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 Table of Contents  
COVID SPECIAL SECTION: COMMENTARY
Year : 2021  |  Volume : 15  |  Issue : 1  |  Page : 74-76

Coronavirus disease-2019 – Frontline dental care: Experience of government dental establishments


1 Command Military Dental Centre (Southern Command), Pune, Maharashtra, India
2 Dte Gen Dental Services, New Delhi, India

Date of Submission08-Aug-2020
Date of Decision02-Dec-2020
Date of Acceptance31-Dec-2020
Date of Web Publication09-Mar-2021

Correspondence Address:
Sukhbir Singh Chopra
Command Military Dental Centre (Southern Command), PO Wanworie, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JODD.JODD_51_20

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How to cite this article:
Chopra SS, Sahoo N K. Coronavirus disease-2019 – Frontline dental care: Experience of government dental establishments. J Dent Def Sect. 2021;15:74-6

How to cite this URL:
Chopra SS, Sahoo N K. Coronavirus disease-2019 – Frontline dental care: Experience of government dental establishments. J Dent Def Sect. [serial online] 2021 [cited 2021 Apr 18];15:74-6. Available from: http://www.journaldds.org/text.asp?2021/15/1/74/310966




  Introduction Top


The coronavirus disease (COVID-19) also known as 2019 novel coronavirus (CoV) and severe acute respiratory syndrome CoV 2 (SARS-CoV-2) was first identified in Wuhan, China, in December 2019. Its rapid spread globally prompted the World Health Organization (WHO) to declare it as a Public Health Emergency of International Concern by January 30, 2020. On March 11, 2020, COVID-19 was declared a pandemic, by WHO as by then it had spread to 110 countries and infected over 118,000 persons.[1],[2],[3],[4]

On March 22, 2020, the Government of India (GoI) ordered a nationwide 14-h voluntary public curfew. This was followed by a 21-day nationwide lock down from March 24, 2020, limiting movement of the entire 1.3 billion population of India as a preventive measure against the COVID-19 pandemic in India.[5] On May 01, 2020, the GoI extended the lockdown by 2 weeks, until May 17, 2020. The government divided all the districts into three zones based on the spread of the virus green, red, and orange with relaxations applied accordingly.[6] The lockdown was extended till May 31, 2020, for a third time on May 17, 2020, by the National Disaster Management Authority.[7] Hence, dental care delivery was adversely affected with all private dental clinic shut during the lockdown and very few government dental establishments functional.


  Modes of Transmission of the Coronavirus Disease-2019 Virus Top


According to current evidence, COVID-19 virus is primarily transmitted between people through respiratory droplets and by direct contact with infected people and indirect contact with surfaces in the immediate environment or with objects used on the infected person (e.g., stethoscope or thermometer).[8],[9],[10],[11],[12]>/sup>

In the context of COVID-19, airborne transmission may be possible in specific circumstances and settings in which procedures or support treatment that generate aerosols are performed, as in dentistry.

The earliest WHO advisory applicable to dentistry stated that some aerosol-generating procedures have been associated with an increased risk of transmission of SARS-CoV. Hence, health care workers involved in performing aerosol-generating procedures in an adequately ventilated room or in negative pressure rooms with at least 12 air changes per hour. Additional contact and droplet precautions suggested by the WHO for those likely to be exposed were use of N 95 mask, eye protection (goggles or a face shield), clean, non-sterile, long-sleeved fluid-resistant gown, and gloves.[8]

In March 2020, the Dental Council of India recommended that clinical procedures involving aerosol generation (air rotor/ultrasonic scalers) to be avoided/minimized for the time being and only emergency procedures to be performed.[13]


  Emergent and Urgent Dental Care Top


Dental emergencies are potentially life-threatening and require immediate treatment for hemostasis, pain, and/or infection control. Conditions to be considered for emergent dental care (EDC) are uncontrolled bleeding; cellulitis or a diffuse soft-tissue bacterial infection with intraoral or extraoral swelling and trauma involving maxillofacial region that potentially compromises the patient's airway.

Urgent dental care (UDC) refers to the management of dental conditions that require immediate attention to relieve sever pain and/or risk of infection and to alleviate the burden on hospital emergency departments. These include severe dental pain from pulpal inflammation, pericoronitis, surgical postoperative osteitis, abscess, or localized bacterial infection, resulting in localized pain and swelling, tooth fracture resulting in pain or causing soft tissue trauma, tooth avulsion/luxation, and dental treatment cementation if the temporary restoration is lost, broken, or causing gingival irritation.[14]

Other UDC includes treatment for extensive caries or defective restorations causing pain, suture removal, denture adjustments on radiation/oncology patients, denture adjustments or repairs when function impeded, replacing temporary filling on endodontic access openings in patients experiencing pain, and adjustment of orthodontic appliances causing trauma to the oral mucosa.


  Our Experience Top


Data from 36 dental establishments spread across nine states of India across 30 cities was analysed. 6606 patients were treated during the period March 20, 2020, to July 31, 2020. All these dental establishments are funded by the GoI and provide treatment at no cost to all the entitled personnel. There was a drop of 96% in terms of number of patients treated during the corresponding period of the previous 5 years. A fairly large number of patients were able to assess the treatment even during the period of lockdown due to proximity of dental establishments to residential areas, many in gated communities. Due to the sharp reduction in number of patients treated during this pandemic, there will be a rebound and the OPD is likely to be overwhelmed with patients seeking treatment once the pandemic subsides.

Prescription for pain control was the most common care provided. However, the entire gamut of urgent and EDC ranging from restoration of fractured and symptomatic teeth, root canal therapy, intra and transalveolar extractions, management of maxillo-facial fractures under general anesthesia was provided.

Since the dental clinics included single dental surgeons (specialist/nonspecialist) and multi-speciality clinics protocols were organized to suit the specific local circumstances and were regulated by the national and local COVID-19 regulations. The delivery of care was also guided by the capacity and availability of personal protective equipment (PPE). Each patient was assessed and managed on their own merit, considering the patient's best interests, professional judgement, local EDC/UDC arrangements, and the prioritization of the most urgent oral health needs. All establishments used PPEs, commencing from as early as March 20, 2020 to as late as April 29, 2020.

From April 01, 2020, onwards all the dental establishments screened patients for elevated temperature, history of cold, and other signs and symptoms of COVID at the entrance, prior to registration at the reception. One of the establishments also used a pulse oximeter to assess the oxygen saturation level in blood. Mouthwash based on povidone-iodine (1%) was used by all patients before intraoral examination. Restricted use of aerosol spray-producing procedures, dental operatory disinfection and sanitization of all patient waiting and clinical areas, and biomedical waste management were done as per the protocols guided by the WHO interim guidelines of January 2020[8] and “Guidelines for Dental Professionals in Covid-19 pandemic situation” issued by the Ministry of Health and Family Welfare (MoHFW).[15]

The dental surgeons kept themselves abreast with the current national and local COVID-19 guidance. The personnel at dental establishments were kept safe by periodic education of contemporary safety protocols scrupulous risk assessment. Only one of the 36 dental establishments reported two cases of COVID 19 in July 2020. These were of two paradental trainees. The contact tracing of these individuals indicated that they had contracted the virus from outside the clinical environment.

In addition to providing dental care, dental establishments and personnel also assisted in management of COVID 19 pandemic by:

  1. Providing physical infrastructure with in the dental establishment for “Flu Clinic” for preliminary screening of COVID-19 patients
  2. Assisted in specimen collection of nasopharyngeal swab specimens
  3. Assisted hospital logistics personnel indenting and distribution of medical and PPE stores
  4. Assisted in COVID-19 data collection, collation, and transmission to other authorities
  5. Dental surgeons are also on standby to assist the physicians in treatment and monitoring of patients and paradental staff for the care of mild cases of COVID-19, including closely monitoring body temperature, breathing rhythm and frequency, blood oxygen saturation, and other vital signs.



  Conclusion Top


During this pandemic of COVID-19, the oral health-care providers are greatly vulnerable and if infected may be a source of spread and cross-infection. Our experience of having treated 6606 patients across 30 cities in India with no incidence of spread/cross-infection from the dental clinical environment reported till date has indicated that well-informed dental surgeon and para-dental personnel could play very important in handling such pandemic to deliver urgent and essential dental care along with maintaining safety of oral health-care providers and patients. In addition, dental health-care providers are also force multipliers, providing assistance to medical personnel in times of pandemic. Hence, a clear understanding of risks involved in dentistry and implementation of recommended precautions during practice coupled with scrupulous infection control protocols aids in identification, accurate triage of patients, and judicious management protocols.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. J Med Virol 2020;92:401-2.  Back to cited text no. 1
    
2.
Hui DS, Azhar EA, Madani TA, Ntoumi F, Kock R, Dar O, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health – The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis 2020;91:264-66.  Back to cited text no. 2
    
3.
Gorbalenya AE, Baker SC, Baric RS, de Groot RJ, Drosten C, Gulyaeva AA, et al. Severe acute respiratory syndrome-related coronavirus: The species and its viruses – a statement of the Coronavirus Study Group. bioRxiv preprint doi: https://doi.org/10.1101/2020.02.07.937862. Available from https://www.biorxiv.org/content/10.1101/2020.02.07.937862v1.full.pdf. [Last accessed on 11 Feb 2021].  Back to cited text no. 3
    
4.
Burki TK. Coronavirus in China. Lancet Respir Med 2020;8:238.  Back to cited text no. 4
    
5.
Ministry of Home Affairs, Government of India circular No 40-3/2020-DM-1(A) dated 24 Mar 2020. Available from: https://www.mha.gov.in/sites/default/files/MHAorder%20copy_0.pdf. [Last accessed on 2020 Jul 08].  Back to cited text no. 5
    
6.
Ministry of Home Affairs, Government of India circular No 40-3/2020-DM-1(A) dated 01 May 2020. Available from: https://www.mha.gov.in/sites/default/files/MHAOrderDt_ 30052020.pdf. [Last accessed on 2020 Jul 08].  Back to cited text no. 6
    
7.
Ministry of Home Affairs, Government of India circular No 40-3/2020-DM-1(A) dated 17 May 2020. Available from: https://www.mha.gov.in/sites/default/files/MHAOrderextension _1752020_0.pdf. [Last accessed on 2020 Jul 08].  Back to cited text no. 7
    
8.
Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected. WHO Interim guidance 25 January 2020. Available from: https://apps.who.int/iris/bitstream/handle/10665/330674/9789240000919-eng.pdf?sequence=1&isAllowed=y. [Last accessed on 2020 Jul 08].  Back to cited text no. 8
    
9.
Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: A study of a family cluster. Lancet 2020;395:514-23.  Back to cited text no. 9
    
10.
Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020;382:1199-207.  Back to cited text no. 10
    
11.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.  Back to cited text no. 11
    
12.
World Health Organization. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) 16-24 February 2020. Geneva: World Health Organization; 2020. Available from: https://www.who.int/docs/default- source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf. [Last accessed on 09 Jul 2020].  Back to cited text no. 12
    
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Precautionary and preventive measures to prevent spreading of Novel Coronavirus (COVID- 19) – Regarding. Dental Council of India Circular No DE-14-Acdemic-2019/8855- dated 17 March, 2020. Available from: https://dciindia.gov.in/Admin/NewsArchives/L.No._8855..PDF. [Last accessed on 09 Jul 2020].  Back to cited text no. 13
    
14.
ADA Guidance dated 31 Mar 2020. What Constitutes a Dental Emergency? Available from http://success.ada.org/~/media/CPS/Files/Open%20Files/ADA_COVID19_Dental_Emergency_DDS.pdf?_ga=2.8349874.1806649990.1586205522-975892202.1586205522. [Last accessed on 2020 Jul 22].  Back to cited text no. 14
    
15.
Guidelines for Dental Professionals in Covid-19 Pandemic Situation. Issued on 19/05/2020 by Ministry of Health and Family Welfare. Available from https://www.mohfw.gov.in/pdf/DentalAdvisoryF.pdf. [Last accessed on 2020 Jul 09].  Back to cited text no. 15
    




 

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