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ObjectivesAgainst the COVID-19 pandemic backdrop and potential disease transmission risk by dental procedures that can generate aerosol and droplets, this review aimed to identify which clinical dental procedures do generate droplets and aerosols with subsequent contamination, and for these, characterise their pattern, spread and settle.Data SourcesSix databases were searched and citation chasing undertaken (to 11/08/20).Study selectionScreening stages were undertaken in duplicate, independently, by two researchers. Data extraction was performed by one reviewer and verified by another.ResultsEighty-three studies met the inclusion criteria and covered: Ultrasonic scaling (USS, n=44), highspeed air-rotor (HSAR, n=31); oral surgery (n=11), slow-speed handpiece (n=4); air-water (triple) syringe (n=4), air-polishing (n=4), prophylaxis (n=2) and hand-scaling (n=2). Although no studies investigated respiratory viruses, those on bacteria, blood splatter and aerosol showed activities using powered devices produced the greatest contamination. Contamination was found for all activities, and at the furthest points studied. The operator’s torso operator’s arm, and patient’s body were especially affected. Heterogeneity precluded significant inter-study comparisons but intra-study comparisons allowed construction of a proposed hierarchy of procedure contamination risk: higher risk (USS, HSAR, air-water syringe [air only or air/water together], air polishing, extractions using motorised handpieces); moderate (slow-speed handpieces, prophylaxis with pumice, extractions) and lower (air-water syringe [water only] and hand scaling.ConclusionSignificant gaps in the evidence, low sensitivity of measures and variable quality limit firm conclusions around contamination for different procedures. However, a hierarchy of contamination from procedures can be proposed for challenge/verification by future research which should consider standardised methodologies to facilitate research synthesis.Clinical significanceThis manuscript addresses uncertainty around aerosol generating procedures (AGPs) in dentistry. Findings indicate a continuum of procedure-related aerosol generation rather than the current binary AGP or non-AGP perspective. This informs discussion around AGPs and direct future research to help support knowledge and decision making around COVID-19 and dental procedures.

The Hall Technique (HT), Non-Restorative Cavity Control (NRCC) and conventional carious tissue removal and restoration (CR) are strategies for managing cavitated caries lesions in primary molars. A randomized controlled three-arm parallel group trial in a university clinic in Germany was used to measure the cost-effectiveness of these strategies. 142 children (HT: 40; NRCC: 44; CR: 58) were followed over a mean 2.5 years. A German healthcare perspective was chosen. The primary outcome was estimated molar survival; secondary outcomes were not needing extraction, not having pain or needing endodontic treatment/extraction, or not needing any re-intervention at all. Initial, maintenance and endodontic/restorative/extraction re-treatment costs were derived from fee items of the statutory insurance. Cumulative cost-effectiveness and cost-effectiveness acceptability were estimated from bootstrapped samples. HT molars survived longer (estimated mean; 95% CI: 29.7; 26.6–30.5 months) than NRCC (25.3; 21.2–28.7 months) and CR molars (24.1; 22.0–26.2 months). HT was also less costly (66; 62–71 Euro) than NRCC (296; 274–318 Euro) and CR (83; 73–92 Euro). HT was more cost-effective than NRCC and CR in >96% of samples, and had acceptable cost-effectiveness regardless of a payer’s willingness-to-pay. This superior cost-effectiveness was confirmed for secondary health outcomes. Cost-advantages were even more pronounced when costs were calculated per year of tooth retention (mean annual costs were HT: 29, NRCC: 154, CR: 61 Euro). HT was more cost-effective than CR or NRCC for managing cavitated caries lesions in primary molars, yielding better dental health outcomes at lower costs. If choosing between these three strategies for managing cavitated caries lesions in primary molars, dentists should prefer HT over NRCC or CR. This would also save costs for the healthcare payer.

This satellite symposium was the fifth in a series for editors, publishers, reviewers and all those with an interest in scientific publishing. It was held on Wednesday, 11 March 2015 at the IADR meeting in Boston, Massachusetts. The symposium attracted more than 210 attendees. The symposium placed an emphasis on strategies to ensure that papers are accepted by peer reviewed journals. The speaker, representing the Journal of Dental Research gave a history of peer review and explained how to access material to advise new authors. The speaker from India outlined the problems that occur when there is no culture for dental research and it is given a low priority in dental education. He outlined remedies. The speaker from SAGE publications described the help that publishers and editors can provide authors. The final speaker suggested that in developing countries it was essential to create alliances with dental researchers in developed countries and that local conferences to which external speakers were invited, stimulated research both in terms of quantity and quality. A wide ranging discussion then took place.