The following article is based on the paper “Coronavirus Disease 2019 (COVID-19): Emerging and Future Challenges for Dental and Oral Medicine”, released by the researchers from Wuhan University School and Hospital of Stomatology on 12 March 2020.
The epidemic of coronavirus disease 2019 (COVID-19), originating in Wuhan, China, has become a major public health challenge for not only China but also countries around the world. On 11 March 2020, WHO declared COVID-19 a pandemic, pointing to “alarming levels” of spread and severity and confirmed that it is a first pandemic caused by a coronavirus. Owing to the characteristics of dental settings as well as transmission routes of the virus, the risk of cross contamination can be high between patients and dental practitioners. For dental practices and hospitals in areas that are (potentially) affected with COVID-19, strict and effective infection control protocols are urgently needed.
According to WHO, “Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus. The COVID-19 virus spreads primarily through droplets of saliva or discharge from the nose when an infected person coughs or sneezes.” Due to the unique characteristics of dental procedures, the standard protective measures applied in daily practice are not effective enough to prevent the spread of COVID-19, especially for patients who are not aware of being infected, or for those who decide to conceal their infection.
Since the virus can persist on surfaces for a few hours or up to several days, depending on the type of surface, the temperature, or the humidity of the environment, it is crucial to thoroughly disinfect all surfaces within the dental clinic. In parallel to respecting the good hand hygiene, it is recommended to use personal protective equipment, such as masks, gloves, gowns, and goggles or face shields which can help protect skin and mucosa from infected blood or secretion.
Based on experience and relevant guidelines and research, the researchers from Wuhan University School and Hospital of Stomatology prepared a number of recommendations for dental practitioners and students in (potentially) affected areas. Those include:
Evaluation of patients: during the outbreak of COVID-19, dental clinics are recommended to establish precheck triages to measure and record the temperature of every staff and patient as a routine procedure. In the areas where the virus spreads, nonemergency procedures should be postponed.
Oral examination: all procedures which are likely to provoke coughing or excessive saliva secretion should be avoided or performed cautiously. “Intraoral x-ray examination is the most common radiographic technique in dental imaging; however, it can stimulate saliva secretion and coughing (Vandenberghe et al. 2010). Therefore, extraoral dental radiographies, such as panoramic radiography and cone beam CT, are appropriate alternatives during the outbreak of COVID-19.”
Treatment of emergency cases: dental emergencies can occur and deteriorate quickly requiring immediate treatment. Rubber dams and high-volume saliva ejectors can help minimize aerosol or spatter in dental procedures. If the tooth needs to be extracted, absorbable suture is preferred. Preoperative antimicrobial mouth rinse could reduce the number of microbes in the oral cavity.
Recommendations for dental education: in order to avoid unnecessary exposure to the virus, the researchers suggest opting for online courses, webinars and problem-based learning tutorials.
“For dental practices and hospitals in countries and regions that are (potentially) affected with COVID-19, strict and effective infection control protocols are urgently needed,” prof. Zhuan Bian and coauthors stated. “Dentists should take strict personal protection measures and avoid or minimize operations that can produce droplets or aerosols. Four-handed technique is beneficial for controlling infection. The use of saliva ejectors with low volume or high volume can reduce the production of droplets and aerosols.”