Preparing dental schools to refunction safely during the COVID-19 pandemic: an infection prevention and control perspective

Abstract

In late 2019 a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in China and spread throughout the world over a short period of time causing a pandemic of a respiratory disease named coronavirus disease 2019 (COVID-19). SARS-CoV-2 is easily transmitted from person to person through respiratory droplets and direct contact. The scarce available data indicate that dental healthcare personnel are at increased risk for acquisition of infection. Following the lockdown lifting, dental schools should be prepared to refunction safely and provide essential educational and healthcare services while protecting their students, patients, and personnel. The generation of aerosols in dental practice, in association with the high-transmissibility of SARS-CoV-2 through aerosol-generation procedures, the simultaneous provision of dental services to patients in the same areas, and the fact that asymptomatic and pre-symptomatic infected persons may transmit the virus, render the implementation of specific infection prevention and control measures imperative for dental schools. Herein we review the few evidence-based data available to guide infection prevention and control measures for COVID-19 in dental schools.

The efficacy of an extraoral scavenging device on reducing aerosol particles ≤ 5 µm during dental aerosol-generating procedures: an exploratory pilot study in a university setting

“…However, more options than these three measures are mentioned in the scientific literature, e.g., four-handed dentistry, room ventilation, masks, and frequent disinfection of the suction system of the dental unit. 2 , 15 , 17 Whenever some of these protective procedures are not possible or their use is limited, especially ventilation of the room, 8 a mobile EOS with a HEPA filter (high-efficiency particulate air) could help to reduce the particle concentration further and faster, as indicated by our current data. We calculated an air exchange rate of 3 h −1 for the tested mobile EOS device.…”

“…It seems well known that to reduce the risk of aerosols in dentistry, more than one protective measure has to be applied. 2 , 15 A recently published systematic review 16 recommended combining strategies of protective procedures, including preprocedural antimicrobial oral rinsing and the use of a high-volume evacuator with a properly sized suction cannula and rubber dam. However, more options than these three measures are mentioned in the scientific literature, e.g., four-handed dentistry, room ventilation, masks, and frequent disinfection of the suction system of the dental unit.…”

Indoor Air Quality Evaluation Using Mechanical Ventilation and Portable Air Purifiers in an Academic Dentistry Clinic during the COVID-19 Pandemic in Greece

“…In this context, dental healthcare facilities, including dental schools, have several characteristics that may facilitate the spread of SARS-CoV-2 among patients, academic personnel, supportive personnel and dental students. These include: firstly, close face-toface contact with the patients and, in particular, with their oral and upper respiratory tract secretions; second, the aerosol-generating procedures (AGPs) that are commonly applied in dental healthcare settings leading to the generation of droplets 0.5 to 5 micrometers (µm) in diameter that can remain suspended based on the environmental conditions; third, the high risk of virus transmission through the AGPs; fourth, the concomitant implementation of dental procedures in the same practice area and fifth, the ability of both asymptomatic and symptomatic SARS-CoV-2-infected patients to transmit the virus [8]. Virus-contaminated droplets generated during the AGPs may be inhaled and infect dentists, staff and patients.…”

“…Virus-contaminated droplets generated during the AGPs may be inhaled and infect dentists, staff and patients. The latter should wear an FFP3 respirator, goggles, a waterproof protective gown and gloves during the AGPs [8].…”

“…In the past decade, studies have been conducted to assess the indoor air quality (IAQ) in various settings including healthcare facilities where the mixture of chemical pollutants forms health-burdened indoor conditions for both patients and healthcare personnel [9]. The implementation of a heating ventilation and air-conditioning (HVAC) system under specific requirements is imperative to ensure an adequate IAQ within dental clinics [8,10]. In dental settings where the HVAC system has no high-efficiency particulate absorbance/air (HEPA) filters, mobile air filtering units can be used close to the dental healthcare areas, considering the room size, the number of people and time spent in the room, the air changes per hour (ACH) and the characteristics of the aerosols produced [8].…”