Table 2 Guidelines that should be adopted in a dental setting during COVID-19 [3, 23,24,25,26,27,28,29]
From: COVID-19 transmission risk and protective protocols in dentistry: a systematic review
Prior to dental treatment | Before entering a dental office | - Delay non-urgent dental and cosmetic services. | ADA, CDC, ADHA, NHS |
-Prevent crowding in appointment setting by booking appointments. | ADA | ||
-Dental procedures in patients with a history of COVID-19 should be postponed for at least 1 month. | WHO | ||
-High-risk patients like diabetic and immunocompromised patients are treated at the early hours of a dental office opening. | NHS | ||
-Use telephone triage, teleconferencing, or Teledentistry options as alternatives to in-office care, if possible. | CDC, NHS, ADA | ||
- Ask staff to stay home if they are sick. | CDC, ADA | ||
-Actively screen and record the temperature of each staff. Send staff home if they develop symptoms while at work. | CDC, NHS | ||
At dental office | -Actively screen the patient at the time of check-in. Patients with fever should refer to specific medical centers. If the patient is afebrile (temperature < 100.4 °F) and otherwise without symptoms consistent with COVID-19, then emergency dental care may be provided. | CDC | |
-No accompanying individuals should be allowed. | CDC, ADA | ||
-Offer hand wash or hydroalcoholic solutions (with 60–75% alcohol) for hand disinfection upon entrance to the dental office. | NHS, ADA | ||
-Provide a large room with adequate ventilation in the waiting area. | NHS | ||
-Appropriate zoning and separation measures should be undertaken. Waiting rooms and reception areas should allow for 2-m separation, ideally marked on chairs and flooring. | NHS | ||
-Remove magazines, reading materials, toys, and other objects that may be touched by others and which are not easily disinfected. | ADA | ||
- Place signage in the dental office for instructing patients on standard recommendations for respiratory hygiene/cough etiquette and social distancing. | ADA | ||
- Require the use of facemasks or cloth face coverings by everyone entering the dental office | CDC | ||
- Dental professionals should implement PPE (isolated wearing like N-95 masks, Health or FFP2-standard masks, gloves, face shields, goggles, gown, surgical cap, shoe cover) | CDC, NHS, ADA | ||
-Preparation of materials and instruments in advance and cover surfaces with disposable protections | NHS | ||
-Materials stored in a refrigerator should be sterilized before and after each treatment | WHO | ||
-Patients should be treated in an isolated and well-ventilated room with negative pressure relative to the surrounding area | CDC | ||
During dental treatment | Â | -Hand hygiene should be performed before and after all patient contact, contact with potentially infectious material, and before putting on and after removing PPE. | CDC |
-Use alcohol-based hand rub (ABHR) with 60–75% alcohol. If hands are visibly soiled, use soap and water for at least 20 s before returning to ABHR. | |||
-Preoperative antimicrobial mouth rinse like peroxide could reduce the number of microbes in the oral cavity. Since SARS-CoV-2 may be vulnerable to oxidation, use 1.5% hydrogen peroxide or 0.2% povidone as a preprocedural mouth rinse. | ADA | ||
-Rubber dams and high-volume saliva ejectors can help minimize aerosol or spatter in dental procedures. | CDC, NHS, ADA | ||
-use extraoral dental radiographs, such as panoramic radiographs or cone-beam C.T., as appropriate alternatives of intraoral radiography | ADA | ||
-If aerosol-generating procedures are inevitable for emergency care, use 4-handed dentistry. | CDC, ADA | ||
-Avoid the use of aerosol-generating procedures, handpieces/ultrasonic instruments, 3-in-1 syringes, and the air-water syringe whenever possible. | CDC, ADA | ||
-Dental professionals should use resorbable sutures to eliminate the need for a follow-up appointment. | ADA | ||
| Â | Â | -Treatment should be completed in one visit wherever possible. | NHS |
| Â | Â | -Environmental cleaning and disinfection procedures should be followed promptly after the completion of clinical care. | CDC |
After dental treatment | Â | -Clean PPE with soap and water, or if visibly soiled, clean and disinfect reusable facial protective equipment. | ADA |
-Manage laundry and medical waste in accordance with routine procedures. | CDC |