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Infectious Diseases

12 August 2020

Avoid non-essential dental visits until Covid transmission rates drop, WHO urges

It is safer for non-essential appointments, such as dental cleanings, to be postponed until Covid-19 rates drop.

  • The WHO advises that all dental check-ups and cleanings be postponed
  • This is until Covid-19 infection rates drop and more is known about the spread of SARS-CoV-2
  • However, urgent oral health services, such as managing severe pain, should continue

There are still many unanswered questions about the new coronavirus, named SARS-CoV-2 (that causes Covid-19).

As some countries are still experiencing an increase in infection rates, the World Health Organization (WHO) has called for all non-urgent dental appointments to be postponed in order to contain the spread of the virus – at least until more is known about it.

“WHO advises that routine non-essential oral health care – which usually includes oral health check-ups, dental cleanings and preventive care – be delayed until there has been sufficient reduction in Covid-19 transmission rates, from community transmission to cluster cases, or according to official recommendations at national, sub-national or local level. The same applies to aesthetic dental treatments,” the guidelines say.

The document does, however, go on to say that in the event of a patient requiring urgent or emergency oral health care treatment to preserve their oral functioning, or for managing severe pain, these services should be utilised.

If possible, patients should be screened remotely and be given advice on maintaining good oral hygiene through social media channels, the WHO said.

Airborne vs. droplet transmission

Although there is currently no data on the spread of SARS-CoV-2 via the dentist’s chair, the virus can spread through direct, indirect, or close contact with infected people through infected secretions, such as saliva, as well as respiratory droplets, which are around 5–10 micrometres in diameter.

Research into airborne transmission of the virus is also ongoing. Airborne transmission is different from droplet transmission, as the particles, called aerosols, are generally considered to be under 5 micrometres in diameter, and can remain suspended in the air for extended periods of time. They can also be transmitted to others over distances further than one metre. 

The WHO updated its scientific brief in July, acknowledging that airborne transmission of the virus appears to be possible.

Minimising the risk during dental procedures

In the guidance document, dated 3 August, the WHO says that dentists are at high risk of being infected with SARS-CoV-2 as they work in close proximity to patients’ faces for prolonged periods.

"Their procedures involve face-to-face communication and frequent exposure to saliva, blood, and other body fluids and handling sharp instruments. Consequently, they are at high risk of being infected with SARS-CoV-2 or passing the infection to patients," the guidance reads.

The organisation also mentions aerosol-generating procedures (AGPs), which are performed globally in oral health care settings, and defined as any medical, dental and patient care procedures that result in the production of airborne particles. In an oral healthcare setting, this can range from dental cleaning to polishing, and surgical tooth extraction.

For this reason, the document lists ways in which broken dentures and orthodontic appliances, for example, can be treated while minimising or avoiding AGPs.

Ventilation also a necessity

Dental facilities must also ensure they have adequate mechanical or natural ventilation, as this is crucial to slowing down the spread of the virus, the WHO advises. 

A study published in May, which looked at the viral RNA of SARS-CoV-2 in toilets and Covid-19 patient wards in two Wuhan hospitals, found that chances of infection are increased in poorly-ventilated areas.

The researchers concluded that the virus has the potential to spread via aerosols, and in order to reduce the risk of airborne exposure, they suggested routine disinfection and better ventilation in closed settings.

Tips from WHO

According to the guidance brief, protection of oral health care personnel and patients during treatment should include:

  • Decluttering all work surfaces in treatment areas 
  • Ensuring that oral health care personnel adhere to hand hygiene protocol
  • Ensuring that oral health care personnel are trained to use appropriate Personal Protective Equipment (PPE)
  • Asking the patient to rinse their mouth with 1% hydrogen peroxide or 0.2% povidone-iodine for 20 seconds prior to examination or starting any procedure (this reduces the salivary load of the virus)
  • Discarding respirators, surgical masks, gowns and gloves after every use 

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Image: Jonathan Borba on Unsplash