Coronavirus covid 19 impacts to dentistry

1. Coronavirus COVID-19
Impacts to Dentistry
Prof. Abdelraouf A. Elmanama
Islamic University of Gaza

3. Key Points
• Recognize dental settings have unique characteristics that warrant specific
infection control considerations.
• Prioritize the most critical dental services and provide care in a way that
minimizes harm to patients from delaying care and harm to personnel and
patients from potential exposure to SARS-CoV-2 infection.
• Proactively communicate to both personnel and patients the need for them to
stay at home if sick.
• Know the steps to take if a patient with COVID-19 symptoms enters your
facility.

5. Introduction about Corona
• A novel human coronavirus initially referred to as the Wuhan coronavirus (CoV), currently
designated as severe acute respiratory syndrome (SARS)-CoV-2, is responsible for the latest
pandemicthatisaffectinghumanhealthandeconomyacross theworld.
• Thisoutbreak beganinWuhan, China, in December2019.
• On 30 January 2020, the WHO declared the Chinese outbreak of COVID-19 to be a Public
Health Emergency of International Concern because of its rampant spread, thus posing a high
risktocountrieswith vulnerablehealthsystems.

6. COVID-19 is nowa pandemicaffecting over200 countries
globally.

8. Crossing the species barrier
Group of viruses : cause a significant percentage of all common colds in human adults and
children
Four human corona virus including- 229E, OC43, NL63, and HKU1 are prevalent and typically
cause commoncoldsymptomsinimmunocompetentindividuals.
Corona virus tocross speciestoinfecthumanpopulationsin thepasttwodecades.
1.Severe AcuteRespiratorySyndrome Coronavirus(SARS-CoV) outbreakin2002
2.MiddleEastrespiratory syndrome coronavirus(MERS-CoV) outbreakin 2012..

9. • SARS-CoV which causes SARS, has a unique pathogenesis because it causes both upper and
lower respiratory tract infections.
• The genome sequence of SARS-CoV-2 is about 89% identical to bat SARS-like-CoV and 82%
identical to human SARS-CoV.
• It has been reported that SARS-CoV-2 uses the same cell entry receptor, ACE2, to infect
humans, as SARS-CoV, so clinical similarity between the two viruses could be expected,
particularly in severe cases.

11. Variation in
Receptor NOT
in Virus

12. Transmissibility
HOW do YOU get COVID-19?
DIRECT
TRANSMISSION
INDIRECT
TRANSMISSION
Cough, sneeze and
droplet inhalation.
Contact with oral,
nasal,eye and mucous
membrane.

13. Clinical Manifestations
 Fatigue.
 Muscleor body aches.
 Headache.
 Newlossoftasteor smell.
 Congestionor runny nose.
 Nauseaor vomiting.
 Diarrhea.

14. Serious complications:
Acuterespiratory distress syndrome.
Arrhythmia.
Shock.
In general, older age and the existence of underlying comorbidities (e.g., diabetes,
hypertensionandcardiovascular disease)wereassociatedwithpoorerprognosis.

15. INCUBATION PERIOD
• Theincubationperiod of COVID-19 has been estimatedat 5 to6 days on average.
• The ASSYMPTOMATIC INCUBATION PERIOD for individuals infected with SARS-CoV-2
has been reported to be 1-14 days, and after 24 days individuals were reported
confirmedthatthose withoutsymptoms can spared thevirus.
• According tokai-wanget al, live virus present in thesaliva also thatcan spread easily.

16. Infectiousness
• People are most infectious when they show symptoms (even mild or non-specific
symptoms), but may be infectious for up to two days before symptoms appear (pre-
symptomatictransmission).
• They remain infectious an estimated 7-12 days in moderate cases and an average of
two weeks in severe cases.

18. COVID-19 & Dentistry
According to Occupational Safety and Health Administration (OSHA),
dental health care personnel (DHCP)
are placed in very high
exposure risk category
as dentists work in
close proximity to the
patient’s oral cavity.

19. Dental procedures create particles of droplets
and aerosol with COVID-19
Firstly, many dental procedures, such as those including;
• The use of high-speed turbines and running water, release a large number of particles of
droplets and aerosols mixedwiththepatient’s saliva totheair.
• These particles are so smallthattheycould stay airborne for a considerable period of time.

20. Dental procedures create particles of droplets
and aerosol with COVID-19
• These particlescouldalsosettleon environmentalsurfacesandotherdentalequipment.
• Researches suggest that the virus could live up to 72 hours on hard surfaces.
Moreover,thedentalofficeusually includessurfaces ofmetal,glassor plastic.
• Thus, dentists and other patients could easily get infected without proper control procedures.
Because it is tough to avoid the generation of particles of droplets and aerosol, this is probably
themostimportantconcern fordentalprofessionals.

22. SOP for Dental Patients during & after COVID-19
Step 1: TELEPHONIC PRE-SCREENING PROTOCOL
•Fixappointmentsthroughphone only&Discourage Walk-inPatients,
•Hot SpotMatching&MedicalSymptomsAssessment*,
•Dentalneedsassessment,
•Askpatienttowear maskand preferablycomealonewithoutany attender.

23. Step 2: RECEPTION/ WAITING AREA
PROTOCOL
• Receptionist / Staff : One Person,
• Discourage footwear within clinic interiors/ provide foot cover,
• Record patient temperature using DigitalNon-contact Infrared Thermometer,
• Mandatory use of Alcohol Based Hand Rub (ABHR) & provide Mask for everyone.
• Seating arrangement with minimum 1.5-2 meters PhysicalDistancing,
• DisplayPatient Education Materialon Hand & Cough Hygiene(leaflet, brochure, posters or TV screen)
• Patientto submit signed Disclosure/ Consent Form*.

25. Step 3: DENTAL OPERATORY PROTOCOL
• Keep the clinicaloperatoryclutter-free.
• Improveair circulationand avoidair-conditioners.
• 0.01%NaOClfor disinfection of dentalwater lines.
• Donningof appropriatePPEfor DentalSurgeonandone dentalassistant.

26. STEP 4: PATIENT ASSESMENT AND TREATMENT PROTOCOL
• Pre-ProceduralMouthrinse:1% Hydrogen peroxideor 0.2%Povidone-iodine:1 min
• Extra oralscrubbing offacewithAntisepticwipe,
• Four-HandedDentistryand RubberDamApplicationforAGP.
• HighVolumeSuction &MinimizeIOPAusage.
Diagnose&
TreatmentPlan Into
NonAerosolGenerating
Procedures (Non-AGP)
Aerosol Generating
Procedures (AGP)

27. Step 5: PATIENT DISCHARGE
• Patientadvisedtore-mask andproceedtoreceptionarea,
• HandHygiene.
• ElectronicTreatmentrecords only.
• Cashless paymentpreferred.

28. STEP 6A; POST -TREATMENT AIRBORNE CONTAMINANT REMOVAL
PROTOCOL Room should be well ventilated with a minimum 6 ACH
(Air Changes per Hour)

29. Step 6B: POST –TREATMENT CHAIRSIDE
DISINFECTION PROTOCOL (Minimum 20 mins):
Instrument change
• Flushing of suction andspittoon drainage with 1% NaOCl .
• Disinfect 3feet area around Chair& Mop the clinical area .

30. Step 7: PROTOCOL AT THE END OF CLINICAL DAY
• REPEAT STEP 6B and6A in this order
• DOFFING of PPE in separate area.
• BIO-MEDICAL waste in double waste bag ONLY.
Step 8: WHEN GOING HOME AFTER A WORKDAY
• We should change from scrubs to personal clothing before returning home .
•Upon arriving home, we should take off shoes, remove and wash clothing [separately from other
household residents] andimmediately shower…

31. Recommendations

32. Hand Hygiene
• According to the CDC hand hygiene guidelines, dentists should perform hand hygiene
before & after all patient contact, contact with potentially infectious material, and before
puttingon & afterremoving PPE,includinggloves.
• It should be performed by using alcohol based hand rub (ABHR) with 60-95% alcohol or
washinghands withsoap & water for at least 20 seconds.

34. PERSONAL PROTECTIVE EQUIPMENT ( PPE )

35. Masks
I. A triple layered surgical mask can be worn by all health care providers when within
1-2 meters of patient.
II. Particulate respirators (N 95 masks authenticated by the National Institute for
Occupational Safety and Health or FFP2 standard masks set by the European Union)
are recommendedfor routine dentalpractice.
III. If available an FFP3 standard mask should be used and in COVID 19 positive patients
this wouldbe considered essential.

38. Eye & face protection
• Upon entry tothepatient room Goggles or a disposable faceshield.
• Reusable –clean and disinfect.
• Disposable –discard..

39. Gowns
• Isolation gown upon entry intothe patientroom.
• Mandatory for aerosol-producing procedures, where splashes and sprays are anticipated.
• Attentionshould bepaid to trainingand proper donning(puttingon),
doffing(takingoff), and disposal of any PPE.

41. Environmental Disinfection of Dental Clinic
Air flow circulation:
The air flow must be planned in a way to facilitateclearing of the contaminated aerosol within the dental
operatory with adequate provision of ventilation to allow a minimum of 6 ACH (Air Changes per Hour ).
It is recommended to:
a) Use a stand alone HEPA 13 or HEPA 14 air filter in the dental operatory.
b) Avoid air conditioners if they are not having in built HEPA filters .

42. Environmental Disinfection of Dental Clinic
c) Usenaturalventilationwhenavailable
d) Introduceadditionalpositive air flow from less contaminatedtomore
contaminatedzoneby using pedestalor table topfans.
e) Placeexhaustfansto evacuatethe contaminatedair totheexternalenvironment.

43. ONE THING ALWAYS KEEP IN MIND
“ EVERY PATIENTS IS AN
ASSYMPTOMATIC CARRIER OF COVID – 19”
SARS-2
COVID-19

44. Take home messages
• Dentistry is of a special nature.
• Greater risks are expected
• Your contribution of preventing the spread of covid-19 infection is
invaluable.
• May seem complex yet live saving procedures should be implemented to
protect your self, your staff and as well as patients

45. Take home message /
Must do checklist

46. Thank you