|Year : 2020 | Volume
| Issue : 8 | Page : 76-79
Managing dental public health challenges during the SARS-CoV-2 pandemic
Department of Community Medicine, Sri Venkateswara Institute of Medical Sciences (SVIMS), Sri Padmavathi Mediical College for Women (SPMCW), Tirupati, Andhra Pradesh, India
|Date of Submission||10-Jul-2020|
|Date of Decision||25-Aug-2020|
|Date of Acceptance||16-Sep-2020|
|Date of Web Publication||30-Nov-2020|
Dr. Chandrasekhar Vallepalli
Department of Community Medicine, Sri Venkateswara Institute of Medical Sciences (SVIMS), Sri Padmavathi Mediical College for Women (SPMCW), Tirupati, Andhra Pradesh.
Source of Support: None, Conflict of Interest: None
As of July 10, 2020, there have been more than 12.1 million confirmed cases of coronavirus disease-2019 (COVID-19), including 551,046 deaths reported globally from 213 countries/regions according to World Health Organization (WHO). A novel type of coronavirus appeared in Wuhan, China in late December of 2019. WHO announced COVID-19 earlier as public health emergency of international concern (PHEIC) and a few days later as pandemic. In dental practice, protecting patients and personnel during the SARS-CoV-2 pandemic is challenging and any possible cross-infection can be prevented by the successful use of the personal protective equipment (PPE) and ensuring strict infection prevention and control measures. To discover the impact of SARS-CoV-2 and other infectious diseases on oral health, this is an opportunity to initiate and engage in scientific research projects.
Keywords: Coronavirus, COVID-19, Dental, Pandemic, Public Health, SARS CoV-2
|How to cite this article:|
Vallepalli C. Managing dental public health challenges during the SARS-CoV-2 pandemic. J Int Oral Health 2020;12, Suppl S2:76-9
|How to cite this URL:|
Vallepalli C. Managing dental public health challenges during the SARS-CoV-2 pandemic. J Int Oral Health [serial online] 2020 [cited 2022 Jan 26];12, Suppl S2:76-9. Available from: https://www.jioh.org/text.asp?2020/12/8/76/301867
| Introduction|| |
According to World Health Organization (WHO), as of July 10, 2020, there have been more than 12.1 million confirmed cases of coronavirus disease-2019 (COVID-19), including 551,046 deaths reported globally from 213 countries/regions, of which top four countries that were contributing about 51% of confirmed cases globally are America, Brazil, India, and Russia. A novel type of coronavirus appeared in Wuhan, China in late December of 2019. In January 2020, the authorities declared the novel betacoronavirus, which was initially referred to as novel coronavirus (2019-nCoV) and later officially termed as severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) as the “COVID-19” etiological pathogen. After quickly spreading globally, On January 30, 2020, COVID-19 was announced earlier as Public Health Emergency of International Concern (PHEIC), and a few days later as pandemic on March 11, by the WHO.
| Dentistry as a Profession in COVID-19|| |
Dentistry is a profession where the dentist works close to the patient’s mouth and many procedures generate aerosol which may contribute to the spread of infection and diseases like COVID-19. Dental health care workers (DHCWs) are always at a greater chance of contracting this infectious disease; and oral health care settings may serve as a medium of transmitting disease. The New York Times published an article on March 15, 2020 entitled “The Workers Who Face the Greatest Coronavirus Risk”, which depicted that dentists are the workers most exposed to the risk of being affected by COVID-19 when compared to other healthcare professionals.
| Transmission and Manifestations|| |
The foremost imperative concern in dental facilities is the transmission of SARS CoV-2 by means of droplets and aerosol, since it is practically difficult to lessen droplets and aerosol production to zero throughout dental procedures, regardless of the entirety of the precautionary measures taken. So the transmission of the infection is primarily through inhalation or ingestion or direct mucous contact with droplets of saliva; it is also important to note that the virus can survive on hands, articles, or surfaces that have been exposed to infected saliva in the previous 9 days.,
The primary clinical presentation was respiratory in nature, and they occur after a 5-day mean incubation period with a range of 0–24 days. Patients with specific co-morbidities including diabetes, hypertension, and coronary heart disease were at increased risk of infection.
| Control of COVID-19|| |
The overall objective for all the nations is to control COVID-19 infection by hindering the transmission of infection and preventing related ailment and death. National COVID-19 response comprises time tested, core public health measures that break the chain of transmission from person to person, together with (i) case detection, testing, isolation, and clinical management and (ii) contact tracing and their quarantine.,,,,
Dentist as a frontline warrior
Dental professionals play a significant role in combating pandemics like COVID-19. To prevent the spread of the infectious disease, DHCWs need to be able to screen and identify possible high-risk COVID-19 patients. No regular dental care on suspected cases of COVID-19 infection should be performed and these patients should be advised to quarantine and self-isolate themselves.
Infection prevention and control measures
Dental practitioners ought to make sure that all their members of the oral health care team are familiar with the COVID-19 transmission and preventive measures. Steps should be taken to make ensure that all patients and oral health care staff follow the strict protocols of respiratory hygiene, cough etiquette, and hand hygiene. All the patients who are visiting dental clinic should follow triage procedures. DHCW ought to wear a facemask all the times within the dental clinic. DHCW should wear a surgical mask, goggles, or face shield for eye protection, gloves, and a gown or protective clothing during procedures that are likely to spill blood or other body fluids.
SARS-CoV-2 will survive for 72h on surfaces of stainless-steel and plastic, 24h in cardboard, and from 40min to 2h and 30min in aerosolized form or in dust. Most disinfectants, including 70% ethanol, 0.1% sodium hypochlorite, 1% povidone-iodine, and 0.5% hydrogen peroxide, will effectively inactivate it within 1–5min.,
Biomedical waste management
Dental waste arising from the treatment of suspected or confirmed COVID-19 patients is considered medically infectious waste that must be carefully discarded strictly in compliance with official guidelines utilizing double-layered yellow color medical waste package bags with “gooseneck” ligation. The surface of the package bags should be labeled and disposed of in compliance with the bio-medical waste management rules.
| Impact of COVID-19 on Dental Practice|| |
Mental health problems
Given the severity and uncertainty surrounding the pandemic in terms of mental well-being, it is common to intensify a spectrum of extreme negative emotions, such as fear and anxiety, stress and distress, anger, and confusion. As reported in previous outbreaks such as SARS, MERS, and H1N1, this can contribute to depression and other mental health concerns. This is essential that public-health education programs and campaigns be introduced to raise the understanding of mental health problems, and that self-regulatory processes and clinical interventions be made broader and more readily accessible.
Personal protective equipment shortage
Another problem was to restrict the dentists’ use of personal protective equipment (PPEs), as they were needed for hospitals and were in short supply worldwide., Elective and nonemergency procedures and appointments for which DHCW usually uses PPE should be canceled. Once the provision of PPE has increased, facilities will go back to normal procedures.
Role of digital technology
Through the COVID-19 pandemic, a wide variety of emerging technology can be seen as an incentive to improve these approaches for public health.
Tele-dentistry, identified as the remote provision of oral health care through the use of information technology, is another developing area with tremendous potential for the future. Tele-health decreases individuals movement in healthcare facilities, reduces the risk of infection, and spreads of the disease. In addition, the WHO regularly promotes reform, advancing the improvement and dissemination of public health activities enabled by both information and communications (e-Health) and mobile devices (m-Health) technologies.
An online medical “chat bot” based on artificial intelligence, the use of a software (virtual assistant) that attempts to simulate a human being in communication with people (via telephone or chat apps), can help diagnose early symptoms in patients, directing them to medical attention if their health condition deteriorates. In some countries, facial recognition firms have introduced thermal facial recognition to recognize people at screening checkpoints with elevated temperatures.
Training of the staff
To offer guidance to personnel and to ensure that they have learned the appropriate use of PPE before taking care of a patient, including consideration for the proper use of PPE including N-95 or surgical masks, gloves, goggles, face shields, hair covers, and gowns. They may require psychological and moral support to maintain their level of confidence and strict adherence to guidelines.
Dangers of self-medication
Self-medication is a universal phenomenon, which is practiced globally with a varied frequency of up to 68% in European countries and with a prevalence rate of 31%–60% in the Indian subcontinent. There will be an enhancement of self-medication in this public health challenging times of pandemic due to limited availability of dental care facilities. Dental public health awareness and education programs should be conducted on a priority basis to make people aware of the dangers of self-medication.
Dental tourism and COVID-19
Dental tourism implies to those individuals who travel from their area of residence to another location to avail dental services. Dental tourism provides the possibility of both helping and impeding public health causes. There will be a negative impact on dental tourism due to the COVID-19 pandemic due to mobility restrictions in their local context.
| Conclusion|| |
Although dentistry is comparatively a smaller portion of the response to COVID-19, dental experts should take this opportunity to evaluate the role of dental care during a very public health emergency. Online dissemination by various international health agencies and national dental professional bodies of educational materials on COVID-19 has kept the DHCW’s well aware. In dental practice, protecting patients and personnel during the SARS-CoV-2 pandemic is challenging and any possible cross-infection can be prevented by the successful use of the PPE and ensuring strict infection prevention and control measures. To discover the impact of SARS-CoV-2 and other infectious diseases on oral health, this is an opportunity to initiate and engage in scientific research projects.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
Ethical policy and institutional review board statement
Declaration of patient consent
Data availability statement
| References|| |
World Health Organization. Coronavirus disease (COVID-19). Situation report-172. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200710-covid-19-sitrep-172.pdf?sfvrsn=70724b90_2. [Last accessed on 2020 Jul 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.
Eurosurveillance Editorial Team. Note from the editors: WHO declares novel coronavirus (2019-nCoV) sixth public health emergency of international concern. Euro Surveill. 2020;25:200131e.
Cucinotta D, Vanelli M WHO declares COVID-19 a pandemic. Acta Biomed 2020;91:157-60.
Nejatidanesh F, Khosravi Z, Goroohi H, Badrian H, Savabi O Risk of contamination of different areas of dentist’s face during dental practices. Int J Prev Med 2013;4:611-5.
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.
Gamio L The workers who face the greatest coronavirus risk. Available from: https://www.nytimes.com/interactive/2020/03/15/business/economy/coronavirus-worker-risk.html?action=click&module=Top+Stories&pgtype=Homepage. [Last accessed on 2020 Jun 24].
Cleveland JL, Gray SK, Harte JA, Robison VA, Moorman AC, Gooch BF Transmission of blood-borne pathogens in US dental health care settings: 2016 update. J Am Dent Assoc 2016;147:729-38.
Meng L, Hua F, Bian Z Coronavirus disease 2019 (COVID-19): Emerging and future challenges for dental and oral medicine. J Dent Res 2020;99:481-7.
Brown JD Antihypertensive drugs and risk of COVID-19? Lancet Respir Med 2020;8:e28.
World Health Organization. COVID-19 Strategy Update (Interim Guidance) Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/strategies-plans-and-operations. [Last accessed on 2020 Jun 26].
World Health Organization. Contact tracing in the context of COVID-19 (Interim Guidance). Available from: https://www.who.int/publications-detail/contact-tracing-in-the-context-of-covid-19. [Last accessed on 2020 Jun 26].
World Health Organization. Surveillance strategies for COVID-19 human infection (Interim Guidance). Available from: https://www.who.int/publications-detail/surveillance-strategies-for-covid-19-human-infection. [Last accessed on 2020 Jun 24].
World Health Organization. Considerations for quarantine of individuals in the context of containment for coronavirus disease (COVID-19) (Interim guidance) Available from: https://www.who.int/publications-detail/considerations-for-quarantine-of-individuals-in-the-context-of-containment-for-coronavirus-disease-(covid-19). [Last accessed on 2020 Jun 24].
World Health Organization. Operational considerations for case management of COVID-19 in health facility and community. Available from: https://www.who.int/publications-detail/operational-considerations-for-case-management-of-covid-19-in-health-facility-and-community. [Last accessed on 2020 Jun 26].
World Health Organization. Critical preparedness, readiness, and response actions for COVID-19. Available from: https://www.who.int/publications-detail/critical-preparedness-readiness-and-response-actions-for-covid-19. [Last accessed on 2020 Jun 24].
Dar Odeh N, Babkair H, Abu-Hammad S, Borzangy S, Abu-Hammad A, Abu-Hammad O COVID-19: Present and future challenges for dental practice. Int J Environ Res Public Health 2020;17:3151.
Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19) Guidance for Dental Settings. Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html. [Last accessed on 2020 Jun 24].
van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al
. Aerosol and surface stability of SARS-cov-2 as compared with SARS-cov-1. N Engl J Med 2020;382:1564-7.
Chin AWH, Chu JTS, Perera MRA, Hui KPY, Yen HL, Chan MCW, et al
. Stability of SARS-cov-2 in different environmental conditions. Lancet Microbe 2020;1:e10.
Kampf G, Todt D, Pfaender S, Steinmann E Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect 2020;104:246-51.
Fallahi HR, Keyhan SO, Zandian D, Kim SG, Cheshmi B Being a front-line dentist during the covid-19 pandemic: A literature review. Maxillofac Plast Reconstr Surg 2020;42:12.
Koh CG, Lee L, Lo C, Wong C, Yap J World Economic Forum report. Challenges and Opportunities in the Post-COVID-19 World. Chapter 10. Available from: http://www3.weforum.org/docs/ WEF_Challenges_and_Opportunities_Post_COVID_19.pdf. [Last accessed on 2020 Jul 5].
American Dental Association. ADA Interim Guidance for Minimizing Risk of COVID-19 Transmission. 2020. Available from: https://www.ada.org/~/media/CPS/Files/COVID/ADA_COVID_Int_Guidance_Treat_Pts.pdf. [Last accessed on 2020 Jun 24].
Dave M, Seoudi N, Coulthard P Urgent dental care for patients during the COVID-19 pandemic. Lancet 2020;395:1257.
Khan SA, Omar H Teledentistry in practice: Literature review. Telemed J E Health 2013;19:565-7.
Lurie N, Carr BG The role of telehealth in the medical response to disasters. JAMA Intern Med 2018;178:745-6.
Neville P, van der Zande MM Dentistry, e-health and digitalisation: A critical narrative review of the dental literature on digital technologies with insights from health and technology studies. Community Dent Health 2020;37:51-8.
Webster P Virtual health care in the era of COVID-19. Lancet 2020;395:1180-1.
Optoelectronic technologies assisting in the fight against COVID-19. APNews 2020. Available from: https://apnews.com/PR%20Newswire/354aae0738073bc95331ee72a458cb50. [Last accessed on 2020 Jun 26].
Deshpande SG, Tiwari R Self medication––a growing concern. Indian J Med Sci 1997;51:93-6.
Vequist DG 4th, Stackpole I Dental tourism: An opportunity for public health. Interview by Lois K Cohen. Compend Contin Educ Dent 2012;33:90, 92-3.