Stopping the COVID-19 pandemic in dental offices: A review of SARS-CoV-2 transmission and cross-infection prevention
Abstract
Impact statement
Introduction
Impact of the COVID-19 pandemic on dentists
Impact of the COVID-19 pandemic on dental patients
More dentists need to take additional steps to stop COVID-19 from spreading
Stopping the COVID-19 pandemic spreading from dental offices
COVID-19 origin
The meaning of COVID-19
Use of PRISMA evidence-based minimum set of items for reporting in systematic reviews and meta-analyses
Health risks and symptoms from COVID-19
SARS-CoV-2 infection detection

SARS-CoV-2 transmission

Spreading SARS-CoV-2 by respiratory droplets

Spreading SARS-CoV-2 by touching fomite surfaces

Stopping the COVID-19 pandemic in dental offices
Unreliability of COVID-19 detection and need for chair-side SARS-CoV-2 testing
Guidance to not treat COVID-19 patients suffering dental pain is likely impractical and unethical
Dentists can prioritize patients who need emergency appointments, and delay others who have COVID-19 until they have recovered
Type | Advice/dental treatment types |
---|---|
Non-emergency treatments | Delay treatment until the patient has two a negative SARS‐CoV‐2 tests, or at least 10 days after symptoms, or reports pain and suffering. |
All dental treatments which are non-emergency. | |
Emergency treatments | Provide treatment using PPE, social distancing, disinfection, cross-contamination prevention, and aseptic techniques. |
Alleviate acute or chronic pain associated with trauma avulsion or luxation, fractures, abscess, cellulitis, infections, swelling, lesions discharging fluid, and perfuse bleeding. |
Not all surgical face masks provide the same protection against transmitting SARS-CoV-2
Most effective mask types | Least effective mask types | Not effective |
---|---|---|
N95 respirator, surgical mask, poly/cotton blend mask, or a polypropylene fabric mask | Fabric mask, swath mask, cotton type 5-13 mask, valved N95 respirator, cotton type 4–8 mask, MaxaT-6 material mask, cotton type 1–10 mask, cotton type 3–9 mask, and a knitted mask | Lack of a mask or use of neck gaiter or use of a bandana to cover mouth. |
Limiting dental office capacity and patient waiting times
Enhanced cross-infection prevention procedures to stop the COVID-19 pandemic in dental offices
Goal | Enhanced cross-infection prevention procedures |
---|---|
Minimize contact risk with COVID-19 patients | All staff and patients should get COVID-19 vaccinations. |
Triage patients who need emergency dental appointments, and delay non-emergency patients who have COVID-19 until they have recovered. | |
Offer video and tele-dentistry dental appointments | |
Ask patients to wait outside in their vehicle until called into office for an appointment | |
Screen patients for COVID-19 prior to entering the dental office. | |
Maintain social distancing, limit the numbers of patients waiting, arrange waiting room seats 6 feet apart, prohibit patients bringing guests | |
Never allow an emergency patient with COVID-19 to have contact with any other patients. | |
Screen for COVID-19 and test for SARS-CoV-2. | Ask patients scheduled for elective dental treatment to have two negative SARS-CoV-2 PCR tests within 24 h of dental appointment. |
Give SARS-CoV-2 tests. | |
Screen everyone for COVID-19 symptoms prior to entering the dental office. | |
Anyone who has COVID-19 symptoms or tests positive must quarantine. Quarantine will end until after two negative SARS-CoV-2 PCR tests, or remain quarantined for 10–20 days after the onset of symptoms. | |
COVID-19 cross-infection prevention | Post signs instructing everyone to wear PPE. At a minimum, patients must always wear a face mask. Do not accept bandana’s, neck gaiters, or knitted masks as effective PPE. |
Dentists and staff must wear effective PPE (personal protective equipment) including N95 respirators or face masks, gowns, gloves, eye protection, face shields, and overalls, that are changed between each patient. | |
Disinfect equipment, dental chair and everything touched by a patient, before treating another patient. | |
Give dental patients a mouthwash prior to dental treatment to disinfect any potential SARS-CoV-2 in the mouth. | |
Supply sanitizers for hands and disinfectants for surface cleaning. | |
Install physical barriers (clear screens) between patients and reception staff. | |
Remove toys and magazines from the waiting area. | |
Increase dental office ventilation, increase air conditioning, and use HEPA or MERV filters to remove potential SARS-CoV-2 particles. | |
Use rubber dams and minimize aerosols during dental treatments. | |
Use electronic forms and contactless payment methods. |
COVID-19 vaccinations
Conclusions
DECLARATION OF CONFLICTING INTERESTS
FUNDING
ORCID iD
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This article was published in Experimental Biology and Medicine.
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