IDA issues COVID appropriate guidelines for Dental professionals.

Dental care invariably carry the risk of COVID-19 infection due to the specificity of its procedures. There is a possibility of both direct transmission (cough, sneeze, and droplet inhalation) during face-to-face communication with patients, as well as contact transmission (exposure to saliva, blood, and other body fluids, and the handling of sharp instruments).

Aerosol (particles of respirable size, <10 μm) production during the use of the rotary and surgical instruments is unique to the majority of dental procedures. These instruments produce a visible spray that can contain particle droplets of water, saliva, blood, microorganisms, and other debris. Particles of droplets and aerosols are small enough to stay airborne for an extended period before they settle on environmental surfaces or enter the respiratory tract. Thus, the 2019-nCoV has the potential to spread through droplets and aerosols from infected individuals in dental clinics.

Since unique characteristics of dental practice warrants specific infection control measures, IDA has come up with specific guidelines for dental professionals.

Minimize Chance for Exposures

• Post a sign at the entrance to the dental practice which instructs patients having symptoms of a respiratory infection (e.g., cough, sore throat, fever, sneezing, or shortness of breath) to please reschedule their dental appointment and call their physician. The same thing applies if they have had any of these symptoms in the last 48 hours.

• Reschedule appointments if your patients have traveled outside India in the last two weeks to an area affected by the coronavirus disease. This includes China, Hong Kong, Iran, Italy, France, Spain, Germany, Japan, Singapore, South Korea, Taiwan, Thailand, Vietnam, or any other COVID19 affected country.

• Take a detailed travel and health history when confirming and scheduling patients. Do not provide non-emergent or cosmetic treatment to the above patients and report them to the health department immediately. Screen patients for travel and signs and symptoms of infection when they update their medical histories.

• Incorporate questions about the new onset of respiratory symptoms into daily assessments of all patients.

• Take temperature readings as part of the routine assessment of patients before performing dental procedures.

• Take the contact details and address of all patients treated.

• Install physical barriers (e.g., glass or plastic windows) at reception areas to limit close contact with potentially infectious patients.

• Make sure the personal protective equipment being used is appropriate for the procedures being performed.

• Use a rubber dam when appropriate to decrease possible exposure to infectious agents.

• Use high-speed evacuation for dental procedures producing an aerosol.

• Autoclave hand-pieces after each patient.

• Have patients rinse with a 1% hydrogen peroxide solution before each appointment.

• Clean and disinfect public areas frequently, including door handles, chairs and bathrooms.

• Post visual alerts icon (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) to provide patients with instructions (in appropriate languages) about hand hygiene, respiratory hygiene, and cough etiquette. Instructions should include how to use tissues to cover the nose and mouth when coughing or sneezing, to dispose of tissues and contaminated items in waste receptacles, and how and when to perform hand hygiene. Provide supplies for respiratory hygiene and cough etiquette, including alcohol-based hand rub (ABHR) with 60-95% alcohol, tissues, and no-touch receptacles for disposal, at entrances, waiting rooms, and patient check-ins.

Personal Protective Equipment

• Facial protection: Wear a surgical or procedure mask and eye protection (face shield, goggles) to protect mucous membranes of the eyes, nose, and mouth during activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions equipment.

• Gown: Wear to protect skin and prevent soiling of clothing during activities that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions. Remove soiled gown as soon as possible.

• Linens: Handle, transport, and process used linen in a manner that prevents skin and mucous membrane exposures and contamination of clothing. Avoid transfer of pathogens to other patients and or the environment.

Hand Hygiene

Wash hands with soap and water for at least 20 seconds before and after contact with patients, body fluids, contaminated instruments, and surfaces, etc.

Respiratory Hygiene and Cough Etiquette

Persons with respiratory symptoms should:

• Cover their nose and mouth when coughing/sneezing with tissue or mask,

• Provide tissues and no-touch receptacles to throw away used tissues and offering face masks to patients who are coughing.
• Dispose of used tissues and masks, and perform hand hygiene after contact with respiratory secretions.

• Dental personnel should use N95 respirators or respirators that offer a higher level of protection instead of a facemask when performing or present for an aerosol-generating procedure.

Waste Disposal

• Ensure safe waste management.

• Treat waste contaminated with blood, body fluids, secretions, and excretions as clinical waste, in accordance with local regulations. Human tissues and laboratory waste that is directly associated with specimen processing should also be treated as clinical waste. Discard single-use items properly.

Patient Care Equipment

Offices also should follow routine cleaning and disinfection strategies used during flu season.

• Handle equipment soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures, contamination of clothing, and transfer of pathogens to other patients or the environment.
• Clean, disinfect, and reprocess reusable equipment appropriately before use with another patient.

Train and Educate Personnel

• Provide task-specific education and training on preventing transmission of infectious agents, including refresher training.