DENTISTRY as we know it has drastically changed.
In this time of the coronavirus pandemic, the California Department of Public Health’s dental care directive is revealing.
In a directive issued on April 7, it advises dentists to postpone indefinitely, repeat “indefinitely”, all routine and non-emergency care.
Even healthy patients should not be referred for dental care to a hospital where the chances of COVID-19 infection is high.
Patients seeking care at the dental clinic must be screened to ensure they don’t have the symptoms of coronavirus infection; have not been in close contact with persons with COVID-19 symptoms; and haven’t been diagnosed with the coronavirus.
The screening is essential to determine the appropriate options for managing the patient’s dental emergency and the appropriate location for that care.
Dentists are reminded that patients with active symptoms should not receive treatment in a dental office.
If consultations are scheduled, patients must wear face masks before entering the dental clinic.
Screening can be done prior to a visit to the clinic by email or, with mobile phone, by text message or voice call.
That’s for an ideal world. Not all Filipinos have access to online communication and many are walk-in patients instead. At this point it becomes tricky as the Philippine Dental Association (PDA) recommends an extra room for face-to-face screening – to protect other patients and the dental staff. Both patient and the interviewer must also wear face masks and preferably face shields.
Once patients pass the screening, they can schedule one-on-one session with the dentist. Companions of children and the elderly should wait outside or in a separate waiting area where they must follow social distancing and safety protocols.
Community transmission rates are high. And infected persons with no symptoms potentially carry and transmit the virus. This is why dental offices should take additional steps for patients.
Dental procedures that do not produce aerosols or air droplets get priority. Those that do can be scheduled towards the end of the day; this way, other patients are not at risk of being exposed to the coronavirus if ever it has been spread in the air by other patients early in the day.
Aerosol droplets and fine particles can linger in the air over a period of time before settling on surfaces. If possible, patients are treated in different rooms to allow staff to disinfect treatment areas. If there is only one clinic room, adequate time should be allotted for the area to be disinfected.
The PDA stipulates that dentists and their staff wear Protective Personal Equipment or PPE such as masks, clothing and footwear.
During PPE shortages, a face shield and Level 3 surgical mask should be used – as the minimum standard.
The standard surgical masks that people buy from drug stores are rated Level 1. Level 2 masks have extra layers and are used, for example, in routine dental hygiene procedures such as hand scaling. Level 3 surgical masks have four layers of protection which offer clinicians comfort and breathability while providing protection from potentially infectious fluid./PN
