Coronavirus disease 2019, which is also known as COVID-19, developed in November 2019 in the city of Wuhan has impact on dentistry.. The World Health Organization (WHO) had declared it a global pandemic. The main pathogen which is causing the infection is called the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). But the new COVID-19 virus mutation is different from SARS-CoV, it uses the same host receptor, namely human angiotensin-converting enzyme 2 (ACE2).
Why is dentistry at risk?
The role of saliva plays an important role in the transmission of COVID-19. Dentist and dentistry practice requires aerosol generated procedures which may be a direct cause of infection to dentists which can be a suspected case of surveillance. Therefore we can easily say that the dentistry profession is at severe risk.In bronchoscopy as we inhale airborne particles and aerosols which are produced during dental procedures on patients with COVID-19 can be very risky where dentistry and dental practices are completely exposed to COVID-19. Therefore, it is very important for dentists to properly implement all preventive strategies to avoid COVID-19 infections. The main focus for the dentist should be proper hand hygiene by means of hand sanitizers mainly 99 percent alcohol-based, proper patient placements in the dental chair, and use of proper personal protective equipment kit (PPE Kit).
|COVID-19: Dentistry and the new Coronavirus|
There is a high risk of cross infections between dentistry practitioners and patients. For dentistry practices and hospitals all over the world (the outbreak is pandemic), very strict and effective infection control protocols are urgently needed. There are different new dental procedures where a large number of droplets and aerosols are generated, the standard protective measures in daily clinical work are not effective enough to prevent the spread of COVID-19, especially when patients are in the incubation period, they could not recognize that they are infected or not.
How a dentist can protect themselves and their patients?
Palm and hand , elbow hygiene has been considered the most critical measure for reducing the risk of transmitting the virus to patients. SARS-CoV-2 can persist on surfaces for a few hours or up to several days, depending on the type of surface, the temperature, or the humidity of the environment (WHO 2020c). This reinforces the need for a good hand and elbow hygiene and the importance of thorough disinfection of all surfaces within dental clinics. Every surface in the waiting room must be considered at risk; therefore, in addition to providing adequate periodic air exchange, all surfaces, chairs, magazines, and doors that come into contact with healthcare professionals and patients must be considered “potentially infected”. It may be useful to make alcoholic disinfectants and masks available to patients in waiting rooms. The entire air conditioning system must be sanitized very frequently. Proper washing of fingers, nails, nose, and eyes are essential.
The use of PPE kit (including masks, gloves, gowns with goggles, and face coverings) is recommended to protect skin and mucosa from (potentially) infected blood or secretions. As respiratory droplets are the main route of SARS-CoV-2 transmission, particulate respirators (e.g., N-95 masks authenticated by the National Institute for Occupational Safety and Health or FFP2-standard masks set by the European Union) are recommended for the routine dentistry practice.
In some countries dental offices have been closed during the epidemic, a large number of emergency patients still go to dental clinics and hospitals for treatment. In all these cases, the most recommended guidelines indicate that a dentist should avoid patients with fever and symptoms of COVID-19.
Patient management decisions
In order to perform a clinically- and ethically-driven decision-making process, dental interventions can be divided into the following categories:
- Management of life-threatening conditions;
- Severe conditions managed with invasive procedures without aerosol generation.
- Severe conditions managed with invasive and/or aerosol-generating procedures;
- Not-urgent procedures;
- Elective and nonelective procedures.
- These considerations should be assessed before starting any urgent treatment.
- Operative procedures should be less invasive as possible and aerosol-generation procedure should be avoided whenever possible;
Disposable devices and instrumentation needed to be used whenever possible to limit the risk of cross-infection;
Potential viral load in patients’ saliva could be reduced with 0.23% povidone-iodine mouthwash for 15 s before intervention ( Eggers et al., 2018);
Isolation with rubber dam should be used whenever possible to limit the spread of microorganisms (Cochran et al., 1989);
Intraoral radiographs should be minimized and use of extraoral imaging technique should be used in order to reduce salivation and gag reflex;
If pharmacologic management of pain is necessary, ibuprofen should be avoided in suspected and confirmed COVID-19 cases ( Day, 2020). (in Alharbi et al, 2020)