The highest congruency between observational and interview data was found in the domain of aerosol and ventilation control. Aerosol and ventilation control was the weakest domain in observations and was most commonly mentioned as a concern by participants. Reports cited limited exhaust capacity, lack of consistent suction support and a marked decrease in aerosol precautions versus practices during the pandemic. One participant mentioned lack of infrastructure and staff awareness, saying that she did not know what a ‘aerosol’ was at the beginning. This is a significant problem as dental procedures frequently result in saliva, blood and spatter within the breathing zone. Harrel and Molinari [35] identified aerosols and splatter as major IPC challenges in dentistry prior to COVID-19. Recent studies by Samaranayake et al., Vernon et al., Choudhary et al., and Cao et al. have demonstrated that layered mitigation strategies (high-volume evacuation, rubber dam isolation, ventilation, air cleaning and procedural controls) are more effective than single interventions [36-39]. The broader literature on airborne transmission emphasizes the critical importance of ventilation and air cleaning wherever respiratory aerosols may be present [40,41]. Given this evidence, poor aerosol control in this context should be seen as a structural safety gap and investment focused on this area is likely to deliver greatest risk reduction.

The study found the strongest agreement between observational and interview data regarding aerosol and ventilation control, which emerged as the weakest domain in practice and the most frequently cited concern among participants. Key issues included insufficient exhaust capacity, inconsistent suction support, and reduced aerosol precautions compared to pandemic-era practices, with some staff lacking basic knowledge about aerosols. This represents a critical safety concern since dental procedures regularly generate saliva, blood, and spatter in the breathing zone. While research has established that layered mitigation strategies (combining high-volume evacuation, rubber dam isolation, ventilation, air cleaning, and procedural controls) are more effective than single interventions, and broader literature emphasizes ventilation's importance for airborne transmission control, the observed poor aerosol control constitutes a significant structural safety gap requiring targeted investment for maximum risk reduction.