A Presentation on COVID 19 and its implications for dental practice, includes careful steps for patient handling, Management of emergencies & personal care to be taken during this pandemic crisis.

1. CORONAVIRUS DISEASE (COVID-19): IMPLICATIONS
FOR CLINICAL DENTAL CARE
PRESENTER
DR.METTINA
.
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2. INTRODUCTION
 An emergent pneumonia outbreak originated in Wuhan City, in the late December 20191.
 The pneumonia infection has rapidly spread from Wuhan to most other provinces and other 24 countries2.
 World Health Organization declared a public health emergency of international concern over this global
pneumonia outbreak on 30th January 2020.
2

3. SYMPTOMS
Fever, Cough, and
Myalgia or Fatigue
Abnormal chest CT,
sputum production,
headache, hemoptysis,
and diarrhea
Anosmia , Ageusia
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4. CHARACTERISTICS OF NOVEL CORONAVIRUS
4
• Coronaviruses belong to the family
of Coronaviridae, of the order Nidovirales,
comprising large, single, plus-stranded RNA as
their genome.
• Currently, there are four genera of coronaviruses:
α-CoV, β-CoV, γ-CoV, and δ-CoV.
• Coronaviruses can cause infectious diseases in
human and vertebrates.

5. ROUTE OF SPREAD
Bats Pangolin Humans
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6. TRANSMISSION
Cough, sneeze, and droplet inhalation
transmission
Contact transmission (contact with oral, nasal,
and eye mucous membranes).
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7. TRANSMISSION IN THE DENTAL OFFICE
 Airborne spread
 Contact spread
 Contaminated surface spread
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8. INFECTION CONTROLS FOR DENTAL PRACTICE
 PATIENT EVALUATION
 HAND HYGIENE
 PERSONAL PROTECTIVE MEASURES FOR DENTAL PROFESSIONALS
 MOUTHRINSE BEFORE DENTAL PROCEDURES
 RUBBER DAM ISOLATION
 ANTI RETRACTION HANDPIECE
 DISINFECTION OF CLINIC SETTINGS
 MANAGEMENT OF MEDICAL WASTE
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9. PATIENT SCREENING
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10. PATIENT -QUESTIONNAIRE
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13. HAND HYGIENE
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• A two-before-and-three-after hand
hygiene guideline is proposed to
reinforce the compliance of hand
washing.
• Dental professionals should wash their
hands before patient examination, before
dental procedures, after touching the
patient, after touching the surroundings
and equipment without disinfection, and
after touching the oral mucosa, damaged
skin or wound, blood, body fluid,
secretion,

14. PERSONAL PROTECTIVE MEASURES
14
PPE is the buzzword during this
pandemic.
(1) Primary protection (standard protection for staff in clinical
settings). Wearing disposable working cap, disposable surgical
mask, and working clothes (white coat), using protective goggles
or face shield, and disposable latex gloves or nitrile gloves if
necessary.
(2) Secondary protection (advanced protection for dental
professionals). Wearing disposable doctor cap, disposable
surgical mask, protective goggles, face shield, and working
clothes (white coat) with disposable isolation clothing or surgical
clothes outside, and disposable latex gloves.
(3) Tertiary protection (strengthened protection when contact
patient with suspected or confirmed 2019-nCoV infection).
Protective outwear is recommended, In addition, disposable
doctor cap, protective goggles, face shield, disposable surgical mask,
disposable latex gloves, and impermeable shoe cover should be

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17. MOUTHRINSE BEFORE DENTAL PROCEDURE
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Chlorhexidine containing mouthwashes have been proven to be ineffective against the Novel
Corona virus hence Betadine & Hydrogen peroxide containing mouthwashes should be used

18. RUBBER DAM ISOLATION
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• The use of rubber dams can significantly
minimize the production of saliva- and blood-
contaminated aerosol or spatter,
• This is especially true when high-speed
handpieces and dental ultrasonic devices are
used.
• It has been reported that the use of rubber
dam could significantly reduce airborne
particles in ~3-foot diameter of the operational
field by 70%5

19. ANTIRETRACTION HANDPIECE
19
• The high-speed dental handpiece without anti-
retraction valves may aspirate and expel the debris and
fluids during the dental procedures.
• The microbes, including bacteria and virus, may further
contaminate the air and water tubes within the dental
unit, and thus can potentially cause cross-infection.
• Anti-retraction high-speed dental handpiece can
significantly reduce the backflow of oral bacteria and
HBV into the tubes of the handpiece and dental unit as
compared with the handpiece without anti-retraction
function

20. DISINFECTION OF THE CLINIC SETTINGS
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• Medical institutions should take effective and
strict disinfection measures in both clinic
settings and public area.
• The clinic settings should be cleaned and
disinfected in accordance with the Protocol for
the Management of Surface Cleaning and
Disinfection of Medical Environment

21. MANAGEMENT OF MEDICAL WASTE
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• The medical waste (including disposable protective
equipment after use) should be transported to the
temporary storage area of the medical institute timely.
• The reusable instrument and items should be
pretreated, cleaned, sterilized, and properly stored in
accordance with the Protocol for the Disinfection and
Sterilization
• The medical and domestic waste generated by the
treatment of patients with suspected or confirmed
2019-nCoV infection are regarded as infectious medical
waste.
• Double-layer yellow color medical waste package bags
and “gooseneck” ligation should be used. The surface
of the package bags should be marked and disposed

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23. CONCLUSION
 Endodontists are in a unique situation as they may be called upon for the assessment and
management of odontogenic pain, swelling, and dental alveolar trauma in suspected or
known COVID-19 patient.
 Health care professionals have the duty to protect the public and maintain high standards of
care and infection control. This new emerging SARS-CoV-2 threat could become a less
pathogenic and more common infection in the worldwide population.
 Indeed, it is predicted to persist in our population as a less virulent infection with milder
symptoms,
 Thus, it is important to make informed clinical decisions and educate the public to prevent
panic while promoting the health and well-being of our patients during these challenging
times.
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24. REFERENCES
 Coronavirus Disease 19 (COVID-19): Implications for Clinical Dental Care
Amber Ather, BDS, DDS, Biraj Patel, BDS, Nikita B. Ruparel, MS, DDS, PhD, Anibal Diogenes, DDS, MS, PhD, and
Kenneth M. Hargreaves, DDS, PhD
 Transmission routes of 2019-nCoV and controls in dental practice
Xian Peng1 , Xin Xu1 , Yuqing Li1 , Lei Cheng1 , Xuedong Zhou1 and Biao Ren
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