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Table of Contents
Year : 2020  |  Volume : 7  |  Issue : 3  |  Page : 79-83

Impact of pandemic COVID-19 on dental services: A review

1 Assistant Professor, Department of Periodontology, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India
2 Consultant Periodontist, MDS, Lucknow, Uttar Pradesh, India
3 Post Graduate Student, Department of Periodontology, Santosh Dental College, Ghaziabad, Uttar Pradesh, India
4 Post Graduate Student, Department of Endodontics, Sardar Patel Dental College, Lucknow, Uttar Pradesh, India

Date of Submission21-May-2020
Date of Acceptance08-Jun-2020
Date of Web Publication24-Jul-2020

Correspondence Address:
Dr. Saransh Srivastava
B-1006, Third Floor, Greenfield Colony, Faridabad, Haryana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/INPC.INPC_19_20

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COVID-19 has emerged as a pandemic outbreak, and it has become a virulent disease. Coronavirus belongs to the family of enveloped, single-stranded, positive-strand RNA viruses classified under Nidovirales order. Dentists are at very high risk to get exposed to the virus due to direct contact with the oral cavity and aerosol produced by the salivary droplets of patients. Hence, several dental care facilities in the affected nations were completely closed or have been presenting minimum remedy for emergency cases. This assessment article aimed to provide a brief knowledge about the origin, mode of transmission, stages of spread of the disease, effect of the outbreak of the disease on dentistry, and patient management and prevention guidelines to be followed by dental practitioners.

Keywords: Coronavirus, COVID-19, pandemic, roniviridae family, severe acute respiratory syndrome coronavirus -2

How to cite this article:
Srivastava S, Tandon P, Jain N, Singh S. Impact of pandemic COVID-19 on dental services: A review. Int J Prev Clin Dent Res 2020;7:79-83

How to cite this URL:
Srivastava S, Tandon P, Jain N, Singh S. Impact of pandemic COVID-19 on dental services: A review. Int J Prev Clin Dent Res [serial online] 2020 [cited 2020 Oct 24];7:79-83. Available from: https://www.ijpcdr.org/text.asp?2020/7/3/79/290696

  Introduction Top

The coronavirus outbreak is a worldwide situation. The epidemics of coronavirus (COVID-19) commenced from Wuhan, China, from December 2019 and now has emerged as a primary challenge to the public health crisis not only in China but also all around the world.[1] On January 30, 2020, the World Health Organization announced that this outbreak had constituted a public health emergency of worldwide concern.[2] This article is based on the applicable suggestions and research about COVID-19 and presents the endorsed control protocols for dental practitioners in the affected regions.[3]

  Coronavirus Origin Top

According to recent studies, just like severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), SARS CoV-2 is zoonotic, and mostly it has originated from Chinese horseshoe bats (Rhinolophussinicus) and direct transmission of the virus from bats to humans is unlikely due to lack of direct contact, pangolins being the maximum probable intermediate host.[4] Coronaviruses belong to the family of Coronaviridae, of the order Nidovirales, comprising large, solitary, plus-stranded RNA as their genome.[4] Currently, there are four genera of coronaviruses: α-CoV, β-CoV, γ-CoV, and δ-CoV.[5],[6] Most of the coronavirus can motive the infectious sicknesses in human and vertebrates.[7]

  Epidemiology: Transmission Mode of Coronavirus Top

Based on the findings of genetic and epidemiologic research, it appears that the COVID-19 outbreak started with a single animal-to-human transmission, followed by sustained human-to-human spread.[8] It is now believed that its interpersonal transmission occurs mainly via respiratory droplets and contact transmission.

  Stages of Spread of Coronavirus Top

  • Stage 1: Getting the imported case: People getting infected outside the country having infection
  • Stage 2: Local transmission: the infected case came from outside the country, spreading infection to those who came in contact with them
  • Stage 3: Community transmission: If the people having infection do not restrict their movement (quarantine), they might spread the infection to people whom they do not even know, through infected surfaces
  • Stage 4: Turning into an epidemic: This chain reaction of the spread of the infection leads to huge explosion of the cases.[5],[6],[8]

  Population at High Risk of Infection Top

Most patients had a good prognosis, while a few patients were in critical condition, especially the neonates and elderly and those with chronic underlying diseases. They need more attention and care due to their immature or weak immune system.[5]

  Incubation Period Top

Based on the current epidemiological investigation, the incubation period is 1–14 days, mostly 3–7 days, and the COVID-19 is contagious during the latency period. It is highly transmissible in humans, especially in the elderly and people with underlying diseases.[9]

Clinical symptoms

A study conducted sampling of 1099 laboratory-confirmed cases and found that the common clinical manifestations included fever (88.7%), cough (67.8%), fatigue (38.1%), sputum production (33.4%), shortness of breath (18.6%), sore throat (13.9%), and headache (13.6%). Patients manifested gastrointestinal symptoms, with diarrhea (3.8%) and vomiting (5.0%).[10],[11],[12]

  Menace of COVID-19 on Dentistry Top

Nosocomial infection risk in dental settings

Due to the unique characteristics of dental procedures where a large number of droplets and aerosols could be generated by the use of a high-speed hand-piece or ultrasonic instruments, which make their secretions, saliva, or blood aerosolize to the surroundings, the standard protective measures in daily clinical work are not effective enough to prevent the spread of COVID-19, especially when patients are in the incubation period, are unaware they are infected, or choose to conceal their infection.[11]

  Prevention and Management of Nosocomial Infection Top

Telescreening and triaging

Initial screening via telephone to identify patients with suspected or possible COVID-19 infection can be performed remotely at the time of scheduling appointments [Figure 1]. The three most pertinent questions for initial screening should include any exposure to a person with known or suspected COVID-19, any recent travel history to an area with high incidence of COVID-19, and presence of any symptoms of febrile respiratory illness such as fever or cough.
Figure 1: Screening of dental patients for COVID-19

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A positive response to any of the three questions should raise initial concern, and elective dental care should be deferred for at least 2 weeks. These patients should be encouraged to engage in self-quarantine and contact their primary care physician by telephone or e-mail.[12],[13],[14]

Evaluation of patients

Upon patient arrival in dental practice, patients should complete a detailed medical history form, a COVID-19 screening questionnaire, and a true emergency questionnaire [Figure 2]. Patients who have a fever (>100.4°F = 38°C) and respiratory disease symptoms should have elective dental care deferred for at least 2 weeks. As per the CDC guidelines, individuals with suspected COVID-19 infection should be seated in a separate, well-ventilated waiting area at least 6 feet from unaffected patients seeking care. Patients should wear a surgical mask and follow proper respiratory hygiene, such as covering the mouth and nose with a tissue before coughing and sneezing and then discarding the tissue.[15]
Figure 2: COVID-19 screening questionnaire

Click here to view

Pharmacologic management

In suspected or confirmed cases of COVID-19 infections requiring urgent dental care for conditions such as tooth pain or swelling, pharmacologic management in the form of antibiotics and/or analgesics is an alternative. This approach may offer symptomatic relief and will provide dentists sufficient time to either refer the patient to a specialist or deliver dental care with all appropriate measures in place to prevent the spread of infection [Figure 3].[14],[15],[16]
Figure 3: Guidelines for dental emergency management during the COVID-19 outbreak

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  Protocols for Dental Treatments during the Outbreak of Covid-19 Top

Dentists must adhere to standard precautions, which are the minimum infection prevention practices, regardless of suspected or showed infection status of the patient such as performing hand hygiene, use of personal protective equipment, respiration hygiene/etiquette, protection from sharp instruments, safe injection practices, sterile instruments and devices, and clean and disinfected environmental surface.[15-17]

In the not likely event of offering dental care to suspected or confirmed cases of COVID-19 infection, dentists must be aware of the following pointers:

  • Preprocedural mouth rinse: SARS-CoV and MERS-CoV had been extraordinarily liable to povidone mouth rinse. Preprocedural mouth rinse with 0.2% povidone-iodine would possibly lessen the load of coronaviruses in saliva. Another alternative is 0.5%–1% hydrogen peroxide mouth rinse
  • Use of disposable (single use) devices which include diagnostic instruments to avert cross contagion
  • Extraoral imaging consisting of panoramic radiography or cone-beam computed tomographic imaging ought to be used to avoid gag or cough reflex which can occur with intraoral imaging. When intraoral imaging is mandated, sensors ought to be double barriered to avoid perforation and cross-contamination
  • Use a rubber dam to minimize splatter era. It can be advantageous to put the rubber dam so that it covers the nostril
  • Minimize the use of ultrasonic devices, high-speed hand-portions, and three-way syringes to lessen the risk of producing infected aerosols
  • Endodontic practices can dilute by using irrigation of 1% concentration sodium hypochlorite.
  • Airborne infection isolation rooms ( AIIRs): Patients with suspected or positive COVID-19 contamination need to no longer be treated in a recurring dental practice putting. Therefore, anticipatory expertise of health-care centers with provision for AIIRs might help dentists to offer emergent dental care if the requirement arises.
  • SARS-CoV-2 can continue to be feasible in aerosol and continue to exist up to a few days on inanimate surfaces at room temperature, with an extra preference for humid conditions. Therefore, hospital staff should make sure to disinfect inanimate surfaces by the use of chemical compounds currently authorized for COVID-19 and keep a dry surroundings to curb the unfold of SARS-CoV-2.
  • Other adjunctive measures which we all can use in our day-to-day clinical practices in the course of this outbreak of COVID-19 are as follows

    • 0.01%–0.02% NaOCl efficaciously inactivates the infectious agents that are probably aspirated into water traces, then dispersed inside the water spray, or those dispersed directly from the patient's mouth
    • Filtration or decontamination – Through high-performance particulate arrestor filters
    • Ultraviolet germicidal irradiation is a sterilization method typically used in hospitals and scientific settings to break airborne microorganisms.

  Conclusion Top

Health-care professionals have the responsibility to protect the general public and keep excessive standards of care and infection control. It is important to make knowledgeable scientific choices and teach the public to avoid panic and at the same time promote the health and well-being of our patients all through these tough times. The prudent practitioner will use this evaluation as a start line and retain to replace himself/herself with beneficial online records as this outbreak continues. “The greatest compassion is the prevention of human suffering through patience, alertness, kindness, and courage.” “BE READY TO DEFEAT COVID-19.”

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Conflicts of interest

There are no conflicts of interest.

  References Top

Phelan AL, Katz R, Gostin LO. The Novel Coronavirus Originating in Wuhan, China: Challenges for Global Health Governance. JAMA. 2020;323:709–10.  Back to cited text no. 1
Mahase E. China coronavirus: WHO declares international emergency as death toll exceeds 200. BMJ 2020;368:m408.  Back to cited text no. 2
World Health Organization. Coronavirus Disease 2019 (COVID-19): Situation Report-36. World Health Organization; 2020b. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200225-sitrep-36-covid- 19.pdf?sfvrsn=2791b4e0_2. [Last accessed on 2020 Feb 26].  Back to cited text no. 3
Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: Implications for virus origins and receptor binding. Lancet 2020;395:565-74.  Back to cited text no. 4
Holshue ML, De Bolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med. 2020;382:929-36.  Back to cited text no. 5
Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anesth. 2020.  Back to cited text no. 6
Fan Y, Zhao K, Shi ZL, Zhou, P. Bat coronaviruses in China. Viruses 2019;11:210.  Back to cited text no. 7
del Rio C, Malani PN. 2019 Novel Coronavirus—Important Information for Clinicians. JAMA. 2020;323:1039-40.  Back to cited text no. 8
Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G, Wallrauch C, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med. 2020;382:970-1.  Back to cited text no. 9
Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med Res 2020;7:4.  Back to cited text no. 10
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.  Back to cited text no. 11
Wang W, Tang J, Wei F. Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China. J Med Virol 2020;92:441-7.  Back to cited text no. 12
Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study. Lancet Respir Med 2020;8:475-81.  Back to cited text no. 13
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20.  Back to cited text no. 14
AtherA, Patel B, Ruprael BN, Diogenes A, Hargreaves MK. Coronavirus disease 19 (COVID-19): Implications for clinical dental care-review. J Endod. 2020;46:1-12.  Back to cited text no. 15
Wang Y, Wang Y, Chen Y, Qin Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures. J Med Virol. 2020;92:568-76.  Back to cited text no. 16
Centers for Disease Control and Prevention. Infection control: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Available from: https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control recommendations.html. [Last accessed on 2020 Mar 09].  Back to cited text no. 17


  [Figure 1], [Figure 2], [Figure 3]


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  Coronavirus Origin
   Epidemiology: Tr...
   Stages of Spread...
   Population at Hi...
  Incubation Period
  Clinical symptoms
   Menace of COVID-...
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