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Uche Odiatu DMD, NSCA Certified Personal Trainer
While thorough handwashing and social distancing may be sufficient for the general populace, for dental practitioners, it is necessary to take far more complex precautions. This is because of the three principal modes of virus spread, all of which are relevant to the dental practice:
A recent study published in the International Journal of Oral Science has investigated the ways in which you can contribute to preventing infection in your dental practice and protect yourself, your staff and your patients from unnecessary viral contamination. These are the most important tips:
The first step is identifying suspected cases of COVID-19 in order to avoid extended contact with a potentially infected patient. Screening your patients using a prepared questionnaire and taking adequate steps based on the results and the patient’s body temperature can go a long way. First of all, the body temperature of the patient should be measured. It is strongly recommended that a contact-free forehead thermometer is used for this.
The following set of screening questions can help identify potential infection:
After the screening questionnaire:
Although appropriate hand hygiene should already be a routine prerequisite, further reinforcement can help mitigate the risk of viral spread.
The study recommends following the two-before and three-after hand hygiene guidelines for dental professionals:
Moreover, all staff should take extra care to avoid touching their own eyes, mouths and noses.
Since airborne droplets are considered to be the main route of infection spread, three-level protective measures are recommended:
Since SARS-CoV-2 is vulnerable to oxidation, preprocedural mouthrinse containing oxidative agents such as 1% hydrogen peroxide or 0.2% povidone-iodine is recommended for the purpose of reducing the salivary load of oral microbes, including potential SARS-CoV-2 carriage. (Note that chlorhexidine, most commonly used as mouthrinse, may not be effective at killing SARS-CoV-2.)
Furthermore, recent studies show that cyclodextrins—broad-spectrum antivirals—show promise for combating viruses. A preprocedural mouthrinse would therefore be most useful in cases when a dental dam cannot be used.
The use of dental dams can significantly minimise the production of saliva- and blood-contaminated aerosol or spatter, particularly when high-speed handpieces and dental ultrasonic devices are used. The use of a dental dam could reduce airborne particles by 70% within a 1 m radius of the operational field. This benefit is especially valuable now.
When a dental dam is applied, additional high-volume suction should be used (for aerosol and spatter) during the procedures along with regular suction. If dental dam isolation is not possible, manual devices, such as CariSolv and a hand scaler, are recommended for caries removal and periodontal scaling, in order to minimise the generation of aerosol as much as possible.
A high-speed dental handpiece with no anti-retraction valves may suck in and expel debris and fluids. Microbes may further contaminate the air and water tubes within the dental unit and thus potentially cause cross-infection as well.
Compared with that, anti-retraction high-speed dental handpieces can significantly reduce the backflow of oral bacteria and viruses into the tubes of the dental unit. As a result, it is strongly recommended that dental handpieces without an anti-retraction function should not be used at this time and that, as an extra preventive measure, only anti-retraction dental handpieces should be used.
While you might be doing your best within your dental clinic, others might not. Therefore, you should take effective and strict disinfection measures in both your clinic settings and public areas. The clinic should be cleaned and disinfected regularly in accordance with available safety protocols, as should the public areas and appliances, including door handles, chairs, desks and lifts.
Remember to dispose of your medical waste, including disposable protective equipment, timeously. Mark the surface of the bags and handle them according to the requirements for the management of medical waste. Also keep in mind that the waste generated by the treatment of patients with suspected or confirmed COVID-19 is regarded as infectious medical waste.
Reusable instruments and items should be properly pretreated, cleaned, sterilised and stored in accordance with your local protocols.
While none of these precautions can prevent or resolve COVID-19 on their own, all of them can contribute to keeping your dental practice and staff and patients safer and healthier—whether there is an ongoing viral epidemic or not.