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The probability of transmission of airborne infectious diseases to dental healthcare workers (DHWs) was modeled using a modified version of the Wells–Riley equation, incorporating indoor air quality (using CO2 as a proxy) and respiratory protection rates from masks. The highest transmission probability was found in high-risk scenarios for measles virus (100%), SARS-CoV viruses (99.4%), influenza virus (89.4%), and tuberculosis (84.0%). The probability of transmission of the modeled pathogens in the low-risk scenarios was low, but higher for airborne viral pathogens than bacterial. Transmission of coronaviruses remain low when a DHW is exposed to a patient with low infectivity, but an increase in infectivity or indoor CO2 increases transmission risk to 52.6% and 99.4%, respectively. The sensitivity analyses estimated that changes in indoor air quality had the strongest influence on probability of pathogen transmission.
Based on the results of this study, the authors conclude that the risk for transmission of tuberculosis in the dental clinic is low, while the risk for measles virus is high. Risk for transmission of coronaviruses is comparable to that of influenza. The CO2 level in the dental clinic has the strongest influence on transmission probability, a fact that stresses the importance of continuous air changes in this setting.
– Laurie C. Carter, DDS, PhD
This abstract is available on the publisher's site.
Dental health care workers are in close contact to their patients and are therefore at higher risk for contracting airborne infectious diseases. The transmission rates of airborne pathogens from patient to dental health care workers are unknown. With the outbreaks of infectious diseases, such as seasonal influenza, occasional outbreaks of measles and tuberculosis, and the current pandemic of the coronavirus disease COVID-19, it is important to estimate the risks for dental health care workers. Therefore, the transmission probability of these airborne infectious diseases was estimated via mathematical modeling. The transmission probability was modeled for Mycobacterium tuberculosis, Legionella pneumophila, measles virus, influenza virus, and coronaviruses per a modified version of the Wells-Riley equation. This equation incorporated the indoor air quality by using carbon dioxide as a proxy and added the respiratory protection rate from medical face masks and N95 respirators. Scenario-specific analyses, uncertainty analyses, and sensitivity analyses were run to produce probability rates. A high transmission probability was characterized by high patient infectiousness, the absence of respiratory protection, and poor indoor air quality. The highest transmission probabilities were estimated for measles virus (100%), coronaviruses (99.4%), influenza virus (89.4%), and M. tuberculosis (84.0%). The low-risk scenario leads to transmission probabilities of 4.5% for measles virus and 0% for the other pathogens. From the sensitivity analysis, it shows that the transmission probability is strongly driven by indoor air quality, followed by patient infectiousness, and the least by respiratory protection from medical face mask use. Airborne infection transmission of pathogens such as measles virus and coronaviruses is likely to occur in the dental practice. The risk magnitude, however, is highly dependent on specific conditions in each dental clinic. Improved indoor air quality by ventilation, which reduces carbon dioxide, is the most important factor that will either strongly increase or decrease the probability of the transmission of a pathogen.