|Year : 2013 | Volume
| Issue : 4 | Page : 161-163
Precautions in dentistry against swine flu
Shailee Fotedar1, Kapil Rajiv Sharma2, Vinay Bhardwaj1, Vikas Fotedar3
1 Department of Public Health Dentistry, Himachal Pradesh Government Dental College, Shimla, Himachal Pradesh, India
2 Department of Pediatric and Preventive Dentistry, Himachal Pradesh Government Dental College, Shimla, Himachal Pradesh, India
3 Department of Radiation Oncology, RCC, IGMC, Shimla, Himachal Pradesh, India
|Date of Web Publication||22-Jan-2014|
Department of Public Health Dentistry, Himachal Pradesh Government Dental College & Hospital, Shimla, Himachal Pradesh
Swine flu or influenza A (H1N1) flu, which was officially declared as a pandemic is causing havoc all over the world, with the large number of people constantly getting infected and where the government is helpless about a situation, we have to protect ourselves. Apart, we as health care providers should feel responsible for reducing the transmission of influenza. During a pandemic, reducing transmission of influenza to health care workers may not only help support the health care workforce, but may also prevent influenza transmission to patients. This is possible by proper infection control measures during patient assessment as well as during treatment. Apart there are specific recommendations for Dental Health Care Personnel which are summarized here. Hence we as dental health care professionals should try to fight that all the dental health care professionals should try to fight the barriers like fear and use all the necessary precautions to prevent the H1NI infection. It is the duty of every health care professional to follow the preventive procedures so that there would be no infections that spreads through the dental operatory.
Keywords: Infection control, influenza A, prevention, swine flu
|How to cite this article:|
Fotedar S, Sharma KR, Bhardwaj V, Fotedar V. Precautions in dentistry against swine flu. SRM J Res Dent Sci 2013;4:161-3
| Introduction|| |
Influenza causes annual epidemics of respiratory illness worldwide and is the most important cause of medically attended acute respiratory illness. Swine Flu or the influenza A (H1N1) Flu, which was officially declared as the Pandemic in 2009 is causing havoc all around the world, with the death toll constantly rising and the number of people being infected constantly.  H1N1 flu or Swine influenza, also called pig influenza, swine flu, hog flu and pig flu, is an infection caused by any one of several types of swine influenza viruses (SIV). SIV or swine-origin influenza virus is any strain of the influenza family of viruses that is endemic in pigs. When an influenza virus that normally circulates in swine (but not people) is detected in a person, it is called a "variant influenza virus."As of 2009, the known SIV strains include influenza C and the subtypes of influenza A known as H1N1, H1N2, H2N1, H3N1, H3N2, and H2N3. 
Transmission of Swine Flu
H1N1 influenza virus appears to be transmitted from person to person through close contact as other influenza viruses does. Although the relative contribution of each mode is uncertain, influenza virus can potentially be transmitted through:
- Droplet exposure from respiratory secretions after coughing and sneezing can contaminate mucosal surfaces such as nose, mouth, and eyes.
- Contact, with an infectious patient or fomite (a surface that is contaminated with secretions) and then self-inoculation of virus onto mucosal surfaces such as those of the nose, mouth & eyes and
- Small particle aerosols in the vicinity of the infectious individual. 
Transmission of influenza through the air over long distances, such as from one patient room to another, is not thought to occur. All respiratory secretions and bodily fluids, including diarrhoel stools, of patients with H1N1 influenza are considered to be potentially infectious.
It has been suggested that swine influenza is as contagious as the usual human influenza. The typical incubation period found for influenza is 1 to 4 days, with an average of 2 to 3 days. 
| Signs and symptoms|| |
Those carrying the virus can reveal typical flu-like symptoms:
- Fever (usually greater than 100°F)
- Chills and rigors
- Muscle and joint pains
- Stuffy nose
- Sore throat
- Vomiting and diarrhea 
Most of the times, swine flu infection is usually mild, but some people with swine flu have shown serious respiratory illness, including pneumonia or respiratory failure leading to death. Patients with chronic medical conditions such as asthma, chronic lung disease, heart disease, diabetes, suppressed immune systems (including from chemotherapy), and kidney failure are at higher risk for complications from swine flu. Further more, pregnant women are at high risk for severe disease. 
Swine Flu treatment
Laboratory testing has shown that the H1N1 swine influenza strain is sensitive to two antiviral medicines that are used to treat human influenza. They are oseltamivir (Tamiflu) and zanamivir (Relenza). Oseltamivir is given in the tablet form. Zanamivir is an inhaled medication. 
| Prevention|| |
The threat of swine flu has put all health care providers on high alert including dental health care providers.
The main aim of the health care provider should be to prevent or limit the transmission of influenza to health care providers as well to patients. Limiting the transmission of influenza can be done by:
Creating awareness among staff
- Educating the staff about the symptoms, transmission and prevention of influenza.
- Staff with respiratory symptoms should be instructed to stay at home and not come to work.
- Staff personnel should resume their duties once they are free from fever (100°F or 37.8°C), or signs of a fever, for at least 24 hrs, after the withdrawal of fever- reducing medications
- Dental health care personnel should do daily selfassessment for symptoms of febrile respiratory illness (fever plus one or more of the following: Nasal congestion/runny nose, sore throat, or cough).
- If any member of the personnel has been diagnosed with 2009 H1N1 influenza, the personnel can continue his routine duties but should monitor himself for symptoms so that any illness is recognized promptly.
- One of the most important things in protecting against the flu is a yearly flu vaccine as recommended by the Centers for disease control.
The timely recognition of influenza cases
During a pandemic period, it is recommended that patients should be contacted at least 24 hours before their appointment to ensure that they are symptom free.
- All patients should be actively screened routinely for symptoms of influenza on entry to practice and before they enter the waiting room or clinical area.
- A disposable surgical mask should be offered to persons who are coughing, or provide tissues and no-touch receptacles for used tissue disposal.
- If the dentist suspects the patient is infected, elective dental treatment should be deferred and the patient should be advised to contact their general health care provider.
- If the dentist suspects the patient is infected and urgent dental care is required, which involves the generation of aerosols, (through the use of turbines, ultrasonic scalers and three-in-one syringes), the treatment to the patient should be provided in hospital with dental care facilities that provides airborne infection isolation (i.e., airborne infection isolation room with negative pressure air handling with 6 to 12 air changes / hour). 
| Infection control Measures|| |
The appropriate and consistent method of infection control measures (standard infection control principles and droplet precautions) is important in preventing the infection during a pandemic. Practioners should have sufficient waste bins and hand cleaning facilities readily available to encourage the following good hygiene measures:
- Both the dental health care providers and patients should cover the nose and mouth with disposable, single-use tissues when sneezing, coughing and wiping or blowing the nose.
- Disposal of used tissues in the nearest waste bin.
- Make sure to wash hands after coughing, sneezing, using tissues or contact with respiratory secretions and contaminated objects.
- keep hands away from the eyes, mouth and nose.
- Wherever possible, practices should remove non-essential items (especially soft furnishings, also toys, books, newspapers and magazines) from reception and waiting areas. 
- The dental health care provider should wear recommended Personal protective equipment(PPE) before entering the treatment room. PPE should include gloves, a gown, eye protection and a National Institute of Occupational Safety and Health(NIOSH) fit-tested, disposable N95 respirator when entering the patient room and when performing dental procedures on patients with suspected or confirmed 2009 H1N1 influenza.  N95 filtering facepiece respirators are air-purifying respirators certified by the (NIOSH) to have filter efficiency level of 95% or greater against particulate aerosols free of oil and greater than 0.3 μ in size.
The effectiveness of N95 respirators relies on how well the respirator seals to the user's face. To ensure N95 respirators work effectively:
- Only use the respirator model and size which fits properly. Improper fit will likely result in inadequate protection.
- Do not use the respirator with beards or other facial hair, as it may interfere with the direct contact between your face and the sealing surface of the respirator.
- Conduct a seal-check every time you put the respirator on.
- If the respirator becomes damaged, soiled or you experience problems with using the respirator (breathing becomes difficult, dizziness, irritation, etc.), one should leave the work area immediately and remove the respirator when you are no longer exposed to the potential airborne hazard. 
Hence, it can be concluded that it is very important for all the dental health care professionals to try to fight the barriers like fear and use all the necessary precautions to prevent the H1NI infection. It is the duty of every health care professional to follow the preventive procedures so that there would be no infections that spreads through the dental operatory.
| References|| |
|1.||Vanka A, Shanthi G, Bhambal A, Saxena V, Saxena S. H1N1 flu (swine flu) precautions for dental professionals. J Indian Assoc Public Health Dent 2011;18:942-44. |
|2.||Key Facts about Human Infections with Variant Viruses (Swine Origin Influenza Viruses in Humans). Available from: http://www.cdc.gov/flu/swineflu/keyfacts-variant.htm. [Last accessed on 2012 Dec 12]. |
|3.||Eastern Michigan University - Emergency Management 2009 Influenza A (H1N1) Outbreak Situation Report. Available from: http://www.emich.edu/uhs/swineflu/updates. [Last accessed on 2012 Dec 17]. |
|4.||Pandemic influenza. Guidance for dental practices. Available from: http://www.dh.gov.uk updates. [Last accessed on 2012 Dec 22]. |
|5.||Prevention of Swine Influenza A (H1N1) in the Dental Healthcare Setting. Available from: http://www.ct.gov/dph/lib/dph/oral_health. [Last accessed on 2012 Dec 29]. |
|6.||Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel. Available from: http://www.cdc.gov/h1n1flu/guidelines_infection_control. [Last accessed on 2013 Jan 10]. |
|7.||Respiratory Hygiene/Cough Etiquette in Healthcare Settings. Available from: http://www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htm. [Last accessed on 2013 Jan 15]. |
|8.||N95 Respirator Training. Available from: http://www.stanford.edu/dept/EHS/occhealth. [Last accessed on 2013 Jan 25]. |