COVID-19 – HOW DENTISTS CAN PROTECT THEMSELVES AND OTHERS.

COVID-19_CORONAVIRUS_DENTAL_DENTALCLINIC

The coronavirus (COVID-19) has challenged health professions and systems and has evoked different speeds of reaction and types of response around the world.

To understand its effect on dental profession, we need know about the virus.

According to WHO COVID-19 is the infectious disease caused by the most recently discovered coronavirus. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019

Viruses which may cause illness in animals or humans are Coronaviruses. Several corona viruses in humans causes Respiratory infections ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). COVID-19 is the most recently discovered coronavirus causes coronavirus disease.

Structure of Covid 19: –

COVID-19 have a typical coronavirus structure with “spike protein” and also expressed other polyprotein, nucleoprotein and membrane protein. The S protein from coronavirus can bind to the receptor of the host to facilitate viral entry into target cells.

In addition, the asymptomatic incubation period for individuals infected with 2019-nCov has been reported to be ~1–14 days, and after 24 days individuals were reported, and it was confirmed that those without symptoms can spread the virus.

Possible transmission routes of COVID 19 virus to Dentist:

2019-nCoV can effectively use ACE2 as a receptor to invade cells, which may promote human-to-human transmission.

Direct transmission route of COVID-19 is cough, sneeze, saliva, droplet inhalation transmission or contact with oral, nasal, and eye mucous membrane.

Dentist are more prone for infection as their procedures involve direct contact with saliva, Blood and other body fluids.

Major concern of transmission is that, in dental practice most of the procedures produce aerosols and droplets that are contaminated with virus. As these aerosol and droplets are mixed with saliva and blood of patients and hard to avoid, they easily get into clinic’s environment and increase the chance of transmission to health care individuals.

Direct or indirect contact with human fluids, patient materials, and contaminated dental instruments or environmental surfaces makes a possible route to the spread of viruses.

Protection Measures: –

  1. As of now no specific protection guidelines are noted.  But just for the safety Dentist can avoid normal dental procedures like restorations, orthodontic treatments, Minor surgical treatments and aesthetic treatments.
  2. Treatments which really require a dentist’s attention during an emergency can be conducted with all the protective measures.
  3. Dentists who are treating patients who need emergency/urgent care shall be seeking guidance regarding what to do about informed consent. The informed consent form should include- Details of Travel, Symptoms of Fever, cold, difficulty in breathing.
  4. Post a sign at the entrance to the dental practice which instructs patients having symptoms of a respiratory infection (e.g., cough, sore throat, fever, sneezing, or shortness of breath) to reschedule their appointment and call their physician.
  5. Before performing dental procedures take temperature readings as part of the routine assessment of patients.
  6. Instead of using hard copies and files to maintain record of the patient it is recommended to save it as digital records with the help of a software as this will reduce the chances of infection.
  7. Dentist and dental staff Require PPE during this epidemic period of COVID -19 – Protective eyewear, Masks, Gloves, caps, face Shield, Protective Outwear.
  8. An antimicrobial mouthwash is generally believed to reduce the number of oral microbes. But for COVID-19 the regular mouthwash are not very effective, generally in dental clinics we use chlorhexidine. Since COVID-19 is vulnerable to oxidation, preprocedural mouth-rinse containing oxidative agents such as 1% hydrogen peroxide or 0.2% povidone is recommended, for the purpose of reducing the salivary load of oral microbes, including potential 2019-nCoV carriage.
  9. Increase the use of rubber dam, as suggested it significantly minimize the production of saliva- and blood-contaminated aerosol or spatter.
  10. As suggested try to use disposable instruments which are easily available in the market.
  11. Dentist have to follow strict disinfectant protocol for their clinical area and waiting area as this virus can we stay in metal, plastic and other object for longer time and can cause cross infection.
  12. The medical waste (including disposable protective equipment after use) should be transported to the temporary storage area of the medical institute timely. The reusable instrument and items should be pretreated, cleaned, sterilized, and properly stored

Summary: –

“An ounce of prevention is worth a pound of cure.”
― Benjamin Franklin

  • As dentist we have to do selective treatment/ emergency treatment in this Pandemic Situations.
  • Dentist have to use all safety measures.
  • As suggested by IDA if any patient reported positive for virus in clinic or dentist found any history for the same, immediately we have to inform emergency helpline number.
  • Provide task-specific education and training on preventing transmission of infectious agents, including refresher training.
  • Wash hands with soap and water for at least 20 seconds after contact with patients or use an alcohol-based hand sanitizer with at least 60% alcohol if soap and water are not available. (These recommendations already are part of Standard Precautions.)
  • Install physical barriers (e.g., glass or plastic windows) at reception areas to limit close contact with potentially infectious patients.