Guidelines for Infection Control and Prevention in Dentistry During the COVID-19 Situation

Due to the COVID-19 outbreak in the past period, many dental patients have been afraid to seek treatment because of fear of infection, even though they experienced severe pain and swelling. Therefore, to address these issues, the Dental Association of Thailand has issued an announcement to create understanding and confidence among the public. It also confirms that dental procedures are highly safe for both patients receiving services and the dental team and staff. Additionally, it elevates the correct recommendations and practices for dental teams during treatment.

Increasing Confidence in Dental Procedures

Since the COVID-19 outbreak, there has been no evidence of infection transmission from dental procedures, either to patients or dentists. However, to reduce risks during severe outbreaks, dental treatment is limited to patients with emergency symptoms who need immediate care. This is subject to the dentist’s consideration after an initial examination.

However, since dental treatment processes may generate aerosol droplets, many people fear this increases the risk. In this case, it should be clarified that using a high-pressure suction device near the aerosol source effectively reduces dispersion. At the same time, all instruments and equipment are thoroughly cleaned and sterilized in high-pressure autoclaves, similar to those used in operating rooms, ensuring they are free from pathogens.

“People are generally afraid of dental treatment, and especially during the COVID-19 outbreak, many with emergency symptoms hesitate to seek care. Dentists must provide correct understanding to patients. At the same time, recommendations and procedural guidelines for dental treatment have been elevated for dentists and related personnel, especially regarding the use of protective equipment, reducing pathogens and aerosol volume, as well as patient screening protocols to ensure they are not at risk or carriers of infection. Appointment scheduling is also adjusted to avoid crowded waiting areas and increase physical distancing. It is recommended that each treatment session should not exceed 50 minutes.”

As an additional measure to reduce pathogens and aerosol volume, which is a concern for many fearing increased COVID-19 infection risk, evidence confirms that rinsing and brushing teeth before procedures can reduce pathogens by 70-95%. Therefore, using an antiseptic mouthwash is an additional measure to further reduce oral pathogens before starting treatment.

Meanwhile, during tooth drilling or treatments that generate aerosols, microorganisms are always present, especially the SARS-CoV-2 virus currently spreading, which is found abundantly in secretions from the throat and behind the nasal cavity. Therefore, using a high-pressure suction device near the aerosol source effectively reduces dispersion. Studies show that using a high-pressure suction device can reduce aerosol volume by up to 90%, and using a rubber dam during drilling can reduce the amount of dispersed pathogens in aerosols by 70-98%.

For facilities that are prepared, it is recommended to promote ventilation systems in general dental treatment rooms to have air exchange rates of 6-12 ACH (air changes per hour). If treating patients suspected or confirmed to have COVID-19, treatment should be provided in rooms with at least 12 ACH ventilation rates.

Key Guidelines for Infection Control and Prevention in Dental Settings During COVID-19

1. Schedule patient appointments in advance to reduce crowding within the facility and allow comprehensive preparation in terms of materials, time, and space.
2. Avoid having patients wait inside the facility before treatment to prevent crowded waiting areas and maintain a distance of at least 1-2 meters.
3. Patients must undergo temperature screening to ensure no fever above 37.5 degrees Celsius, sanitize hands thoroughly with 70-80% alcohol, wear masks or surgical masks at all times inside the clinic (except during treatment), and be advised not to touch any surfaces while waiting for screening.
4. All patients must be screened for risk assessment according to the definition of suspected SARS-CoV-2 infection before receiving dental treatment.
5. Patient screening must assess the risk of SARS-CoV-2 infection based on the following criteria:
   • Risk history includes travel abroad within the past 2 weeks, contact or close proximity to COVID-19 patients, or history related to areas with cluster infections.
   • Symptoms that may indicate infection include fever, dry cough without nasal discharge, sore throat, which are respiratory infection symptoms. Even without other symptoms, consultation is necessary to differentiate COVID-19 from other types of flu. Other distinctive symptoms include difficulty breathing, shortness of breath, unexplained pneumonia, loss or reduction of smell, and loss or reduction of taste.
6. If a patient has a risk history, any symptoms from the screening form, or a body temperature above 37.5 degrees Celsius, they should be referred to a physician first and avoid oral procedures except in emergency or urgent cases. Treatment should be based on the facility’s capacity and performed with caution, strictly following infection prevention measures.
7. Screening records should include the full name and signature of both the screener and the screened patient and be stored in the patient’s medical record system.
8. Dentists and dental staff should wash their hands before and after contact or treatment of patients, following all 6 steps of handwashing according to the World Health Organization (WHO) new standards.
9. Hands should be washed with water and liquid soap mixed with disinfectant or rubbed with 70-80% alcohol gel.
10. Dentists’ and assistants’ equipment must be clean, safe, ready for use, tightly sealed, and highly effective.
11. Dental facilities must be clean, sterile, well-ventilated, and comply with dental health care standards.
12. Medical instruments must be clean, undamaged, sterile, and highly effective.

Following all these guidelines will help dental centers gain confidence and ensure safety from COVID-19 in every treatment, thereby creating long-lasting quality of life and dental health.