CHANDIGARH,23.06.20-Dental surgeons are at the highest risk of contracting the Coronavirus, alongside paramedics, nurses, and other healthcare workers.By nature, dentists are at high risk of exposure to several types of aerosol particles and droplets that live in patients’ saliva and blood in addition to instruments contaminated with saliva, blood, and tissue debris.

COVID-19 has changed the way dental clinics are functioning. Dental care clinics will require newly structured and redesigned clinics with huge investment in the right equipment to maintain strict hygiene, sterilization and airflow.The dentists and their staff are exposed to high risk and hence are forced to spend heavily on Personnel Protection Equipment and structural changes in clinic.

A . Changesin Work Practices

  1. Dental clinics should limit clinical care to one patient at a time whenever possible. Record pre appointment history of travel, fever and exposure to any covid-19 patient.
  2. Check for fever and AarogyaSetu App for all patients in waiting area and get a consent form filled by patient.
  3. Provide disposable gloves, mask, shoe covers and head cap to every patient and attendant.
  4. Set up operatories so that only the clean or sterile supplies and instruments needed for the dental procedure are readily accessible
  5. Avoid aerosol-generating procedures whenever possible.
  6. Preprocedural mouth rinses (PPMR) with hydrogen peroxide or povidone iodine reduces the microbial count in mouth.
  7. Dentist and the staff should wear personal protective equipment (PPE) along with good N95 mask and there should be separate donning and doffing areas in clinic.
  8. Keep the duration of operating procedures shortto reduce viral loads.

B . Engineering changes

Ventilation and air quality management in dental clinics is very important.Studies suggest directing airflow through a negative pressure isolation room is a preferred model for protecting healthcare workers during patient care.

The Occupational Safety and Health Administration (OSHA) provides guidance on preparing workplaces for COVID-19 and defines steps to reduce employee exposure.

  1. Maintain air circulation with natural air through a frequent opening of windows and using an independent exhaust blower to extract the room air into the atmosphere. The CDC also defines a minimum of six air changes per hour (ACH) as criteria for an efficient ventilation system
  2. Avoid the use of a ceiling fan while performing procedure.
  3. Place a table fan behind the operator and let the airflow towards the patient.A strong exhaust fan to be so located to create a unidirectional flow of air away from the patient.
  4. The window air condition system/ split AC should be frequently serviced,and filterscleaned
  5. Use of indoor portable air cleaning system equipped with HEPA filter and UV light may be used. Ultraviolet germicidal irradiation units, commonly employed in hospital operatories and waiting areas, are successful adjunctive means for eliminating aerosols. The high spectral emission lamps from these units produce photons that expose microorganisms to a short light wavelength (254 nm) that is lethal to a microorganism.

C. Changesin environmental Infection control

Dental clinics should perform routine cleaning, disinfection, and sterilization protocols, and follow the recommendations for Sterilization and Disinfection of Patient-Care Items.

Environmental cleaning and disinfection procedures are followed consistently and correctly after each patient.We should wait for 15 minutes after completion of patient work before we begin to clean and disinfect room surfaces. This time will allow for droplets to sufficiently fall from the air after a dental procedure, and then be disinfected properly. Hence appointments are spaced properly.After 15 minutes the operatory is totally disinfected including the mopping of dental chair, floor and shelves with the best possible and appropriate disinfectants.

Ultraviolet germicidal irradiation (UVGI) is done for 10 -15 minutes depending upon wattage of the light source, room size and UV light position in the room. Disinfectant defogging and fumigation of 30-45 min is done after surgical procedures and at the end of the day.

We have done all possible changes at our The Perfect Smile Dental Clinic as recommended by World Health Organization(WHO),Occupational Safety and Health Administration (OSHA) ,Indian Dental Association(IDA),Indian Orthodontic society(IOS)and our main governing body Dental council of India(DCI) for the safety of our patients and our staff .

With these changes in dental clinics and with selective dental procedures it is very safe for the patients to get dental work done.

DR.SARABJEET SINGH

MOBILE: 9876061283