Dental periodontal procedures: a systematic review of contamination (splatter, droplets and aerosol) in relation to COVID-19

Introduction: The COVID-19 pandemic has significantly affected routine dentistry, particularly periodontal care. This systematic review examined literature on splatter, droplet settle and aerosol contamination from periodontal procedures relevant to COVID-19. Methods: Systematic searches (Medline, Embase, CENTRAL, Scopus, Web of Science, LILACS, ClinicalTrials.gov) identified studies measuring contamination linked to periodontal treatments. Screening and data extraction were conducted in duplicate; methodological quality and sensitivity were assessed, and narrative synthesis undertaken. Results: Fifty studies met inclusion: ultrasonic scaling (n=44), air polishing (n=4), prophylaxis (n=2), and hand scaling (n=3). Outcomes included bacterial (e.g., CFUs), blood, and non-bacterial/non-blood tracers. All studies detected contamination at all sampled sites; hand scaling contamination was very low. Contamination occurred even with suction at baseline, and higher power settings increased contamination. Contamination patterns varied with operator position and was found on operator, patient, and assistant; higher levels were around the operator’s head and the patient’s mouth and chest. Settled splatter was identified up to 30 minutes post-procedure. Conclusion: Ultrasonic scaling, air polishing and prophylaxis generate splatter, droplets, and aerosol even with suction, with some droplets taking 30–60 minutes to settle. Infection control, enhanced cleaning around the patient, and appropriate PPE (especially respiratory, facial and body protection) are recommended; lower device power settings should be considered to reduce contamination amount and spread.