Interim guidance for Essential Oral Health Services Amid COVID19 – WHO

Transmission of SARS-CoV-2: implications for infection prevention precautions

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It is very important for the effective prevention of oral problems and self-care during this COVID-19 pandemic. Let us take a look at specific needs and considerations for essential oral health services in this context in accordance with WHO operational guidance on maintaining essential health services. Advising the patients through remote consultation or social media plays a vital role. Transmission of SARS-CoV-2, the virus that causes COVID19, can occur through direct, indirect, or close contact with infected people through infected secretions such as saliva and respiratory secretions or through their respiratory droplets, which are > 5-10 μm in diameter.

Droplets <5μm in diameter are referred to as droplet nuclei or aerosols. [Know in detail about Aerosol-generating procedures (AGPs) in the attached document]. When AGP cannot be avoided, assistance during procedures (four-handed dentistry), the use of high-speed suction and of a rubber dam, when possible, as well as the use of appropriate PPE – including a fit tested N95 or FFP2 respirator, or higher have to be ensured.

Carrying out one cycle of standard cleaning and disinfection according to the standard operating procedures (SOP) of the entire treatment area (environmental surfaces) after every patient in the context of COVID-19 is mandatory. Single visit procedures are to be prioritized to avoid re-call visits. Gain awareness regarding management of health care waste following best practices, reprocessing, routine policies and procedures.

COVID-19 is transmitted mainly in three ways in oral health care settings:

1. Direct transmission through inhalation of droplets generated through coughing or sneezing;
2. Direct transmission via exposure of mucous membrane such as eye, nasal or oral mucosa to infectious droplets; and
3. Indirect transmission via contaminated surfaces.

Oral health care teams work in close proximity to patients and are at high risk of being infected with SARS-CoV-2 or passing the infection to patients. This document comprises of details on containment of the spread of SARS-CoV-2 in oral health settings, infection prevention, protocols for efficient sterilization and high-level disinfection. Also reviews the guidelines for the patients, oral health care personnel, about appropriate usage of Personal Protective Equipment (PPE), following a risk assessment and standard precautions, modifications in the set-up of oral healthcare facility, suitable approaches to recommended treatment, ect.

Urgent or emergency oral health care interventions that are vital for preserving a person’s oral functioning, managing severe pain or securing quality of life should be provided. If an oral health care professional is in doubt, referral to a specialized treatment facility must be ensured. Timely management of urgent or emergency oral health care interventions helps patients avoid seeking treatment at hospital emergency departments, thereby ensuring that they remain available to serve individuals seeking COVID-19-related care.

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Source: WHO