Discussing the updates on the PDA Interim Guidelines
on Infection Prevention for CoVid-19 Pandemic
as of May 31, 2020
(Part 1)
We are now five (5) months into the pandemic and all of us have to adapt to the so-called “new normal” including the way we interact with patients to prevent the spread of the virus.
As there is an unexpected spread of the virus which, in turn, has become a pandemic affecting nations and crashing economies, we too have concerns over infection control.
As the world’s health experts scramble to find a cure and to develop a vaccine for the virus, we need to adapt to the situation.
To date experts are still trying to understand how the virus behaves, spreads, including its mechanisms, so we can have a better picture on how we can best contain the pandemic, if not eliminate the virus.
While there are several studies already published about the spread of the virus, we still need to have guidelines to protext dental health workers from getting infected in the course of their dental work.
We need to understand the reality that dental health professionals are also at risk of getting infected with the virus as these professionals are working with the oral cavity involving the saliva. The saliva is known to harbor SARS-CoV-2 virus, the virus that is the cause of the coronavirus disease (Covid) 19. It has been touted that close contact of the saliva containing the virus may increase the risk of getting infected.
In addition, the use of dental equipment mist saliva during aerosol generating procedures (AGP) such as ultrasonic scaling, use of high-speed handpiece, 3-way syringe and high (surgical suctions, high volume evacuators).
These are the risks that are unique to dental workers who are managing or working on dental interventions, where aerosol generation, handling of sharps, and proximity of the provider to the patient’s oropharyngeal region is something that cannot be avoided.
The reality is that around 80% of confirmed Covid 19 cases are asymptomatic.
The undetected or unidentified cases are responsible for the infection of 79% of documented cases.
For this reason, it is important to have adequate precautions must be observed in the dental office, so it can prevent exposure for both dentists and patients.
Currently, transmission experts are looking into the transmission of the disease even in the absence of actions such as talking and breathing. This new development puts forward the need for further investigation.
As of this writing, there is a need to have more pieces of evidence, which should be carefully analyzed.
The temporary guidelines made by the Philippine Dental Association (PDA) to lessen the risk of Covid infection, are based on published studies made available to all health professionals to help understand the nature of the virus and how the virus is being transmitted.
Furthermore, the guidelines provided by other authorities in different continents were used as a basis, considering best practices and clinical experiences of countries that are also hit by the Covid virus.
The recommendations aim to protect dental health workers, patients, and to stop the spread of the virus to the community.
Of this, the PDA Science Committee together with the Specialty affiliates of PDA strongly propose for dental health workers to be extremely cautious and meticulous in observing the recommended protocols.
We need to understand that there is no one solution to prevent the spread of the virus especially among the dental health workers and potential cross contamination in a dental health workplace setting. The dentists and other dental workers need to use personal protective equipment (PPE) must be used as a measure included in the infection control protocol and with the use of disinfectants, known to be friendly with the environment.
Most dental health workers are now practicing precaution for the prevention of droplet transmission.
However, more air engineering controls should be put in place to eliminate aerosols brought by heavy breathing, talking, sneezing, coughing, and most dental procedures.
There is a need to think of treatment alternatives in order to avoid misting out of saliva to prevent fomites or even inadvertent transmission among those who work in a dental health workplace.
The key here is to limit the engagement of the dentists with patients to only urgent and important procedures and only perform elective dental work if there is absolute guarantee that there is no chance of virus transmission or cross contamination that will happen.
Next week, we will further deal with the guidelines set by the PDA for dentists to prevent virus transmission amid the Covid 19 pandemic.