One split‐mouth RCT (10 participants) receiving dental treatment, found that there may be a reduction in CFU with rubber dam at one‐metre (MD −16.20, 95% CI −19.36 to −13.04) and two‐metre distance (MD −11.70, 95% CI −15.82 to −7.58). However, an 'n of 1' design study showed that the combination system may reduce CFU compared with rubber dam plus HVE (MD −125.20, 95% CI −174.02 to −76.38) or HVE (MD −109.30, 95% CI −153.01 to −65.59).
One RCT (50 participants) found that there may be no difference in CFU between a combination system (Isolite) and a saliva ejector (low‐volume evacuator) during AGPs (MD −0.31, 95% CI −0.82 to 0.20) or after AGPs (MD −0.35, −0.99 to 0.29). One split‐mouth RCT (six participants) found that HVE may not be more effective than conventional dental suction (saliva ejector or low‐volume evacuator) at 40 cm (MD CFU −2.30, 95% CI −5.32 to 0.72) or 150 cm (MD −2.20, 95% CI −14.01 to 9.61). Use of a high‐volume evacuator (HVE) may reduce bacterial contamination in aerosols less than one foot (~ 30 cm) from a patient's mouth (MD −47.41, 95% CI −92.76 to −2.06 3 split‐mouth RCTs, 122 participants very high heterogeneity I² = 95%), but not at longer distances (MD −1.00, −2.56 to 0.56 1 RCT, 80 participants). Moreover, we do not know the 'minimal clinically important difference' in CFU. The results presented below should be interpreted with caution as the evidence is very low certainty due to heterogeneity, risk of bias, small sample sizes and wide confidence intervals. Two studies measured contamination per volume of air sampled at different distances from the patient's mouth, and 14 studies sampled particles on agar plates at specific distances from the patient's mouth. All studies measured bacterial contamination using the surrogate outcome of colony‐forming units (CFU). Eight studies had high risk of bias eight had unclear risk of bias. We included 16 studies with 425 participants aged 5 to 69 years.
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