分证据表明DMOSP会产生大量生物气溶胶,但这些生物气溶胶传播SARS-CoV-2等疾病的传染性证据非常薄弱,但仍应予以考虑。应通过在临床环境中分离和培养活病毒来进行确认。本综述提供的证据是通过从现有实验和经验证据推断得出的,并非基于SARS-CoV-2。因此,对本综述的结果应极为谨慎地进行解读。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f69/9376374/5f7424995c0e/froh-03-974644-g0001.jpg

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