Recommendations for dentists during COVID‐19

Abstract

Background: Dentists are considered to be in a group of health professionals that are at highest risk of COVID-19 transmission, as they are in close contact with patients, and exposed to spatter of secretions, saliva and aerosol. Furthermore, a high percentage of COVID-19 positive patients may not be detected due to absence of symptoms. Therefore, appropriate personal protective equipment and treatment protocols are crucial to ensure provision of dental care during the pandemic. Aim/Hypothesis: The aim of this study was to propose recommendations for patient risk assessment, triage, as well as measures for the prevention of infection of health professionals and nosocomial transmission in dental settings. Materials and Methods: The search strategy was agreed upon by the authors prior to the initiation of the literature search. The electronic databases on MEDLINE (PubMed), Embase and Cochrane were chosen and the literature search was limited to the period up to April 17th, 2020. Studies considered for inclusion were sought using a broad search strategy with the following terms: COVID-19, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), influenza and related respiratory viral diseases. International (e.g. WHO) and national (e.g. public health institutes, dental associations) guidelines were screened to assess legal and ethical frameworks related to dental emergency care. Results: The patient risk assessment was based on a patient questionnaire including epidemiological history and clinical manifestation. Patients were then classified with unknown, high and very high risk of COVID-19. Patient triage recommendations suggested grading the emergency level of treatments into urgent, as soon as possible and postpone. Measures needed to prevent COVID-19 transmission were graded based on the current evidence for dental health professionals, dental clinics, and patients. Dentists have a responsibility to provide the most essential and appropriate dental care. During pandemic the duty of care when treating patients should be balanced with ensuring a safe working environment. Conclusions and Clinical Implications: The risk of COVID-19 infection by dental staff and also the risk of nosocomial transmission in dental practices is considered high. These recommendations are aimed at dental health professionals to implement preventive measures during COVID-19. The proposed recommendations may require further review and development based on new scientific evidence. Keywords: COVID-19, ethical issues, emergency dental care, patient questionnaire, triage