Covid-19 has become a worldwide emergency and has been declared as “global pandemic” by WHO. This health alert pertains to dental health providers regarding emergency and elective dental care in light of COVID-19, the rationale for this action, including of what constitutes a dental emergency and conditions requiring urgent care.
Why dentistry is a risky branch:COVID-19 virus was recently identified in saliva of infected patients. Dentists, when performing aerosol generating procedures may be unknowingly providing direct care for infected but not yet diagnosed COVID-19 patients or those considered to be suspected cases for surveillance.
Due to characteristics of dental settings, the risk of cross infection may be high between dental surgeons and patients especially when patients are in the incubation period, are unaware they are infected or choose to conceal their infection.
Need for clear guidelines: On 15th march 2020, the New York Times published an article entitled ‘’the workers who face the greatest coronas virus risk”, where an impressive schematic figure described that dentists are the workers most exposed to the risk of being affected by COVID-19.
So it is essential to give clear and easy guidelines to manage dental patients and make working dentists safe from any risk. Although in some countries dental offices have been closed during the epidemic, a large number of emergency patients still go to dental clinics and hospitals for treatment.
In any case, the most recommended guidelines indicate that only urgent oro-dental diseases should be considered for intervention during COVID-19 outbreak. This action will drastically limit interpersonal contacts, waiting time of patients in dental clinics and, in general, conditions predisposing patients to be infected.
Requested action: Suspend non-essential (elective) dental care for the time being for both children and adult patients. This action aims to protect patients and dental surgeons, to help “flatten the curve” by slowing the spread of corona virus, and to preserve critical personal protective equipment, which is in critical demand around the country.
Elective dental procedure:It is a dental procedure that is chosen (elected) by the patient or by a dentist and that is advantageous to the patient; the procedure is seen beneficial but not absolutely essential at that time, as opposed to “dental emergencies” or “urgent dental care”.
Dental emergencies:According to American Dental Association (ADA), “are potentially life threatening and require immediate treatment to stop ongoing tissue bleeding (or to) alleviate severe pain or infection”.
Conditions include:Uncontrolled bleeding; Cellulitis or diffuse soft tissue infection with intraoral or extraoral swelling that potentially compromises the patient’s airway; or trauma involving facial bones that potentially compromises the patient’s airway.
Urgent dental care:The ADA has now expanded its guidance to include urgent dental care, which “focuses on the management of conditions that require immediate attention to relieve severe pain and/or risk of infection and to alleviate the burden on hospital emergency departments”.
(These should be treated as minimally invasively as possible). For examples of conditions requiring urgent dental care:Severe dental pain from pulpal inflammation; Pericoronitisor third molar pain; surgical post-operative osteitis, drysocket dressing changes; abscess, localized bacterial infection resulting in localized pain and swelling; tooth fracture resulting in pain or causing soft tissue trauma; dental trauma with avulsion/luxation; dental treatment required prior to critical medical procedures; biopsy of abnormal tissue; extensive dental caries or defective restoration causing pain; suture removal; denture adjustment on radiation/oncology patient’s; replacing temporary filling on endo access openings in patient’s experiencing pain; snipping or adjustment of an orthodontic wire or appliance piercing or ulcerating the oral mucosa;
Non-emergency dental procedures:Routine or non-urgent dental procedures include but are not limited to:
Initial or periodic oral examinations and recall visits, including routine radiographs; routine dental cleaning and preventive therapies; orthodontic procedures other than those to address acute issues (for example pain, infection, trauma); extraction of asymptomatic teeth; restorative dentistry including treatment of asymptomatic carious lesions; aesthetic dental procedures.
When treating emergencies or providing urgent dental treatment:
In other words, the standard protective measures (universal precautions) may not adequately protect dentists or staff. That is why in some countries dental offices have been closed during this pandemic to control the spread of corona virus infection from patients to dentists and vice-versa.
Author is BDS, PGIMS, Rohtak