Covid 19 is a pandemic viral disease caused by a novel coronavirus (SARS COV 2). The virus presents itself in salivary and bask pharyngeal secretions and spreads rapidly through respiratory droplets. A covid 19 positive patient shows symptoms such as fever above 100 degree Celsius, cough, cold, runny nose, sore throat, body pain, breathlessness, loss of appetite, loss of taste, loss of smell also. Asymptomatic patients who do not show these signs and symptoms are of a greater threat as they are the carriers of COViD 19.
Dentistry today has drastically been changed due to this COVID 19 pandemic. The dentists are at the highest risk during dental treatment of contracting and transmitting the novel coronavirus. A dentist comes in close contact with the patient’s oral cavity, blood and saliva. Procedures carried out in the dental field that produces aerosols would spread the saliva mixed with blood. In addition handling of various dental instruments, X-ray films, RVGs, OPGS and dental materials would lead to cross contamination during the dental treatment procedure, so adequate precautions have to be undertaken to halt the further spread of the novel coronavirus.
Following procedures have to be adapted in every dental clinic in this present COVID 19 pandemic scenario:-
1. Introduction of PPE kits for the dentists and dental assistants consists of non impermeable gown with a hood, shoe cover, N-95 mask, protective eyewear, face shield, head cap and surgical latex double gloves.
2. A telephonic conversation is a must wherein the receptionist of dental office should take a thorough history of the patient asking the patient for any history of travel for past 3 months, coming in close contact with any COVID 19 positive patient, if the patient is /was suffering from any cough, cold , fever, history of hospitalization apart from COVID 19, history of self quarantine as implemented. Once the receptionist finds that the patient was under self-quarantine and gives no history of any medical issues, the patient can be appointed accordingly.The receptionist should appoint fewer patients in a day with a time interval of 1 hour.This would prevent the crowding of patients and would give ample time for room sterilization and disinfection.
3. At the reception desk of the dental office, the patient entering is given a hand sanitizer followed by gloves.Every patient entering should strictly wear a mask and hand gloves. A digital thermometer is used for thermal screening and record the temperature on the patient’s COVID 19 com sent form. A previously COVID 19 form is given to the patient to write his or her travel history, history of contact with a person suffering from cold, cough, fever, history of quarantine. This has to be thoroughly filled with the patient for clinical records.
4. Thorough sterilization of dental equipment for best hygiene and safe practising, all instruments are autoclaved at 121 degree Celsius.
5. Educating the dental staff to follow strict sterilization protocols, precise handling of dental instruments and appropriate use of Personal Protective Equipment kits should be carried out.
6. Awareness posters which give information about sanitization and sterilization steps should be displayed in every dental clinic.
7. The dental clinic should be well equipped with newer equipment such as HEPA filters ( it filters bacteria and smallest known virus) and well ventilated rooms, fumigation system, high volume extra oral suction, indoor air cleaning system, all chemicals required for disinfection and appropriate and equipped PPE kits.
8. COVID 19 virus can potentially survive in the environment for several hours or days. The premises and areas potentially contaminated with the virus should be disinfected before reuse.
9. Floors should be cleaned with 1 % sodium hypochlorite. Surfaces should be disinfected with 1% sodium hypochlorite after every procedure and after finishing daily work.
10 . Practice non-aerosol generating procedures
Before starting the dental treatment procedure patient is advised to gargle with an antiseptic mouthwash. The patient has to be then draped by the assistant. All dental treatment procedures are carried out under strict sterilization protocols. Disposal of blood stained gauze, cotton pellets is done in waste receivers. After the treatment is done and when the patient leaves the treatment room the assistant collects all hand instruments for further sterilization. The dental chair is thoroughly disinfected with 1% sodium hypochlorite along with its auxiliary parts. New cotton gauze should be used for every surface. Spittoons should be cleaned with 1% sodium hypochlorite.
All the three way syringes, water outlets, suction tubes should be flushed with a disinfectant solution for 30 -40 seconds. Handpieces should be cleaned by disinfectant to remove debris and packed into autoclave pouches.dental impressions should be disinfected before pouring. Biomedical waste management should be implemented as per the government guidelines. Separate bins with specific colour coding s and disposable plastic bags to dispose of the soiled waste should be undertaken. Doffing of PPE kit should be done in a separate room. Healthcare workers on reaching home should follow all precautions like removal of shoes, change of clothes, having a bath , removal of wrist watches if any.
Walk-in patients without any prior dental appointments should be encouraged with no signs and symptoms of fever, cold, cough, body pain, breathlessness. Such patients should be treated only under dental emergencies. If they show any positive signs they should be referred to a physician and can be prescribed analgesics to postpone the dental procedure. The patient follows up should be done telephonically in 24 hours or in a week to know if the patient has developed any symptoms which would wRn the dental staff. The patient should also be advised to inform the dental office if they show any adverse symptoms.
All these guidelines are updated from time to time and hence the dentist should be informative and known to everyday procedures.
That being said as dentists and dental practitioners we are trained to handle such circumstances and hence dentistry is safe.