We all know how important sanitization is pre, during, and post covid scenarios for our as well as the safety of the clinic staff and patients. Though sanitization has always remained our main concern, even pre covid, certain sanitization protocols are mandatory during and post covid.

What you should prioritize ?

• Recognize dental settings , armamentarium and equipments that have specific ways of sterilizing and infection control considerations.
• Prioritize the most critical and emergency dental treatments. Deliver dental care in a way that the patient experiences maximum benefits of the treatment.
• Proactively communicate and maintain follow-up appointments via telephonic or video consultations.
• Know the steps and precautions to take when a person affected with covid-19 enters your dental clinic.

The 3 R’s

As contributors to the healthcare community, dentists majorly need to follow 3 R’s in their dental clinics during covid times:
–Rethink
–Re-evaluate
–Reinforce

Dental practice includes an insanely high amount of transmission risk that undeniably poses a great occupational hazard. Center for Disease Control and Prevention (CDC) recommends that dental facilities postpone elective procedures, surgeries and prioritize urgent and emergency visits and procedures now and for the coming several weeks.

This aligns with recommendations from the American Dental Association (ADA) and the Indian Dental Association. It complies with the Centers for Disease Control for optimal patient and self-care coming from the highest authority of healthcare, these precautions are formulated based on two precautionary lines

1 – For patients who are suspected COVID-19 positive which should ideally include screening everyone as a mandatory safety measure.

2 – For patients who have confirmed COVID – 19 positive.

Basic and emergency dental clinic preparations during covid

Fundamental preparations you should carry out in your practices for emergency patient care during and also after this lockdown:

1 – Make sure that no unwell support staff comes to work. Execute sick leave policies that are provisional, non-punitive in nature. Provide ultimate assistance to your staff, they’re the ones that shall help you get through these difficult times.

2 – Teleconsultations – Being the need of the hour, facilitating encouragement of social distancing to avoid endangering the health of everyone involved. Telephone triage, although slightly compromising on the diagnostic efficiency is the best solution to segregate patients depending upon the severity of one’s pain.

3 – Install physical barriers like plastic and glass sheets to minimize direct contact in anyways whilst the treatment of any patient.

4 – When any patient does come to you for dental care, ensure efficient screening. This shall help you decide whether the treatment is elective or emergency in nature. Appropriate screening and patient education play a pivotal role during this crisis.

In case you suspect a COVID-19 affected patient, provide an N95 mask to the patient, to cover the nose and mouth to prevent cross-contamination.

In case the patient does not show any symptoms send the patient back and instruct the patient to call medical personnel.- In case the patient, for example, has trouble breathing refers the patient to a medical facility without wasting time.

5 – In cases of emergency dental care, which is medically necessary for a patient who suffers, or is suspected of having COVID-19 treatment should be carried out in a way that is minimally invasive and cause least to no aerosol production.
Airborne Precautions should be mandatorily carried out. According to guidelines, an isolation room with negative pressure relative to the surrounding area and the use of an N95 filtering disposable respirator should be followed. Carry out treatments ideally in a hospital setting with all pre-requisite norms fulfilled.

6 – Revamping work settings -Avoid aerosol creating procedures while working, if necessary switch to four hand dentistry along with high suction to eliminate aerosols. Dental Tribune has published a hypothesis wherein Povidone Iodine has shown to be effective against most viruses, including coronavirus – hence adding this solution to a water bottle could help create virus-free aerosols.

7 – Use the highest level of Personal Protective Equipment possible, along with eye protection. Most dentists recommend the use of OHP sheets which can be makeshift use for face protection is available easily.

8 – Make sure the products have EPA – approved emerging viral pathogen claims along with periodical fumigation of the entire dental setting. Regular disinfection of the floor and walls with 1000mg/L chlorine-containing disinfectant through floor mopping, spraying, and wiping.
Fumigate the entire area within 6 feet radius of the patient. Disposed of the vain armamentarium should be adequately.

9 -The Dental Council of India recommends scrubbing the patient with isopropyl alcohol extra-orally and pre-procedural rinse of 0.2% povidone-iodine to be safe.

10 – Dispose of all toys, magazines, newspapers and stay minimalistic whilst keeping items in the common area.

11 – Dispose of the biomedical waste all other disposable armamentaria accordingly to prevent further contamination.

12 – Once again, reiterating the most important point which is encouraging social distancing by all means and protocols necessary.
13 – Try to lend basic utilities such as mouth masks, gloves, and sanitizers which we generally use while treating patients, to our brother in arms who are fighting at the frontline during this crisis.

The COVID-19 Emergency Treatment Protocols Recommendations of Subject wise experts

Emergency protocols for MDS dentists about the don’ts provided by the Maharashtra State Dental Council are

• Department of Oral Medicine and Radiology – Do not take IOPA’s, extraoral radiographs, CBCT except in cases of emergency.
• Conservative Dentistry and Endodontics – No aerotor use and surgical endodontics should be carried out. Anything causing aerosol production should be strictly avoided.
• Oral and maxillofacial surgery – Medicinal approach to treat mild to moderate space infections. Defer extractions, Implants, and biopsy for a month at the very minimum.
• Pedodontics – Defer aerotor use for any procedure. Avoid elective procedures in the first place.
• Periodontics – No use of ultrasonic scalar/micromotor. Defer oral prophylaxis.
• Orthodontics – Do not indulge in bracket bonding, changing wires, and debonding.
• Prosthodontics – No tooth preparation, implant placement, impression taking, and removal of faulty prosthesis should be
  carried out.
• Oral Pathology – Avoid haemogram for elective surgical procedures

Always remember prevention is better than cure ‘ especially the only plausible option for an illness that doesn’t have any cure yet. Until then, stay apart to stay united. We’re all in this together and together we shall overcome it.

Highlights

• Follow guidelines given by government / IDA sanitization protocols strictly. Don’t compromise on sanitization protocols against the hiking prices in the market.
• Keep in mind the 3 R’s; Re-think, Re-evaluate and Reinforce things in your dental clinic during covid times.
• Prioritize critical, emergency and non emergency dental care.
• Subject matter dental experts should follow the guidelines and Don’ts while treatment planning in their dental clinics as well as during consultations during the covid times.