Discussing the updates on the PDA Interim Guidelines
on Infection Prevention for CoVid-19 Pandemic
(Part 3)
We continue with the discussion on the infection prevention for Covid as presented by the Philippine Dental Association (PDA).
All dental treatment that involves direct action or activity on or in the oral cavity, defy the one meter distance recommended by experts in avoiding transmission of SARS CoV2 virus. The actions involve direct contact with saliva which may generate droplets in the operatory, post-consultation.
Also, the use of equipment such as handpieces to restore teeth, electronic scalers for cleaning are some of the procedures which aerosolize saliva, leaving fomites in the operatory process..
Due to these situations, the dental is encouraged to exercise extreme precaution during each dental procedure.
All dental procedures which do not use air driven or powered instruments inside the oral cavity are considered as non-aerosol generating procedure (NAGP).
Dental professionals need to observe standard infection control procedures.
At the same time, droplet precautions should be exercised at all times.This is to prevent contact with saliva coming from the patient.
We need to realize that these procedures do not use devices to forcefully release saliva into the air, and it may consequently produce aerosol because the patient’s mouth is kept open for a long time.
These dental procedures lead to heavy breathing and project salivary fluids, which could either way release the virus, if it is present on the patient, out in the operatory process.
In addition, some procedures, known as simple ones, may lead to a more complicated treatment.
Dental professionals should be aware of examples of NAGP, which are:
a. Oral Examination, b. Extra-Oral Radiograph, c. Denture records taking, prostho try-in, occlusal adjustments (extra-oral), d. FPD try-in and cementation (no in mouth adjustment with hand piece), and e. Impression Taking
Dental procedures which generate misting of saliva outside the patients’ oral cavity are considered as aerosol generating procedure (AGP).
We need to realize that these procedures may contaminate the entire operatory leaving fomites and some pathogens suspended in the air until after the procedure.
Moreover, procedures that last for several minutes, may lead to loading the atmospheric environment of the operatory with high number of possible pathogens.
The thing is that incessant crying is not a procedure, it however, generates volumes of salivary droplets which could be aerosolized by coughing and vomiting.
The Covid manifestation in children is mostly mild and they could be asymptomatic carriers of the virus.
Some of the AGPs are:
a. Restoration and tooth preparation with the use of high & low speed dental hand pieces; b. Use of 3-way syringe; c. Removal of calcular deposits using ultrasonic scalers and similar equipment
In order to reduce inhalation of the virus in the operatory during an AGP, specifically SARS CoV2 virus, if present in an asymptomatic patient, the following should be observed: a. Let patient rinse prior and during treatment with 0.2% povidone iodine or 1% hydrogen peroxide to reduce viral load in the saliva; b. Use rubber dam during restoration or preparation of the teeth; c. Adhere to engineering controls in air flow for the reduction of atmospheric pathogens; d. Use of fluid repellent coveralls/isolation gowns, head caps, face & eye protection (goggles/face shields), mask and gloves.
Personal protective equipment must be worn by both the dentist and the dental assistants or any other member of the dental team.
Next week, we will discuss the preparations that the dental team should observe prior to any dental procedure.