There are the differences between a broadly public-health oriented perspective and the importance of specialist knowledge during a public health emergency (PHE). A balanced perspective between these positions is needed to effectively address the needs of public health. Many published oral health care protocols suggest that providing emergency and urgent dental treatment for problems such as dental trauma, pain, invasive infection, swelling, and bleeding is necessary and should be prioritized.
With advanced development of technologies nowadays, dentist can use virtual technologies, teledentistry and online care to help and give advice to the patients without actually meeting them in person. Virtual visits can help the dentists to identify whether the patient is needed to refered to a proper clinic visit for dental treatment. Comprehensive exposure history can be used to screen infected individuals that do not have any symptoms and it is beneficial for public health reporting as well. The primary treatment should provide advice, analgesia, and antibiotics (where appropriate).
Most of the case of toothache can be solved effectively by prescribing paracetamol (acetaminophen) or ibuprofen. If the symptoms do not subsides after 48 – 72 hours of self management, the patients should then visits the dental clinic with proper infection control protocol followed to prevent the spread of infections. Mobile dentistry services may be provided for patients of higher risk of infections. When carrying out emergency dental treatment, appropriate physical distancing protocols and personal protective equipment (PPE) should be used to prevent cross infection. Actions such as continuous use of face masks, maintaining hand and respiratory hygiene, used of sterile instruments and device, disinfection of equipment surfaces regularly, minimizing aerosol generating procedures (AGPs) and scheduling of appointments to promote social distancing must be taken to protect both the patients and dental staffs. The research also suggests that prescribing a pre-visit mouthwash, such as chlorhexidine gluconate (CHX), cetylpyridinium chloride (CPC), povidone-iodine (PVP-I), and hydrogen peroxide (H2O2), can help in prevention of Covid-19.
Moreover, patients should not be accompanied by any other person unless medically necessary when visiting the dentists in order to maintain social distancing. If a companion is necessary, the companion should be given similar screening and protective measures prior on entering the clinic.
Next, reorganizing dental clinics may be good for infection control as well. Dentists should prevent performing aerosol generating procedures (AGPs) whenever possible. However, if AGPs is absolutely necessary during dental treatment, dentists should use high-volume suction devices, protective face masks (N95 or higher protection), face shields, body suits and protective eyewear, and shorten the duration of the procedure in order to minimize the risk of getting infected. Despite its utter importance in providing care, sometime personal protective equipment (PPE) may be difficult to obtain in areas with poor resources, which is a significant concern for all dentists.
We know that it is important in providing necessary dental care to the community; however, reopening of dental clinics should be an adaptive process according to local epidemiological reports in order to protect the dental health care provision team. Hence, implementing COVID-19 screening procedures prior to arrival at work for dental staff and flexible, non-punitive sick leave policies are necessary to protect both dental staff and patients. Moreover, the risk of exposure for both patients and dental staff should be assessed before and two days after receiving the dental treatment. Therefore, active communication with other medical practitioners is crucial in preventing the disease.
Even after the arrival and availability of effective vaccines, it will take time to return to a normal state of clinical practice regarding the chances of infection in dental offices; hence universal infection control protocols should be followed continuously until the local health authority states that it no longer necessary to do so.
Identifying Susceptible Groups
During this Covid-19 pandemic, chronic disease patient, pregnant ladies, nursing home residents (may include geriatric, disabled or debilitated patients), cancer patients, incarcerated individuals and underrepresented minority and marginalized populations are included as individuals that are highly susceptible and more prone to develop any oral disease or infections. Hence, these highly susceptible individuals have more needs of emergency dental treatment and need to be given priority and equitably in accessing the healthcare services and dental treatment. In addition, these groups of highly susceptible individual are often at a lower socioeconomic group and have poorer general health condition than the general populations. Therefore, there are many problems arise when treating these highly susceptible patients remotely.
Next, it is important to protect the quality of life and the necessities of oral health care timely for these highly susceptible individuals. If we do not take immediate actions on treating the disease, there will be serious consequences in these vulnerable patients. For example, poor dental health condition in pregnant mothers may lead to many problems in the pregnant mother and their babies such as early childhood caries and chronic disease. As the saying “Prevention is better than cure”, nowadays the dental treatment field have change to preventing the disease instead of treating the disease. Therefore, it is crucial to provide pediatric patients with appropriate dental care such as topical fluoride application and pit and fissure sealants to prevent the onset of dental disease in the future. It is also important to raise awareness of oral health in the children since they are small by teaching and encourage them to take care of their oral hygiene and having online dental visits. Next, it is very important to provide dental treatment for organ transplant patient before their organ transplant operation. This is because the organ transplant patients will take immunosuppressive drugs after the operations to prevent organ rejection reaction and these immunosuppressive drugs will increase the risk of infections in the patients if the dental treatment is done after the operation due to weakened immune system in the patient. Moreover, anxiety and stress disorders in vulnerable individuals could lead to more adverse effects when dental related complaints rise such as pain, mouth ulcers, bruxism, xerostomia, etc. So, this highly susceptible group must be given priority in accessing dental services which can be provided remotely.
Managing Expectations and Concerns of the Patient and Public
The most common reason when a patient visits the dental clinic is when they are experiencing pain in their mouth. Patients are anxious and fear when experiencing pain. Hence, it is important for the dentists to identify the cause of pain and explain their findings to the patients in order to relieve the patient’s anxiety. A good dentist-patient relationship can also help in educating and improving oral health awareness in the community. Although there are some restrictions when having dental consultation online due to the Covid-19 pandemic, but with the advancement of communication technologies such as smart phones, makes it possible for the patients to share photograph and images of their mouth to their dentists which make diagnosis and treatment easier for the dentists. In addition, providing the most recent educational content and resources regarding oral health to the public is also easier with the development of social network. Dental practitioners can also educate the patients regarding the cause, signs and symptoms of the dental conditions through informative flyers and dental guides. Moreover, preparing COVID-19 related resources and information may be beneficial for both health care workers and patients. Many individuals are scared and nervous when visiting a dentist. Hence, dentists can help the patient to relieve their anxiety through pre-visit online consultations so they will be informed and know what to expect during the actual dental office visit and treatment. In addition, some patients may be concern about the infection control in the dental clinic during this Covid-19 pandemic. So, it is necessary for the dentists to explain clearly about the infection control protocol in the dental clinic and give reassurance to the patients that they are being protected. This fear and anxiety might even continue after the development of effective vaccines for COVID-19 and needs to be relieved for better prognoses as patients’ cooperation with the dentist’s instructions plays an important role in achieving better results, specifically for periodontal management.
Assisting in Epidemiology of the Pandemic
Saliva has been classified as an important diagnostic choice for early COVID-19 case detection. Oral swabs from COVID-19 patients showed a higher positive rate (by RNA content) in early stages of the disease when compared to a number of other test methods. The virus that cause Covid-19 which is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is able to enter the salivary gland cells via the expression of angiotensin converting enzyme-2 (ACE2) receptors to which the virus binds. Furthermore, the existence of 2019-nCoV nucleic acid in saliva penetrate from the salivary gland has been associated with the severity of COVID-19. These preliminary investigations claim that saliva may have a role as a diagnostic tool but whether or how the diagnosis based on saliva could enhance surveillance need to undergo further investigations and clinical research.
2021-7-25-1627198485