Challenges In Dentistry Due To COVID-19

Going to the dentists has never been more challenging than in the past year. Because of the coronavirus and its transmission mode patients have become the main source of infection for dentists.

As when we know main area for spread of disease is through mouth and that itself puts dentist at a higher risk of getting infected.

They need to keep their practices,clean and disinfected, change tools ,wear protective gear, space out appointments,this can lead to a lower number of patients, which itself brings issues like lower income and higher expenses.

WHAT IS COVID- 19

The virus that causes COVID-19, SARS-CoV-2, present in nasopharyngeal and salivary secretions of patients infected with SARS-CoV-2, spreads primarily through respiratory droplets, aerosols and fomites.

Evidence shows that normal breathing and talking can produce small droplets that are subject to aerosol transport, which remain suspended in the air for several hours.The potential for infected individuals who are pre-symptomatic or asymptomatic to transmit the virus to others high.

Oral manifestation due to covid

Dysgeusia (taste disorder) is the first recognized oral symptom of novel coronavirus disease (COVID-19)

Oral manifestations included

1)Apthous stomatitis

2) Pustule

3) Fissured or depapillated tongue

4) Macule and papule

The most common sites of involvement in descending order were tongue (38%), labial mucosa (26%), and palate (22%).

Prevention and safety protocol

American Dental Association (ADA) ask’s Dental care providers to:

•If possible, perform procedures in a negative pressure room, (airborne infection isolation room or AIIR) for aerosol-generating dental procedures.

•Follow standard, contact, and airborne precautions including hand hygiene practice.

•Consider taking extraoral radiographs instead of intraoral (e.g. panoramic radiography) to avoid gag reflex.

•Limit the number of dental healthcare providers (DHCP) present during the procedure to only those essential for patient care and procedure support. Visitors should be limited to those who are necessary.

•Use a dental hand-piece with anti-retraction function, four-handed dentistry, high evacuation suction and rubber dams to minimize droplet splatter and aerosol generation.

•Minimize the use of ultrasonic instruments, high-speed handpieces, and 3-way syringes.

•Perform endodontic procedures with dilute (1%) solutions of sodium hypochlorite to extend supplies without adverse effects on outcomes.

•Use resorbable sutures (i.e. sutures that last 3 to 5 days in the oral cavity) to eliminate the need for a follow up appointment.29

•Disinfect surfaces with EPA-approved chemicals and maintain a dry environment.

•Wear an N95 or equivalent or higher-level respirator such as a disposable filtering facepiece respirator, a powered air-purifying respirator, or an elastomeric respirator; eye protection (e.g. goggles, reusable face shields) gloves, gown.

# Interim guidance from the ADA includes

•Implementing a pre-appointment screening process via text, telephone, or email to ensure that patients with symptoms consistent with COVID-19 – or recent exposure to infected individuals – do not travel to the dental office;

•Expanding the in-office registration process to screen out patients with symptoms consistent with COVID-19, or who have been exposed to or recently tested for SARS-CoV-2; to provide and require proper use of a face mask; to check patients’ temperature (<100.4°F) with a thermometer; and to provide wipes or materials to clean pens, clipboards, counters, phones, keyboards, light switches, and other “high touch” surfaces;

•Extending time between patients, as necessary, to allow for proper cleaning and decontamination of examination rooms;

•Extensive preparation strategies for the physical office and staff to prepare the environment and familiarize the staff with new policies and procedures to reduce the risk of transmission of SARS-CoV-2;

•Implementing a chairside checklist to prepare operatories;

•Staff protection strategies that may include recommendations for in-office clothing , special guidance for staff who are pregnant or have other factors that increase the risk of severe COVID-19 disease, and a COVID-19 daily screening log for dental team members to use before entering the practice.

•Limiting the number of patients in the waiting room at the same time,as part of physical distancing

•Using tele-dentistry such as real-time video consultations to determine if a patient’s oral health needs can be handled remotely.

By – Poojita Shetty

D.Y.PATIL UNIVERSITY SCHOOL OF DENTISTRY

NAVI MUMBAI