This document provides an overview of COVID-19 from a prosthodontic point of view. It discusses the virus's origins, symptoms, modes of transmission, risk groups, diagnosis, treatment and management. It notes dentists are at high risk due to working in patients' mouths and aerosol generation. Only emergency and urgent dental care should be provided, with strict precautions like PPE, disinfection and screening. Procedures like removable prosthetics and minor restorations can be done, while most implant and complex surgeries should be postponed. Strict guidelines are needed to provide safe dental care during the pandemic.

1. COVID 19 IN
DENTISTRY (PROSTHODONTIC POINT OF VIEWS)
BY
DR. MANELA SHILL
MDS 2nd yr
Dept. of prosthodontics crown & Bridge and
implantology
BY
DR. SONU KUMAR
MDS 2nd yr
Dept. of prosthodontics crown & Bridge and
implantology

2. CONTENTS
• INTRODUCTION
• TERMINOLOGIES
• HISTORY
• BACKGROUND
• TIMELINE OF
RESPONSE BY WHO
• MICROBIOLOGY
• SYMPTOMS
• MODE OF TRANSMITION
• GROUPS AT RISK
• DIAGNOSIS
• PREVENTION
• TREATMENT
• COVID 19 IN DENTISTRY
• TO DEVELOP
GUIDELINE FOR
DENTAL CARE
PROVISION DURING
PANDAMIC
• CATEGORIES OF
DENTAL TREATMENT
• CLASSIFICATION OF
COVID 19
• SCREENING,
TREATMENT
CONSIDERATION
• CONCLUSSION
• REFERANCES

3. DISCLAIMER
• All the materials (literature) that I have put in this presentation
that might change according to time because this Is new virus
and everything is under trial.
• Purpose of this presentation is to spread awareness among our
collogues about COVID 19
• THANK YOU
• Dr Sonu Kumar Gupta
• National President DMF
• sonu.dmf@gmail.com

4. INTRODUCTION
• Covid 19 pandemic it was initiated in 20019 from the city of
Wuhan China, shows flue like symptoms and mainly spread
by close contact and by droplet infections.
• Some authors claim that salivary gland it is reservoir of this
viruses and it spread by Aerosol generation. Some of authors
claimed that the mouth is like graveyard for this virus, and in
oral cavity tongue is the most common site where virus can
stay longer in the oral cavity.

5. • As a prosthodontist it is routine work to prepare full coverage
crown, full mouth rehabilitation, mouth preparation etc. this
all procedure generates more amount of aerosol which is
harmful for the dentist, patients, dental assistant and for the
society also.
• We are the peoples who is more close to the covid 19 so it is
important to know details about this virus and there
management.

6. TERMINOLOGIES
• VIRUSES:- an infective agent that typically consists of a nucleic
acid molecule in a protein coat, is too small to be seen by light
microscopy, and is able to multiply only within the living cells of a
host.
• EPIDEMIC:- a widespread occurrence of an infectious disease in
a community at a particular time.
• PANDEMIC;- prevalent over a whole country or the world.

7. BACKGROUND
• Corona virus term was coined in 1968
• Corona= Crown like structure
• 1975= family Corona viridae
• 2005= sub family
A. Corona virus.
B. Torovirus.

8. TIMELINES OF RESPONSES
December
31st 2019,
China alerted
WHO of
several flu-
like cases.
Jan 5th,
WHO
advised
against
travel
restrictions.
11th January, the
first coronavirus
death
7th of
January, the
virus was
identified as
a
coronavirus.
Jan 22nd, the
first
emergency
committee
was convened

9. Jan 31st,
WHO declared
a public health
emergency
February 3rd,
WHO’s
SPRP: was
released
Feb 4th, WHO
requested the
activation of
crisis
management
policy
Feb 4th, WHO
requested the
activation of
the UN crisis
management
policy
February 11,
WHO gives a
new name
COVID 19

10. SPRP:- STRATEGIC
PREPAREDNESS & RESPONSE PLAN
ONE
1.Rapidly
establishing
international
coordination
& operational
support.
TWO
1.Scaling
upcoming
readiness and
response
operations.
THREE
1.Accelerating
priority
research and
innovation.

11. MICROBIOLOGY
•
Envelop = Viral Glycoprotein
Genetic Material = m RNA
Protein Spike = Glycoprotein
Strain= R and L
TYPES
SARS COV = China 2003
MERS COV = Saudi Arabia 2012
N COV = 2019 China

12. SYMPTOMS
• Varies from MILD to SEVERE
1. FEVER
2. COUGH & SHORTNESS OF BREATH
3. PNEUMONIA
4. KIDNEY FAILURE
5. DEATH

13. OTHERS
• Muscles pain
• Confusion
• Headache
• Vomiting

14. MODE OF TRANSMITTION
• Droplet infection
• By sneezing, coughing and patients
contact
• Aerosol generation.
• In contact with infected patients
• Vertical transmit ion
from mother to featus (under
investigation)

15. PEOPLE AT HIGH RISK (CLINICALLY
EXTREMELY VULNERABLE)
• have had an organ transplant
• are having chemotherapy or antibody treatment for
cancer, including immunotherapy
• are having an intense course of radiotherapy (radical
radiotherapy) for lung cancer
• are having targeted cancer treatments that can affect the
immune system (such as protein kinase inhibitors or
PARP inhibitors)
• have blood or bone marrow cancer (such as leukaemia,
lymphoma or myeloma)
• have had a bone marrow or stem cell transplant in the
past 6 months, or are still taking immunosuppressant
medicine

16. • have been told by a doctor they you have a
severe lung condition (such as cystic
fibrosis, severe asthma or severe COPD)
• have a condition that means they have a
very high risk of getting infections (such as
SCID or sickle cell)
• are taking medicine that makes them much
more likely to get infections (such as high
doses of steroids)
• have a serious heart condition and are
pregnant

17. PEOPLE AT MODERATE RISK
(CLINICALLY VULNERABLE)
• are 70 or older
• are pregnant
• have a lung condition that's not severe
(such as asthma, COPD, emphysema or
bronchitis)
• have heart disease (such as heart failure)
• have diabetes
• have chronic kidney disease
• have liver disease (such as hepatitis)

18. • have a condition affecting the brain or
nerves (such as Parkinson's
disease, motor neurone disease, multiple
sclerosis or cerebral palsy)
• have a condition that means they have a
high risk of getting infections
• are taking medicine that can affect the
immune system (such as low doses of
steroids)
• are very obese (a BMI of 40 or above)

19. DIAGNOSIS
RT PCR
RAPID TESTING
KIT
COVID 19 ELISA
CT CHEST
ON CT CHEST
bilateral
Pneumonia,
Ground Glass
Shadow,
Bilateral patchy
shadow.

20. PREVENTION
• Covering mouth and nose
• Social distancing
• Mask and PPE kit for Health
worker
• Handwash
• Avoid contact with animals
• Through cooked food
• Stay in home quarantine if you
are feeling unwell
• Use herbals to build immunity

21. TREATMENT
• No specific medication
• Supportive Care
• No vaccine
• Symptomatic care
• PARACETAMOLE ONLY (avoid to use
IBUPROFEN)
• HYDROXYCHLOROQUINE
• ANTI RETROVIRAL DRUGS
• PLASMA THERAPY
• ANTIBIOTICS TO PREVENT SECONDARY
INFECTION

22. MANAGEMENT
1. Country level co ordination planning and monitoring
2. Risk communication and community engagement
3. Surveillance rapid response and case investigation
4. Points of entry
5. National laboratories
6. Infection prevention and control
7. Case management
8. Operational support and logistics

23. COVID 19 IN DENTISTRY
• DENTISTS ARE MORE PRONE TO THIS VIRUS
BEACAUSE OF
• Work into the mouth
• Chances of salivary contamination
• Aerosol generation
• Salivary gland is reservoir of this virus
• Tongue is the part of oral cavity where we they can get
attached for more periods of time.

24. MANAGEMENT IN DENTAL
CLINIC
• TYPES OF DENTAL CARE
1.EMERGENCY 1.URGENT
1.NON-
ESSENTIAL

25. WHAT IS AN EMERGENCY?
• In dentistry, an emergency is a potentially life-
threatening condition that requires immediate
treatment, including:
1. • oral-facial trauma
2. • cellulitis or other significant infection,
especially if compromising the patient’s airway
3. • prolonged bleeding
4. • pain that cannot be managed by over-the-
counter medications

26. WHAT IS URGENT CARE?
• In dentistry, urgent care is the management
and treatment of conditions that require
immediate attention to relieve pain and/or
risk of infection, including:
1. • severe dental pain from pulpal
inflammation
2. • pericoronitis or third-molar pain
3. • surgical post-operative osteitis, dry socket
dressing changes
4. • abscess or localized bacterial infection
resulting in localized pain and swelling

27. 5• tooth fracture resulting in pain, pulp exposure or causing soft
tissue trauma
6• dental trauma with avulsion/luxation
7• final crown/bridge cementation if the temporary restoration is
lost, broken or causing gingival irritation
8• biopsy of a suspicious oral lesion or abnormal oral tissue
9• replacing a temporary filling in an endodontic access opening
for patients experiencing pain
10• snipping or adjusting an orthodontic wire or appliance piercing
or ulcerating the oral mucosa
11• treatment required before critical medical procedures can be
provided

28. WHAT IS NON-ESSENTIAL CARE?
• In dentistry, non-essential care is the provision of routine or
non-urgent procedures, including:
1. recall examinations and routine radiographs
2. • routine dental cleanings and preventive therapies
3. • orthodontic procedures other than those to address acute
issues (e.g. pain, infection, trauma)
4. • extraction of asymptomatic teeth
5. • restorative dentistry, including treatment of asymptomatic
carious lesions
6. • cosmetic dental procedures, including teeth whitening

29. PROSTHODONTIST POINT OF VIEWS
• Procedures that can be performed:
1) Removable denture fabrication :
2)Fixed prosthodontics :
• No crown preparations to be done
Fractured prosthesis can be removed
Already prepared teeth: Either Bisacrylic chairside temps or lab
fabricated heat cure
Already fabricated fixed prosthesis: has to be sterilized as
described below and can be cemented using permanent cement

30. • Recementation of dislodged crowns/bridges
• • Missing anterior tooth/teeth can be
replaced a temporary
• Maryland bridge or Essix appliance.
• • Missing posteriors:
• Removable denture to avoid occlusal plane
discrepancy and to restore function.

31. PRECAUTIONS TO BE TAKEN:
• Impression trays
• Avoid using plastic trays; Metal trays to be water rinsed,
dried, packed and autoclaved before and after use
• Ultrasonic cleaners:
• washing under running tap water followed by judicious use of
ultrasonic cleaners is recommended.

32. • Impression disinfection
• Alginate : to be disinfected using
• 1% sodium hypochlorite solution.
• Quaternary ammonium compounds, glutaraldehyde based;
alcohol based.
• Elastomeric impressions
• 1% Sodium hypochlorite solution,
• Quaternary ammonium compounds, glutaraldehyde based

33. • Wax rims and wax bites
• disinfected using an sodium hypochlorite spray; "spray-wipe-
spray" technique; wax bites can be enclosed in a sealed plastic
bag for the proper contact time.
• Acrylic appliance disinfection
• Povidone Iodine or 1% Sodium hypochlorite are preferred.
Avoid storing prostheses in a disinfectant before insertion
Instead rinse thoroughly after disinfection and store acrylic
items in diluted mouthwash until inserted.
• Fixed prosthesis disinfection: Immersion in Cidex (alkaline
glutaraldehyde) or 1% sodium hypochlorite.
• Gypsum casts: Difficult to disinfect. Microwave irradiation of
the casts for 5 minutes at 900 W does give high level
disinfection of the gypsum casts.

34. IMPLANT SURGERY
• Implant surgeries should be postponed as far as possible.
However, osteotomies for implant site preparation maybe
possible in select clinical situations.
• FOLLOWING PROCIDURES CAN BE PERFOMED
• Bone expansion: In cases with softer bone (D3,D4) and narrow
ridges, bone expansion procedures can be accomplished using
expansion screws or convex ossteotomes. This may lead to
thinning of the labial bony wall, which can be augmented by
performing a GBR (Bone grafting) procedure.

35. • Immediate placements: Most immediate implant placements
do not require too much osteotomy site preparation. Apical
preparation for achieving primary stability can be achieved
using the same protocol explained above.
• Indirect Sinus Lifts: Can be performed using concave
ossteotomes followed by bone augmentation.
• Ridge augmentation and socket grafting procedures can be
performed as always.

36. AVOID:
FOR IMPLANT DENTISTRY
• 1.Avoid mandibular anterior cases
• 2. Speed> 100 rpm: the smoke can cause aerosol even in
absence of saline
• 3. No Piezo surgical devices
• 4. No autogenous grafting using trephine/ACM/piezo:
• 5. Complex surgical procedures

37. CAUTION
• Before going for any procedure take proper history proper
screening and proper PPE.
• It can be dangerous for any dentist if they are comes in
contact with any patients.
• If you are suspect then go for home quarantine
• Can take Hydroxychloroquine as a prophylactic measures
• Stop your practice if u are suspected and try to go for
screening.

38. PPE KIT

39. ADA GUIDELINES

40. CONCLUSION
As we are the dentist then we are the person who is most close
to mouth of any patients.
And we are more prone to infection then other one. So the
knowledge about this virus is very important so that we can
prevent the spread of this virus.
We must be constantly aware of infectious threats that may
challenge the current infection control regimen, especially in
dental practices and schools of dental medicine.

41. REFERENCES
• 1.Indian Dental Association, COVID-19 Protocol, 2020 www.ida.org
• 2. Guidelines on clinical management of COVID-19, Government of
India. 2020.March17 https://www.mohfw.gov.in/pdf/Guidelines on Clinical
Management of COVID1912020.pdf [accessed on 6th April, 2020]
• 3. Update on the 'index technique' in worn dentition: a no-prep
restorative approach with a digital workflow. Ammannato R, Int J Esthet
Dent. Dent 2018;13(4):516-537.
• 4. Contemporary treatment techniques in Pediatric Dentistry, Kher MS
et al, Springer Publication, 2019
• WHO open online