Year : 2020 | Volume
: 7 | Issue : 3 | Page : 151--153
COVID-19 pandemic: Challenges to dental practice in India
Nisha Dubey1, Sanjeev Tyagi1, Raghvendra Kumar Vidua2, Pooja Sinha1,
1 Department of Conservative Dentistry and Endodontics, Peoples Dental Academy, Bhopal, Madhya Pradesh, India
2 Department of FMT, AIIMS, Bhopal, Madhya Pradesh, India
Raghvendra Kumar Vidua
Department of FMT, AIIMS, Bhopal - 462 020, Madhya Pradesh
Background: The coronavirus (COVID-19) has posed a unique kind of challenge before different segments of the dental profession and invited different responses from this profession. The major challenge before the dental profession is now the risk of contracting infection and becoming a part of the transmission chain further. Aims and Objectives: The dentists and associated health-care workers are at particular risk for this infection as it may be transmitted by the respiratory route through the oral cavity, where the dentists are involved in working for hours as well as through fomites that are generated and unavoidable during the dental procedures. Therefore, the study aims to review the existing literature available to find out the impact of COVID-19 over the current dental practices. Method: It's a type of systemic review of existing literature to find out the Challenges to Dental Practice in India COVID-19 Pandemic. This article also discusses the measures employed for the prevention against this infection by dentists in this pandemic. Conclusion: COVID-19 has given a major setback on the rapidly growing dental practice and associated market business in India, but hopefully, the things will change in due course of time, and this profession will soon come out from the shackles of this infection.
|How to cite this article:|
Dubey N, Tyagi S, Vidua RK, Sinha P. COVID-19 pandemic: Challenges to dental practice in India.J Dent Res Rev 2020;7:151-153
|How to cite this URL:|
Dubey N, Tyagi S, Vidua RK, Sinha P. COVID-19 pandemic: Challenges to dental practice in India. J Dent Res Rev [serial online] 2020 [cited 2020 Dec 1 ];7:151-153
Available from: https://www.jdrr.org/text.asp?2020/7/3/151/297527
The COVID-19 virus has been identified in respiratory secretions and saliva of infected patients. They can have a crucial role in the human-to-human transmission. Dentists and other health-care professionals often employ the aerosol-generating procedures. Hence, while working on the undiagnosed, asymptomatic, or symptomatic patients with variable factor of concealment, they may contract the infection even if only limited information available about this virus now.
The scientists have raised the possibility that the salivary glands in the mouth may act as a reservoir of SARS-CoV-2 as latent infection; further, the ACE2 receptors are abundantly expressed in the epithelial cells of the buccal and gingival tissues and specifically in the tongue where this virus primarily binds. Further, in the aerosols producing high-risk dental procedures in which dentists are directly and very closely exposed to this virus as they have no other option but to come closure to the oral cavity of the patient which may be proved as risky zone harboring the COVID 19, to provide the treatment for dental problems as it can't be offered by maintaining social distancing. Therefore, it is crucial for dentists to rethink about preventive measures for themselves to avoid the COVID-19 infection by focusing on patient placement, hand hygiene, and making a habit of using all personal protective equipment (PPE) during the work.
In India, as of now, all the routine dental health-care services have been stopped once the threat of COVID-19 was perceived. Only the emergency procedures on rare occasions that too with the usage of appropriate PPEs are being taken care of. It is largely because of the fact that the present dental practices focus only on the teeth or up to the maximum of the oral cavity-related history and examination and jump straight forward on to the intervention on teeth without paying much attention to the other body diseases and infections, the individual may harbor at that point of time. As the risk of cross infections is high between dental practitioners and patients in the format of current dental practice, clinics and hospitals urgently need strict and effective infection control protocols. It is now a known fact that the dentists particularly the oral surgeons, not using appropriate PPEs, may get the infection then they may further transmit the same unless detected and contained. This necessitates us to think about the behavioral change.
Dental Market in India
As per a report, India, with over 5000 dental laboratories and 267 dental institutes, is one of the largest dental markets for dental care services, dental products, and other required materials. The dentist-to-population ratio in urban area is 1:9000, and in rural area, it is 1:200,000 at present. The Indian dental devices market has been estimated to be of worth around US$ 0.260 billion for the year 2014 and was expected to grow at a compound annual growth rate (CAGR) of 6.79% for the duration 2016–2021. Further, India with around 180,000 registered dental graduates and the overall market size of approximately $2 billion (approximately INR 13,000 crores) was speculated to grow at the rate of 20% per annum. However, because of COVID-19, it has suffered a major setback to the dental industry and has led to almost shut down of dental practices to the zero level at present, even to the extent of losing the per day individual income in its course.
Many dental procedures such as dental drills generate a lot of aerosols and splatters contaminated with the pathological agents. The findings in the research are suggestive of susceptibility of the oral cavity to COVID-19 infection, and the saliva plays an important role in its transmission. Considering the risk of infection, in most cities of China, the routine dental practices have been suspended, and only dental emergency cases were allowed with the strict implementation of infection prevention and control measures. The Center for Disease Control guidelines advocates for the use of respirators in place of face masks for protection. The health and safety executive back in 2008 recognized the challenges of widespread delivery of filtering face piece 3 (FFP3) during a pandemic.
Up to now, there has been no consensus on the provision of dental services during the pandemic of COVID-19, but in India, almost all the services in dental clinics and dental hospitals have been closed except for emergency services in government dental hospitals. As per a poll by the American Dental Association's Health Policy Institute, almost 95% of dentists have closed their offices except for emergency cases, and this has caused a significant financial impact on dental practices, with income for the vast majority of dentists <5% of usual. On the basis of relevant guidelines and research, dentists are advised to take strict personal protection measures, hand hygiene, universal infection control measures, environment control, precheck triages in the form of temperature recording as a routine procedure, using of saliva ejectors and postponement of nonemergency dental practices, and avoiding procedures that can produce aerosols., It was reported that dental practice had been postponed for at least 1 month for convalescing patients with SARS, but it is unknown yet whether the same would be applied for patients with COVID-19 also.
The reverse transcription-polymerase chain reaction-based COVID 19 test can be conducted, and possibility of saliva as a quick, noninvasive diagnostic modality for screening may be explored through more studies before taking the patient for dental intervention., Alternatively, preoperative antimicrobial mouth rinses have been found reducing the number of microbes in the oral cavity. Procedures that are likely to induce coughing, such as use of a three-way syringe and intraoral X-ray examination should be avoided.
Dental emergencies can occur and exacerbate in a short period and therefore need immediate treatment. Rubber dams and high-volume saliva ejectors can help minimize aerosol or spatter in dental procedures. Furthermore, face shields and goggles are essential with the use of high- or low-speed drilling with water spray. After treatment, environmental cleaning and disinfection procedures should be followed. Alternatively, patients could be treated in an isolated and well-ventilated room with adequate periodic air exchange or negatively pressured rooms. The disinfection of all surfaces and articles like furniture present in the dental clinics or hospitals as potentially infected must be adequately performed. It may also be useful to make alcohol-based disinfectants, hand wash, and disposable masks to patients and relatives in waiting rooms. Alternatively, the patients and relatives may be asked to cover their faces with a piece of cloth like handkerchief and maintain social distancing. The entire air-conditioning system also requires disinfection very frequently.
The guidelines and regulations need to be developed in consultation with the dental practitioners along with the encouragement for the usage of evidence-based standard precautions. The Information Education and Communication to all the dental practitioners, staff, and public about all the possible aspect of the infection should be promoted. All the patients with a relevant medical history or condition suggestive of COVID-19 infection should be advised to first undergo appropriate evaluation and treatment as per the protocol.
Further, minimally invasive operative procedures should be encouraged, and aerosol-generating interventions should be discouraged along with the usage of disposable devices and instrumentation as much as possible, and if not feasible, then proper sterilization practice should be followed. Practices of using povidone-iodine 0.23% gargles before procedure for reducing viral load and affixing isolation with rubber dam during procedure have been found to be effective in reducing spread of infections so they may be encouraged while intraoral radiographs and analgesic such as ibuprofen should be discouraged in suspected and confirmed COVID-19 cases.
Unresolved Questions and Future Research Directions
There is no doubt that coronavirus research has gained an unprecedented and urgent momentum. Consequently, researchers throughout the world are working in unison to provide answers to many unresolved questions, as well as to develop a new preventive vaccine. In dentistry, in particular, a number of questions remain to be unresolved like the time to which this scenario will continue and when the dental profession would again achieve the similar momentum as earlier, and it is also unclear whether the profession is in need to have additional barrier protection measure which is most suitable for this profession to reduce the risk of contracting this infection during handling of the patient.
The COVID-19 has led to a major setback to the dental practice in India by shutting down it to nearly at zero level. Although in some countries, dental offices have been closed during the epidemic, a large number of emergency patients still go to dental clinics and hospitals for treatment. In any case, the most recommended guidelines indicate that dentists should avoid scheduling any patient except only for most urgent dental diseases. This action will drastically limit interpersonal contacts. At present, nobody knows about the exact and full-blown outbreak of the disease and the deadline to which the risk of infection would persist. Therefore, the dental profession would have to prepare itself in the form of safety measures most suitable to it and stand again as it cannot endure to remain shut down indefinitely. In due course of time, it has to begin again and may be by considering every patient as potentially infected by this virus and using PPE and infection control protocols. As the dental professionals have the duty to protect the public and maintain high standards of care and the prudent dental professionals will use this review as a starting point and continue to update themselves about the virus and safety measures. Nonetheless, the tendency of human beings to fight back against the odds will prevail here too, and hopefully, soon the dental profession will flourish in India as previously in upcoming days.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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