Dental Health Care Professionals Work During Covid-19 Pandemic

Health care workers are at the greatest risk — they can encounter diseases and infections daily and typically work in close proximity to one another and their patients. Many are already under quarantine because of exposure to the virus. Need of the hour is to prevent certain viral infections.

The ADA recommends following standard precautions with all patients, at all times. While treating patients keep following points into mind. These are:

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ISOLATION & IDENTIFICATION

As Dental health care personnel is commonly exposed to oral cavity , he/she should be alert. Identify patients with an acute respiratory illness. Take proper medical history. Ask every patient about their travel history or being in contact with such person having a travel history. Patient’s body temperature should be checked using a non-contact forehead thermometer or with cameras having infrared thermal sensors . Patients who present with fever (>100.4°F = 38°C) and/or respiratory disease symptoms, should have elective dental care deferred for at least 2-3 weeks.

Dental professionals, including endodontists, may encounter patients with suspected or confirmed SARS-CoV-2 infection. They will have to be careful while providing & at the same time prevent nosocomial spread of infection. There is a potential for transmission of COVID-19 via aerosol, fomites or fecal-oral route that may contribute to nosocomial spread in the dental office setting

INFECTION CONTROL MEASURES

To help prevent the transmission of all respiratory infections proper infection control measures should be taken such as: Perform hand hygiene. Wash your hands often with soap and water for at least 20 seconds. 60% alcohol based senitizers should be used Offering face masks to patients who are coughing. Isolate them in a single-patient room with the door kept closed to limit their contact with other patients and personnel. These patients should wear masks outside their rooms. Offices also should follow routine cleaning and disinfection strategies used during flu season.

SELF PROTECTION

Dental personnel assessing a patient in case of emergency with a flu- like or other respiratory illness should wear a disposable surgical face mask, nonsterile gloves, head cap, gown and eye wear to prevent exposure which should be worn once and discarded. The CDC recommends all health care workers, including dentists and staff, receive the flu vaccine, and personnel experiencing a flu-like illness should not report to work. To avail more information regarding COVID-19 , ADA suggests checking for updates on the CDC's coronavirus infection control page for health care professionals. Dental personnel who are concerned about the supply of personal protective equipment to monitor the CDC's health care supply of personal protective equipment webpage for updated guidance.

POSTPONE ELECTIVE DENTAL PROCEDURES

According to The CDC's Guidelines for Infection Control in Dental Health-Care Settings—2003 , dental personnel may consider postponing nonemergency or elective dental procedures until a patient is no longer contagious with diseases that can be transmitted through airborne, droplet or contact transmission. In case of emergency, both dental personnel and medical health care providers should work together to determine the appropriate .

PHARMACOLOGIC MANAGEMENT

In suspected or confirmed cases of COVID-19 infections, patients requiring emergency dental care such as tooth pain and/or swelling, antibiotics and/or analgesics should be given as an alternative for symptomatic relief This will provide dental professionals some time to develop a plan to deliver dental care with all appropriate measures in place to prevent the spread of infection.

On March 17, 2020, the British Medical Journal recommended the use of acetaminophen for analgesia and not ibuprofen in treating COVID-19 infected patients, as ibuprofen may interfere with immune function . This recommendation was endorsed by the World Health Organization (WHO) on March 18, 2020.

In certain cases such as dentoalveolar trauma or any fascial space infection requiring emergency dental intervention, dentists should be aware of the following recommendations: Dentists should follow standard, contact, and airborne precautions including the appropriate use of personal protective equipment (PPE) and hand hygiene practices 23.

Dentists should use a rubber dam to minimize splatter generation (of course, for non-surgical endodontic treatment). It may be advantageous to place the rubber dam so that it covers the nose. The actual procedure should minimize generation of aerosol. For example, ultrasonic instruments may impose a greater risk of generating contaminated aerosols. In addition, dentists should reduce the use of high-speed handpieces and three-way syringes.

Negative pressure treatment room/Airborne infection isolation rooms (AIIRs): It is worth noting that patients with suspected or confirmed COVID-19 infection should not be treated in a routine dental practice setting. Instead, this subset of patients should only be treated in negative pressure rooms or AIIRs. Therefore, anticipatory knowledge of health care centers with provision for AIIRs would help dentists to provide emergent dental care if the need arises (23).

Human coronavirus can survive on inanimate surfaces up to 9 days at room temperature, with a greater preference for humid conditions (27). Therefore, clinic staff should make sure to disinfect inanimate surfaces using chemicals recently approved for COVID-19 and maintain a dry environment to curb the spread of SARS-CoV-2 (28).

REFERENCES

1. Mary Beth Versaci. ADA releases coronavirus handout for dentists based on CDC guidelines : (24 Feb 2020) ADA News
2. Michael Day Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists 2020 BMJ page. 1
3. Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis 2020 Feb 19. pii;3099(20)30120-1. Available from: http://dx.doi.org/10.1016/S1473-3099(20)30120-1
4. Wang Y, Wang Y, Chen Y, Qin Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures. J Med Virol 2020 Mar 5. doi: 10.1002/jmv.25748. http://dx.doi.org/10.1016/S1473-3099(20)30120-1
5. Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | CDC [Internet]. [cited 2020 Mar 9]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html
6. Eggers M, Koburger-Janssen T, Eickmann M, Zorn J. In Vitro Bactericidal and Virucidal Efficacy of Povidone-Iodine Gargle/Mouthwash Against
7. Respiratory and Oral Tract Pathogens. Infect Dis Ther 2018;7:249–59.
8. Kariwa H, Fujii N, Takashima I. Inactivation of SARS coronavirus by means of povidone-iodine, physical conditions, and chemical reagents. Jpn J Vet Res 2004;52:105-12.
9. Hokett SD, Honey JR, Ruiz F, Baisden MK, Hoen MM. Assessing the effectiveness of direct digital radiography barrier sheaths and finger cots. J Am Dent Assoc 2000;131:463-7.
10. Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and its inactivation with biocidal agents. J Hosp Infect 2020;104:246–51.
11. UNITED STATES ENVIRONMENTAL PROTECTION AGENCY WASHINGTON, D.C. 20460 OFFICE OF CHEMICAL SAFETY AND POLLUTION PREVENTION List N: EPA’s Registered Antimicrobial Products for Use Against Novel Coronavirus SARS-CoV-2, the Cause of COVID-19.
12. ADA Calls Upon Dentists to Postpone Elective Procedures. Available at: https://www.ada.org/en/press-room/news-releases/2020-archives/march/ada-calls-upon-dentists-to-postpone-elective-procedures. Accessed March 16, 2020, n.d.