Role of dentists during COVID-19

Ever since the introduction of COVID-19, the whole globe is at a crucial stage. All the works are at a temporary shutdown and people are bound to stay indoors to save themselves as well as their loved ones. Are we doing enough? Where are we the most useful? What will happen if too many of us get contaminated and sick? These are some questions that has bothered us all along.

To our brief knowledge, there are musketeers around the world like medical professionals, police officers, media, bank personnel, and many others who go outside each day and do the best of their jobs to save us from this deadly virus. Little do we know about a hidden sector of the medical field, which is not solely regarded to be countable in this pandemic. We are talking about dentists here.

As a medical professional, even dentists bear a role in managing any medical hazard. Unfortunately, the question of their participation has not been given much heat amidst this pandemic, which leaves them with a feeling of helplessness.

As always happens, healthcare professionals have been immediately involved in the national emergency, working hard, often day and night. Unfortunately, small numbers of them have also become infected, and some have tragically died. Dentists are often the ﬁrst line of diagnosis, as they work in close contact with patients. On 15 March 2020, the New York Times published an article entitled “The Workers Who Face the Greatest Coronavirus Risk”, where an impressive schematic ﬁgure described that dentists are the workers most exposed to the risk of being aﬀected by COVID-19.

Dental care settings invariably carry the risk of 2019-nCoV infection due to the specificity of its procedures, which involves face-to-face communication with patients and frequent exposure to saliva, blood, and other body fluids, and the handling of sharp instruments.

The pathogenic microorganisms can be transmitted in the dental settings through inhalation of airborne microorganisms that can remain suspended in the air for long periods. Or it might be due to contact of conjunctival, nasal, or oral mucosa with droplets and aerosols containing microorganisms generated from an infected individual and propelled a short distance by coughing and talking without a mask and indirect contact with contaminated instruments and/or environmental surfaces. Infections could be present through any of these conditions involved in an infected individual in dental clinics and hospitals, especially during the outbreak of 2019-nCoV

Dentists have been recommended to take several personal protection measures and avoid or minimize operations that can produce droplets or aerosols. Moreover, the use of saliva ejectors with a low volume or high volume can reduce the production of droplets and aerosols.

Taking into consideration the severity of the pandemic COVID-19, and in the light of the massive commitment of several dental associations and the most prestigious dental journals, it is essential to give clear and easy guidelines to manage dental patients and to make working dentists safe from any risk.

A fundamental concept is that the transmission of the virus is mainly through inhalation/ingestion/direct mucous contact with saliva droplets; it is also critical to remember that the virus can survive on hands, objects, or surfaces that were exposed to infected saliva. Since the viral load contained in the human saliva is very high, rinses with antiseptic mouthwashes can only reduce the infectious amount but are not able to eliminate the virus in the saliva.

The most recommended guidelines indicate that dentists should avoid the scheduling of any patient: only such urgent dental diseases can be considered during the COVID-19 outbreak. This action will drastically limit the interpersonal contact, the waiting time of patients in dental cabinets, and, in general, the conditions predisposing patients to be infected.

When the dentists treat patients, they should intercept the potentially infected person before they reach the operating areas; for example, those with a fever measuring >37.5◦C and the posing of a few questions about the patient’s general health status in the last 7 days, and about the risk of having been in contact with other infected persons.

There are several detailed practical strategies to block virus transmission to provide a reference for preventing the transmission of 2019-nCov during dental diagnosis and treatment, including patient evaluation, hand hygiene, personal protective measures for the dental professionals, mouthrinse before dental procedures, rubber dam isolation, anti-retraction handpiece, disinfection of the clinic settings, and management of medical waste.

Looking at the present scenario, dentists can also play a significant role be it by providing more space in dental offices or by carrying out a general examination, checkup of patients. Basically, at this state, the world requires more number of hands to carry out medic activities everywhere. If other colleagues get sick or become unable to handle the incoming increased ratio of patients, the implications of dentists will be mandatory. Not to mention, their proficiencies can provide a classical approach to diagnosis, monitoring, and treatment of the COVID-19 patients effectively like swabbing, vital monitoring, and even carrying out emergency procedures.

Till date, not any conformed oral manifestation of COVID-19 has been identified but variations in symptoms are creating challenges for us. The virus needs to be identified and the patient should be diagnosed at a quicker pace. That can only be possible if we work together. Only then will we be able to fight and defeat this disaster.