As some countries are now reopening dental practices amid the coronavirus pandemic, dental practitioners face new challenges and uncertainties. Though most dentists still were able to treat emergencies during the lockdown, some practitioners decided to close their offices altogether following their government’s recommendations. And while life is now slowly returning to normal, dental offices need to adopt increased safety measures to protect their staff and patients. The French National Authority for Health (La Haute Autorité de Santé, HAS) has recently released a set of detailed recommendations for dental practitioners to help them navigate through this uncertain time.
Based on the document published by the French authorities, upon reopening of dental practices patients can expect being asked coronavirus-related questions, having temperatures taken, being asked to wash or disinfect their hands frequently, wear a face mask and keep distance from other patients in the office, or to wait outside. All unnecessary objects such as magazines, toys, water dispensers will be removed.
The document emphasised the need to focus on activities that minimise the risk of transmission to staff, patients and the public, but still support high-quality clinical care. This could be achieved by using preoperative mouthwashes, high-volume suction, dental dams and personal protective equipment.
Dental practice involves the use of rotary dental and surgical instruments, such as handpieces or ultrasonic scalers and air-water syringes. These instruments create a visible spray that can contain particle droplets of water, saliva, blood, microorganisms, and other debris. And while surgical masks protect mouth and nose from droplet spatter, they do not provide complete protection against inhalation of airborne infectious agents.
Revised dental protocol
To ensure the maximum protection for both dental practitioners and patients, the French authorities suggest implementing a revised dental protocol:
- the patient needs to keep a face mask until the beginning of the treatment and put it back on at the end of the treatment
- the patient’s mask should be placed on a designated tray (which will be regularly disinfected) or in a bag (such as a freezer bag) brought by the patient
- oral care with an antiseptic mouthwash should be prioritized
- the use of spittoons is not recommended
- intraoral X-rays must be performed with extreme care, as they stimulate saliva secretion and may cause a cough reflex. Extra-oral dental radiographs, such as panoramic radiography or CBCT can be an alternative when indicated
- the use of dental dams should be preferred in all possible clinical situations
- once the dam is tightly installed, the field is disinfected with sodium hypochlorite
- dentists should use powerful suction, if possible, with two aspirations
- four-handed work is recommended
- the use of an air-polisher is not recommended
- if the use of a rotating instrument creating a spray is necessary, the dentist should use a red or blue ring contra-angle to a turbine
- the water flow should be reduced to the minimum
- each use of a disposable rotary instrument should be followed by sterilization procedure
- If the procedure requires stitches, the dentist should use resorbable stitches
In this evolving situation every country will prepare comprehensive national guidance for their own settings, so that dentists can return to providing wider patient care. In France, dental practitioners reopened their offices mid-May.
Based on « Réponses rapides dans le cadre du COVID-19 – Mesures et précautions essentielles lors des soins bucco-dentaires après le deconfinement » published on 14 May 2020 by La Haute Autorité de Santé (HAS)