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 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 12  |  Issue : 1  |  Page : 37-40

Compendium on safe dental instrumentation in COVID-19


Department of Prosthodontics, SRM Dental College, Chennai, Tamil Nadu, India

Date of Submission09-Sep-2020
Date of Decision12-Feb-2021
Date of Acceptance16-Feb-2021
Date of Web Publication30-Mar-2021

Correspondence Address:
Dr. Gopi Naveen Chander
Department of Prosthodontics, SRM Dental College, Ramapuram, Chennai-89, Tamil Nadu
India
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DOI: 10.4103/srmjrds.srmjrds_94_20

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  Abstract 

Dentists are at higher risk due to COVID-19. The proximity during patient management, contacts with aerosols and saliva increases the chances to COVID-19 exposure. The patient management under prevailing COVID situation is done with greater preventive measures. Knowledge on virus, mode of transmission, advices on protection protocol to patient, dentist, and operatory units are essential to prevent the disease. Comprehensive protocol and many reports have been proposed on the preventive measures by the various organizations. In addition, it has been appraised periodically. In these situations, the basics are overlooked and can lead to confusion among the dentists. The review summarizes on the essential recommendations proposed by various organizations that can be followed by the dentists. Further it provides evidence on managing specific aspects on dental procedures, armamentarium, and clinical environment that were overlooked earlier.

Keywords: 2019 novel coronavirus, COVID-19, dental practice, dental protocols, severe acute respiratory syndrome-coronavirus-2


How to cite this article:
Rawoof M A, Chander GN. Compendium on safe dental instrumentation in COVID-19. SRM J Res Dent Sci 2021;12:37-40

How to cite this URL:
Rawoof M A, Chander GN. Compendium on safe dental instrumentation in COVID-19. SRM J Res Dent Sci [serial online] 2021 [cited 2021 Jun 25];12:37-40. Available from: https://www.srmjrds.in/text.asp?2021/12/1/37/312479


  Introduction Top


Coronavirus is a single-stranded RNA virus, belonging to family of Coronaviridae causing diseases in mammals and birds. It is a host-specific virus that affects the human respiratory system. The symptoms vary from mild to severe depending upon the host immunity.[1] 2019 novel coronavirus (n-COV 19) was first reported in Wuhan, China, and later, it had universal spread worldwide.[2] The international committee on taxonomy of virus renamed it as severe acute respiratory syndrome-COV-2.

The spread of the virus can be either by direct or indirect transmission.[2],[3] The direct spread happens on contact with the infected persons. The virus directly spreads through the droplets resulting from coughing, sneezing, and on contact with the infected individuals.[4] In few situations, the patients are asymptomatic, and it is difficult to differentiate or identify the spread from the asymptomatic patients.[5] The indirect transmission happens on contact with surfaces with infectious droplets. Contact transmission was identified as the major cause of spread, and it happens by touch or by exposure to droplets of blood, body fluids, and secretions.[4],[5]

The infectious particles are produced from the diseased individual during coughing, sneezing, breathing and talking. These particles can spread to wider distance with air currents to cause infections.[4],[5] The infectious droplets can travel to a distance of 1 m, and it can vary depending on the force of expulsion, gravity, and conducting atmosphere.[3] Infected droplets remain vital on various surfaces, remain suspended in air over time and distance. The contact to this droplet is the major source of infections than airborne transmission. Virus viability varies with surfaces, temperature, and environment. The virus survives less in higher and dry temperatures. The viability of the virus varies with the surfaces. On average, it remains vital between 3 and 7 days and more infectious during the first 3 days.[3] The knowledge on virus spread is essential to prevent the spread. The use of gloves, alcohol-based hand rub, or sanitizer wipes is advised to reduce the risk of infection.[5]


  Symptoms of COVID-19 Top


The common symptoms of COVID-19 infection are tiredness, fever, and dry cough. Nasal congestion, runny nose, sore throat, or diarrhea are observed in many. These symptoms are usually mild and begin gradually. Patients can also be asymptomatic. Many recover without any special treatments. Twenty percent have breathing difficulties and associated complications. It gets enhanced with comorbidities.[6],[7],[8]


  Safety Protocol For Dental Practice Management Top


The risk is higher in dentistry due to the proximity of working to the oral environment and the contact to the saliva. Blood and saliva are easy carriers and aids in disease spread.

The patient triaging is insufficient to prevent the transmission. Precautious steps required to prevent the spread of disease. The threat levels for the various workers in dental office are listed in [Table 1]. The dentist safety protocols are divided into three categories – outpatient management, dentist care, and dental clinic/operatory protocols.[7] The following can aid in the effective management of patients in dental clinics:[9]
Table 1: Risk level in dentistry to Coronavirus Disease 2019

Click here to view


  • Nonemergency and elective treatment procedures should be postponed
  • Emergencies involving pain or active infection should be treated
  • Effective information on patients should be obtained before appointments
  • Elective procedures should be delayed to patients suffering from pain and at higher-risk zone of getting infection
  • The initial dental triage should focus on 3 A's – Advice, analgesics, and appropriate antimicrobials. The dental appointment can be rescheduled if the 3 A do not work
  • Appropriate information on recent travel history, symptoms of fever, cold or cough and medical history through the phone. If the patient clears the screening, appointments can be made or it has to be rescheduled for a later date
  • The patient attenders should be avoided or limited to 1 per patient
  • The patient waiting room should have safe distancing measures with spaced seating arrangement and its always better to have one patient or limited number of waiting patients in the dental office
  • The patient's body temperature should be recorded before entering the office. It is advised to reschedule appointment for those with above normal temperatures
  • It is recommended for the patient to use a hand sanitizer before entering dental office and povidone-iodine mouthwash to gargle.


Dental professionals should employ severe care and caution. The safety to be protocol followed by dental professionals are as follows:[10]

  • Effective hand hygiene protocol with soap water wash every 2 h and after handling patients
  • Head cap, face shields, goggles facemask, and personal protective equipment (PPE) should be used at all times while treating patients. N95 masks can be used on discretion
  • Stressful working hours should be avoided. To reduce the number of assistants in dental office should be reduced. It is preferable to have one assistant. Safe distancing measures should be followed
  • Temperature must to be checked thrice a day; before start, during lunch break and at the end of the day.



  Dental Clinic Protocols Top


The clinic should be properly cleaned and disinfected twice a day during the lunch break and at the end of the day. It is preferable to use alcohol wipe or an alcohol disinfectant and recommended to use a double-wipe procedure. The first wipe cleans the surface and removes any visible soil. The second wipe disinfects the surface and removes the microbes. The clinic floor should be disinfected with suitable disinfectants. Air circulation in the clinic can be enhanced with natural cross ventilation. The use of HEPA filters and exhaust fans can reduce the aerosol deposition in clinics. The dental chair should be cleaned and disinfected for each patient. The dental instruments should be kept in a cold bath of disinfectant for 15 min, washed, dried and regular sterilization and disinfection protocol must be followed.[10]


  Personal Protective Equipment (PPE) Top


PPE is used for personal health care and acts as a protective barrier. PPE includes goggles, face-shield, masks, gloves, cover-up gowns, head and shoe covers. The factors that influence in selection of PPE are:[10]

  • Resistance to exposure
  • Materials should not be allergic
  • Designs should be comfortable for the operator
  • Durability and appropriateness for the task
  • Cost effectiveness.


The eyes, nose and mouth should be covered by face shield and goggles. It offers a barrier to aerosols and reduces the chances of getting infection. The face shield acts as a physical distancing equipment and provide a clear vision to the operating area. The clear plastic of face shield offers better visibility for the operator/clinician. The adjustable band aids in firm attachment of shield to fore head. The face shield covers the sides and length of the face. It is fog resistant providing a better vision to the working environment. It is preferable to use, recyclable and sterilizable material.

The goggles should have the following features.

It should be transparent with sides fully covered with essential side shields:

  • Must have a snug fit to face/close to eyes
  • Anti-fog resistance
  • Ventilate with adjustable strap retainer
  • Nose bridge should be present for better adaptation
  • Adjustable band to fasten the goggles firmly
  • It should be re-usable.


The virus targets the upper and lower respiratory tracts. The use of masks is crucial in protecting the health care worker from infections particularly during treatment procedures. It offers protection by preventing the entry of infectious droplets. The use of masks depends on the risk profile of the personnel. The commonly advised masks for personnel working in hospital or community settings are Triple layer and N-95 Respirator mask.[5]

N 95 mask is also known as respiratory mask. It is a snug fitting mask that filters 95% particles. It offers a barrier for fluid penetration and splash resistant. It is advised for health care settings. Individuals with breathing disorders are advised not to use respiratory mask.[6]

It is preferable to adapt certain guidelines before and after use of the masks. Masks should be mandatorily used to prevent the transmission of disease. It should be checked for any potential damage before use. The colored side of the mask and the metal strip should face outward. Pinch the metal strip for molding to the shape of the nose.

Hand gloves are essential to handle the contaminated objects/surfaces. The latex and nitrile gloves are commonly used in clinical environment. The nitrile gloves are more puncture and chemical resistant compared to latex gloves. It cost less and more comfortable to wear. Furthermore, between the material the nonpowdered gloves are preferred than powdered gloves.[5],[6]

The aerosol procedures can lead to body contact of microbes. The exposure can be limited with the use of surgical gowns. Disposable, full sleeved, sterile gowns are preferable over reusable gowns. The reusable gowns should be disinfected, washed and sterilized and washed before the next use. The security is enhanced with the use of head and shoe covers. The head cover should cover all hair extensions, and it should extend till the back of neck for effective protection. The shoe-covers should mask all exposed areas of feet and ankles. It is essential to be familiar on all aspects of PPE for its prudent use.[5],[6],[7]


  Sterilization and Disinfection of Instruments Top


The sterilization of instruments is fundamental and mandatory. The differences in sterilization and disinfectant agents, types of dry and wet sterilization are important. The knowledge on sterilization of the common dental instruments/equipment is mandatory and most required in the present situation. [Table 2] provides the universal precautions to be followed in disinfection and sterilization of common dental instruments. Though the procedures are established, it can be useful appraisal for the dentists.[9],[10],[11]
Table 2: Sterilization and disinfection methods of common dental instruments

Click here to view



  Conclusion Top


The fundamental preventive protocols to be followed to prevent COVID transmission in clinical environment were reviewed. Many of the procedures deliberated were part of regular preventive protocol. It is mandatory to adhere to these procedures, and it is vital to be updated for the safety requirements. The summarized information can be used as reference and followed by dentists to prevent disease transmission.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): Emerging and future challenges for dental and oral medicine. J Dent Res 2020;99:481-7.  Back to cited text no. 1
    
2.
Paudel S, Dangal G, Chalise A, Bhandari TR, Dangal O. The coronavirus pandemic: What Does the Evidence Show? J Nepal Health Res Counc 2020;18:1-9.  Back to cited text no. 2
    
3.
Spagnuolo G, De Vito D, Rengo S, Tatullo M. COVID-19 Outbreak: An Overview on Dentistry. Int J Environ Res Public Health 2020;17:2094.  Back to cited text no. 3
    
4.
Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci 2020;12:9.  Back to cited text no. 4
    
5.
Centers for Disease Control and Prevention. Transmission of Coronavirus Disease 2019 (COVID-19). Available from: https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html. [Last acessed on 2020 Jun 03].  Back to cited text no. 5
    
6.
World Health Organization. Coronavirus Disease 2019 (COVID-19): Situation Report, 72. Available from: https://coronavirus.jhu.edu/map.html. [Last accessed on 2020 Jun 03].  Back to cited text no. 6
    
7.
Coronavirus Disease (COVID-2019) Situation Reports. Geneva: World Health Organization; 2020. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus2019/situation-reports/. [Last accessed on 2020 Jun 03].  Back to cited text no. 7
    
8.
Barabari P, Moharamzadeh K. Novel coronavirus (COVID-19) and dentistry – A comprehensive review of literature. Dent J (Basel) 2020;8:E53.  Back to cited text no. 8
    
9.
Bizzoca ME, Campisi G, Muzio LL. Covid-19 pandemic: What changes for dentists and oral medicine experts? A narrative review and novel approaches to infection containment. Int J Environ Res Public Health 2020;17:E3793.  Back to cited text no. 9
    
10.
Abramovitz I, Palmon A, Levy D, Karabucak B, Kot-Limon N, Shay B, et al. Dental care during the coronavirus disease 2019 (COVID-19) outbreak: Operatory considerations and clinical aspects. Quintessence Int 2020;51:418-29.  Back to cited text no. 10
    
11.
Mahesh G, Nagda SJ. Infection control for dental laboratory. J Indian Prosthodont Soc 2000;11:16-9.  Back to cited text no. 11
    



 
 
    Tables

  [Table 1], [Table 2]



 

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  In this article
Abstract
Introduction
Symptoms of COVID-19
Safety Protocol ...
Dental Clinic Pr...
Personal Protect...
Sterilization an...
Conclusion
References
Article Tables

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