Recommendations for Control of Infection with Novel Coronavirus in Dentistry

Review Article

J Dent & Oral Disord. 2020; 6(2): 1129.

Recommendations for Control of Infection with Novel Coronavirus in Dentistry

Falcón-Guerrero BE1* and Falcón-Pasapera GS2

¹School of Dentistry, CIMA Latin American University, Perú

²School of Dentistry, Peruvian University Cayetano Heredia, Perú

*Corresponding author: Falcón-Guerrero BE, School of Dentistry, CIMA Latin American University, Perú

Received: April 09, 2020; Accepted: April 29, 2020; Published: May 06, 2020


The country’s president reported the first case of coronavirus (COVID-19) in Perú, on Friday, March 6, 2020; Soon after, on March 11, 2020, the WHO recognized it as a global pandemic. Perú has adopted strict and severe measures to protect our population from the spread of this infection; Despite these measures, the number of infected is growing with a significant number of patients developing the effects of COVID-19. The dentist cannot be oblivious to this problem due to the nature of his profession; therefore, it may be subject to a significant risk of cross contamination and spread of this respiratory disease, with strict prevention measures being very important. The purpose of this narrative review is to establish recommendations for infection control in dentistry, with a specific focus on personal protection should be implemented to prevent further spread of COVID-19, both from dentists and from patients.

Keywords: Coronavirus; COVID-19; Control; Prevention; Infection; Dentistry; Dental; Perú


Coronaviruses cause respiratory, enteric, liver, and neurological diseases; such as the coronavirus of the severe acute respiratory syndrome (SARS-CoV) in 2003 and the coronavirus of the respiratory syndrome of the Middle East (MERS-CoV) in 2012 that have caused epidemics in humans [1] Chen et al. [2] describe that SARS-CoV-2 is a coronavirus and belongs to the group of β-coronaviruses, being the third known zoonotic coronavirus disease. Zhu et al [3]. they isolated a new coronavirus, called 2019-nCoV, that formed a clan within the subgenus sarbecovirus, subfamily of Orthocoronavirinae, from human respiratory tract epithelial cells. Recent research reported that SARS-CoV-2 likely originated in bats, based on the similarity of their genetic sequence with that of other coronaviruses [4].

The first unexplained case of new pneumonia was detected on December 12, 2019, and was later determined by the Chinese Center for Disease Control and Prevention (CDC) as a new coronavirus [5]. From there, a unexplained case series of pneumonia in Wuhan, China. On January 12, 2020, the World Health Organization (WHO) tentatively named this virus as the new coronavirus 2019 (2019- nCoV). On January 30, 2020, the WHO announced a public health emergency of international concern. On February 11, 2020, the WHO formally named the 2019-nCoV-triggered disease as the 2019 coronavirus disease (COVID-19) [6,7].

The first case of COVID-19 disease in Peru was reported by the country’s president Martín Vizcarra, on Friday, March 6, 2020 [8]. The WHO recognized it as a global pandemic on March 11, 2020 [9].

Common symptoms include fever (98.6%), fatigue (69.6%), and dry cough [59.4%), [10] another study found fever (43.8% on admission and 88.7% during hospitalization), cough (67.8%). Nausea or vomiting (5%) and diarrhea (3.8%) were rare [11] Hui et al, [12] indicated that fever and respiratory symptoms predominate, and diarrhea is common. Chen et al, [13] found fever (83%), cough (82%), shortness of breath (31%), muscle pain (11%), confusion (9% patients), headache (8%), sore throat (5%), runny nose (4%), chest pain (2%), diarrhea (2%), and nausea and vomiting (1%). Huang et al, [14] described fever (98%), cough (76%) and myalgia or fatigue (44%) as common symptoms at the beginning of the disease; Less common symptoms were sputum production (28%), headache (8%), hemoptysis (5%), and diarrhea (3%). Dyspnea developed in 22 (55%) of 40 patients. And Ding et al, [15] described in their study, fever (100%), cough (100%), difficulty breathing (100%), nasal tampon (60%), pharyngalgia (60%), myalgia (40%) ), fatigue (40%), headache (40%) and expectoration (40%).

The median estimated virus incubation period is approximately 5,5 days with a range of 0 to 14 days, and according to the Centers for Disease Control and Prevention (CDC) is within 2 to 14 days [16,17]. Guan et al, [11] mention that the median incubation period was 4 days (interquartile range, 2 to 7 days). Another study mentions that the median incubation period was 3 days, although the incubation period could be from 0 to 24 days in exceptional cases; [18] and finally, Backer et al, [19] mentioned an average incubation period of COVID-19 of 6.4 days that varies from 2,1 to 11,1 days

Transmission of infectious diseases is based on three conditions: sources of infection, routes of transmission, and susceptible hosts. Human-to-human transmission was considered a primary mode of transmission for COVID-19. According to the sixth version of the guide for the diagnosis and treatments for COVID-19 issued by the Chinese National Health Commission, COVID-19 is transmitted through respiratory aspirates, droplets, faeces, and, quite possibly, transmission by aerosols [20]. In the absence of vaccines or antiviral drugs for the treatment of COVID-19, hygiene measures (hand washing) and non-pharmaceutical interventions, such as social distancing and movement restrictions (which are the basic strategies available to mitigate the spread of disease in the population) [21].

Due to the characteristics of dental settings, the risk of cross infection can be high among dentists and patients. For dental offices and clinics in countries and/or regions that are affected with COVID-19, strict and effective infection control protocols are urgently needed [22]. The American Dental Association (ADA) recommends control measures for respiratory infections, along with precautions for contact, and thus prevent transmission of COVID-19 and all flu-like illnesses in a dental care setting [23].

This work aims to establish considerations for infection control in dentistry, with a specific focus on personal protection and the equipment used in dental care, which should be implemented in the dental office to avoid further spread of COVID-19 infection, both from dentists and patients.

The dentistry as staff at risk to COVID-19

Health workers face a high risk of exposure to infectious diseases, including the new COVID-19 in China. The WHO confirmed 8098 cases and 774 deaths (9.6%) during the SARS outbreak in 2002, of which health workers accounted for 1,707 cases (21%). Recent evidence suggests that even someone who is not symptomatic can spread COVID-19 with high efficiency, and conventional protective measures, such as face masks, provide insufficient protection; suggesting that people can be infected by patients with subclinical infection, either by droplets or by direct contact with secretions from infected cases, followed by subsequent inoculation into the mucous membranes [24]. Unlike SARS-CoV, transmission of COVID-19 occurs during the prodromal period when infected people are slightly ill and carry out their usual activities, which contributes to the spread of infection [25].

The forms of contagion are defined as: (a) those who live in the same household with a confirmed infection; (b) those with direct or face-to-face contact (for any period of time) with an infected person or with their biological fluids, without having adequate protection measures; (c) those who are within 2 meters of a person with a confirmed infection for more than 15 minutes; (d) be informed by a public health institution that there has been contact with a confirmed case [17,26].

COVID-19 is highly infectious, pathogenic, and highly transmissible; person-to-person transmission occurred primarily through nosocomial transmission; This is transmitted predominantly through direct or indirect contact with the mucous membranes in the eyes, mouth or nose. The respiratory tract is probably not the only transmission route for COVID-19; therefore, exposure of unprotected eyes to COVID-19 could cause an acute respiratory infection. It is necessary that when examining suspicious cases, protective glasses should also be worn [27-29].

In dentistry we are exposed to many microorganisms by the presence of aerosols produced by the use of the high-speed handpiece. Aerosols are an important source of the emission of microorganisms, and it is essential to comply with all the biosafety regulations that protect both the operator and the patient [30]. Therefore, the ADA has issued a brochure that provides strategies to help prevent the transmission of respiratory disease in the dental health care setting, and routine cleaning and disinfection strategies [31].

Therefore, the closeness that occurs between dentists and patients during the examination and the direct treatment that is always performed in the dental chair, can represent a great infectious risk, increasing the possibility of cross infection between patients and dentists within dental offices, more than other clinical disciplines.

Strategies to prevent transmission within the dental office

Zhang et al, [32] provided the effective measures taken to reduce infection among health professionals and made suggestions to improve job security during the outbreak of the COVID-19 epidemic. This contributes to the rapid detection, the effective classification or triage and the isolation of infected health personnel. Therefore, guidelines and procedures should be established to detect infectious diseases at an early stage to timely determine pathogens, transmission routes, diagnosis, and treatment among healthcare professionals.

An epidemic can affect a large population, therefore the availability and appropriate use of personal protective equipment, such as N95 respirators, masks, gowns, and gloves, are crucial to protect the health of health professionals [33].

Patient selection

This should be the first step in reducing the risk of exposure of the dentist and uninfected people to COVID-19 disease. Trying to reduce the number of patients in the waiting room and attend to scheduled appointments.

Before starting any care, screening patients should be asked questions, such as: (a) In the past 14 days, have you had a fever (> 37.5°C), cough, sore throat, or breathing problems? ; (b) Have you had close or family contact with a suspected or confirmed case of COVID-19 ?; (c) Does it come from areas with a higher risk of COVID-19 in the last 14 days? [17,26].

Based on this preliminary examination, patients can be classified as low, intermediate, and high risk, resulting in different modalities of infection control precautions (Table 1) [17].

Citation:Falcón-Guerrero BE and Falcón-Pasapera GS. Recommendations for Control of Infection with Novel Coronavirus in Dentistry. J Dent & Oral Disord. 2020; 6(2): 1129.