While doctors around the world are helping patients battle the COVID-19 pandemic, treatments for other health conditions seem to have taken a backseat. Dental health is one of them, and dentists are facing significant challenges in continuing to provide the necessary oral care. Several public health organizations have stated that the risk of contracting a Coronavirus infection is significantly higher in a dental setting, and have also provided guidance on how to reduce this risk and manage dental concerns during COVID-19.

Risk of contracting COVID-19 in a dental setting

In dental settings, asymptomatic and minimally symptomatic patients may spread COVID-19 infection to others through their saliva, which is rich in Coronavirus load. This means that it can infect others who come in contact with the saliva, e.g., through dental tools or other items in the clinic. Additionally, a majority of the dental procedures require close contact with the patient’s oral cavity and respiratory tract fluid secretions, which also are the primary sources of the spread of the novel Coronavirus infection.

According to the interim guidance on oral health services released by the World Health Organization (WHO), the risk of airborne transmission of Coronavirus during “Aerosol generating procedure” (AGPs) was marked as a high-risk dental procedure. These include water/air spray generating equipment, root canal treatment, teeth polishing, cementation of tooth’s crown, surgical tooth extraction and dental implant fixation. Such procedures result in the production of airborne particles (less than 5 μm in size) which remain in the air and can travel over a short distance. These aerosols can carry Coronavirus and may cause infection if they are inhaled. Also, it is hard to practice physical distancing between the dentist and the patient during an examination or procedure. Hence, it is advised that patients visit a dental clinic only for emergency procedures.

Do you require emergency help?

According to guidelines issued by most governments as well as public health organizations, it is important to recognize what constitutes a dental emergency and what does not. The American Dental Association (ADA) has provided a ready reckoner for this:

Dental emergencies: According to the ADA, these are ‘potentially life-threatening and require immediate treatment to stop ongoing tissue bleeding [or to] alleviate severe pain or infection’. Examples include uncontrolled gum or dental bleeding, bacterial infections with oral swelling that compromises the airway, or trauma involving facial bones.

Urgent dental care: These are situations that require immediate attention to relieve severe pain and/or risk of infection. Examples include severe dental pain due to inflammation of the pulp, tooth fracture, third-molar pain, post-operative inflammation of the bone, bacterial infection with localized pain/swelling, dental treatment required prior to critical medical procedures, crown/bridge cementation and a few others.

Non-emergency dental procedures: These include routine dental examinations, periodic cleaning, aesthetic procedures or regular check-ups.

It is always advisable to have a teleconsultation with your dentist in the first instance, who will use their expertise and professional judgement to conclude whether a patient requires emergency or urgent medical support.

Latest guidelines for carrying out dental procedures in India 

• Dental clinics will remain closed in the containment zones. Oral health professionals can only provide online dental teleconsultation in those areas.
• Urgent procedures should be undertaken only after an online consultation, tele-triage, consent, and through appointments only.
• Practice of non-aerosol generating procedures (AGPs) should be encouraged in a dental setting for emergencies.
• All administrative staff and incoming patients in the dental setting should be trained on physical distancing, hand hygiene, cough etiquettes and use of facemask.
• For disinfection of the dental setting, 1% sodium hypochlorite with a minimum contact time of 10 min is recommended for floor mopping. On the other hand, for disinfecting the dental and other electronic equipment, alcohol-based rub or spirit (containing min 60%-90% ethyl alcohol) should be used. Disinfection should be done daily and after carrying out every dental procedure.