Ensuring safety- by all, for all!
By: Dr Deepak Mala
Humans have suffered severe infectious diseases including viral outbreaks several times in the past. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a virus that differs from severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) but can cause similar symptomology associated with pneumonia. This viral disease was named “COVID-19” by the World Health Organization (WHO) and was first recognized in Wuhan, Hubei Province, in China in December 2019. It is believed that it may have originated from a wet market.
As the virus spread across the globe, WHO declared this disease to be a public health emergency of international concern and characterized it as a pandemic. It was identified that fever, non-productive cough, myalgia or tiredness were typical symptoms during the start of this sickness and sputum production, headache, haemoptysis, and diarrhoea were less common symptoms associated with Covid-19. Another main symptom was identified to be pneumonia which was to be detected by a chest X-ray or a chest CT depicting tiny patchy shadows and interstitial abnormalities particularly in the lung periphery.
Although it was previously assumed that animal-to-human transmission was the primary method, but became quickly clear that infected humans are also carriers. Patients, whether symptomatic or asymptomatic, are evaluated for infection as well as transmission. According to several researches conducted immediately after the outbreak, person-to-person transmission happens largely by droplet dispersion or contact pathways. Droplet transmission occurs exclusively in situations of close contact (within 1 metre) with people who have respiratory symptoms because there is a danger of oral/nasal mucosa or conjunctiva being exposed to possibly exposing contaminated respiratory droplets when the person sneezes, coughs, or talk loudly.
Though most of the healthcare sectors were badly hit due to the Covid-19 pandemic, but the dental sector was completely shut due to high probability of spreading virus. Non-emergency dental and cosmetic procedures took a great beating and were postponed for a long time. But now things have changed largely and patients with dental concerns now go for a smooth process by scheduling appointments, avoiding overcrowding in the appointment setup process and the dental treatments should be postponed for at least one month in individuals with a history of COVID-19. High-risk patients, such as diabetics and immune-compromised individuals, are ideally seen in the first few hours of a dental office’s operation. If possible, the patients must use telephone triage, teleconferencing, or Teledentistry as alternatives to in-office care and dentists should also ask staff to stay home if they are unwell. The concerned doctor must actively monitor and record each employee’s temperature. If employees experience symptoms while at work, they should be sent home.
In view of the fear of the third wave, the dental clinics must ensure that at the time of check-in, patients must be actively screened and those suffering from fever should seek treatment at specialised medical facilities. If the patient is a febrile (temperature 100.4 °F) and otherwise free of COVID-19 symptoms, emergency dental treatment may be performed. There should be no accompanying persons permitted. Upon entering the dentist clinic, hand wash or hydroalcoholic solutions (60–75 percent alcohol) for hand disinfection must be kept ready besides keeping the waiting area spacious as well as well ventilated. Adequate zoning and separation measures should be implemented.
The clinics must also install signs in the dentist office to advise patients on conventional respiratory hygiene/cough etiquette and social distance suggestions. Everyone entering the dentist office should wear facemasks or fabric face covers. PPE (isolated wearing such as N-95 masks, Health or FFP2-standard masks, gloves, face shields, goggles, gown, surgical hat, shoe cover) should be used by dental professionals. Materials and instruments should be prepared ahead of time, and surfaces should be covered with disposable protections. Refrigerated materials should be sterilised before and after each treatment. Patients should be treated in a well-ventilated, isolated room with negative pressure compared to the surrounding environment.
During Dental Treatment:
The dentists and the staff must ensure hand hygiene before and after all patient interaction, before and after contact with potentially infectious material, and before and after putting on as well as taking off PPE. Using an alcohol-based hand rub (ABHR) that contains 60–75 percent alcohol is a mandatory. Preoperative antibacterial mouth rinses, such as peroxide, may help to lower the amount of microorganisms in the oral cavity. Because SARS-CoV-2 is susceptible to oxidation, employ a preprocedural mouth rinse containing 1.5 percent hydrogen peroxide or 0.2 percent povidone. Rubber dams and high-volume saliva ejectors can aid in the reduction of aerosol or spatter during dental procedures.
Extraoral dental radiographs, such as panoramic radiographs or cone-beam CT can be used in place of intraoral radiography. If aerosol-generating procedures are inevitable for emergency care, use4-handed dentistry. When possible, avoid using aerosol-generating techniques, handpieces/ultrasonic devices, 3-in-1 syringes, and the air-water syringe. To avoid the need for a follow-up session, dental practitioners should utilise resorbable sutures. Whenever feasible, treatment should be completed in a single visit. Following the conclusion of clinical care, environmental cleaning and disinfection measures should be carried out as soon as possible.
After Dental Treatment:
Proper disposing of single use PPE kit should be done and reusable face protective equipment should be cleaned and disinfected if visibly dirty. Maintain laundry and medical waste in line with standard operating procedures.
The writer is PG Scholar at Government Dental College & Hospital, Srinagar.