Is dental care safe in private practice during COVID times?

Dr. Ritu Ahal, Prof. (Dr.) Rajesh Ahal

These Covid times have been challenging times for everyone and in every sphere of life. There have been 2 previous episodes of Covid like spreads in the last 2 decades – SARS & MERS. But, this time it has spread to 6 continents!
Many have developed extreme fear that they would contact the virus if they visit any health or medical facility, including for dental treatment. There are thousands of patients, who have been on antibiotics and pain killers since weeks now and they have begun to develop antibiotic resistance and the stomach linings of many has begun to get effected. Many mothers who have been breast feeding their infants have passed the same to their young ones! The doctors will be facing a new wave of health problems soon, as Dental Emergencies & Urgencies are NOT getting the attention due. The FEAR is the NEW NORMAL, now unfortunately.
The Private Dental Clinics are also aware of the NEW NORMAL and many have prepared themselves to handle the patients as per the new guidelines that have been issued by the Dental Council of the U.T., The Dental Council of India, The Union Ministry of Health & Home and the Supreme Court of India. The Dental Fraternity looks forward to making the people aware of the changes that are required as well as their co-operation to allow us to take care of their Dental Emergencies and also assuage them that they should not fear seeking Dental Treatment in Covid Times. Covid is going to stay for long and having any prolonged dental issues could decrease one’s immunity further making them prone to any infections including Covid. Therefore, for a strong immuned body and mind do not avoid seeking medical or Dental care.
One has to plan for a dental visit. The following aspects have to be followed by the patients:
1. The prospective patient has to seek an appointment over the phone, instead of just entering a dental clinic without an appointment.
2. The patient should brush before coming to the clinic – it reduces the viral load in the mouth.
3. It is very important, not to have more than one or two patient in the waiting area of a Dental Clinic ensuring the social distancing.
4. If feasible, the patient can seek a Tele or a video consultation first and many facilities are now offering even Paid Tele/video Consultations.
5. The patient should remove watch, jewelry and other accessories at home. They can bring a small purse/wallet and mobile phones to the clinic.
The patient should not be escorted with many people. If possible, only the patient should enter the clinic. An adult can escort a child or an elderly patient. The patient would be asked to enter the details in a Questionnaire, true to his knowledge and honesty and also give a written consent for the same. The patient’s oxygen saturation level and temperature would have to be noted for each visit and hand sanitization offered. The clinic would have certain areas to allow seating to maintain social distancing and one should seat only on those. The purse/ mobile phones would need to be deposited outside the clinical area. One should not lean on the reception desk but, maintain a respectable distance even though the same would have been disinfected by the clinic staff. The patient will be offered to wear a pair of gloves and some barrier clothing to safeguard and protect him/her.
The latest guidelines issued by Ministry of Health Affairs has made it mandatory that no dental clinic shall open in the containment zone. Clinics in the red, orange and green zone can offer consultations and urgent dental care. A complete list of such procedures has been notified by the Health Ministry. The patient would therefore need to be treated for his urgent dental issues and as of now the guidelines stipulate treatment of emergency and urgent dental care. The guidelines also stipulate the completion of some dental procedures which were started before the onset of Covid Lockdown. A cooler fan would have to be directed towards the patient.
It is now mandated that every dental clinic would strive to have a good disinfection and sterilization protocol, so as to ensure that there is no infection of the attending doctors and the support staff and the infection should not be transmitted further. Therefore, it is important to ensure that every instrument used is disinfected first, followed by double check dis-infection in a ultrasonic bath having bio-enzymes and then the same be autoclaved in a B-Class Autoclave ( in which a vacuum is created – thus ensuring complete destruction of all types of infective organisms). The disposable low volume suctions would need to be used along with autoclavable high volume suction tips. The tips of the 3- way syringes would also need to be autoclaved after each use. The use of barriers on the chair controls, light handles has also become applicable for more effective barrier techniques.
Certain aspects have become important to be used in the dental clinics now. These include: Use of Ultrasonic baths, Oil Free Compressors, B- Class Autoclaves, Pouching of Instruments for Autoclaving, Use of High Volume Intra Oral Suction systems, Rubber Dam systems, Disinfection of Chairs after each use, Use of Protection Equipment for Dental Surgeon, Staff and the patient.
Some new technologies are being floated around – such as Cluster Ion Technologies, High Volume extra oral suction systems, Negative Ion systems. But, these technologies still need to be validated for its efficacy, efficiencies, lamellar flow studies and long term effect on the body. So, until we have long term effect studies the use of such technologies is still a doubt as some are contemplating its non reversible effects on the skin.
The Personal Protection Equipment (P.P.E.) is the New Normal. The use of disposables has increased manifold now and also the need for an effective Bio- Medical Waste Management Collection, so that the infection control is maintained to prevent any spread.
The demand and use of the facemasks and gloves by non medical/ dental players has resulted in acute shortage of the same, which in turn has resulted in sky-high rocketing of the costs of the basic protective gear for professional use. The dental fraternity is also facing a double whammy due to the increase in the value of the U.S. Dollar, thus having to bear a further brunt of more expensive dental materials. This would definitely increase the basic cost of the dental treatment, unless the GST on the same is brought down to a zero, by the Government on accounts of the same being given an essential status.
(The authors are Senior Clinical Dental Surgeon and Senior Clinical Dental Specialist.)