 Image courtesy of CDC/Alissa Eckert, Dan Higgins |
WHO declared COVID-19 a pandemic March 11, pointing to "alarming levels" of spread, severity and inaction. This is the first pandemic caused by a coronavirus, according to WHO. The last disease outbreak it characterized as a pandemic was H1N1, or the swine flu, in 2009.
On its new FAQ webpage, the ADA lists some steps dentists can take to help prevent transmission of the disease in their offices, in addition to standard precautions, including:
• Screening patients for travel and signs and symptoms of infection when they update their medical histories.
• Taking temperature readings as part of their routine assessment of patients before performing dental procedures.
• Making sure the personal protective equipment they use is appropriate for the procedures being performed.
• Using a rubber dam when appropriate to decrease possible exposure to infectious agents.
• Using high-speed evacuation for dental procedures producing an aerosol.
• Autoclaving handpieces after each patient.
• Having patients rinse with a 1% hydrogen peroxide solution before each appointment.
• Cleaning and disinfecting public areas frequently, including door handles, chairs and bathrooms.
Coronaviruses are enveloped viruses, meaning they are one of the easiest types of viruses to kill with the appropriate disinfectant product. The Environmental Protection Agency has developed a list of registered surface disinfect products for use against SARS-CoV-2, the coronavirus that causes COVID-19.
As of March 11, the U.S. Food and Drug Administration was not aware of any widespread shortages of medical devices, but it had heard reports of increased market demand and supply chain challenges for some personal protective equipment.
Practices experiencing difficulty obtaining personal protective equipment may have to triage patients as a way to help ensure that adequate equipment is available for patients whose appointments are most urgent.
The CDC has not changed its guidance on single-use disposable face masks, which should be worn while treating one patient and then discarded.
The CDC recommends dentists who are concerned about a potential or imminent shortage of personal protective equipment monitor its health care supply webpage for updated guidance and alert their local or state health department and local health care coalition, which are best positioned to help facilities troubleshoot temporary shortages. Dentists also can report shortages to the FDA at deviceshortages@fda.hhs.gov.
Appropriate questions to ask to screen patients for the coronavirus disease when confirming appointments or they arrive for treatment could include if they have traveled in the last 14 days or been in close contact with someone who has been diagnosed with or is under investigation for COVID-19 and if they have a cough, fever or shortness of breath.
Dentists should encourage patients who answer yes to these questions to contact their primary physician or public health department as soon as possible to find out if they should be seen or tested. If dentists suspect a patient has COVID-19, they should contact their local or state health department immediately. They should do the same if a staff member is suspected or confirmed to have COVID-19.
The CDC's Guidelines for Infection Control in Dental Health-Care Settings—2003 note dental health care personnel may consider postponing nonemergency or elective dental procedures until a patient is no longer contagious with diseases that can be transmitted through airborne, droplet or contact transmission.
If urgent dental treatment is necessary, dentists and patients' medical providers should work together to determine the appropriate precautions to take on a case-by-case basis and decide whether the dental facility is an appropriate setting to provide the necessary services to the potentially infectious patient, as dental settings are not typically designed to carry out all of the transmission-based precautions recommended for hospital and other ambulatory care settings.
ADA members also asked if they should have patients wait in their cars instead of waiting rooms and if they should have a glass partition between front office staff and the waiting room.
The CDC recommends social distancing — remaining out of congregate settings, avoiding mass gatherings and maintaining a distance of about 6 feet from others when possible — as an effective way to decrease the likelihood of transmitting SARS-CoV-2. With that in mind, dentists may consider taking steps such as asking patients to arrive on time for their appointments rather than too early; removing reading materials, toys and other objects that may be touched by patients and are not easily disinfected; and scheduling appointments with an eye on minimizing contact with other patients in the waiting room.
While a physical barrier like a glass partition may reduce the risk of exposure to the coronavirus, that is not feasible in all practices.
Dentists can email additional questions related to SARS-CoV-2 and COVID-19 to msc@ada.org.
The coronavirus disease outbreak has led to the cancellation of various events, including the 2020 American Dental Education Association Annual Session and Exhibition scheduled for March 14-17 in National Harbor, Maryland, the International Association for Dental Research/American Association for Dental Research/Canadian Association for Dental Research General Session and Exhibition scheduled for March 18-21 in Washington, D.C., and the 2020 Thomas P. Hinman Dental Meeting scheduled for March 19-21 in Atlanta.
For more information about the coronavirus disease, visit the CDC's COVID-19 webpage.