Covid-19 is not considered highly contagious: however, it is believed that the infection’s rapid spread is via droplet contamination or close contact with an infected surface. The destructive virus gets introduced into an individual’s body via mouth, nose, and eyes treatment.

The list that WHO provided medical procedures that generate aerosol does not include dental AGPs (aerosol-generating procedures). However, various reports suggest that routine dentistry entails AGPs.

Clinical dental procedures like Alignerco Coupon involve staying in close contact with patients, making dental professionals more susceptible to the coronavirus infection and possible spread of the virus. However, it is yet to be researched extensively.

Primary Care Dentistry

If possible, the doctors should deal the patients with remotely through telephone triage, and they should be treated based on AAA (advice, analgesic, and antimicrobials). However, if the clinician considers the patient’s condition to be an emergency and sanctions a face-to-face consultation for further treatment, only then should the patient be referred to visit a dental care center.

Conditions that likely require treatment in dental care center:

• Treatments that can be done only by medical professionals like full and partial dentures treatment in Kolkata.

• Life-threatening emergencies like orofacial swellings (that cause restriction in the airway leading to breathing difficulty).

• Treatments that cannot be done via AAA like single sitting RCT.

• Dento-alveolar injuries like luxations and fractures or dentoalveolar trauma like facial/oral laceration.

• Dental pain including the one which requires a root canal treatment in Kolkata and facial pain that is uncontrollable and cannot be treated by self.

• Post-extraction bleeding which cannot be controlled by the patient with the help of local measures.

With appropriate PPE and the implementation of infection prevention measures, the doctors could offer face-to-face consultations for a range of treatments to the patients without any Covid-19 symptoms. However, if the patients are suspected of having a Covid-19 infection, they should be referred to urgent dental care centers (UDCCs).

Considerations for effective management of endodontic treatments

It is due to the need for reducing the risk of infection transmission and social distancing, specific considerations for effective management of patients is recommended, especially when undergoing root canal treatment in Kolkata, like:

• The waiting room should not be full of patients as it can increase the risk of infection transmission due to minimized social distancing.

• Waiting rooms should be zoned with adequate spacing between seats. If the waiting room cannot accommodate more than a couple of patients, only one patient should be asked to wait while the other person is examined.

• Symptomatic patients suspected of having a Covid-19 infection should be asked to wait and get treated in separate areas than asymptomatic patients.

• Patients who belong to the vulnerable group (people aged 70 or more, obese, pregnant, diabetic, suffer from heart/lung disease) should be given priority.

• The patients should book appointments beforehand for full and partial dentures treatment in Kolkata and the doctors can regulate other remedies as the number of patients per time slot.

• Dentists and nurses should not come out during the surgery that includes an AGP procedure because of the risk of droplet contamination. All the necessary equipment should be laid out in the best possible way to avoid unnecessary sourcing of items.

• A nurse should stay outside the surgery room to provide any materials required in the surgery. The nurse should transfer the necessary materials via a trolley inside the surgery room.

• The doctor should adequately don the appropriate PPE prior to AGPs.

• PPEs should be donned in safe rooms and disposed of in dedicated areas.

• When any AGPs like single sitting RCT are completed, the doctor should allow the aerosol-cloud to be cleared before using the room any further. Aerosols can generally remain for 10-30 minutes before dissipating.

• Following aerosol’s dispersion and settling, the medical staff should clean the room meticulously before surgery is carried out on the next patient.

Suggestions for Endodontic treatment management during the pandemic

These are the suggestions for managing patients in pain or the ones requiring emergency orthodontic intervention:

Pre-operative

• Scrub the patient’s lips and its surrounding area with PVP-I (povidone-iodine) to maintain an aseptic technique.

• Gargling with PVP-I should be considered before any treatment to minimize the salivary viral load.

Intra-operative

• The doctors should utilize Single-use instruments in possible cases to eliminate the need for continuous sterilization and decontamination.

• Rubber dam isolation in cases like single sitting RCT is of vital importance as it can reduce the microorganisms present, minimizing the risk of contamination.

• Following isolation using a rubber dam, the dentists should scrub the teeth/tooth (isolated one) with PVP-I, hydrogen peroxide, or sodium hypochlorite with the help of a tweezer and cotton wool pledget as it prevents infection.

• Use a fast handpiece with less / no water to access the cavity and a high-volume suction to reduce the aerosol production.

• Avoid using ultrasonic scalers as they are generally known to have high aerosol production.

• Whenever possible, the dentists should provide single sitting RCT as it reduces AGPs’ risk, and the need for further appointments is diminished.

Post-operative

Depending on the patient’s unique symptoms, after treatments like RCTs, full and partial dentures treatment in Kolkata, etc., the dentists should prescribe analgesics. The dentists should ask the patients to follow-up at intervals.

The dental professional should give appropriate advice regarding the treatment during this pandemic. There is a higher risk of further complications, including flare-ups of extreme pain, tooth fracture, etc.

Conclusion

The AAA principle strategy may be beneficial for a considerable number of individuals, but the implications of such an approach to any emergency dental care are far-reaching. Both the AAA procedure, as well as face-to-face consultation, comes with respective pros and cons. So, whatever the case may be, the doctors, along with the patients, should take steps wisely that do not result in an unfortunate, unintended consequences for them.