The particularities of dental work, and especially those treatments that generate saliva aerosolization, make dentists particularly vulnerable to COVID-19. Furthermore, taking into account that it has been confirmed that the pathogen can be transmitted from person to person through flugge droplets (up to 1 meter away).
Given the severity of the pandemic and the new measures adopted by the Spanish government to limit the spread of the virus, professionals in the dental sector have been forced to become aware of the situation and take extreme precautions.
Recommendations to dentists to prevent the spread of the coronavirus in dental clinics
The General Council of Dentists published last February a technical report on the management of dental patients in the COVID 19 pandemic. The text reports on the measures to be taken by professionals in the sector for the prevention and control of symptoms in the dental cabinet. The organization also offers other informative materials, as well as a triptych that has already been made available to the different professional dental schools in our country.
What are these recommendations to avoid contagion in dentistry?
Dentist with a surgical mask
• First, it is recommended to take all universal and specific measures to collaborate in the control of the infection. Those that are already being exercised by the vast majority of citizens.
• The use of valved FFP2 masks is recommended to dentists.
• If their use is not possible or not available, it is recommended to change the usual surgical mask every 2 hours.
• It is important to always wear gloves, a gown and eye protection that is properly adjusted.
• It is vitally important to wash your hands before and after caring for the patient.
• As the coronavirus is inactivated after 5 minutes of contact with normal disinfectants such as household bleach, cleaning and hygiene are very important. Clean and disinfect all work surfaces and the patient’s environment immediately after each treatment.
• Cleaning and disinfection will be carried out with a disinfectant included in the clinic’s cleaning and disinfection policy or with a sodium hypochlorite solution containing 1,000 ppm of active chlorine (1:50 dilution of a bleach with a concentration of 40-50 gr/liter prepared recently).
• All standard universal disinfection and sterilization standards must be scrupulously followed.
• It has been proven that the use of certain mouthwashes, prior to dental procedures, greatly decreases the viral load. It is recommended to use a 1% hydrogen peroxide mouthwash or a 0.2% povidone mouthwash for 1 minute.
• The use of the rubber dam is highly recommended in certain treatments. Its use reduces the viral load present in aerosols generated by dental procedures by up to 70%. Taking into account that, despite their use, aerosols usually occur (although to a much lesser extent), reinforce this technique, with a previous mouthwash.
• Rotary instruments that are not provided with a non-return valve can suck up debris, bacteria, and viruses, contaminating the air and water circuits, producing an increased risk of cross-infection. Most of the rotary instruments used in our country today have non-return valve systems.
In addition, before each consultation, it is also recommended to exercise extreme caution with certain patients who:
• In the 14 days prior to the appearance of your symptoms, you have been in close contact with a probable or confirmed case.
• Present clinical symptoms consistent with an acute respiratory infection, fever, and any of the following symptoms: dyspnea, cough, or general malaise.
Questions to ask patients
From the General Council of Dentists it is recommended to ask a series of basic questions to patients to help them in decision-making:
- Do you have a fever or have you had it in the last 14 days?
- Have you had a respiratory problem (including cough) in the last 14 days?
- Have you traveled to risky countries in the last 14 days?
- Have you been in contact with anyone with confirmation of coronavirus?
- Have you been in close contact with people who had acute respiratory symptoms in the last 14 days?
Hydroalcoholic gel, available in dental clinics
Other recommendations for dentists
In addition, there are other series of recommendations that can help establish more barriers to contagion. In many of them, common sense is the protagonist.
• Avoid shaking hands with the team and with patients.
• Make hydroalcoholic gel available to the clinic team and those who come to the dental office.
• Maintain a safe distance of one meter whenever possible.
• Remove magazines and newspapers from the waiting room as a precaution
• Clean the door handles several times a day.
• Ventilate waiting and treatment rooms at least twice a day.
• It is advisable to guarantee the decontamination of office supplies such as pens, and others such as credit cards or health cards, after each use.
Tips to be taken into account by patients
Patients can also take certain actions that help prevent the spread of the pandemic. Most are well known to most:
• Stay home as much as possible and limit your trips and nonessential contacts with other people. Therefore, from our point of view, they should reschedule their appointment with the dentist if it is not an emergency.
• If you have a dental emergency (toothache, fractures, abscesses, loss of a tooth, etc …), call your dentist before going to the office. Your dentist will tell you what to do while waiting for your appointment.
• Wash hands frequently
• Cough or sneeze into the elbow
• Use disposable tissues and throw them away after each use
• Maintain a distance of one meter whenever possible