Acute endodontic and dental trauma provision during the COVID-19 crisis

Abstract

Discusses common endodontic emergencies likely to present during COVID-19. Suggests a management protocol for endodontic emergencies and a brief management protocol for dento-alveolar trauma.

Pattern and Causes of Oral and Maxillofacial Injuries Presented to a Tertiary Care Public Dental Hospital in Strictly Imposed COVID-19 Lockdown Scenario

“…Firstly, oral healthcare providers operate in close proximity to the patient's face, eyes and nose, which increases the risk of viral transmission via saliva (oral secretions) and respiratory secretions (speaking, sneezing, coughing, etc.) [5][6][7][8]. Secondly, clinical treatments which use high-speed hand-pieces and ultrasonic scalers generate copious small droplets, also known as aerosolized droplet nuclei or aerosols.…”

“…These aerosols are able to remain suspended in the air for prolonged periods and may be inhaled by people working beyond the immediate clinical treatment zone [4][5][6][7][8]. Consequently, physical distancing (staying apart by at least 1 m) and meticulous use of personal protective equipment and infection control protocols in oral healthcare provision have become pivotal to contain the disease and control its transmission [8,9]. An array of evidence-based protocols has been developed for the prevention and control of COVID-19 infection within dental practice which have been adopted by many countries [10][11][12].…”

“…Exclusive emergency care provision adopted by healthcare services was aimed at minimizing hospital and clinical encounters during lockdown periods which were imposed for containment of community spread of the COVID-19 virus [15]. Consequently, routine and elective surgical procedures were cancelled and deferred until transmission rates were stabilized and the reproductive rate (R 0 ) of the COVID-19 virus was demonstrated to be below one [8,16]. The majority of healthcare facilities, including intensive care units, and healthcare staff were primarily deployed for COVID-19 care provision over less urgent healthcare demands [15].…”

“…Nevertheless, management of traumatic injuries remained one of the most maintained services, accounting for 82% of OMF services provided [17]. Moreover, dental trauma such as avulsion, luxation and complicated crown fractures with pulpal involvement has been prioritized as needing emergency treatment despite the COVID-19 crisis [8].…”

“…In Sri Lanka, oral healthcare provision has been closely integrated into the existing public healthcare delivery model, which follows a hierarchical delivery structure of levels of care [21]. Accordingly, in line with clinical practice restrictions around the world [4][5][6][7][8][9], providing routine dental treatment which involved aerosol-generating procedures was temporarily suspended. However, like many other countries, essential oral cancer and OMF trauma retained priority care status [22][23][24][25] in Sri Lanka.…”