|Year : 2021 | Volume
| Issue : 2 | Page : 120-131
Severe Acute Respiratory Syndrome Coronavirus 2 and Dentistry: A Summative Review of Guidelines issued by National Health Authorities
Gyanendra Kumar1, Neeraj Gugnani2, Dina Rabea3, Ruba Odeh4, Ferah Rehman1, Rihab Mabrouk5
1 Department of Pediatric Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi, India
2 Department of Pediatric Dentistry, DAV Dental College, Yamuna Nagar, Haryana, India
3 Department of Pediatric Dentistry, Faculty of Dentistry, AinShams University, Cairo, Egypt
4 Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, UAE
5 Department of Pediatric Dentistry, Faculty of Dental Medicine, University of Monastir, Monastir University, Monastir, Tunisia
|Date of Submission||14-Oct-2020|
|Date of Decision||10-May-2021|
|Date of Acceptance||24-May-2021|
|Date of Web Publication||29-Jul-2021|
Dr. Gyanendra Kumar
Department of Pediatric Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
| Abstract|| |
COVID-19 was first reported in China, in November 2019 and since then the spread of this disease was so rapid that on March 11, 2020, it was declared a pandemic by the World Health Organization. Due to the high transmissibility of the COVID virus and the associated morbidity and mortality, various International and National health authorities released different guidelines for day-to-day living, laying down “new norms” which has impacted our lives enormously. Although these guidelines seem to be convoluted but owing to some differences in the guidelines, it raises an ambiguity in the minds of dentists. Hence, we felt the need of this review to summarize different guidelines issued by various National health authorities for catering emergency and routine dental care. We included guidelines from CDC, ADA, NHS, India, UAE, Egypt, and Tunisia and compared and consolidated to reach a consensus that teledentistry is a good alternative to face-to-face management for nonemergency patients. Triage should be done for all patients coming to the health-care facility. Temperature and other vital parameters should be recorded in our daily practice. Antibacterial mouth rinses before the dental procedure can reduce the microbial load and therefore can alleviate transmission. To reduce indirect transmission through fomites on inanimate objects various waiting area changes must be ensured. Air conditioners can be used in well-serviced conditions with due care given to ventilation of the operatory after each patient. Strict disinfection protocols and personal protective equipment for dentist safety are mandatory.
Keywords: COVID-19, guidelines, standard operating protocol
|How to cite this article:|
Kumar G, Gugnani N, Rabea D, Odeh R, Rehman F, Mabrouk R. Severe Acute Respiratory Syndrome Coronavirus 2 and Dentistry: A Summative Review of Guidelines issued by National Health Authorities. J Indian Soc Pedod Prev Dent 2021;39:120-31
|How to cite this URL:|
Kumar G, Gugnani N, Rabea D, Odeh R, Rehman F, Mabrouk R. Severe Acute Respiratory Syndrome Coronavirus 2 and Dentistry: A Summative Review of Guidelines issued by National Health Authorities. J Indian Soc Pedod Prev Dent [serial online] 2021 [cited 2021 Dec 3];39:120-31. Available from: https://www.jisppd.com/text.asp?2021/39/2/120/322511
| Introduction|| |
COVID-19 is an infectious disease caused by the novel coronavirus and is known to result in severe upper respiratory tract infection. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a zoonotic virus similar to earlier SARS-CoV and the Middle East Respiratory Syndrome Virus (MERS-CoV). Zoonotic viruses are those viruses which spread from animals to humans and in this disease, the most probable origin is considered to be horseshoe bats (Rhinolophus sinicus). COVID-19 was first reported in November 2019 and since then the spread of this disease was so rapid that on March 11, 2020, it was declared a pandemic by the World Health Organization.
The most common route of its spread has been considered to be person-to-person via respiratory droplets and through touching inanimate objects impregnated with the virus and then subsequently touching the oral-nasal cavity. Other routes of transmission such as fecal-oral and air transmission have also been suggested but yet unclear. Once infected, the majority of patients are known to exhibit only mild symptoms such as fever, cough, sore throat, body pains, weakness while some patients remain completely asymptomatic, some patients develop severe respiratory failure requiring oxygen supplementation or mechanical ventilation support in an intensive care unit with mortality being reported in few of the severely affected patients.
Ironically, the virus is known to spread not only through these symptomatic patients but also from presymptomatic or asymptomatic carriers. Due to the high transmissibility of the COVID virus and the associated morbidity and mortality, various International and National health authorities released different guidelines for day-to-day living, laying down “new norms' which has impacted our lives enormously. These new life norms include social distancing, use of masks in public, working from home, frequent hand sanitization, etc. The pandemic also impacted dental practices worldwide. Amongst various professional services, dentists are being considered to be one of the high-risk professions for cross-infection of the virus. This is mainly due to the proximity of the dentist to the patient's oral cavity, aerosol generation during dental procedures, and inevitable contact of the dentist with the patient's saliva. In the initial days of the pandemic, dentists couldn't provide routine services due to national lock-downs, fear of the spread of infection, lack of guidelines. Although the deferment of routine and elective care in dentistry and other health arenas can be acceptable for some period of time, there are situations that require urgent or emergency care, for example, facial infections which may be life-threatening, acute pain, and dental trauma which always need attention and professional care. Hence, very soon after the start of the pandemic, guidelines for providing dental care for emergent situations also started pouring from various research groups and national health authorities. Initially, such guidelines and SOPs recommended to defer all the elective procedures and to treat only those requiring emergency dental care. Although the deferment of routine and elective care in dentistry and other health arenas is appreciative and acceptable for some period of time, this step resulted in huge financial losses sustained by dental care providers worldwide. Though on one hand closing dental practices completely or stopping all the elective care might have helped in reducing the chances of cross-transmission but on the other hand, it might have also led to an increase in dental problems and subsequent dental emergencies. Owing to economic concerns of the dentists and treatment needs of the patients, slowly the guidelines were getting updated to include strategies for providing even the routine dental care. Some of these guidelines were evidence based while most were based on the basis of expert opinions and surrogate research works. Indigenous guidelines and standard operating protocols for providing safe dental practice have been issued by various international and national scientific societies. Although these guidelines seem to be convoluted but owing to some differences in the guidelines, it raises an ambiguity in the minds of dentists. Hence, we felt the need of this review to summarize different guidelines issued by various National health authorities for catering emergency and routine dental care. It is opined that reaching a consensus through this systematic review will help dentists worldwide, in understanding the similarities and differences in the guidelines and will be able to practice in an informed manner.
| Design and Methods|| |
This summative review was planned to prepare a comparative summary of different guidelines issued for safe dental practice during these pandemic times. It is a collaborative effort and involved professionals from India, UAE, Egypt, and Tunisia. Hence, it was decided to include the guidelines issued by their respective National Health Authorities. For this, the web portals of their National Health Agencies were searched and the updated version as of mid-July was considered. If required a Google search was used in conjunction to aid in the search process. In addition, it was also decided to include the guidelines issued by National Health agencies from a few of the developed countries mainly CDC and ADA from the USA and NHS from the UK. The access details of the guidelines are summarised in [Table 1].
We itemized the guidelines content to help tabulate and compare these guidelines. The contents included were brainstormed by keeping in mind the complete process of patient's visit to the dental clinic and ranged from remote management to patient's entry, clinic infection control, dentist safety, etc.
The data from each guideline was extracted in the tabular form using these main contents. Two persons were responsible for extracting the data from each of these guidelines. The information from India, CDC, and NHS guidelines were extracted by GK and FR while information from ADA and UAE guidelines were extracted by RO and RM, guidelines from Egypt by DR and RO, guidelines from Tunisia was extracted by RM and DR. Two guidelines (Tunisia and Egypt) were only available as a handout in PDF format issued by their national authorities in local vernacular language and hence were translated to English by RM and RO. Back-to-back translation was also carried to ensure content validation. Two investigators, NG and GK were responsible for comparing the summary tables.
| Results|| |
The summary of guidelines was compared and compiled as shown in [Table 2].
| Discussion|| |
It is important to critique the safety norms, guidelines, and other operating protocols as released by various health organizations. Summarising the guidelines, which are actually released in such urgent situations, help to settle the controversies and highlight the similarities; which in turn will help dentists worldwide to practice safely with confidence. As mentioned earlier we itemized the contents to extract the data from various guidelines and have tried to cover all the aspects of patient's care. The details of these guidelines are discussed below:
Dental professionals are at high risk to get infected with the corona virus as dental treatment invariably involves proximity to the oral cavity for examination and therapeutic interventions. In such situation, tele-dentistry has emerged as one of the safe methods which provide the opportunity to guide the patients about oral health while following the norms of social distancing. It involves the use of information technology, for example, telephone, website or any social media portal for making audio calls, video calls or for exchanging photos to replace the visual examination, etc. All the guidelines included in this review have recommend the use of tele-dentistry during these challenging times. In addition, the guidelines issued by NHS and UAE also suggest to evaluate the urgency of dental treatment, enquire about COVID exposure of their family contacts, etc., The guidelines issued by MoHFW, India has emphasized to download oral health app for screening and have emphasized to use a web-based form which includes consent also. Tele-dentistry can be easily incorporated and offer many advantages to ensure safety however some researchers argue that dentists may find it difficult to learn new technology of teledentistry and adopt for their practice. Another concern raised is that the lack of face-to-face communication may lead to lesser satisfaction of patients in discussing their problems to dentists.
Tele-triage and in-office triage
Triaging is the procedure in which patients' treatment needs are prioritized according to the severity of their condition. Triaging for dental treatment needs can be done in two ways and tele-triage and triage in the clinic. Tele-triage is considered to be helpful as it will minimize the risk of exposure and community spread as during tele-triage patients by phone. A few of the included guidelines, namely NHS and UAE, have suggested to evaluate the urgency of dental treatment by phone while all the other guidelines have proposed having a “triage set-up” in the dental clinic/health care facility.,,,, As the risk of cross-contamination of COVID calls for some restriction on elective and other aerosol-based procedures, the dental staff involved in triaging should evaluate patient's symptoms efficiently and give treatment directions according to the urgency of the case. To ensure this, guidelines mandates that the front desk clinical staff must be competent in tele-triaging patients according to the subjective assessment of the severity of the dental condition and identify COVID-19 exposure risk categories. This will facilitate effective social distancing within the clinical practice and increase the efficiency of managing dental emergencies.
Emergency or urgent dental cases must be managed immediately, while others might be managed pharmacologically if required, and placed under follow-up for any progress in their symptoms.
It is also recommended to establish a triage point in the dental clinics mainly to ascertain the urgency of dental treatment required and for determining patient's symptoms, for example, temperature record, medical history and identify symptoms using a short questionnaire. This COVID-19 short questionnaire is used to identify possible asymptomatic infected patients. Urgent dental treatment should be provided to emergency conditions; however, other cases should be deferred for later appointments and followed up over the phone if required.
Temperature screening and vitals recording
One of the common symptoms of COVID-19 is fever, and in these pandemic times, each febrile patient should be considered as a probable carrier of the virus. In this regard, most of the governmental authorities have recommended temperature checks at the entry gates for offices, medical hospitals, clinics, etc., Similarly, most of the included guidelines have also recommended temperature screening except for guidelines issued by NHS and Tunisia Health authorities. For this purpose, it is recommended to use touchless forehead infra-red temperature scanners and if any other contact thermometer is used it should be appropriately cleaned after each patient.
A temperature of >100.4°F is considered febrile and if the patient have higher temperature, dental treatment should be deferred for 14 days and the patient should be advised for home quarantine. In addition to patients, all health workers coming to the facility should also be screened for temperature and respiratory symptoms. Pulse oximeter use is not considered mandatory for most organizations; however, vital signs assessment should be done in the treatment room before performing any procedure for the patients as advised by the UAE government.
Use of mouthwash
Salivary glands and saliva are thought to be reservoir and carrier of the virus, respectively. This prompts the researchers to look out for strategies that can decrease the viral load in saliva and oro-pharygeal regions to decrease the chances of infection and to facilitate safer practices. Although there is lack of evidence to suggest that oral rinses would be effective against SARS-CoV-2, yet a number of guidelines have suggested the use of oral rinses as a prophylactic measure to decrease the viral load in saliva In this regard, among the included guidelines in this review, CDC has also pointed about the insufficient evidence to support the use of preprocedural mouthwashes, however, it has still suggested preprocedural mouthwash usage based on previous experimental and clinical research studies on other infections similar to COVID-19 such as SARS, MERS, and H5N1, wherein mouthwashes have exhibited the reduction in the level of oral microorganisms in aerosols and splatter generated during dental procedures on the basis. In the context of SARS CoV-2, various mouth rinse formulations have been recommended including 1.5% H2O2 to be used for 30 s, Povidone-Iodine with a contact time of 15-and 30-s in concentrations of 0.5%, 1.25%, and 1.5% while in general chlorhexidine has been considered inadequate.,,
Further, in vitro studies by Anderson et al. and Egger et al. supported the use of PVP-I against SARS-CoV-2. They suggested PVP-I could be readily integrated into COVID-19, infection control measures in hospital and community settings., This may be attributed to the release of this guideline before any published research on this aspect, but some of the recent studies have reported that shedding of the SARS-CoV-2 virus during the initial stages of disease is high and occurs in the upper respiratory tract., Oral hygiene through gargling could help minimize the risk of infections.
Among the included guidelines, ADA and NHS have not mentioned the use of preprocedural mouth rinse in their guidelines. Indian guidelines recommend rinsing with 10 ml of the 0.5% solution of PVP-I solution throughout the oral cavity for 30 s. Guidelines issued by United Arab Emirates and Tunisian official Dental council also advised preprocedural mouth rinse with 1% hydrogen peroxide for 1 min.
Research papers also suggest that rinsing with 1% of hydrogen peroxide should not be done as a treatment for COVID-19 and the sole purpose of such preprocedural mouthrinses is to protect the professionals from contracting the virus during the procedure from patients who might have already infected by SARS-CoV-2. The use of such mouth rinse is also recommended by otolaryngologists but as a dentist it is imperative to know that the frequent use of hydrogen peroxide can be harmful to the oral tissue as it carries a possibility of pigmenting the restorations, tooth darkening. Povidone should be avoided in pregnant cases or cases with active thyroid disease or undergoing radioactive therapy. This practice is not an alternative to rigorous cross infection control and appropriate personal protective equipment (PPE).
Reception and waiting area
Recent research has also indicated that inanimate objects can be potential source of spreading the COVID-19 infection. Therefore, the current guidelines from various dental organizations compiled in this summative review recommend modification in the waiting area to avoid access to such inanimate objects which can later lead to cross-touching and subsequent virus transfer. The guidelines also suggest that visual alerts about hand hygiene and respiratory etiquette should be pasted in the clinic waiting area. In addition, it is recommended that alcohol-based hand rubs with 60%–95% alcohol should be freely available in the waiting area with mandatory usage at the time of patient's entry in the clinic.,,,, For the disposal of domestic waste or tissues by the patient guidelines suggests the use of no-touch dustbins in the waiting area.,,,, Redesigning of the complete waiting area is recommended which includes, installation of physical barrier at the reception table to avoid the first contact and close proximity with the patient, placing chairs at least six feet apart to ensure social distancing, taking steps to minimize the number of patients at any one point of time by avoiding the overlapping appointments etc., Guidelines from UAE suggests to clearly display visible instructions at the practice entrance stating that: only patients with appointments will be admitted, with an advise that the patients who wish to make an appointment should do so by phone and importantly, people making deliveries should also contact reception before entering the practice. Such methods would surely be helpful in stopping the cross-contamination and spread of the disease. It is also recommended that appointments should be spread between 20 and 30 min to allow for enough time to disinfect all clinical areas and avoid cross-infection between patients in waiting rooms. NHS guidelines also advise to establish single entry and exit points for patients. ADA guidelines recommend wiping all the touchable surface areas with a disinfectant approved for the SARS CoV-2 virus. The guidelines issued by the Indian Health department recommend ensuring the availability of sufficient three-layer masks and sanitizers and papering tissue at the registration desk. Lastly, guidelines recommend cashless/contactless payment methods to be preferred.,,,,
Ventilation of operatory and waiting area
The rise of this pandemic has raised concerns about the closed dental chambers and guidelines usually recommend appropriate ventilation of the dental operatory and the waiting area. According to CDC guidelines, ventilation should be such that flow of air occurs from high clean to lesser clean area. Provide air vents in the reception area and return air vents in the waiting area which extracts clean air from reception into the waiting area. Guidelines focus on Heating, ventilation, and air conditioning (HVAC) systems. HVAC stands for “Heating, ventilation, and air conditioning” technology for providing comfort to indoor and vehicular environments. Its main purpose is to provide thermal comfort and acceptable indoor air quality. It is recommended to consult an HVAC professional to safely enhance the amount of outdoor air supplied through the HVAC system and also increase filtration efficiency. Further, ADA recommends the use of local exhaust ventilation to grab and remove aerosols created during treatment while the Indian guidelines recommend enabling air circulation of natural air by frequent opening of windows and using an independent exhaust blower to flow out the room air to the outside atmosphere., It would surely depend on the finances available that the dentists would plan to opt either for the HVAC system or use the blower/exhaust method. If exhaust is used, it is encouraged to utilize a solid exhaust fan which ought to be fixed in order to make a unidirectional progression of air away from the patient. Further, it is also advised to use a fan behind the operator while performing a clinical procedure instead of a ceiling fan. The window AC/split AC must be frequently serviced, and filters cleaned. According to Indian guidelines, indoor portable air cleaning system can be used fitted with High efficiency particulate air (HEPA) filter and ultraviolet (UV) light.
UAE suggests at least 15–20 min for ventilation following any aerosol-generating procedures in the operatory. According to UAE dental council, every 30 min resting time should be given to let the deposition of droplets on the surfaces before the disinfection protocol. Natural ventilation through open windows is recommended, fresh and clean outside air is needed in the operatory according to the Egyptian dental council while Tunisian guidelines recommend to close the door and open windows for air circulation in the waiting area and operatory after the procedure for ventilation. In addition to the use of HVAC systems and use of exhausts for better air circulation, guidelines by ADA and MOHFW India, and UAE health authorities recommend the use of dental dams and high volume evacuation suction to reduce droplet splatter and spread of aerosols. CDC and NHS, Egypt did not mention about extra-oral suctions.
Air conditioner and HEPA filters
The CDC guidelines are not clear in relation tocleaning of clinic HVAC systems possiblyexposed to SARS-CoV-2. Currently, there is a lack of evidence from CDC that viable virus may compromise and contaminate these systems. The use of HEPA filters is suggested by CDC while guidelines by NHS have not mentioned the use of air conditioning and HEPA filters., ADA recommends the use of easily decontaminated physical barriers, local exhaust ventilation to seize and eliminate aerosols generated during treatment; and the use of directional airflow to remove workplace hazards. The guidelines by Indian health authorities advised that frequent servicing and cleaning should be performed for the air conditioning system. Furthermore, the utilization of portable air-cleaning system along with UV light and HEPA filter is advocated. UAE also recommended HEPA filters and negative pressure rooms for COVID-19 cases. Egypt and Tunisian guidelines did not mention anything about air conditioners and HEPA.
Clinic disinfection protocol
Frequently contacted surfaces in health-care settings may get contaminated and become the potential sources of coronavirus transmission. Additionally in dental practices, droplets and aerosols from infected patients may defile different surfaces in the dental workplaces, and consequently keeping a clean and dry climate in the dental office would help decline the determination of 2019-nCoV. CDC guidelines recommend cleaning and disinfecting the room, surfaces of all inanimate objects, and other equipment for controlling the spread of infection within the dental health care settings-2003. Guidelines issued by Indian health authorities for clinic disinfection are quite detailed [Table 2] and include disinfection protocol for even minute things used in dentistry. Further, the guidelines by ADA and UAE advise using disposable items including disposable mask and tubing for sedation., ADA also highlights the use of that armamentarium which generates less or no aerosol in the operatory.
All dental patients ought to be considered as possibly infected as it remains unclear which precautions by the dental personnel are most efficient for protection against SARS-CoV-2 infection., Consequently, it is strongly suggested to use PPE, such as gloves, face shields, eyewear protection, disposable scrubs and gown, disposable shoe-covers, and masks.,, Till date, there is no concrete evidence about which type of mask would be best to protect against COVID-19. Surgical masks were formulated with a single-way protection design–to hold bodily fluids leaving the wearer–subsequently keeping the patient safe from the risk of contamination by the dentist. However, a study was done on dummy heads and concluded that the filtration effect of surgical masks was also for the operator who was wearing the mask which filters an artificial aerosol made of water and sodium bicarbonate. In dentistry, for airway protection, filtering face-piece (FFP) mask is advocated. FFP masks are designed to block virus particles and are categorized based on their filtration efficacy towards particles ≥0.3 μm in diameter: FFP1 (80% filtration efficacy); FFP2 (94% filtration efficacy); and FFP3 (99% filtration efficacy). COVID-19 air droplet particles are expected to be 0.06–0.14 μm in diameter, FFP2/N95, N100, and FFP3/N99 are believed to be the most effective masks. Disposable surgical masks, on the other hand, are still a valid protection method for nonaerosol-generating procedures. Furthermore, facepieces can be divided into valve or nonvalve respirators. Valve respirators help in breathing and forestall moisture development inside the mask; thus, can filter the inhaled air, yet not the exhaled air. Nonvalve respirators offer suitable due protection by filtering both inhaled and exhaled air. FFP3/N99 and N100 facepieces without valves seem, by all accounts, to be the devices of choice to ensure the best degree of protection for both patient and dentist, nonetheless, it is hard to accomplish normal breathing when these masks are applied for an extensive period of time. The utilization of mask should be disposable during the surgical procedure and for a period that does not surpass 2 h; therefore it is recommended to utilize a valve-less mask having the highest filtration efficacy or a respirator mask covered by a disposable mask. In dentistry, it is compulsory to use eyewear protection, to protect the eyes from mechanical (e.g. foreign bodies), chemical (e.g. disinfectants), and biological (e.g. saliva, blood, oral fluids) hazards. Eyes are a common pathway for contamination with SARS-CoV-2. Appropriate eyewear protection with covering frames must be used and should have the maximum possible coverage of the face. Otherwise, plastic face shield may be demonstrated with glasses as it gives more prominent field of security to the face against aerosol droplets. Face shield can be placed directly on the forehead or as component of the disposable mask. The use of a face shield is usually accompanied by wearing glasses or magnifying loupes. Achieving appropriate eye protection might be difficult when using an operating microscope. CDC suggests N-95 respirators or more significant level mask for suspected/confirmed COVID patients for all aerosol and nonaerosol-generating procedures, while for nonCOVID patients surgical mask is satisfactory for nonaerosol-producing procedures and N-95 respirators or FDA approved surgical mask is required for AGPs. NHS recommends disposable fluid-resistant surgical masks for non-AGPs and FFP3 respirators for AGPs. ADA recommends NIOSH-certified, disposable N95 FFP respirator or better mask. Eye protection is mandatory with goggles and/or face shield in all the guidelines. Head cap and Shoe cover are not mentioned in the CDC and NHS guidelines. Gloves and gowns either disposable or cloth gowns are recommended. ADA recommends using all the PPE including eye protection, hair cover, shoe cover, and gown. Similar recommendations are listed by MOHFW, India. UAE suggests Dental healthcare personnel assessing a patient should wear medical mask/respirator, surgical gloves, disposable surgical gown, head cover, shoe cover, and eye protection (e.g. goggles) to prevent exposure. It recommends to offer a disposable mask to patients if they are not having one. They also insist on using disposable coveralls, head cap, and shoe cover for AGPs that are to be changed between patients. Guidelines from Egypt suggest the use of mask for a maximum of 6 h unless visually contaminated, wet, teared or used during an aerosol-producing procedure. Nikkab “women face cover” should not be considered a substitute for a mask. Tunisia dental council suggested the use of all the components of PPE, and while using cloth gown they should be washed with detergent at 60°C.
Sterilization protocols do not differ for respiratory pathogens according to all the organizations recommendations. Subsequentlydentists can keep on after routine cleaning, sanitization, and disinfection conventions as being followed according to CDC, infection prevention and control guidelines, or sterilization protocols as mandated by their health authorities.
| Conclusion|| |
With the emergence of the COVID-19 pandemic, various renowned organizations have given their respective guidelines for dental management based on their country population, risk scenario, and local factors. However, it has created conflict among dental professionals to choose which guideline to follow while managing dental patients. Through the present summative review following conclusions can be drawn:
- Teledentistry is a good alternative to face-to-face management for nonemergency patients
- Triage should be done for all patients coming to the health-care facility
- Temperature and other vital parameters should be recorded in our daily practice
- Mouth rinses before performing the procedure can reduce the microbial load and therefore can alleviate transmission
- In order to reduce indirect transmission through fomites on inanimate objects various waiting area changes must be ensured
- Air conditioners can be used in well-serviced conditions with due care given to ventilation of the operatory after each patient
- Strict disinfection protocols and PPEs for dentist safety is mandatory.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Pal M, Berhanu G, Desalegn C, Kandi V. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2): An update. Cureus 2020;12:e7423.
Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents 2020;55:105924.
Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci 2020;12:9.
Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al.
First case of 2019 novel coronavirus in the United States. N Engl J Med 2020;382:929-36.
Leap J, Villgran V, Cheema T. COVID-19: Epidemiology, pathophysiology, transmission, symptoms. Crit Care Nurs Q 2020;43:338-42.
Jadhav GR, Mittal P. Coronavirus disease 2019: Implications for clinical dental care. J Endod 2020;46:1341-2.
Richards W. Being a dentist in the pandemic. Evid Based Dent 2020;21:58-9.
Faccini M, Ferruzzi F, Mori AA, Santin GC, Oliveira RC, Oliveira RC, et al.
Dental Care during COVID-19 outbreak: A web-based survey. Eur J Dent 2020;14:S14-9.
Gugnani N, Gugnani S. Safety protocols for dental practices in the COVID-19 era. Evid Based Dent 2020;21:56-7.
Martins MD, Carrard VC, Dos Santos CM, Hugo FN. COVID 19 Are telehealth and tele education the answers to keep the ball rolling in dentistry? Oral Dis 2020 Jul 2;10.1111/odi.13527. doi: 10.1111/odi.13527.
Smith AC, Thomas E, Snoswell CL, Haydon H, Mehrotra A, Clemensen J, et al.
Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). J Telemed Telecare 2020 Mar; 26:309-13
Ghai S. Teledentistry during COVID-19 pandemic. Diabetes Metab Syndr 2020;14:933-5.
Krithikadatta J, Nawal RR, Amalavathy K, McLean W, Gopikrishna V. Endodontic and dental practice during COVID-19 pandemic: Position statement from the Indian Endodontic Society, Indian Dental Association, and International Federation of Endodontic Associations. Endodontology 2020;32:55-110. [Full text]
Lee YL, Chu D, Chou SY, Hu HY, Huang SJ, Yen FY. Dental care and infection-control procedures during the COVID-19 pandemic: The experience in Taipei City Hospital, Taiwan. J Dent Sci 2020;15:369-72.
da Silva Pedrosa M, Sipert CR, Nogueira FN. Are the salivary glands the key players in spreading COVID-19 asymptomatic infection in dental practice? J Med Virol 2021;93:204-5.
Eggers M, Eickmann M, Zorn J. Rapid and Effective Virucidal Activity of Povidone-Iodine Products Against Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and Modified Vaccinia Virus Ankara (MVA). Infect Dis Ther 2015;4:491-501.
Carrouel F, Conte MP, Fisher J, Gonçalves LS, Dussart C, Llodra JC, et al.
COVID-19: A recommendation to examine the effect of mouthrinses with β-cyclodextrin combined with citrox in preventing infection and progression. J Clin Med 2020;9:1126.
Geller C, Varbanov M, Duval RE. Human coronaviruses: Insights into environmental resistance and its influence on the development of new antiseptic strategies. Viruses 2012;4:3044-68.
Gercina AC, de Souza Amorim K, Pagaduan R, de Almeida Souza LM, Groppo FC. What is the best mouthrinse against Coronaviruses? Oral Surg, 13 Aug 2020, DOI: 10.1111/ors.12549.
Anderson DE, Sivalingam V, Kang AEZ, Ananthanarayanan A, Arumugam H, Jenkins TM, et al.
Povidone-iodine demonstrates rapid in vitro virucidal activity against SARS-CoV-2, The virus causing COVID-19 disease. Infect Dis Ther 2020;9:669-75.
Wolfel R, Corman VM, Guggemos W, Seilmaier M, Zange S, Muller MA, et al.
Virological assessment of hospitalized patients with COVID-2019. Nature 2020;581:465-9.
To KK, Tsang OT, Leung WS, Tam AR, Wu TC, Lung DC, et al.
Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: An observational cohort study. Lancet Infect Dis 2020;20:565-74.
Gui D, Pepe G, Magalini S. Just one more hygiene practice in COVID-19. Eur Rev Med Pharmacol Sci 2020;24:3438-9.
Vergara-Buenaventura A, Castro-Ruiz C. Use of mouthwashes against COVID-19 in dentistry. Br J Oral Maxillofac Surg 2020;58:924-7.
Guidelines for the acceptance of peroxide-containing oral hygiene products. American Dental Association Council on Dental Therapeutics. J Am Dent Assoc 1994;125:1140-2.
Otter JA, Donskey C, Yezli S, Douthwaite S, Goldenberg SD, Weber DJ. Transmission of SARS and MERS coronaviruses and influenza virus in healthcare settings: The possible role of dry surface contamination. J Hosp Infect 2016;92:235-50.
Centers for Disease Control and Prevention. Guidelines for infection control in dental health-care settings – 2003. MMWR Recomm Rep 2003;52:1-61.
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al.
Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020;395:507-13.
Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al.
A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020;579:270-3.
Meng L, Hua F, Bian Z. Coronavirus Disease 2019 (COVID-19): Emerging and future challenges for dental and oral medicine. J Dent Res 2020;99:481-7.
Checchi L, Montevecchi M, Moreschi A, Graziosi F, Taddei P, Violante FS. Efficacy of three face masks in preventing inhalation of airborne contaminants in dental practice. J Am Dent Assoc 2005;136:877-82.
Radonovich LJ Jr., Simberkoff MS, Bessesen MT, Brown AC, Cummings DA, Gaydos CA, et al.
N95 Respirators vs medical masks for preventing influenza among health care personnel: A randomized clinical trial. JAMA 2019;322:824-33.
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727-33.
Zhou SS, Lukula S, Chiossone C, Nims RW, Suchmann DB, Ijaz MK. Assessment of a respiratory face mask for capturing air pollutants and pathogens including human influenza and rhinoviruses. J Thorac Dis 2018;10:2059-69.
Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, et al.
Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev 2020;4:CD011621.
Checchi L, Montevecchi M, Violante F, Moreschi A, Taddei P, Graziosi F, et al.
Management rules for a dental practice: Biological risk and safety at work. Dent Cadmos 2012;80:140-56.
Montevecchi M, Checchi V, Felice P, Checchi L. Management rules of the dental practice: Individual protection devices. Dent Cadmos 2012;80:247 63.
Checchi V, Bellini P, Bencivenni D, Consolo U. COVID-19 Dentistry-Related Aspects: A Literature Overview. International Dental Journal 2021;7 1: 21 – 26.
[Table 1], [Table 2]