Infection control in dental practices during COVID-19

As cases of COVID-19 continue to rise, there is a need for evolving infection control in dental practices. According to the CDC, COVID-19 attacks respiratory droplets expelled through the nose or mouth when the individual coughs or sneezes and contaminated surfaces can transmit the airways. Dental health professionals are at risk because of the possibility of frequent exposure to saliva, aerosols and other oral or body fluids, including through the use of dental instruments. It is important to strategize ways to protect both patients and dental staff by implementing better infection control practices to decrease the potential spread of COVID-19. 

Here are some infection control practices to consider before, during, and after dental visits :

Things to consider before Office Visit

Patient Evaluation and Screening

Due to the high risk of infection for both patient and staff, dental practices should evaluate if the patient needs emergency or non-emergency dental care. This will determine if the patient whether the patient should visit the office. Also,  dental professionals should be able to identify a suspected case of COVID-19, if identified, the patient should quarantine and report to the infection control department.  Screening patients before and during an office visit: asking screening questions about recent respiratory problems or if they’ve experienced any fever-like symptoms within the past 14-days is recommended. Remember to document shortness of breath, cough or other possibilities before procedure or shift. Screening both patients and DHCP temperature before their shift, appointment, or procedure by using a non-contact free forehead thermometer is recommended.

Hand hygiene

 Reducing COVID-19 through hand hygiene practices is important, as fecal-oral transmission during dental procedures is likely. Reinforcing hand hygiene by staff before dental procedures, after, and touching surfaces i.e. chairs, dental lights, drawer handles, and oral equipment can reduce the spread of COVID-19.  It’s also important to wash your hands after touching equipment or coming in contact with skin, body fluids. Dental staff must avoid touching their face during or after contact with the patient and must wash their hands after every procedure to ensure their safety and their patients.

Check out, ADA Interim Guidance for Minimizing Risk of COVID-19 Transmission

Infection Controls Considerations During Procedure 

 What is considered a dental emergency:  Emergencies that are life threatening or require immediate treatment i.e. uncontrollable bleeding, tissue bacterial infection, third-molar pain, pain from pulpal inflammation, suture removals.

To reduce dental office staff and the patient chance of infection or spreading during the procedure, offices must implement: 

• Personal Protective Measures/Equipment (PPE): Droplets are airborne, it is important for dental staff to practice social distancing but during a procedure, staff must wear protective disposable equipment to protect themselves and patient from infection; including
  • Protective Outerwear i.e Long sleeve water-resistant gowns
  • Protective Eyewear (goggles) and Face shields to protect from droplets 
  • Mask for Respiratory protection
  • Latex or Nitrile Gloves
  • Shoe covers

Using reusable eye protection? Thoroughly clean and disinfect according to instructions prior to use.

• Using Sanitized Equipment: Using Rubber Dams, Drills and High volume suctions (handpiece) are important during emergency procedures.
  •  Rubber Dams (recommended) reduce the production of saliva and staff contact with contaminated aerosol. 
  •  High volume suctions(recommended) for infection control reduces fluid during procedures, bacteria, and viruses in the mouth can splatter, using suction can reduce virus transmission.

Sanitizing all equipment i.e. dams, drills and ultrasonic devices are important not to spread bacteria from patient to patient (oral contact) or staff, including sanitizing surfaces around procedural areas. 

Things to Consider

Communication between dental staff and patients is important to ensure infections are under control. Reminding patients and staff to stay home during this time is encouraged, especially when they are feeling unwell.  Dental offices can postpone elective or non-emergency procedures. Dental staff can connect and develop a plan for patients who may have questions during this time. It’s important to protect all involved, like dental offices and procedures.  How to manage waste: Offices should create a designated disposable area for all Disposable protective equipment and clothing.

A reminder, reusable instruments, i.e drills, cleaned and sterilized and stored properly. Remember to mark and dispose of all waste, do not mix with the regular trash.  To stop virus transmission and reduce infection, Dental offices must develop safe practices that include patient and staff evaluation and disinfecting the clinic and managing how they dispose of waste and materials. 

Check out ADA’s, Three interim treatment guidance flowcharts and What Constitutes a Dental Emergency

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