195 CMAAO CORONA FACTS and MYTH COVID : Dentistry
Dr K Aggarwal
With input from Dr Monica Vasudev
1067: Update on Covid-19
IMA-CMAAO Webinar on “COVID-19 and Dentistry”
22nd August, 2020
Dr KK Aggarwal, President CMAAO
Dr Ramesh K Datta, Hony Finance Secretary IMA
Dr Jayakrishnan Alapet
Dr S Sharma
Prof Dr Mahesh Verma
Vice Chancellor, Guru Gobind Singh Indraprastha University
Former, Director and Principal of Maulana Azad Institute of Dental Sciences
Key points from the discussion
- Dentistry has progressed in the past few decades and it is now a huge group of Dental Sciences.
- Nine specialties where MDS is offered: Oral medicine & Radiology, Prosthodontics, Conservative Dentistry & Endodontics, Orthodontics, Pediatric Dentistry and Preventive Dentistry, Periodontology, Oral & Maxillofacial surgery, Oral Pathology and Public Health Dentistry.
- The dental profession has been very aware and proactive in strategising how to tackle the infection.
- Initially only emergent and urgent cases such as pain, infection, bleeding, trauma, were attended to and elective procedures were delayed or postponed.
- Guidelines for dental professionals were the first guidelines issued by the health ministry.
- Every patient is a potential source of infection, whether Covid-19 or not.
- All specialties other than oral medicine, oral pathology and a little bit of orthodontics generate aerosols as dentists work with a hand high speed instrument. Air and water produces a splatter of droplets with microbes.
- The risk of infection in the dental profession is because of close proximity to the patient, micro-organisms in the mouth (remain viable and suspended in the air for long time as droplets) and droplets adhere to the surfaces (fomites).
- Safety not only of the patient/doctor, but also the staff in the immediate vicinity and other staff is important.
- For aerosol procedures, gown (impervious), mask (N95and triple layer), face shield, goggles, shoe cover, gloves are required.
- Clinic is cleaned and sterilized before and after every patient. This is time-consuming so fewer patients are attended to now. One chamber works at a time, more ventilation, exhaust, windows open, extra-oral suction system, HEPA filters, UV lights, more air changes in AC (8-12/hour)
- Infection and biomedical waste protocols are strictly followed now as increased risk of cross infection.
- Earlier dentistry as a speciality was studied after completing MBBS (UK Royal Colleges), including in India (Annamalai University). As there are lot of biomechanical procedures involved, dentistry soon grew as a separate speciality.
- Dentists work together with many medical specialities like ENT, plastic surgery, oncosurgery.
- Often oral manifestations of a disease appear first and so are first incidentally diagnosed by dentists.
- Oral cavity has lot of ACE2 receptors. So, the coronavirus can cause gingivitis, periodontitis. It does not involve tooth. But, if periodontium is affected, it can loosen the tooth.
- Oral hygiene is very important as the oral cavity has millions of different pathogens. It is important to reduce the viral load before any procedure so fewer aerosols are formed. Ask the patient to do pre-treatment or pre-procedural rinse with hydrogen peroxide, povidone iodine.
- Three basics for dental health: Brushing, flossing and swish (with water).