Introduction:
There are several potential transmission sources in the spreading of highly infectious disease coronavirus (COVID-19). Among the several sources of transmission, dental services have received a huge volume of attention. So several guidelines have been released on how this infection could be transmitted through dental services and what should be done to prevent further transmission. This article will emphasize the guidelines in order to develop a practical feasibility protocol for the reopening of the dental clinic and the reorientation of dental services.
COVID-19 has affected almost all aspects of human life worldwide. Many protocols have been established to minimize the transmission. Many considerations regarding the possible hazardous activities or workplaces have been raised based on the transmission pattern of SARS-CoV-2. Among all the sources of transmission, the concern about dental practice Coronavirus transmission has been widely recognized around the world, leading to the development of precautionary measures during routine dental care.
Why Is Utmost Care Needed for Dental Procedures?
It was reported that dentistry was the most at-risk profession for the transmission of Coronavirus compared to the other professions or occupations according to the nature of the dental procedures and the proximity of the dental team with the patients. The disease can readily spread from the infected patients to the dental team and from the dental team to other patients if appropriate protective infection control measurements are not taken.
Usually, dental procedures require protective equipment and other cross-infection control measures to prevent virus transmission. Dental settings have unique characteristics that warrant specific infection control considerations.
What Are the Infection Control And Prevention Measures for Routine Dental Healthcare Delivery?
The Centers for Disease Control and Prevention (CDC) has recommended certain additional infection prevention and control practices along with the standard routine dental practices. These additional practices for all patients include:
Elective Procedures, Surgeries, and Non-urgent Outpatient Vsits Should Be Done After Assessing the Patients
Dentist need to provide dental treatment only after they have thoroughly assessed the patient considering the risk of the patient deferring care. Prioritize the dental care that is at the highest need. First, the vulnerable patients who will be at risk if care is delayed should be treated.
Implement Teledentistry
First, the patients should be contacted prior to the treatment. Assess the patient’s dental condition and determine whether the patient needs to be seen in the dental setting and should be screened for symptoms of COVID-19. If the patient reports with the symptoms of COVID-19, then avoid dental care if it is not an emergency. If possible try to postpone the treatment until the patient completes her or his quarantine.
Limit the Number of Visitors Accompanying the Patient
Inform the patient or request the patient who is in need of treatment or who cannot be delayed of the treatment to limit the number of visitors accompanying him or her to the dental appointment.
Wearing a Mask Should Be Made Mandatory, and Screening of the Patient Should Be Done
Advise the patient and the accompanying one to wear a mask when entering the facility and also inform them that the patient will be screened for fever and other consistent symptoms of COVID-19.
What Arrangements Have to Be Made in the Dental Clinic to Prevent the Spread of Infection?
1) Post visual alerts like posters or pamphlets at the entrance and in waiting areas to provide instructions about hand hygiene, and awareness about the disease, which includes wearing a mask, and how and when to perform hand hygiene.
2) Provide supplies like alcohol-based hand-rub with at least 60 percent alcohol, tissues, and no-touch receptacles for disposal at the entrance, waiting area, and in the patient check-ins.
3) Schedule appointments to minimize the number of people in the waiting room.
4) Patients can opt to wait in their personal vehicle or outside the dental facility and can be contacted when it is their turn for dental care.
5) Install physical barriers like glass or plastic windows at reception areas to limit the contact of the patients with the staff.
6) Ensure that patients maintain social distance from the other patients and as well as with the staff. Arrange the seating chairs accordingly.
7) Remove the toys, magazines, and other frequently touched objects from the waiting room that cannot be regularly cleaned or disinfected.
8) Ensure that the patients are wearing a mask ,if not provide a facemask. Make sure to have adequate supplies of face masks.
What All Precautions the Dental Healthcare Personnel Should Follow?
1) If the dental healthcare personnel is found to be febrile or has signs or symptoms consistent with COVID-19, then he or she should immediately return home and should get quarantined, and should arrange for further medical attention.
2) As a part of routine practice, the dental healthcare personnel should be asked to regularly monitor themselves for fever and other symptoms that are consistent with COVID-19.
3) The Dental healthcare personnel should be informed to stay home when they are not keeping well.
The sick leave policies implemented for dental healthcare personnel should be flexible, non-punitive, and consistent with public health guidance.
What Precautions Have to be Followed During the Dental Procedure?
1) The Dental healthcare personnel should limit the clinical care to one patient at a time.
2) Set up operatories such that only the clean and sterile supplies and instruments needed for the procedure are readily accessible, and the other supplies should be in covered storage away from potential contamination.
3) Any supplies or instruments which were not used during the procedure but were exposed are considered to be contaminated and should be either disposed of or reprocessed properly after the completion of the procedure.
4) Avoid aerosol-generating procedures like using handpieces, air-water syringes, and ultrasonic scalers. Prioritize minimally invasive and restorative procedures that can be done using hand instruments alone.
5) If aerosol-generating procedures are necessary, then use four-handed dentistry, high evacuation suction, and dental dams to minimize the droplet spatter and aerosols.
What All Precautions Should the Dental Healthcare Personnel Follow During and After the Dental Procedure?
Before Entering the Patient Room:
1) Perform hand hygiene which includes washing the hands with water and soap at least for 20 seconds or should use sanitizer.
2) Should wear a clean gown or protective clothing that covers the skin from becoming soiled with blood or saliva or any other potentially infectious materials.
3) Gowns and protective clothing should be changed when they become soiled.
4) Should put on a surgical mask or respirator.
5) Should wear eye protection like goggles or a face shield.
6) Should put on clean and sterile gloves, and the gloves should be changed immediately if they become torn or heavily contaminated.
After Completion of the Dental Procedure:
1) Remove the gloves.
2) Remove the gown or protective clothing and discard disposable gowns after each use or launder cloth gowns after each use.
3) Perform hand hygiene.
4) Remove eye protection.
5) Remove and discard the surgical mask. and do not touch the front of the mask or respirator while removing it.
6) Perform hand hygiene again after removing the mask.
How Should the Process Be Maintained On Exposure to SARS-CoV-2 After Dental Visits?
Dentists need to request the patients to contact the dental clinic immediately if they develop signs or symptoms or are diagnosed with COVID-19 within two days following the dental treatment or if given a COVID-19 test. They should also inform the COVID test results as soon as it is available.
Conclusion:
Dental settings should balance the need to provide the necessary dental services while minimizing the risk to the patients and the dental healthcare personnel. Prioritize the most critical dental services and provide care in a way that minimizes harm to patients from delaying care and from potential exposure to SARS-CoV-2 infection. It is very important for the dental team to follow this framework of guidelines to prevent the spread and as well as to provide the necessary care to the patients.
