key: cord-0972443-nfwy27ye authors: da Silva Nascimento, Allen Matheus; de Azevedo, Anne Karollyne Lima; de Sousa Menezes, Ana Beatriz title: High‐power laser and its implications in covid‐19 season date: 2020-12-16 journal: Oral Surg DOI: 10.1111/ors.12585 sha: 59ff916223199709ae24a4d0d695d18889d42f49 doc_id: 972443 cord_uid: nfwy27ye nan Dear editor, The dental community was forced to adapt to a new reality and seek new protocols that promote greater safety in care due to the pandemic of coronavirus disease 2019 (COVID-19) caused by acute acute respiratory syndrome severe coronavirus 2 (SARS-CoV-2). The main form of SARS-CoV-2 contagion occurs through respiratory droplets or contact transmission. However, there may be other routes of transmission of the disease, such as by means of aerosol particles. 1, 2 In this context, dental professionals have paramount importance in the control and prevention of this infection, as they deal in close relationship with the bucco and nasophayngeal area and work with equipment that produces aerosol, such as high-speed turbines, ultrasonic scrapers and air/water syringes. 1 Due to these aerosols, the average microbial load suspended in the air increases more than three times during dental procedures, compared to the previous period of the beginning of treatment. 3 These airborne particles, during and after procedures, can enter through the respiratory tract and connective membranes of the dentist, his assistants and patients, increasing the risk of COVID-19 1,4,2 contagion and when dispersed throughout the environment they can settle on surfaces up to 2 m away, as presented in the work of Miller and Micik. 4 In view of this scenario, it is important to emphasize the use of high-intensity laser therapy (HILT) which in dental procedures has several applications, such as endodontic treatments, root decontamination, treatment and prevention of dental caries, bone and soft tissue surgeries and may present air/water spray as a cooling system and thus produce aerosol. 2,5 Some HILT do not have a refrigeration system, however 5 , as presented in a pilot study conducted by Lopez et al (2015) , due to the increase in temperature generated in target cells, to the point of causing rupture of membranes, as well as pyrolysis and combustion, there is the formation of spray or ablation plume. 5 The analysis in research of the composition of this released material showed the presence of viral, fungal and bacterial agents. 6 In addition, the quantity and characteristic of vaporized cellular matter is determined by the type of laser used, the dose used and the type of tissue to be treated. [6] [7] [8] The HILT is considered a viable alternative in the search for less traumatic procedures that seek ways to replace high and low rotational instruments as a way to reduce the discomfort caused by vibration, noise and pressure of these equipments. 9,10 However, information regarding hilt vaporized material, such as dispersion distance, particle size, chemical and biological composition, is still scarce. Because there is inadequate knowledge, the most common biosafety methods can sometimes prove insufficient. The reality of the COVID-19 pandemic has brought the need for strategic rethinking to reduce contamination of the dental environment, since the professionals involved are groups at high risk of contagion. Therefore, it is necessary for the office to be a safe environment for both the professional and the patient and be prepared to prevent cross-infections. Furthermore, further research is needed on the infectious load suspended in the air caused by HILT as well as its dispersion, so that it is possible to evaluate whether more effective protection and prevention measures are necessary. In addition, studies comparing the spread of contaminants by the high-speed turbine and HILT may be important to contribute to the choice of a safer instrument to be used in this new scenario. Allen Matheus da Silva Nascimento https://orcid. org/0000-0001-6343-6408 Challenges of dentistry in the face of the covid-19 pandemic Restorative dentistry protocol for the health emergency COVID-19 Confirmation of spatter dispersion during dental work Air pollution and its control in the dental office High power laser use in the COVID-19 pandemic era in dentistry: tips for the readers Characterization of size-specific particulate matter emission rates for a simulated medical laser procedure-A pilot study Laser-generated air contaminants from medical laser applications: a state-of-the-science review of exposure characterization, health effects, and control Influence of biosafety materials of the laser output power Effects of Er: YAG laser in caries treatment: a clinical pilot study Investigational study of the use of Er: YAG laser versus dental drill for caries removal and cavity preparation-phase I