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Year : 2021  |  Volume : 10  |  Issue : 1  |  Page : 62-64

Coronavirus infection in India: From the desk of dental surgeon

Department of Periodontology and Oral Implantology, Institute of Dental Sciences Sehora, Jammu, Jammu and Kashmir, India

Date of Submission01-May-2020
Date of Decision01-Jun-2020
Date of Acceptance01-Aug-2020
Date of Web Publication4-Mar-2021

Correspondence Address:
Malvika Singh
Department of Periodontology and Oral Implantology, Institute of Dental Sciences Sehora, Jammu, Jammu and Kashmir
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JCSR.JCSR_42_20

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How to cite this article:
Singh M. Coronavirus infection in India: From the desk of dental surgeon. J Clin Sci Res 2021;10:62-4

How to cite this URL:
Singh M. Coronavirus infection in India: From the desk of dental surgeon. J Clin Sci Res [serial online] 2021 [cited 2021 Aug 3];10:62-4. Available from: https://www.jcsr.co.in/text.asp?2021/10/1/62/310765

After being declared as a pandemic by the World Health Organization (WHO) coronavirus infection took the whole world by surprise and left us all unprepared to tackle this demon.[1] Being an airborne infection, dentists are often considered as the most vulnerable group among the health-care workers as they deal with such patients in day-to-day basis. This article attempts to propose some basic requirements to be followed by dental practitioners who have to treat corona-positive patients.

When examining or performing any dental procedure, the gloves of dentist becomes soiled with patient's saliva and blood making dentists most vulnerable to this infection. Therefore, it is suggested that elective procedures, surgeries and non-urgent dental visits should be avoided. Instead, patients should be assessed telephonically on the basis on the severity of their chief complaints while taking into account their travel, medical and dental history. Those patients who respond affirmatively for the same should be advised to seek immediate medical help and only those patients that require utmost care and attention should be called for emergency treatment on dental clinics/hospitals. All the staff members should be well trained and educated in the form of a refresher training program so that the team becomes prepared about handling (possibly a COVID-19 positive) patients and answering their queries.

Disinfection of dental clinic, patient waiting room and front desk: All surfaces including dental clinic, waiting room, front desk as well as bathrooms should be kept cleaned and sanitised frequently (as the virus has been found to stay alive for 24 h on such surfaces). These should be cleaned with 0.1% sodium hypochlorite, 0.5% hydrogen peroxide or 62%–71% ethanol. Waiting room and clinic should be properly and adequately ventilated with air exchange for 6 times an hour during operatory hours and should be cleaned preferably with hypochlorous acid. The use of air purifiers with ultraviolet (UV)-C lamps is recommended. Dental clinic should be an isolated room with negative pressure relative to the surrounding area and should have an N95 filtering disposable respirator for persons entering the room. Dental chair-side surfaces, chair keyboard keys, connected computers/laptops, oral cameras, dental surgery drawer handles, water taps, stationaries, working desks, telephone sets, doorknobs and peripheral surfaces such as floor, walls, washing sink/faucets etc., should be disinfected in the intervals between patients using 70% ethanol.

Evaluation of risk from patients should include initial enquiry before giving appointment about their medical signs and symptoms, history of travel specially to endemic areas and the possibility of coming in contact with patients diagnosed with coronavirus infection. The patients who answer in the affirmative should be instructed to seek medical help first. The patients who answer negatively should be instructed to take their temperature before coming to dental clinic. Walk in-visits should be avoided and patients should be instructed to reach dental clinic/hospital on time to decrease the number of patients waiting in waiting area/outpatient department. The escorts of the patients should be educated and instructed to wait outside .

On patient's arrival, every patient entering the waiting area should be given a surgical mask. There should be a prominent sign (display boards or charts) directing the patient to use a hand sanitiser from a non-touch dispenser stand and to vigorously rub their hands for 20 s. Waiting area should also have pictorial representation of signs and symptoms of coronavirus infection indicating them to seek immediate medical help if they have the same kind of infection. Patients should be made to be seated 3 feet (1 m) apart from each other. They should be given disposable tissues and handkerchiefs during coughs and sneezes (as a preventive measure) and the same should be immediately disposed into a garbage bin.

Medical, travel, clinical and family history of all staff working in the clinic/hospital should be recorded. Immunosuppressed team members Pregnant staff <28 weeks pregnant or have underlying predisposing health conditions should be advised to stay home on paid leave.

Personal protective equipment designed to adhere to the highest levels of sterilisation protocol include the following. Hand hygiene[2] includes hand washing with water and soap and hand disinfection using alcohol-based solutions, each for 20s. Dental professionals and personnel should follow hand hygiene protocols before examination of patients, and beginning of dental treatment; after contact with patients, environmental surfaces and materials/substances contaminated with blood and body liquids/secretions and after contact with secretions, mouth mucosa, and injured skin. Also, hand hygiene protocols should be precisely followed immediately before and after wearing gloves. Use of two pairs of gloves during dental surgical procedures is highly recommended.

Surgical gowns worn by professionals and other personnel should either be disposed or sterilised after treating every patient. Other personal protective measures like goggles and face shields should be recommended as ocular tissues have been shown to be susceptible to transmission of aerosols.[3] The goggle/shield should be properly washed and completely disinfected after each use. Head caps, disposable or made from cloth should be worn by all personnel involved in patient care and disposed or sterilized after use. Surgical face masks or special masks [N95 respirator or FFP2 masks] should be used when the operator is at a distance of less than 6 feet. If a respirator is not available, a combination of a surgical mask and a full-face shield should be used.

Treatment of emergency cases: Dental problems often include situations poses risk to the lives of patients and hence only such situations which need urgent care should be considered for dental treatment. Before the start of dental treatment, patients should be instructed to rinse their mouth with povidone iodine solution or mouth wash containing hydrogen peroxide[4],[5] to reduce the number of microorganisms, which are in contact with blood during invasive dental treatments. Procedures that are likely to induce coughing should be avoided (if possible) or performed cautiously.

Use of other materials/instruments/equipment: Rubber dam should be used as it can minimise the dispersion of droplets, secretions, and aerosols and in cases of unavailability of the same, hand instruments, e.g., hand scalers/curettes are recommended for periodontal purposes.[6] The application of rubber dam in endodontic treatments is highly recommended at all times along with using hand instruments instead of rotary systems.Intraoral radiographs should be avoided and extraoral dental radiographies should be encouraged. In cases of reversible pulpitis, patient should be given adequate analgesia along with instructions to prevent the same. However, in case of irreversible pulpitis, root canal treatment should be done and intracanal medications should also be given in dental clinic

Hand scalers/curettes used in periodontics and oral implantology: should replace ultrasonic scalers in combination with high volume suctions to reduce aerosol production and splatter. Patients having acute periodontal and periapical abscess should be prescribed analgesics and antibiotics. For patients with acute pericoronitis, curettage should be done along with prescribing analgesics and antibiotics. They should be instructed to telephonically call the doctor if problem persists to decide the further course of action (operculectomy or tooth extraction). Patients having acute necrotising ulcerative gingivitis/periodontitis, the affected area should be isolated, dried and cleaned, swabbed with cotton pellets under local anaesthesia. They should be allowed to rinse with 3% hydrogen peroxide solution along with the prescription of medications as post-operative instructions. For patients with dentine hypersensitivity, desensitising agents should be applied with finger over affected areas along with prescribing desensitising dentifrice and other instructions. Patients with oral ulceration should be treated with application of topical analgesia. However, in cases of primary herpetic gingivostomatitis and herpes infection, antiviral agents should be prescribed

With regard to prosthodontics, in cases of ill-fitting/loose dentures causing pain and discomfort, patients should be encouraged to keep the same away. However, cementation of fixed prosthesis should be done in dental clinic. Orthodontic cases should be postponed generally. However, in cases of trauma from fractured or displaced orthodontic appliances, same should be treated immediately. In paediatric and preventive dentistry, for elective cases, high treatment priority is given to chemomechanical caries removal and atraumatic restorative techniques. Hand instrumentation for cavity preparation should be preferred to rotary preparations. However, if rotary instruments are to be considered, rubber dam isolation should pertain. Moreover, manual scaling and polishing are endorsed. Biopsies of oral tissues can be taken if suspecting a malignant condition.

Patient care equipment, offices also should follow routine cleaning and disinfection strategies used during flu season. Equipment soiled with blood, body fluids, secretions and excretions should be discarded and disposed of according to the sterilisation protocols. All reusable equipment should be cleaned, disinfected and reprocessed before being used in the next patients. The medical waste from the treatment of patients suspicious to COVID-19-should be considered an infectious residue and should be packed in two-layered packages and sealed properly.

Basics of COVID-19 prevention like washing hands, using an alcohol-based hand sanitiser with at least 60% alcohol by volume when soap and water are not readily available or when appropriate, avoiding touching the eyes, nose or mouth with unwashed hands, coughing/sneezing into a tissue and putting the tissue directly into a dustbin and wearing a surgical mask in public form the main steps and the specific measures mentioned will be only in addition to and not a replacement for the basics. The guidelines while treating a patient in periodontal set up is highly recommended maintaining safety of clinician as well as patient.

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Conflicts of interest

There are no conflicts of interest.

  References Top

World Health Organization (WHO). Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). Available from: https://www.who.int/docs/default-source/coronaviruse/who-china-jointmission-on-covid-10-final-report.pdf. [Lase accessed on 2020 Apr 05].  Back to cited text no. 1
Fang LS. The Pandemic and the Dentist 2020. Available from: https://www.docseducation.com/blog/pandemic-and-dentist. [Lase accessed on 2020 Apr 21].  Back to cited text no. 2
Larson EL, Early E, Cloonan P, Sugrue S, Parides M. An organizational climate intervention associated with increased handwashing and decreased nosocomial infections. Behav Med 2000;26:14-22.  Back to cited text no. 3
Belser JA, Gustin KM, Katz JM, Maines TR, Tumpey TM. Influenza virus infectivity and virulence following ocular-only aerosol inoculation of ferrets. J Virol 2014;88:9647-54.  Back to cited text no. 4
Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med Res 2020;7:4.  Back to cited text no. 5
Kathuria V, Ankola AV, Hebbal M, Mocherla M. Carisolv- an innovative method of caries removal. J Clin Diagn Res 2013;7:3111-5.  Back to cited text no. 6


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