Dental visits after COVID-19.

Dental visits after COVID-19. 

The virus that causes COVID-19, SARS-CoV-2, is profusely present in nasopharyngeal and salivary secretions of patients infected with SARS-CoV-2, and is believed to be spread primarily through respiratory droplets, as well as aerosols and fomites. Importantly, emerging evidence shows that normal breathing and talking can produce small droplets that are subject to aerosol transport and that aerosolized SARS-CoV-2 particles can remain suspended in the air for several hours, although it is unclear how much aerosol spread contributes to viral transmission.The widespread transmission of SARS-CoV-2 in many communities, the potential for infected individuals who are pre-symptomatic or asymptomatic to transmit the virus to others, and the unique nature of dental interventions with close proximity of the provider to the patient’s mouth and throat, all contribute to the high risk for dental personnel teams becoming exposed and transmitting the virus to other patients or staff. Some dental procedures may lead to aerosol generation, further increasing transmission risk to dental providers or future patients through direct inhalation or contact with contaminated surfaces.

After COVID-19, the dental visits will change. Before Your Appointment, your dental office may call you before your appointment and ask you some questions about your current health. They may also repeat these questions when you arrive to make sure nothing has changed. 

Your dentist’s office staff may also ask that you limit the number of people you bring to the appointment. That could mean leaving your children at home or allowing older children to go into the office alone while their parent waits outside during their appointment.     
  
At Your Appointment, be sure to wear a mask to your appointment. When you arrive at the dental office, you may be asked to wait outside until they’re ready for you. This will reduce the number of people in the office and reduce the amount of time you’re close to other people. When you enter the office, you may have your temperature taken. Inside the office, you may notice things people often touch in the waiting room – like toys or magazines – have been removed. They may have hand sanitizer available for you to use and may wipe down items you touch, such as pens, clipboards or furniture.    

After your appointment is over, the staff will thoroughly clean the areas where you’ve been using disinfectants that are effective against the virus that causes COVID-19 to prepare for the next patient. This helps reduce the risk of illness being passed to others.     If you start feeling ill with the symptom of COVID-19 within 14 days of your appointment, call the dental office. You may have already been carrying the virus at the time of your appointment, so anyone who came into contact with you during that time could be at risk for getting sick too.

The COVID-19 pandemic has impacted how dental care can be safety delivered in the short term, and likely will stimulate permanent changes in how dental care is delivered. The profession will need to consider a number of unanswered questions; for example, whether the workflow and layout of dental clinics should be permanently reorganized, and whether expanded PPE is warranted for care of all dental patients as part of Standard Precautions. Dental care providers should be prepared to assist patients in understanding their dental insurance benefits, which may have changed due to the pandemic. The COVID-19 pandemic may also hasten the adoption of innovative dental workforce models, including dental therapists who complete at least 3 years of academic training and provide a limited scope of treatment, such as prevention, fillings, and treatment for periodontal disease, in collaboration with a dentist. Dental therapists have been found to reduce overall dental costs and expand access in rural and tribal areas. In a recovering economy, the lower cost of dental therapists may foster their adoption or more independent scope of practice.

The COVID-19 pandemic presents several opportunities for dental researchers to focus on key issues. Important research priorities may include estimating the costs and benefits of expanded PPE use (and other changes in dental practice workflows), developing and testing innovative approaches to minimize aerosol generation during dental procedures, testing and validating tele-dentistry models, and evaluating alternative dental workforce models, such as dental therapists.

Optimization Strategies for dentist:

• Before entering a patient room or care area:

-Perform hand hygiene (wash your hands with soap and water for at least 20 seconds or use a hand sanitizer).

-Put on a clean gown or protective clothing that covers personal clothing and skin (e.g., forearms) likely to become soiled with blood, saliva, or other potentially infectious materials.

-Gowns and protective clothing should be changed if they become soiled.

-Put on a surgical mask or respirator.

-Mask ties should be secured on the crown of the head (top tie) and the base of the neck (bottom tie). If mask has loops, hook them appropriately around your ears.

-Respirator straps should be placed on the crown of the head (top strap) and the base of the neck (bottom strap). Perform a user seal check each time you put on the respirator.

-Put on eye protection (goggles or a face shield that covers the front and sides of the face).

-Protective eyewear (e.g., safety glasses, trauma glasses) with gaps between glasses and the face likely do not protect eyes from all splashes and sprays.

-Personal eyeglasses and contact lenses are NOT considered adequate eye protection.

-Put on clean non-sterile gloves.

-Gloves should be changed if they become torn or heavily contaminated.

-Enter the patient room or care area.

• After completion of dental care:

-Remove gloves.

-Remove gown or protective clothing and discard the gown in a dedicated container for waste or linen.

-Discard disposable gowns after each use.

-Launder cloth gowns or protective clothing after each use.

-Exit the patient room or care area.

-Perform hand hygiene (wash your hands with soap and water for at least 20 seconds or use a hand sanitizer).

-Remove eye protection.

-Carefully remove eye protection by grabbing the strap and pulling upwards and away from head. Do not touch the front of the eye protection.

-Clean and disinfect reusable eye protection according to manufacturer’s reprocessing instructions prior to reuse.

-Discard disposable eye protection after use.

-Remove and discard surgical mask or respirator.

-Do not touch the front of the respirator or mask.

-Surgical mask: Carefully untie the mask (or unhook from the ears) and pull it away from the face without touching the front.

-Respirator: Remove the bottom strap by touching only the strap and bring it carefully over the head. Grasp the top strap and bring it carefully over the head, and then pull the respirator away from the face without touching the front of the respirator.

-Perform hand hygiene.