Dentists & COVID-19 – Everything You Need To Know

The global emergency in a nutshell

COVID-19, which is now deemed a pandemic by the World Health Organization has infected 181 countries & territories out of 197 countries (Fig 1), and 1 international conveyance (the Diamond Princess cruise ship harboured in Yokohama, Japan)1. The number of cases are rising by the hour and the numbers are huge. However, getting the virus does not mean inevitable death as the case fatality rate is estimated to be 0.25-3% 2.

Worldwide common appeal to dentists

In the light of the COVID‐19 outbreak, the Indian Dental Association (IDA) has issued an advisory wherein they strongly recommend all the dentists practicing in the country to voluntarily suspend non‐essential or non‐urgent dental care up to at least 31st March 2020. The Govt. of India has advised the same, and so have all Indian state dental councils.

Globally, most national dental associations, including US & Europe is recommending that dentists must postpone elective procedures until further notice.

To work or not to work?

Dentists worldwide are facing this unique question and arguments are being put forth.

Reasons cited to not work 3 –

1. Risk of nosocomial infection in dental settings –

• Dental patients who cough or sneeze on the chair or in waiting area
• The use of a high-speed handpiece or ultrasonic instruments makes patients’ secretions, saliva, or blood aerosolize to the surroundings - large number of droplets and aerosols are generated
• Dental apparatus could be contaminated with various pathogenic microorganisms after use.
• Infections can occur through the puncture of sharp instruments or direct contact between mucous membranes and contaminated hands.

2. Compliance with higher authorities who have issued these guidelines and directives.

Reasons cited to continue work 4 –

1. Ethics –

A. “Hospitals are open and medical doctors are working even when they are at a high risk. If they can show courage to treat infected patients, why not us?”

B. “ I’ve already given appointments to patients living in faraway towns.”

2. Finances –

A. “Most of us depend on our clinic revenue for a living. We have monthly rents and EMI’s to pay, monthly salaries to give.”

B. “I’ve already given appointments to my implant/FMR/ortho cases.”

3. Need of a global lockdown –

“If I shut down for 2 weeks but if everything else is still open, the virus will still progress. Then I’ll be asked close down for another 2 weeks. There must be a national or global 2 week quarantine. Everything shuts down for 2 weeks, everyone stays home and anyone with symptoms goes to a mobile testing station.”

I understand that it breaks our heart to not treat our patients. But sometimes, it is wiser to not work in order to safeguard those very same patients. My opinion is - barring emergency procedures, avoid any other treatments, even if lucrative, as this risks the patient, your team, your other patients, your family and yourself.

Remember that this is a temporary state and not a permanent decision. You may open your clinic for an hour or two daily for dental emergency patients only with strict infection protocol.

Taking care of dental emergency during a global emergency

Let us understand this in detail. This has specially been written keeping the COVID-19 pandemic in mind, however it can be used for any other such event in the future too. There are 2 main parts to this -

1. Who is a dental emergency patient? A patient with -

• Severe toothache/ pain (not just a twinge)
• Swelling of gums, face, or neck
• Bleeding in mouth that does not stop
• Infection or a substantial risk of it
• Trauma (such as a broken tooth)

2.What is a strict infection protocol?

We can simply adopt the dental clinic infection protocol straight from Wuhan, China 5. Even though this was the birthplace of the novel coronavirus, they continued emergency dental treatments and reported no new cases from their dental clinic. For this, you have to alter the design of your dental clinic like the dental department of Wuhan University did (Fig. 2). You may use temporary partitions for this.

1. Waiting cum Triage area – In the yellow area, establish precheck triages. Your triage staff in this area should wear disposable surgical mask, cap, and work clothes. While patients and their accompanying persons should be given medical masks. Triage staff should ask patients questions about the health status and history of contact or travel.6 They should measure and record the temperature of every staff and patient as a routine procedure.

Patients with fever should be registered and referred to designated hospitals. If a patient has been to epidemic regions within the past 14 days, a quarantine for at least 14 days should be suggested to him.