लेखक : लेखापढी      २० असार २०७८, आईतवार ११:५९ मा प्रकाशित     

The current outbreak of Coronavirus Disease 2019 (COVID-19) has become a severe global acute respiratory pandemic around the world in just a few months with an increasing number of infections and deaths. This global pandemic has claimed a number of lives in just a few days and can be a threat to mankind. Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness and recover without requiring special treatment.  Older people and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop serious illnesses. The pathogen that caused the new coronavirus disease is a new type of coronavirus, which belongs to the beta-type coronavirus with a cell membrane. They have enveloped viruses with a positive-sense single-stranded RNA genome and a Nucleocapsid of helical symmetry.

Itis imperative to ensure the safety of healthcare workers (HCWs) not only to safeguard continuous patient care but also to ensure they do not transmit the virus. The health care workers are the ones who are at greater risk in this pandemic. They stand with yet no option as they are obliged by their duty irrelevant to their families and social life. I will be emphasizing the risk of direct contamination in saliva procedures related to the dentists. Due to the characteristics of COVID-19, and the characteristics of dental procedures, dental practitioners are facing unprecedented challenges. The high risk of exposure to droplets and aerosols from saliva and other body fluids during the procedures may lead to cross-infection between dental practitioners and patients. It is the responsibility of every dental practitioner to fully understand the characteristics of COVID-19 and strictly implement the most appropriate protective measures to reduce and control the risk of cross-infection in dental procedures. The infection prevention and control practices during dental treatment are urgently needed. Undoubtedly, it’s a challenge to operate a dental procedure. Although no data are currently available to accurately assess novel coronavirus transmission risk during dental procedures, due to the relatively closed environment of dental clinics and the unique nature of dental procedures, both dental personnel and patients are easy to get the infection through currently known respiratory droplet transmission, aerosol transmission, close contact transmission and other ways.

Latest reports on COVID have drawn attention to dental risk which suggests that the salivary gland in the epidemic process of asymptomatic infections and can be a latent reservoir of infection. It’s hard to identify asymptomatic coronavirus carriers in dental clinics under the current circumstances. Infection control, hand hygiene, clinic disinfectant, individual protection, proper disposal are the must. The dental personnel should follow the prevention principle strictly, abide by the rules and regulations on disinfection and isolation, and perform hand hygiene procedures strictly. Clean area, potential pollution area and pollution area need to be set up and treatment should be carried out in the negative pressure isolation room. Dental personnel should wear isolation gowns, medical sterilised gloves, surgical masks, medical caps and goggles or mask. The procedures should be followed strictly when wear and remove the protective equipment. Body temperature and physical signs are monitored twice a day dental personnel should wear full-face respirators besides the procedures of secondary protection. Infection control in dentistry is an important topic that has gained more interest in recent years and guidelines for the prevention of cross-contamination. In dentistry, cross-contamination can occur by direct contact with microorganisms from patient to patient or patient to dentist and vice versa (droplet transmission and inhalation of airborne pathogens). This COVID 19 is an add on risk for dental professionals. Dental health care professionals are at risk for acquiring or transmitting hepatitis B, influenza, measles, mumps, rubella and varicella. All these diseases are vaccine-preventable. Limit the cross-contamination is a crucial part of an ideal dentist. You never know u may be at a dentist for a minor cause and yet you return with a severe disease that outbreaks within many years. Similar goes with the dental professional a little careless at work might degrade your health status.

The biological modes of transmission in dental practices include:

Saliva present in almost all dental procedures and a common substrate for the transmission of pathogens. Whenever possible, the patient must also wear a face covering.

Blood its presence during dental procedures should compel all dental staff to pay more attention to the possibility of contracting an infection.

Aerosol can be said to be potentially the most dangerous and most recent difference due to SARS-CoV-2. It is produced by spray- or aerosol-producing tools, including rotating/ultrasound/piezo instruments (high level) and air-water syringes (low level). On account of their diffusing action, these tools can widely spread the saliva of a potentially infected patient, thereby exponentially increasing the risk of contamination/contagion.

The timing of dental procedures is also a factor to be considered. Indeed, the duration of each dental activity is related to the risk of coming into contact with pathogens and their diffusion in the environment. Furthermore, talking loudly, coughing, sneezing, or gagging are other sources of transmission in addition to the human-to-human contact within the dental settings. Body temperature screening is mandatory everywhere.

There are indeed various areas to be addressed in the field of dentistry. The COVID-19 pandemic has raised concern among oral healthcare providers worldwide about the delivery of dental care. Availability of enough PPEs is a major challenge for dental clinics. It is the responsibility of dental care workers to keep themselves informed and ensure safety and control transmission within dental facilities. It’s high time we bring changes in the dental operating protocols. Using chemomechanical caries removal or a traumatic restorative technique (ART) with a rubber dam instead of rotary instruments are recommended.. Manual scaling is preferred over ultrasonic instruments. Minimizing gagging reflex with suction tip or impression tray, and disinfecting prosthesis and impression after removal from patient’s mouth is advised. Dental extraction should be performed while the patient is in a supine position to avoid operating on the patient’s breath way. Endodontic treatment requires a rubber dam with efforts to reduce unnecessary contact with other objects or equipment. Panoramic radiographs and CBCT (Dental cone beam computed tomography) are preferred over intraoral radiographs that could result in oral mucosal irritation and over excretion of saliva and in turn, increases the susceptibility to infection. It is recommended to use a single clinic, with a limited number of patients, and any suspected case that needs urgent treatment is advised to be treated on the last appointment of the day.

To summarize, The aim of this article is to recommend infection control strategies and patient management protocols to provide optimum dental care and simultaneously prevent the spread of this global pandemic. A small step individually can result in a high achievement collectively. So, Let’s think locally and act globally. It’s really a matter of great concern. This Pandemic can be a lesson if we don’t reckon it. It’s us who are responsible for our safety. Self-care is how you take your care back. The risk of health care professionals can’t be neglected. The ubiquitous spread of COVID 19 amplifies the overall protocols of a health care professional. So, It’s an earnest appeal for everyone to take precautions.
“Stay Safe and Stay in practice.”

 Kajol Shah
(Pursuing Bachelor of Dental Surgery(BDS) at BP Koirala Institute of Health Sciences.)

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