Dental Implications during COVID –19 (Coronavirus)

The ongoing spread of severe acute respiratory coronavirus disease (COVID -19) has held the entire national as well as the international community to ransom and caused widespread health concerns. In spite of global efforts to contain the disease, the flare up of the virus is still on the rise because of the spread pattern of this infection through nasopharyngeal or salivary secretions of the affected patients.

Dental professionals or other health care professionals may encounter patients with suspected or confirmed Covid-19 infection and will have to act diligently not only to provide care but at the same time prevent the spread of infection.

Certain measures for prevention of COVID19 infection and dental patient management

Certain specific measures for dental patient management during this covid-19 outburst are discussed as under.

1. Initial screening: Initial screening should be done via telephone. It will help in instructing your patients having symptoms of a respiratory infection (cough, sore throat, fever, sneezing, or shortness of breath) or any travel history to covid-19 inflicted countries to reschedule their dental appointment and call their physician.

2. Detailed patient evaluation: Patients should complete a detailed medical history form, COVID-19 screening feedback form. Dental professionals should measure the patient’s body temperature using a forehead infrared thermometer. Take the contact details and address of all patients treated.

3. Therapeutic management and video conferencing: In case of suspected or confirmed cases of COVID19 infections needing urgent dental care for conditions like tooth pain and/or swelling, certain pharmacological management in the form of antibiotics and/or analgesics is an alternative. In case of follow ups, you can very well do telephonic or video conferencing.

4. PPE (Personal Protective Equipment): Personal protective equipment should be used while performing procedures. PPE includes gown, mask, goggles/ face shield. It protects the skin and mucous membranes from exposure to infectious materials in spray or spatter. It should be worn whenever there is potential for contact with spray or spatter. One should follow recommended sequences for PPE donning and removal.

5. Negative-pressure treatment rooms/ airborne infection isolation rooms (AIIRs): It is worth noting that patients with suspected or confirmed COVID-19 infection should not be treated in a routine dental practice setting. Instead, this subset of patients should only be treated in negative-pressure rooms or AIIRs.

6. Autoclaving and use of rubber dam/ high speed evacuation: Autoclaving plays an important role. Autoclave your hand pieces after doing each and every patient or use disposable handpieces. Use of rubber dam is recommended to decrease the possible exposure of infectious agents. Use of high speed evacuation should be done for the removal of aerosols during certain dental procedures.

7. Mouth rinse with 0.5-1% hydrogen peroxide: Tell your patients to do mouth rinse with 0.5-1% hydrogen peroxide before each appointment as it has non-specific virucidal activity against corona viruses.

8. Use of disinfectants and physical blockades: Every dental professional should use disinfectants to clean the door handles, chairs and washrooms. Physical barriers such as glass windows or plastic barriers should be installed in the reception areas to limit close contact with potentially infectious patients.

In conclusion, health care professionals have a responsibility to protect the general public and maintain high standards of care and infection control. Educate the public to prevent panic while promoting the health and well-being of our patients during these challenging times.

Written by: Dr. Rashi Sharma (Oral Pathologist & Microbiologist)