No. 1 March 2020
Important Notice
These are unprecedented times. We have an important role to play to prevent the spread of this virus. It is very likely that the government and the health authorities in each country would have issued guidelines on how to prevent the spread of COVID-19. ALL OF US UNDERTAND THE NEED TO FOLLOW THE GUIDELINES VERY STRICTLY.
In the following article, measures undertaken in some countries are described. However, as stated at the beginning, LOCAL GUIDELINES WILL SUPERSEDE THESE.
In addition, please keep up to date.
Guidelines for the Prevention of Spread of COVID -19 in Dental Practice
Introduction
Dental practices provide an environment conducive for the spread of this infection due to many dental procedures generating aerosols, droplets and splatter. Therefore, dentists and other Dental Health Care Professionals DHCPs (dental therapists, dental hygienists and dental nurses) are at risk of getting infected. The primary infection control goal is to prevent transmission of disease to DHCPs and other patients.
Measures
The following measures are to be followed: 1. Post signs at entrances to the Dental Practice advising patients with any signs and symptoms of respiratory infection (cough and fever) not to enter the premises but to seek medical advice and care without delay.
2. Screen apparently healthy patients before proceeding with any treatment. Information to take note of are:
a. Whether the patient had close contact with an individual diagnosed with COVID-19 after return. If so, treatment should be deferred. Recent travel to any countries where COVID-19 is present. At the present time, most countries are in this category. Please visit the WHO website for the latest information.
b. Verify when the patient returned from high-risk areas. If the patient reports that at least two weeks have passed since his/her return and no signs and symptoms have appeared, the treatment can proceed.
3. In any case, treatment is best restricted to emergency procedures designed to relieve symptoms such as pain, swelling etc.
4. Procedures such as scaling, aesthetic restorations and definitive restorations, orthodontic treatment and other elective procedures are to be deferred. This can be explained verbally to the patients at the entrance to the Dental Practice and also by displaying notices at the entrance.
5. Current advice is only to proceed with appointments for patients who do not show symptoms. Facemasks should be used by people who show symptoms of COVID-19 to help prevent the spread of the disease to others.
6. In small or crowded waiting rooms that do not offer safe distance between patients, reception staff can offer patients the option to wait outside and receive a phone call or text message when it is their turn for treatment.
7. When handling emergencies:
a. To facilitate contact tracing if required, proper patient registration system should be maintained which include accurate personal data with contact details.
Commonwealth Dental Association
Website: http://www.comdental.org
Promoting Oral Health in the Commonwealth
President’s Newsletter
b. Dentists and DHCPs should wear personal protection equipment (PPE). Such PPE can be impermeable isolation gowns, head caps, goggles, masks and two pairs of gloves, covered shoes and fluid resistant shoe cover or boots. Wear a surgical mask and eye protection with solid side shields or a face shield to protect eyes, nose, and mouth during procedures likely to generate splashing or spattering of blood or other body fluids. Also, change masks between patients, or during patient treatment if the mask becomes wet.
c. Ideally, single use items must be used. In resource limited settings, certain items (e.g. gowns and masks) may have to be re-used after sterilization. Then enough numbers of these items must be available.
d. If re-using, wash them preferably in a washing machine with hot water at 60 – 90o C. If machine washing is not possible, soak linen in 0.05% chlorine for 30 minutes.
e. Dental instruments such as dental burs, endodontic files etc. should be used only once.
f. Perform routine surgery cleaning. Clean all frequently touched surfaces such as worktops, and doorknobs and handles. Use the cleaning agents that are usually used in these areas
g. After treating each patient, surrounding areas should be cleaned as follows:
• Dental chair, tray, stool, table-tops, light handles, door- knobs and handles: wipe with 70% ethyl alcohol
• Metal instruments: autoclave
• Re-usable dedicated equipment- 70% ethyl alcohol
• Toilets: clean with 0.5% hypochlorite
• Reusable PPE: boots 0.5% hypochlorite; goggles: soap and water and 70% ethyl chloride.
h. Staff: • Advise sick staff members to stay at home. That is, if a staff member has a “new, continuous” cough or has a temperature of 37.8°C or higher, he/she should self-isolate for seven days if they are living alone, or 14 days if they living with someone else.
• All staff must always practise good respiratory etiquette and hand hygiene. If coughing, do so into a tissue and bin it. If a tissue is not available, cough into one’s sleeve.
• All staff must clean their hands often with an alcohol-based hand sanitizer that contains at least 60-95% alcohol or wash their hands with soap and water for at least 20 seconds. Soap and water should be used preferentially if hands are visibly dirty.
• Provide soap and water and alcohol-based hand rubs for the staff. Place hand rubs in multiple locations to encourage good hand hygiene.
• If a staff member is confirmed to have COVID-19, he/she has a duty to inform fellow members of his/her condition but maintain confidentiality. Anyone exposed to a co-worker with confirmed COVID-19 should seek medical attention as soon as possible. In addition, the Dental Practice should undergo a thorough deep clean.
• An additional professional duty is to counter misinformation propagated especially through social media.
Conclusions
This guidance not exhaustive. Please refer to local guidelines and advice from the specialists in infectious diseases. In any case, implement sensible precautions. KEEP UP TO DATE.
Resources
British Dental Association
Centre for Disease Control CDC, USA
Indian Dental Association
Sri Lanka Dental Association
