During surgical procedures that use a laser or electrosurgical unit, the thermal destruction of tissue creates a smoke byproduct. Laser plumes or surgical smoke represent another potential risk for DHCP. Lasers transfer electromagnetic energy into tissues, resulting in the release of a heated plume that includes particles, gases (eg, hydrogen cyanide, benzene and formaldehyde), tissue debris, viruses, and offensive odors. One concern is that aerosolized infectious material in the laser plume might reach the nasal mucosa of the laser operator and adjacent DHCP. No evidence indicates that HIV or HBV have been transmitted through aerosolization and inhalation. While there is no evidence that infections have been transmitted through plumes or smoke, there are some viruses and bacteria such as human papilloma virus, HIV, coagulase-negative Staphylococcus, Corynebacterium species and Neisseria species that have been detected in laser plumes.
Laser/Electrosurgery Plumes/Surgical Smoke
1. No recommendation is offered regarding practices to reduce DHCP exposure to laser plumes/surgical smoke when using lasers in dental practice.
2. Practices to reduce HCP exposure to laser plumes/surgical smoke have been suggested, including use of:
a. Standard precautions (eg, high-filtration surgical masks and possibly full face shields);
b. Central room suction units with in-line filters to collect particulate matter from minimal plumes;
c. Dedicated mechanical smoke exhaust systems with a high efficiency filter to remove substantial amounts of laser-plume particles.