Covid-19 Dreamsmilez Dental Clinic Infection Control Safety Measures
Infection control protocols towards patient and clinic staff safety with specific focus on Covid-19 pandemic: Based on recommendations of: KSDC [Karnataka State Dental Council] | CDC [Centre for Disease Control, Atlanta, USA] | ADA [American Dental Association] | WHO [ World Health Organisation]
1. Introduction
COVID-19 is an infectious disease caused by a newly discovered coronavirus known as SARS-CoV-2. It was first identified in China during a respiratory disease outbreak in 2019. In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic.
The disease can result in myriad of symptoms such as cough, fever, shortness of breath and in severe cases, severe acute respiratory failure and even death. However, majority infected individuals experience mild to moderate symptoms or even no symptoms and can recover.
The disease is known to spread via respiratory droplets, touching of contaminated surfaces, airborne routes, etc. (1)
2. What are the dental implications of covid-19?
During the dental appointment, dental professionals and patients are in close proximity and this can increase the risk of transmission of the virus. Additionally, saliva can act as a reservoir for viral particles.
Some dental procedures can also generate splatter and aerosols which can lead to contamination and transmission. (2)
3. DreamSmilez COVID-19 Safety Protocols: What are WE doing?
At DreamSmilez, we understand the shared responsibility in containing the spread of COVID-19 and practicing safe dentistry. We also realize that visiting the dental office can cause general worry during these difficult times.
Therefore, our doctors and staff members made it an absolute priority to put into place a well-researched and well-executed set of safety protocols to ensure that your dental visit is as safe as possible!
3.1. Screening Process:
We contact patients prior to their appointment and screen them for recent/current symptoms and contact history pertaining to COVID-19.
Patients may be asked to answer an online COVID-19 Questionnaire. Patients with a recent history of COVID-19 may be asked to provide their COVID-19 test results.
In the case of a dental emergency/need for urgent care, an in-clinic appointment will be given and the patient will be given instructions for the appointment. Refer to Section 2.
When an In-Clinic Appointment is not feasible, we will conduct a ‘Video Consultation’ as an alternative option. Your dentist will take a careful history and advise appropriate medications (if required) and instructions to address your dental concerns.
Patients are advised to monitor their dental health and contact the dental office in the case of worsening/severe symptoms and also for regular follow up assessment.
An in-clinic appointment can be given at a later date for evaluation or for required dental procedures. (3,4)
3.2. Appointment Planning
We encourage our patients to take a prior appointment before coming to the clinic and intimate us of accurate information regarding their health status.
Longer and more spaced out appointments are placed to ensure adequate time for the clinical evaluation and procedure, disinfection and sterilization between patients and to reduce crowding inside the clinic.
Patients are advised to adhere to the following instructions:
- Please contact our dental office if there is any development of COVID-19symptoms prior to the appointment.
- It is absolutely mandatory to wear a mask/face covering when coming for the appointment. Entry into the clinic premises is subject to wearing of a mask.
- Please be on time for the appointment. Arriving 10-15 minutes prior to the appointment is recommended. Please call the dental office from the car/vehicle once you have reached the clinic premises.
- Please limit the number of accompanying individuals when coming for the dental appointment.
- Patient aged below 14 years and above 60 years can bring 1 person.
- Please bring minimal items inside the clinic. Avoid large bags, totes, shopping bags, etc. A small bag to carry phone, essential items and a pen is advised. (5)
3.3. What can you expect when you visit the clinic for an appointment?
Screening:
All individuals entering the dental office are first screened at the entrance (temperature and blood oxygenation) using contactless infrared thermometers and high-class pulse oximeter devices. An individual with a temperature above 100.4°F and blood oxygenation below 95% will not be admitted into the clinic and will be kindly asked to sit separately, until further instructions.
Sanitation:
All individuals will be provided with hand sanitizer and are advised to follow prescribed hand hygiene protocols when inside the clinic. Disinfection spray is used for other body surfaces.
Patient PPE:
Patients will be provided with Personal Protective Equipment (PPE) namely a head cap, surgical mouth mask, gloves, disposable patient drape and foot covers prior to the appointment.
Waiting Room Design:
Please maintain social distancing etiquette when in the waiting area and adhere to social distancing markings placed for your convenience in the waiting area. (6)
Personal protective equipment refers to wearable equipment that is designed to protect the doctor and support staff from infectious agents that can be present in saliva, blood, etc. Based on guidelines given by the CDC and WHO, all our doctors and staff will be wearing personal protective equipment for the dental appointment.
This includes:
- Respirators OR N95 Mask + Three-ply Surgical Mask
- Surgical head cap
- Protective Eyewear
- Face Shield
- Gown
- Double gloves
- Foot covers
Our front office will direct you towards the dental operatory where the doctor and assistant will be waiting wearing PPE.
Only the patient is allowed in the clinical area. For children below 14 years and senior citizens above 60 years, one accompanying member is allowed ONLY.
Surfaces within the operatory (dental chair, treatment tray, etc.) are covered with disposable covers. We have minimized the items in the appointment rooms to necessary items only. (3,4)
Patients are advised to wear their mask at all times unless instructed to remove it. Avoid touching surfaces, own face and mouth and practice hand sanitization regularly.
Pre-Procedural Virucidal Mouth Rinse
Patients will be provided with a pre-procedural virucidal mouth rinse (1% Povidone Iodine) before beginning the appointment.
Studies have shown that virucidal mouth rinses greatly reduce the viral load in the mouth and can help in reducing the transmission of the disease. (5,8)
Once the appointment is over, exit the dental operatory and proceed to the waiting area. Please wear mask at all times and maintain social distancing.
Our team will assist you with paperless and cashless payment methods and guide you for the removal of patient PPE.
Please adhere to post-treatment instructions given by your dentist. All prescriptions, instructions, patient detail recordings, etc. will be sent digitally (WhatsApp/Email).
3.4. Disinfection and Sterilization, Air Ventilation
- Disposable surface covers and items are replaced after every appointment.
- Dental chair is thoroughly disinfected after all procedures.
- Fumigation is done after appointments.
- Used instruments are removed in the appropriate manner and taken for cleaning, disinfection and sterilization.
- Regular mopping of frequently touched surfaces with disinfectant solutions (door handles,
- counter tops, etc.)
International standards followed for disinfection and sterilization. (Autoclave, UV Light Chamber)
Our staff is carefully trained and quality checked in the sterilization and disinfection process.
Clinic design has been modified to ensure adequate circulation of air and air filters have been put into place. (6)
3.5. Protocols for Clinic Doctors/Staff
As a routine practice, clinic doctors, dental auxiliaries and clinic staff will be screened regularly (temperature, oxygen, COVID-19 symptoms).
Any team member exhibiting COVID-19 symptoms/recently tested positive for COVID-19 will stay home/under quarantine.
Members of the dental team are adequately trained in the management of dental care in the COVID-19 scenario.
4. Frequently Asked Questions (FAQs)
Please contact your dentist if you are experiencing any dental illness. A telephonic/video consultation is always advised in order to manage the symptoms or assess if any immediate treatment is needed.
During peak-epidemic periods, we advise postponement of non-urgent dental care as a safety precaution.
However, in the case of a dental emergency/urgent care, it is important to visit the dental office.
A dental emergency may include: (9)
- Uncontrolled bleeding
- Severe uncontrolled pain
- Infections leading to swellings visible inside or outside the mouth that are persistent and recurrent in nature.
- Any swelling causing obstruction in breathing
- Injury involving the face or the facial bones
- Jaw abnormalities such as dislocation or lock-jaw
- Severe difficulty in opening the mouth
- Persistent non-healing ulcers
Conditions when Urgent Dental Care can be required:(9)
- Severe dental pain from an infection in the tooth/teeth
- Third molar pain and infection
- Post tooth removal complications/dry socket
- Active pus discharge/localized swellings
- Tooth fracture/injury to the tooth
- Final crown and bridge cementation if the temporary has been lost or broken
- Old fillings causing severe pain
- Suture/stitch removal
- Orthodontic wire or appliances piercing or impinging on the oral mucosa and causing ulcers
- Biopsy of abnormal tissue.
The COVID-19 virus can spread through various means (droplet infection, airborne, touching a contaminated surface, etc.). As it is widespread and contagious in nature, there is no absolute definitive way to determine the exact point of exposure to the virus for infected individuals. Therefore, it is important to follow all precautions advised by international, national and local health advisories to limit the spread of the virus within and outside the dental office.
All persons who are positive for COVID-19 or exhibiting symptoms consistent to the illness are advised to isolate themselves and postpone elective/non-urgent dental treatments. If you are experiencing dental symptoms, please contact your dentist for a video consultation and express your dental concerns. In case of a dental emergency, your dentist will advise the appropriate care.
As children and elderly (>65 years of age) belong to a high-risk group of individuals susceptible to the COVID-19 virus, it is important to take a prior appointment and walk-in appointments are not encouraged.
Please provide thorough history regarding the patient health status so that we can advise you better especially for those patients with existing co-morbidities such as diabetes, cardiac disease, asthma, cancer, etc.
Our dental team is highly qualified and trained to assess the urgency of dental care for an elderly/child patient. If deemed necessary, our dental team will perform in-clinic dental procedures under the safety precautions explained above. (10)
General Safety Precautions as recommended by WHO: (11)
COVID-19 Vaccine: (12,13)
https://www.mohfw.gov.in/covid_vaccination/vaccination/index.html
- Coronavirus disease 2019 (COVID-19) – Diagnosis and treatment – Mayo Clinic [Internet]. [cited 2021 May 8]. Available from: https://www.mayoclinic.org/diseases-conditions/coronavirus/diagnosis-treatment/drc-20479976
- Centre for Disease Control and Prevention. COVID-19 Personal Protective Equipment (PPE) for Healthcare Personnel. Centre for Disease Control and Prevention Guidelines [Internet]. 2020;1. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html
- Indian Dental Association’s Preventive Guidelines for Dental Professionals on the Coronavirus Threat. 2020;1–5. Available from: https://www.ida.org.in/pdf/IDA_Recommendations_for_Dental_Professionals_on_the_Coronavirus_Threat.pdf
- Indian Dental Association’s Preventive Guidelines for Dental Professionals on the Coronavirus Threat.
- Summary of Infection Prevention Practices in Dental Settings Basic Expectations. Centers for Disease Control and Prevention (CDC) [Internet]. 2016;43. Available from: http://www.cdc.gov/oralhealth/infectioncontrol/pdf/safe-care.pdf
- Patel M. Infection control in dentistry during COVID – 19 pandemic: what has changed? Heliyon [Internet]. 2020;6(10):e05402. Available from: https://doi.org/10.1016/j.heliyon.2020.e05402
- Amato A, Caggiano M, Amato M, Moccia G, Capunzo M, de Caro F. Infection control in dental practice during the covid-19 pandemic. International Journal of Environmental Research and Public Health. 2020;17(13):1–12.
- Reis INR, do Amaral GCLS, Mendoza AAH, das Graças YT, Mendes-Correa MC, Romito GA, et al. Can preprocedural mouthrinses reduce SARS-CoV-2 load in dental aerosols? Medical Hypotheses [Internet]. 2021 Jan 1 [cited 2021 May 8];146:110436. Available from: /pmc/articles/PMC7691843/
- IDA Protocol COVID-19 [Internet]. [cited 2021 May 8]. Available from: www.ida.org.in
- Ismail A. Managing pediatric dental patients during the SARS-CoV-2 pandemic [Internet]. Vol. 12, Journal of International Oral Health. Wolters Kluwer Medknow Publications; 2020 [cited 2021 May 8]. p. S80–4. Available from: https://www.jioh.org/article.asp?issn=0976-7428;year=2020;volume=12;issue=8;spage=80;epage=84;aulast=Ismail
- (No Title) [Internet]. [cited 2021 May 8]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/downloads/COVID-19_PPE_illustrations-p.pdf
- Coronavirus disease (COVID-19): Vaccines [Internet]. [cited 2021 May 8]. Available from: https://www.who.int/news-room/q-a-detail/coronavirus-disease-(covid-19)-vaccines
- Information Regarding COVID-19 Vaccine [Internet]. [cited 2021 May 8]. Available from: https://www.mohfw.gov.in/covid_vaccination/vaccination/index.html