The Coronavirus Disease 2019 (COVID-19) epidemic began in Wuhan, China, in December
On January 1st, 2020, WHO announced that this outbreak represents an international
public health emergency, affecting 2,725,920 people by April 24, 2020, causing, 191,061
On February 11, The International Committee on Taxonomy of Viruses has made public
the name of the virus causing COVID-19: severe acute respiratory syndrome coronavirus
The two modes of transmission are via aerosols, through drops of fluid spread by coughing,
sneezing, and fecal-oral (digestive).
Characteristics of COVID-19
The incubation period is 1–14 days, most commonly 3–7 days. Patients are contagious
in the latency period. On average, a patient can infect another 2–2.5 people.
The main symptoms are represented by:
Cough (especially dry)
Shortness of breath
Digestive manifestations in a small percentage of patients
The fraction of severe, critical cases and mortality rate is higher, compared to influenza.
The number of deaths per day relative to the total number of cases gives us a percentage
Control of infection in oral healthcare settings
In light of the thread of COVID-19 pandemic, the conception of strict and efficient
protocols for oral healthcare settings is of paramount importance. This specialty
is prone to cross infection among patients and healthcare workers. This article provides
recommendation on patient evaluation, treatment approach for dental emergencies and
infection control protocols.
Screening for COVID-19 status and triaging for dental treatments
During the pandemic, it is recommended to perform exclusively emergency dental procedures
to protect the medical personnel, the patients and to reduce as much as possible the
consumption of personal protective equipment. Patients’ general health assessment
before dental treatment is very important (Fig. 1
), as dental health workers can identify undiagnosed COVID-19 patients. Emergency
dental patients that test positive for SARS-CoV-2 should be referred for emergency
care where appropriate Transmission-Based Precautions are available. The indication
for SARS convalescing patients was to postpone dental treatments for 1 month.
Same recommendation could be adopted for COVID-19 patients.
Screening for COVID-19 status and triaging patients for dental treatments and guidelines
of dental problem assessment.
What is considered an emergency in dentistry, according to ADA?
Dental emergencies are those that put the patient's life at risk and require immediate
treatment to stop bleeding, reduce pain and stop infection. The emergency dental cases
are represented by:
Severe pain of pulp origin
Pericoronaritis, pain in the third molar region
Postoperative osteitis, dry alveolitis
Dental fractures causing pain or soft-tissue injuries caused by trauma
Luxations, dental avulsions
Dental treatments required before general medical procedures
Final cementation of crowns, decks if provisional restoration is lost, deteriorated
or causes gum irritation
Other emergencies shall be considered as follows:
Extended cavities or damaged restorations causing pain (Temporary restorations are
Suppression of suture threads
Dental treatments of oncology patients
Dental adjustments when function is impaired
Change of temporary fillings in endodontic access cavities, if they have caused pain
Adjustment of the orthodontic apparatus if it has caused pain or ulceration on the
Assessment of the gravity of the dental emergency is very important. The evaluation
of the dental and general health status of the patient is based on the workflow in
Fig. 1. Dental practitioners should aim to ease patients suffering and alleviate the
burden that dental emergencies would place on hospital emergency departments.
Effective control of infection in the dental office
Social distancing protocol for patients should be adopted in the dental office. Appointments
should be scheduled apart to minimize contact between patients. If this standard is
not applicable, patients can wait in their personal vehicle, until it is their turn.
Since the main route of transmission of the virus is the aerial one, it is necessary
to use personal protective equipment, gloves, face masks (N-95 or FFP2), goggles or
facial shield to protect the skin and mucous membranes of the medical personnel as
well as waterproof robes, jumpsuits. If the mask is damaged, or the doctor has difficulties
breathing, the mask should be changed. Dental health worker should have a seasonal
flu vaccine this year, ill-health status of medical personnel has to be assessed daily.
Rigorous hand hygiene and surfaces in the dental office is the most important measure
of reducing the transmission of microorganisms to patients. Depending on surface type,
temperature, humidity, SARS-CoV-2 may persist on surfaces from a few hours to a few
days. All reading materials, magazines and toys should be removed from the dental
To minimize the formation of drops and aerosols, it is recommended to perform minimally
invasive procedures, to use the surgical vacuum cleaner, 4-hand work, and rubber dam
isolation of the operator field. Before dental procedures it is recommended that the
patient rinses with antimicrobial oral solutions.
Resorbable sutures after surgical procedures are recommended. Aerosol generating procedures
should be scheduled at the end of the program. If procedures were performed without
N95 masks, both the healthcare provider and the patient are at moderate risk for SARS-CoV-2
infection/transmission. Fourteen days of quarantine are recommended after this exposure.
As intraoral x-ray can induce saliva secretion and coughing,
extraoral radiographies (panoramic, Cone Beam Computer Tomography) are alternatives.
After providing dental care, facial protective equipment should be cleaned and disinfected.
The X-ray equipment, the light and the dental chair should be disinfected according
to the instructions of the manufacturer. The floors should also be disinfected. Handpieces
must be sterilized after each patient. Frequently used surfaces such as: door handles,
bathrooms, desks must be disinfected often.
In the areas severely affected by COVID-19, the patients arriving in the waiting room
should receive protective masks.
The COVID-19 pandemic represents a global challenge, given the increased contagiousness
of SARS-CoV-2, dental healthcare providers have to adopt new protocols for a better
infection prevention in the dental office and new working protocols aimed to prevent
spreading the virus.
Declaration of Competing Interest
The authors have no conflicts of interest relevant to this article.