How to prevent the transmission of COVID-19 in dental clinics?

Odontólogo, asistente y paciente vistiendo equipo de protección personal durante la practica dental como: gabacha, gorro, mascarillas KN95, mascarilla quirúrgica y guantes.

Because of the presence of COVID-19 in Costa Rica, we are taking protection of our patients and collaborators very seriously.

In order to provide a safe work environment and prevent the spread of SARS-CoV-2, we follow the protocols recommended in a study titled “Prevention of COVID-19 in the Dental Practice”, as well as those suggested by the Costa Rican Ministry of Health, the Costa Rican Dental Association, the ADA (American Dental Association), and the CDC (Centers for Disease Control and Prevention).

Protocols in Gil Dental Clinics

Once escorted to your dental chair, you will be asked to rinse with 0.075% of Cetylpyridinium Chloride for 1 minute to lower the viral load in our mouth. At the end of the treatment, you will be instructed on how to correctly discard of your personal protective equipment.

Due to the current situation, we ask our patients to comply with the following instructions:

  • Be punctual to your appointment. This keeps the number of patients in our waiting area to a minimum.
  • Wear a mask while in our facilities.
  • Only patients who require assistance should bring a companion with them to their appointment.

All of our collaborators must follow the recommended protocols. In addition to hand washing, body temperature control, oxygenation and smell, the staff and doctors put on their work uniforms at the clinic and not at their homes. Furthermore, they change their shoes upon arrival at the clinic for ones that are used only inside the clinic. Their mouth cover cannot be removed at any time other than for lunch. In the lunch area, all staff and doctors maintain the required distance.

Doctors and assistants are required to use personal protective equipment (gown and head cover), KN95 masks, surgical mask over the KN95 mask, face shield and gloves.

The Clinic´s surfaces are constantly cleaned (tables, doorknobs, handles) and between patients, the dental chairs are sanitized more rigorously. Additionally, we use high-power suction in our consultation rooms to reduce the aerosol that is generated during the appointment.

Due to high-power UVC EMITTERs we have installed, our Escazú Clinic has a Certificate of Purified Air. The UVC EMITTERs clean the air and guaranteed the air to be 99% free of viruses, bacteria and mold. Because of the air conditioning system in our San Pedro Clinic, it was not possible to install the same air purifying system. Nevertheless, we keep the windows open to allow for ventilation and circulation of stagnant air..

We guarantee that we  follow the strictest protocols for our protection and that of our clients.

How to maintain dental health?

Now that we are more concerned than ever before about health care, we must also be more careful about protecting our teeth and gums.

  • Most broken teeth occur when we bite down on something hard that we are not anticipating. For example, a bone in a piece of chicken, an olive pit, a kernel of popcorn, etc. We should try to avoid these foods or eat them very carefully.
  • Avoid using your teeth to open or cut things. Also avoid chewing on pencils, pen caps, ice, etc.
  • Popcorn or almonds have small shells that can get inside your gums and cause pain and swelling.
  • If you have provisional restorations in your mouth because you have ongoing treatment , avoid eating chewy foods. Be careful when flossing. Insert the floss and then slide it out from the side.

These recommendations should be accompanied by proper brushing and flossing. Floss at least once a day, preferably at night, and brush your teeth with a soft toothbrush for 2 minutes after each meal.

We have noticed an increase in TMJ pain in our patients and a considerably increase in fractured teeth. We researched possible causes and found an article in the New York Times that addressed this issue. It mentioned that living and working conditions due to Covid have increased our stress and are affecting our mental health. This stress leads to bruxism, an involuntary habit of teeth clenching and grinding.

The article mentions two main factors that could be causing tooth trauma. The first is due to most people are working from home, where they often do not have a desk. As a result, the position of the body during the day is not adequate, leading to bruxism at night. The second factor is related to a decrease in the quality of sleep. This causes an inability of the body to rest during sleep which causes tension that leads to bruxism.

The simplest solution is to use a night guard every night while sleeping and, if possible, during the day. It is also important to find a suitable worksplace that allows for correct body position. Finally, the article offered the following recommendations to do at the end of the day to bolster relaxation.

  • Lie on the floor on your back with your arms extended above your head. Gently move your arms, shoulders, hips and feet from side to side.
  • Take a hot shower and focus on breathing deeply, inhaling through your nose. Relax and avoid thinking about work.
  • Before going to sleep, close your eyes, place your tongue on the roof of your mouth and deeply through your nose.

How to prevent COVID-19 transmission?

It is important to take the following steps to prevent the transmission of COVID-19 (SARS-CoV-2):

  • Wash your hands frequently with soap and water.
  • Sneeze or cough into your forearm.
  • Do not shake hands, hug or kiss.
  • Do not touch your face with dirty hands.
  • Maintain the recommended social distance and avoid social gatherings.

Bibliography

Lineamiento técnico para la prevención y contención de COVID-19 para odontólogos y personal auxiliar de Costa Rica
https://www.ministeriodesalud.go.cr/sobre_ministerio/prensa/docs/lineamientos_odontologos_v2_27032020.pdf

Guidance for Dental Settings
https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html

Villani, F.A.; Aiuto, R.; Paglia, L.; Re, D. COVID-19 and Dentistry: Prevention in Dental Practice, a Literature Review. Int. J. Environ. Res. Public Health 2020, 17, 4609. https://doi.org/10.3390/ijerph17124609

Recommended PPE ensembles for dentistry
https://www.osha.gov/coronavirus/control-prevention/dentistry

A Dentist Sees More Cracked Teeth. What’s Going On?
https://www.nytimes.com/2020/09/08/well/live/dentists-tooth-teeth-cracks-fractures-coronavirus-stress-grinding.html

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