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Table of Contents
REVIEW ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 2  |  Page : 33-35

Coronavirus disease-19 and dentistry


1 PG Student, Department of Pedodontics and Preventive Dentistry, College of Dental Sciences and Research Center, Ahmedabad, Gandhinagar, India
2 Private Practitioner, Chief Endodontist, Aarsh Dental Clinic, Ahmedabad, Gandhinagar, India
3 Reader, Department of Oral Medicine and Radiology, Goenka Research Institute of Dental Science, Gandhinagar, India
4 Specialist Pedodontist, Ministry of Health, Taif, KSA
5 Senior Lecturer, Department of Orthodontics, College of Dental Sciences, Davangere, Karnataka, India
6 Private Practitioner, Specialist Pedodontist, Dr.ashu's Dental Clinic, Vadodara, Gujarat, India

Date of Submission15-May-2020
Date of Acceptance31-May-2020
Date of Web Publication27-Jun-2020

Correspondence Address:
Dr. Prachi Asnani
Department of Pedodontics and Preventive Dentistry, College of Dental Sciences and Research Center, Ahmedabad, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INPC.INPC_18_20

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  Abstract 


Coronavirus disease 2019 or coronavirus disease, described as a pandemic recently, is a cumulation of respiratory disorders transmitted mainly through droplets from an infected person. Aerosols produced during various dental procedures can cause a high risk of transmission. This report describes measures that can be adopted by oral health-care personnel to minimize the risk of cross-contamination in clinical practice during this severe acute respiratory syndrome corona virus 2 pandemic.

Keywords: Coronavirus, coronavirus disease 2019, dentistry, pandemics


How to cite this article:
Asnani P, Asnani M, Patel N, Khan MM, Kauser A, Soni A. Coronavirus disease-19 and dentistry. Int J Prev Clin Dent Res 2020;7:33-5

How to cite this URL:
Asnani P, Asnani M, Patel N, Khan MM, Kauser A, Soni A. Coronavirus disease-19 and dentistry. Int J Prev Clin Dent Res [serial online] 2020 [cited 2020 Dec 2];7:33-5. Available from: https://www.ijpcdr.org/text.asp?2020/7/2/33/288187




  Introduction Top


Coronavirus disease 2019 (COVID-19) epidemically started from Wuhan, China, in December 2019 and has become a major challenging public health problem for not only China but also countries around the world.[1] In the beginning of 2020 on January 8, the Chinese Center for Disease Control and Prevention officially announced a novel coronavirus as the causative pathogen of COVID-19.[2] The novel coronavirus was initially named 2019-nCoV and officially as severe acute respiratory syndrome corona virus 2 (SARSCoV-2).[3] The World Health Organization announced the outbreak of COVID-19 had constituted a public health emergency of international concern on January 30, 2020.[4]


  Symptoms Top


A person with COVID-19 has had a wide range of symptoms reported, ranging from mild symptoms to severe illness. Symptoms may appear 2–14 days after exposure to the virus. Common symptoms include cough, shortness of breath or difficulty breathing, fever, chills, muscle pain, and sore throat. Rarely, it includes symptoms such as loss of taste or smell and gastrointestinal symptoms such as nausea, vomiting, or diarrhea.[5]


  Transmission Top


It appears that the COVID-19 outbreak started with a single animal-to-human transmission, followed by sustained human-to-human spread. The virus is thought to spread mainly from person-to-person when in close contact with one another (within about 6 feet) through respiratory droplets produced when an infected person coughs, sneezes, or talks.

Health-care professionals immediately get involved in the national emergency, working hard round the clock: unfortunately, small numbers of them also get infected, and some die tragically. Dentists are often the first line of diagnosis, as they work in close contact with patients. The New York Times published an article entitled, “The Workers Who Face the Greatest Coronavirus Risk” on March 15, 2020, where an impressive schematic figure described that dentists are the workers most exposed to the risk of being affected by COVID-19, much more than nurses and general physicians.[6]

Dentists have been recommended to take several personal protection measures and avoid or minimize operations that can produce droplets or aerosols. Associations like ADA and others have tabulated the list of emergency procedures that the dentist should attend and non emergency procedures that they should avoid during these covid times [Table 1].[7],[8],[9] A fundamental concept to avoid the transmission of the virus is mainly through inhalation/ingestion/direct mucous contact with saliva droplets.[10],[11]
Table 1: Emergency and nonemergency treatments

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  Important Recommendations for a Safety Dental Care Management during the Current Severe Acute Respiratory Syndrome Corona Virus 2 Pandemic Top


Avoid overcrowding in waiting rooms by scheduling the appointment. With a safety time frame between dental consultations. Evidence states that the close contact between susceptive infected individuals increases the risk for SARS CoV-2 infection.[12] Patients with urgent need for dental care should be evaluated on a case-by-case basis and life-threatening cases should be admitted in a hospital. Dental procedures should be postponed for patients with signs and symptoms of COVID-19 and health authorities should be notified for the same. Analgesics and antibiotics should be used for symptomatic relief for patients with tooth pain and/or swelling.[13],[14]

Staff should be educated to use the personal protective equipment including N95 respirators, clinical gloves, safety glasses, hair covers, and disposable aprons. A N95 respirator is a respiratory protective device designed to block at least 95% of even very small (0.3 μ) test particles. A surgical mask is a loose-fitting, disposable device that creates a physical barrier between the mouth and nose of the wearer and potential contaminants in the immediate environment.[15] Current evidence shows that N95 respirators appeared to have a protective advantage over surgical masks in laboratory settings and on procedures that generate aerosols.[16],[17] For patients in health facilities, the use of surgical masks seems rational.[18]

Clean hands with soap and water or handrub with 70% ethanol or 70% isopropanol,[5] before and after assistance as previous studies have shown that 70% ethanol or 70% isopropanol are usually effective viruses including SARS-CoV and MERS-CoV.[19],[20]

Extraoral radiographs are preferable over intraoral radiographs to prevent cough or vomiting reflexes and consequently aerosol generation.

The use of rubber dam isolation during dental procedures is a must. Avoid the use of ultrasonic and sonic scalers, air polishing, air-water syringe, air abrasion units, and rotary handpieces. Anin vitro study showed that the airborne material generated using ultrasonic scaler can be spread for a distance of at least 20 cm from the operative site.[21] Therefore, removing the mask before 30 min in this environment may increase the risk of contact with contaminated particles. Efficient removal of contaminated ambient air could include improvements in the general ventilation and the use of high-volume evacuator.

The waste from dental procedures should be disposed in specific packages for biomedical waste only. These must be replaced when reaching 2/3 of their capacity or at least within 48 h, since the inadequate disposal offers high risk to ecological and public health.[22]


  Conclusion Top


Every cloud has a silver lining. Just like the sun shines after every storm, the dentistry too is going to shine out of this COVID storm. When done with all precautionary measures, dental clinics can revive into action and help battle this pandemic in their own ways.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Phelan AL, Katz R, Gostin LO. The novel coronavirus originating in Wuhan, China: Challenges for global health governance. JAMA 2020;doi:10.1001/jama.2020.1097.  Back to cited text no. 1
    
2.
Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020. N Engl J Med 2020;382:1199-207.  Back to cited text no. 2
    
3.
World Health Organization. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/. [Last accessed on 2020 May 12].  Back to cited text no. 3
    
4.
Mahase E. China coronavirus: WHO declares international emergency as death toll exceeds 200. BMJ 2020;368:m408.  Back to cited text no. 4
    
5.
Centers for Disease Control and Prevention. Available from: https://www.cdc.gov/coronavirus/2019-ncov/. [Last accessed on 2020 May 12].  Back to cited text no. 5
    
6.
Gamio, L. The Workers Who Face the Greatest Coronavirus Risk. Available from: https://www.nytimes.com/interactive/2020/03/15/business/economy/coronavirus-worker-risk.html?action=click&module=Top+Stories&pgtype=Homepage. [Last accessed on 2020 May 12].  Back to cited text no. 6
    
7.
American Dental Association. What Constitutes a Dental Emergency? American Dental Association; 2020. Available from: https://success.ada.org/~/media/CPS/Files/Open%20Files/ADA_COVID19_Dental_Emergency_DDS.pdf. [Last accessed on 2020 Apr 09].  Back to cited text no. 7
    
8.
Christensen GJ. Elective vs. mandatory dentistry. Am Dent Assoc 2000;131:1496-8.  Back to cited text no. 8
    
9.
CDC Recommendation: Postpone Non-Urgent Dental Procedures, Surgeries, and Visits; 2020. Available from: https://www.cdc.gov/oralhealth/infectioncontrol/statement-COVID.html. [Last accessed on 2020 May 13].  Back to cited text no. 9
    
10.
Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): Emerging and future challenges for dental and oral medicine. J Dent Res 2020; Journal of Dental Research 2020;99:481-47.  Back to cited text no. 10
    
11.
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. 11
    
12.
Ghinai I, McPherson TD, Hunter JC, Kirking HL, Christiansen D, Joshi K, et al. First known person-to-person transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the USA. Lancet 2020;395:1137-44. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32178768. [Last accessed on 2020 Apr 07].  Back to cited text no. 12
    
13.
Zhao D, Yao F, Wang L, Zheng L, Gao Y, Ye J, et al. Comparative study on the clinical features of COVID-19 pneumonia to other pneumonias. Clin Infect Dis 2020;ciaa247. doi: 10.1093/cid/ciaa247. Available from: https://pubmed.ncbi.nlm.nih.gov/32161968/. [Last accessed on 2020 May 13].  Back to cited text no. 13
    
14.
U.S. Food & Drug Administration. N95 Respirators and Surgical Masks (Face Masks); 2020. Available from: https://www.fda.gov/medical-devices/personalprotective-equipment-infection-control/n95-respiratorsand-surgical-masks-face-masks. [Last accessed on 2020 Apr 09].  Back to cited text no. 14
    
15.
Offeddu V, Yung CF, Low MS, Tam CC. Effectiveness of masks and respirators against respiratory infections in healthcare workers: A systematic review and meta-analysis. Clin Infect Dis 2017;65:1934-42.  Back to cited text no. 15
    
16.
Smith JD, MacDougall CC, Johnstone J, Copes RA, Schwartz B, Garber GE. Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: A systematic review and meta-analysis. Can Med Assoc J 2016;188:567-74.  Back to cited text no. 16
    
17.
Feng S, Shen C, Xia N, Song W, Fan M, Cowling BJ. Rational use of face masks in the COVID-19 pandemic. Lancet Respir Med 2020 p. 434-6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32203710. [Last accessed on 2020 May 13].  Back to cited text no. 17
    
18.
Kariwa H, Fujii N, Takashima I. Inactivation of SARS coronavirus by means of povidone-iodine, physical conditions and chemical reagents. Dermatology 2006;212 Suppl: 119-23.  Back to cited text no. 18
    
19.
Kampf G. Efficacy of ethanol against viruses in hand disinfection. Hosp Infect 2018;98:331-8.  Back to cited text no. 19
    
20.
Meeker HG, Magalee R. The conservative management of the gag reflex in full denture patients. Y State Dent J 1986;52:11-4.  Back to cited text no. 20
    
21.
Harrel SK, Barnes JB, Rivera-Hidalgo F. Aerosol and splatter contamination from the operative site during ultrasonic scaling. Am Dent Assoc 1998;129:1241-9.  Back to cited text no. 21
    
22.
Muhamedagic B, Muhamedagic L, Masic I. Dental office waste – Public health and ecological risk. Mater Sociomed 2009;21:35-8.  Back to cited text no. 22
    



 
 
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