Background

SARS-CoV-2, the virus that causes COVID-19, is spread primarily through respiratory droplets. Airborne transmission from person-to-person over long distances is unlikely. However, the contribution of aerosols, or droplet nuclei, to close proximity transmission is currently uncertain. The virus has been shown to survive in aerosols for hours and on surfaces for days. There are also indications that patients may be able to spread the virus while pre-symptomatic or asymptomatic.

The practice of dentistry involves the use of rotary dental and surgical instruments such as handpieces or ultrasonic scalers and air-water syringes. These instruments create a visible spray that contains large particle droplets of water, saliva, blood, microorganisms, and other debris. This spatter travels only a short distance and settles out quickly, landing on the floor, nearby operatory surfaces, Dental health care professionals (DHCP), or the patient. Surgical masks protect mucous membranes of the mouth and nose from droplet spatter, but they do not provide complete protection against inhalation of airborne infectious agents.

Recommendations 

Postpone Elective Procedures, Surgeries, and Non-urgent Dental Visits

Services should be limited to emergency visits only during this period of the pandemic. These actions help staff and patients stay safe, preserve personal protective equipment and patient care supplies, and expand available health system capacity.

Contact Patients Prior to Emergency Dental Treatment

Telephone triage all patients in need of emergency dental care. Assess the patient’s dental condition and determine whether the patient needs to be seen in the dental clinic. Use teleconferencing options as alternatives to in office care. If dental treatment can be delayed, provide patients with detailed home care instructions and any appropriate pharmaceuticals.

Provision of Emergency Care to Patients Without COVID-19 in a Dental Clinic During the COVID-19 Pandemic

If a patient must be seen in the dental clinic for emergency care, systematically assess the patient at the time of check-in. Emergencies include patients in severe acute pain or with life-threatening conditions like Ludwig’s angina or sepsis from odontogenic infection. If patient must be seen;

• Avoid aerosol generating procedures whenever possible. Do not use the handpiece
• If aerosol generating procedures are necessary for emergency care, use four-handed dentistry, high evacuation suction and dental dams to minimize droplet spatter and aerosols. Wear gloves, a gown, eye protection (i.e., goggles or a disposable/reusable face shield that covers the front and sides of the face), and an N95⁴ or higher-level respirator during emergency dental care for patients without COVID-19.

Recommendations are in line with CDC advice.

Contributed by:

Dr. Olawale Adamson
Lecturer and Consultant Oral and Maxillofacial Surgeon
CMUL and LUTH