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 Table of Contents  
LETTER TO THE EDITOR
Year : 2020  |  Volume : 14  |  Issue : 2  |  Page : 105-107

Dental chair: An ideal setting for sample collection in COVID-19 testing


Division of Oral Pathology, Army Dental Centre (R and R), New Delhi, India

Date of Submission28-May-2020
Date of Acceptance30-May-2020
Date of Web Publication15-Jul-2020

Correspondence Address:
Sudip Indu
Division of Oral Pathology, Army Dental Centre (R and R), New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JODD.JODD_38_20

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How to cite this article:
Indu S, Jayan B. Dental chair: An ideal setting for sample collection in COVID-19 testing. J Dent Def Sect. 2020;14:105-7

How to cite this URL:
Indu S, Jayan B. Dental chair: An ideal setting for sample collection in COVID-19 testing. J Dent Def Sect. [serial online] 2020 [cited 2020 Aug 8];14:105-7. Available from: http://www.journaldds.org/text.asp?2020/14/2/105/289753




  Introduction Top


The current spread of severe acute respiratory syndrome-coronavirus 2 and its associated disease has caused widespread public health concerns across the world. COVID-19, a zoonotic infection, hypothesized to have originated in bats and later transmitted to humans, is abundantly present in nasopharyngeal and salivary secretions of affected patients.[1] Despite global efforts to contain the disease spread, the outbreak is still on a rise because of direct transmission through cough; sneeze; person-to-person transmission routes such as contact with oral, nasal, and eye mucous membranes; and transmission through saliva and fecal–oral routes. Information on human infection with the COVID-19 virus is evolving, and the WHO continues to monitor developments and revise recommendations as necessary.[2],[3]

A dental chair in a dental operatory can just be an ideal setting for upper respiratory tract specimen collection such as the nasopharyngeal and oropharyngeal secretions [Figure 1]. The various advantages that the dental chairs render are:
Figure 1: The dental chair with desired angulations and inbuilt light arrangements

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  • Patient can be comfortably seated and the height and the desired angulation of about 70° of the patient can be easily achieved
  • The dental chairside in-built light attachments are more than adequate for sample collection
  • The requisite armamentarium of mouth mirror, cheek retractor, and sealed SteriPack sterilization pouches are readily available within the dental operatory
  • Correct biomedical waste disposal methods (BMW Disposal Rules 2016) which are critical at these times of COVID-19 sample collection are already in place in our dental operatory.


The basic armamentarium for sample collection will include primarily the viral transport medium (VTM) which is a ready-made medical supply kit containing two plastic flexible swabs: one swab each for nasopharyngeal and oropharyngeal sample collection. Other than this, mouth mirror for retraction, ziplock sealed pouches for VTM transfer, scissors, gloves, and ice pack for safe storage and transfer of collected sample [Figure 2].[4]
Figure 2: The armamentarium required for specimen collection

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Before the procedure is initiated, the following steps have to be warily ensured:

  • Optimal timing for specimen collection should be within 3 days of symptom onset and not later than 7 days from all patients, ideally prior to the initiation of antimicrobial chemoprophylaxis or therapy
  • Carefully check for expiry date of VTM kit (red/green top viral transfer container)
  • Swab types – Use only sterile dacron or rayon swabs with plastic shafts
  • DO NOT use calcium alginate swabs or swabs with wooden sticks, as they may contain substances that inactivate some viruses and inhibit some molecular assays
  • Ensure the availability of personal protection equipment (i.e., N95 mask, gloves, eye goggles, face shields, and surgical gowns)
  • Ensure that proper labeling and complete filling of patient requisition form with patient name, date of birth, and other requisite details is done before dispatch of the sample
  • Make sure that appropriate BMW segregation techniques are followed for the disposal of wastes generated during sample collection.



  Procedure of Oropharyngeal Swab Top


  1. Make the patient sit comfortably in the dental chair
  2. Use the mouth mirror to retract the cheek and depress the tongue
  3. Use a throat swab to collect specimens by swabbing the patient's posterior pharynx and tonsillar area (avoiding the tongue) [Figure 3]
  4. Insert the swab into the vial of VTM. Cut the excess of the swab such that the top of the swab shaft is just below the top of the tube and ensuring the swab tip is completely immersed in the liquid.
Figure 3: Oropharyngeal swab collection

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  Collection of Nasopharyngeal Swab Top


Precollection steps

If the patient has a lot of mucous in his/her nose, this can interfere with the collection of a representative sample. Ask the patient to use a tissue to gently clean out visible nasal mucous before a swab is taken. Then, ensure the following:

  1. Place the flexible swab on the outside of the face
  2. Adjust the direction of insertion into the nostril and length of insertion
  3. Insert the flexible shaft swab through the nostrils parallel to the palate (not upward) [Figure 4]
  4. Once resistance is met (the swab should pass into the pharynx relatively easily), rotate the swab several times and withdraw the swab
  5. Gently rub and roll the swab and then withdraw after few seconds
  6. Insert the swab into the vial of VTM.
Figure 4: Nasopharyngeal swab collection

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  Sample Transfer to Laboratory Top


After both the swabs are collected in the VTM, the sample has to be covered in a three-layered protection pack. First, the cap has to be firmly covered by a micropore surgical tape. The whole VTM is covered in a cotton pack. The cotton-wrapped media is now packed in a SteriPack ziplock pouch and is further transferred in an ice pack at 4°C with appropriate labeling and requisition slip [Figure 5]. Specimens may be held refrigerated for up to 72 h.[5]

Dental professionals can play an immense role in not only preventing the transmission of 2019-NCOV through strict infection control protocols, but also being a valuable health-care provider as they can equally complement and augment the medical professionals in carrying out diagnostic sample collection tests from nasopharyngeal and oropharyngeal passageways on suspected patients on a dental chair.[6]
Figure 5: Packing and transfer of viral transfer medium with swabs in ice pack (4°C)

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ather A, Patel B, Ruparel NB, Diogenes A, Hargreaves KM. Coronavirus disease 19 (COVID-19): Implications for clinical dental care. J Endod 2020;46:584-95.  Back to cited text no. 1
    
2.
World Health Organization. Laboratory Testing for Coronavirus Disease (COVID-19) in Suspected Human Cases: Interim Guidance, 19 March 2020. World Health Organization; 2020. Available from: https://apps.who.int/iris/handle/10665/331501. [Last accessed on 2020 Jun 20].  Back to cited text no. 2
    
3.
Heller L, Mota CR, Greco DB. COVID-19 faecal-oral transmission: Are we asking the right questions? Sci Total Environ 2020;729:138919.  Back to cited text no. 3
    
4.
World Health Organization. Laboratory Biosafety Guidance Related to the Novel Coronavirus (2019-nCoV). World Health Organization; 2020. Available from: https://www.who.int/docs/defaultsource/coronaviruse/laboratory-biosafety-novelcoronavirus-version-1-1.pdf. [Last accessed on 2020 Jun 20].  Back to cited text no. 4
    
5.
Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons for Coronavirus Disease 2019 (COVID-19). Available from: https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimen. [Last accessed on 2020 Jun 20].  Back to cited text no. 5
    
6.
Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci 2020;12:9.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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