How will Coronavirus Pandemic change clinical dentistry ?
About the webinar
Dentistchannel.online hosted a webinar by Dr. Himanshu Gupta on ‘Clinical Dentistry in COVID-19 Era’ on 19th April, 2020 at 11AM IST. This webinar was witnessed by dental professionals across the globe.
COVID19 and Dental Practice
On January 8, 2020, a novel coronavirus was officially announced as the causative pathogen of COVID-19 by the Chinese Center for Disease Control and Prevention. Since then it has become a major challenging public health problem for not only China but also countries around the world. Due to the characteristics of dental settings, the risk of cross infection may be high between dental practitioners and patients.
Infection Control in Dental Settings
Dental patients who cough, sneeze, or receive dental treatment including the use of a high-speed handpiece or ultrasonic instruments make their secretions, saliva, or blood aerosolize to the surroundings. Dental apparatus could be contaminated with various pathogenic microorganisms after use or become exposed to a contaminated clinic environment. Thereafter, infections can occur through the puncture of sharp instruments or direct contact between mucous membranes and contaminated hands.
“Dental practice settings definitely need a makeover
and there is a need of taking extra- precautions!”
Effective and basic Infection Control Protocols
- Hand hygiene has been considered the most critical measure for reducing the risk of transmitting microorganism to patients.
- SARS-CoV-2 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.
- The use of (PPE) personal protective equipment, including masks, gloves, gowns, and goggles or face shields, is recommended to protect skin and mucosa from (potentially) infected blood or secretion.
At Entry, Reception
- All patients and attendants wash their hands with hand sanitizer as soon as they
- Patients with fever, cough and cold to be screened, with special emphasis on thermal screening
- Otherwise also it would be good to have all patients to get tested for corona virus
- Elicit travel history, thorough case history including for flu like symptoms and respiratory illness.
- It is very important to take Informed consent.
- If you have air conditioners install HEPA (high efficiency particulate air) filters and use air purifiers with HEPA filter.
- Wipe all surfaces with isopropyl alcohol or other antiseptics sanitizer spray at least 3 times daily or after every patient leaves.
- Social distancing at clinics should be implemented and importantly congestions must be avoided.
- Preferably give sufficient time between two appointments, which will help you to clean, disinfect your clinic for every patient.
- Reduce paper work, switch to electronic patient records, electronic payments.
At Operatory, Clinic Area
- ACs and air purifiers with HEPA filters.
- Use of laminar air flow is preferable.
- If AC is not there in a clinic it’s preferable to have cross ventilation in the clinic. It reduces buildup of aerosol.
- Ask the patient use povidone iodine nasal spray, gargle with povidone iodine and before any procedure, one may irrigate with povidone intraorally and use suction to remove the solution, it reduces viral load.
- Throw extracted teeth and cotton to their designated bins containing sodium hypochlorite, remove excess saline or water or any liquid in the instrument tray, allow the instruments to dry for 5 minutes before washing them with a soap and a scrub brush wearing a glove.
- Wipe all surfaces (include door handles, platforms, wash basins) with ethyl /isopropyl alcohol or other antiseptics at least 3 times daily.
- Use sanitizer spray for chair and accessories, x-ray machine etc after every patient.
- Spittoon may be cleaned as usual followed by a bowl of hot water and sanitizer spray.
ULTRASONIC SCALER, AIROTOR =AEROSOL
- Reduce the use of airotor if possible and switch to atraumaic restorative technique (ART), chemomechanical caries removal (CMCR).
- Weigh advantages and disadvantages of using airotor.
- Add povidone iodine to water bottle (1:9) attached to chair which is to be used with airotors and scalers.
- Use high vacuum suction (INTRAORAL & EXTRAORAL) if airotor is used.
- Use screens to reduce spread of aerosol. This helps to a large extent for the aerosol to settle on the patient and around and not spread.
- If possible avoid 3 way syringes used to clean and dry teeth intraorally
- Preferable to discard burs, files, reamers after use or sterilise them in povidone iodine as well.
- After autoclaving instruments may be placed in UV chambers, even accessories like loupes, eye wear, handpieces may be placed in UV chambers
- UV lights also be installed and switched on between patients in the operating rooms.
Disinfection of the Clinic
- Entrances, doorways, staircases, clinical area, sterilisation rooms to be cleaned as usual, followed by sodium hypochlorite spray and mops.
- Fumigation at the end of the day is must.
Impressions and Lab works
- Impressions casts and prosthesis may be washed with povidone iodine, sodium hypochlorite or gluteraldehyde solution by immersion for 10 minutes and then washed with saline or water before using.
Common questions in minds of dentists …
When should dentists resume to work?
- Preferably wait till the entire thing blows over.
- Do not be in a hurry to start clinical practice. Remember you are in high risk category.
Will patients visit dentists after COVID19 ?
- Patients will return post-pandemic, but they may scrutinize the dental profession more closely, especially safety issues.
- Putting best evidence into practice is a good start in an uncertain environment.
Should Dental professionals consider Hydroxychloroquine as prophylaxis ?
It can be taken as prophylactic measures, but it is strictly advised to do so under the guidance and prescription of physicians. Although the rates of untoward incidences are less, it is not worth taking chances. Hence, consider Hydroxychloroquine only under physicians advise.
It is important to make informed clinical decisions and educate the public to prevent panic while promoting the health and well-being of our patients during these challenging times. High standards also provide consistency throughout the profession so that patients receive quality care and dental professionals can stay safe too.