Sardar Patel Post Graduate Institute Of

Dental And Medical Sciences

Department Of Public Health

Dentistry
COVID AND DENTAL
CARE
INTERN BATCH A (2016-17)
CONTENTS
► Introduction
► Structure and variants of covid
► Covid timeline
► Epidemiological triad
► Predisposing factors, signs and symptoms of covid
► Impact of covid on dentistry – protocols for clinic
protocols for patients
► Preventive measures- Levels of prevention
Hand hygiene, masking and vaccination
Prevention in dental clinic

► Teledentistry
► Relevant studies on Covid-19
► Conclusion
INTRODUCTION
The
recent spread of SARS-CoV-2 and its associated coronavirus disease has gripped
the entire international community and caused widespread public health concerns.
Despite global efforts to contain the disease spread, the outbreak is still on a rise
because of the community spread pattern of this infection. 

► Thus, the aim of this seminar is to provide a brief overview of the

epidemiology, symptoms, routes of transmission of COVID and its
implications on dentistry.

.
 WHAT IS COVID 19 ?
► Coronaviruses are a family of viruses
that can cause illnesses such as the
common cold, severe acute respiratory
syndrome (SARS).
► IN 2019, a new coronavirus was
identified as the cause of a disease
outbreak that originated in China.
► The virus is now known as the Severe
Acute Respiratory Syndrome
Corona virus 2 (sars-cov-2).
► The disease it causes is called Corona
virus disease 2019(Covid-19).
► In March 2020, the World Health
Organisation(WHO) declared Covid-
19 outbreak a pandemic.
Epidemic-
It is the unusual occurrence in a community or region of cases of an illness,
specific health-related behaviour, or other health related events clearly in
excess of normal expectancy.

Endemic-
It is perhaps most commonly used to describe a disease that is constantly
maintained in or restricted to a particular location, region or population.

Pandemic-
It is an epidemic occurring worldwide, or over a very wide area, crossing
international boundaries are usually affecting a large number of people.
 Structure of COVID
•SARS-CoV-2 is the 7th
member of the family of
corona viruses that infect
humans. It is a novel virus
belonging to the
subgenus sarbecovirus,
Orthocoronavirinae subfamily,.

• It is an enveloped RNA virus

with a diameter of 60–140 nm,
spherical shape, and
pleomorphic that shows a
crown-like appearance under
an electron microscope.
As of July 2021, there are
four dominant variants of
SARS-CoV-2 spreading
among global populations:

o the Alpha Variant (formerly

called the UK Variant),

o the Beta Variant (formerly

called the South Africa
Variant),

othe Gamma Variant

(formerly called the Brazil
Variant), and

othe Delta Variant (formerly

called the India Variant).
How did we get here?
 
 By July 2020, COVID-19 had swept across
all the 28 states and 8 union territories of India.
The infected cases had particularly escalated
in the states of:

• Maharashtra
• Tamil Nadu
• Andhra Pradesh
• Karnataka
• Uttar Pradesh
• West Bengal
• Gujarat
• Telangana
• Bihar
EPIDEMIOLOGICAL TRIAD OF COVID-19
SIGNS AND SYMPTOMS OF COVID-19
PREDISPOSING FACTORS:
 ORAL MANIFESTATIONS OF COVID
Altered taste (Dysgeusia)
oIt’s the first recognized oral symptom of
novel coronavirus disease.

Covid tongue
oIt is a possible association between
geographic tongue and SARS COV-2 infection.
oIt presents with irregular areas of
depapillation on the dorsal surface of tongue.
oThese areas may change in size shape and
position.
Other oral manifestations includes:
• Ulcer
• Erosion
• Bulla
• Vesicle
• Pustule
• Macule
• Papule
• Plaque
• Pigmentation
• Halitosis
• Whitish Areas
• Hemorrhagic Crust
• Necrosis
• Swelling
• Erythema
• Spontaneous Bleeding.
What is the impact of
COVID on dentistry?
• Dentists may encounter patients with suspected or confirmed COVID infection
and will have to act diligently not only to provide care but at the same time
prevent nosocomial spread of infection
• Transmission occurs primarily through droplet spread or contact routes. Due to the
characteristics of dental settings, the risk of cross infection between dental health
care personnel (DHCP) and patients can be very high.
• The risk of bidirectional spread of infection between patient and dental care
providers makes it critical to take additional precautionary measures to eliminate
the spread of covid-19
 
Zones and Dental Clinics
 

In India, the dental clinics were closed in

the CONTAINMENT ZONE; however,
they continued to provide tele triage.
In the RED ZONE, Emergency dental
procedures were performed.
The dental clinics in ORANGE AND
GREEN ZONE functioned to provide
dental consults.
Dental operations were restricted to
Emergency and Urgent treatment
procedures only.
 
Emergency Treatment:
► The ADA says something should be treated right away if it’s life-threatening or if
it causes severe pain or a high risk of infection. Generally, your dentist decides
what’s urgent. This may include:
Non Emergency Treatment:
► These are sometimes called elective procedures. It’s dental work that doesn’t affect
your health right now. In other words, you can put it off until later if you’re worried
about COVID-19. Some examples include:
 What are Dental Clinics Doing to Protect Patients and Staff
from COVID-19?

►Appointments: Telephonic screening of all patients is done prior to

giving them an appointment. Appointments should be spaced with
more time allotted for each patient to reduce the number of people in
the clinic at any given time to ensure social distancing among patients.
►Screening: The temperature and pulse oximeter reading of anyone
entering the clinic is recorded for screening purposes. A detailed
medical and travel information is being taken from all patients.
► Eliminating shared spaces: Chairs are placed six feet apart in the
waiting room.
► Increasing sanitation: New procedures have been established to
ensure that chairs and non-disposable instruments are thoroughly
disinfected after the treatment of every patient.
► Changing procedures to avoid aerosols: Some equipment or certain
procedures may end up producing more aerosols than others. If aerosols
are unavoidable (which may be the case for certain surgeries or
extensive procedures) then dentists are required to use other tools to
effectively remove the aerosol.

 
► To mitigate the persistence of corona
virus from surfaces, dentists have
started to use:
❑ UVC sanitization units, resembling
lamps, that emit ultraviolet radiation at
a low enough level. These devices
eliminate nearly all bacteria, viruses
and other pathogens present on
surfaces.
❑ Air purifiers that continuously
eliminate pathogens by oxidizing them
on surfaces and in the air.
► Personal Protective Equipment (PPE):

⮚Using PPE is a must to protect the

healthcare workers.

⮚Primary PPE includes gloves, surgical

masks, N95 masks, hairnets, protective
eyewear, face shields and protective
clothing (e.g. gowns and jackets).

⮚PPE is changed after treating each

patient to minimize the risk of cross
contamination,

⮚Reusable PPE (e.g. protective eyewear

and face shields) should be cleaned with
soap and water when visibly soiled,
disinfected between patients.
 Protocols for Patient:
► Minimise or eliminate wearing a wrist watch, hand and body jewellery and carrying of
additional accessories bags etc.

► Use their own wash rooms at home to avoid the need of using toilets at the dental
facility.

► Wear a facemask during transport and before entering the premises.

► Have the body temperature checked and use a sanitiser on the entrance.

► Patients consent and declaration to be obtained in a physical print out or electronic

system.

► Maintain social distance.

HOW TO PREVENT
SPREAD OF COVID-19?
LEVELS OF COVID-19 PREVENTION

Primordial prevention- prevention of emergence of risk factors.

• Strengthening of healthcare system
• Research on long term defence against new pathogens and diseases.
 Vaccination

• Foremost primary prevention strategy

is vaccination.

• High vaccination coverage in a

population reduces the spread of the
virus and helps prevent new variants
from emerging.

• The first Covid-19 vaccine in India

was given on 16 January 2021,
kickstarting the vaccination drive,
making it available to health and
frontline workers.

• The vaccination drive started on 27th

January 2021 in our college.

• Being vaccinated does not mean that

we can put caution to the wind and put
ourselves and others at risk. So proper
masking and hand hygiene is
necessary.

*The interval between two doses of the covishield vaccine has been extended from 4-8
weeks to 12-16 weeks.
Which mask do I choose?

• According to WHO, wearing a

medical grade mask is one of the
active measures that can limit the
spread of certain respiratory
diseases, including covid-19.

• The WHO currently recommends

that FFP-2 or N95 masks be worn
by medical staff who are
performing aerosol generating
procedures.

• As new variants spread potentially

faster than the original virus,
double masking has been advised
lately.
 Secondary
Prevention
► Defined as action which halts the
progress of the disease at its
incipient stage and prevents
complications
► In the case of COVID-19 it includes
the detection of diseases in
asymptomatic patients with
screening or diagnostic testing.
► Screening of all travellers coming
into the country.
Tertiary
Prevention
► The goal of tertiary prevention is to
reduce the negative impact of an
already established disease by restoring
function and reducing disease related
complications
► It aims to improve the quality of life for
people with COVID-19 disease.
► This could involve use of antiretroviral
drugs to prevent the multiplication and
damaging effects of the virus in the
lungs to be particular.
► The COVID-19 associated pneumonia can
be so severe that the patient could
require mechanical ventilation.
PREVENTION IN DENTAL PRACTICE
∙ If possible, perform procedures in a negative pressure room, (airborne infection
isolation room for aerosol-generating dental procedures.

∙ Follow standard, contact, and airborne precautions including hand hygiene practice.

∙ Consider taking extraoral radiographs instead of intraoral radiographs.

∙ Limit the number of dental healthcare providers (DHCP) present during the procedure
to only those essential for patient care and procedure support. Visitors should be
limited to those who are necessary.

∙ Use a dental hand-piece with anti-retraction function, four-handed dentistry, high

evacuation suction and rubber dams to minimize droplet splatter and aerosol
generation.

∙ Minimize the use of ultrasonic instruments, high-speed handpieces, and 3-way

syringes.
∙ Pre-procedural mouth rinse: Mouth rinse containing oxidative agents such as 1%
hydrogen peroxide or 0.2% povidone is recommended to reduce the salivary load of oral
microbes.

∙ Perform endodontic procedures with dilute (1%) solutions of sodium hypochlorite to

extend supplies without adverse effects on outcomes.

∙ Use resorbable sutures to eliminate the need for a follow up appointment.

∙ Disinfect surfaces with EPA-approved chemicals and maintain a dry environment.  

∙ Wear an N95 or equivalent or higher-level respirator such as a disposable filtering face

piece respirator, a powered air-purifying respirator, or an elastomeric respirator; eye
protection (e.g. goggles, reusable face shields); gloves; and a gown.
What Can I Do in the Meantime?
▪ Brush twice daily: Spend at least 2- 3 minutes on brushing.

▪ Use Fluoride toothpaste :Fluoride is absorbed into the enamel

and helps to repair it by replenishing the lost calcium and
phosphorous, required to keep your teeth hard.

▪ Avoid sticky foods: These are also linked to tooth decay and
should be avoided.

▪ Drink lots of water: Water helps in keeping your mouth clean

and fighting dry mouth. It washes away leftover food and residue
that cavity- causing bacteria are looking for. Moreover, it also
dilutes the acids produced by such bacteria.

▪ Floss regularly.
TELEDENTISTRY: AN OPPORTUNITY TO
AVOID RISKS
► To observe government decisions,
telemedicine is now largely appreciated
to minimize the risk of increased
COVID-19 dissemination and cross
infections at medical or dental offices .
► TM is a new concept of healthcare to
deliver care across distance using
advanced communication technologies
(smartphones, tablets and laptops) .
► TM completely modified the traditional
medical approach of working,
promoting a virtual method of visits,
consultations, and follow-up instead of
physical contacts and face-to-face
clinical evaluations
► Among professionals, this type of
digitalization can create a doctor to
doctor connection to exchange
patients’ data, diagnostic doubts,
and therapeutic counselling.
► Between dental clinicians and
patients, this communicative
workflow can support questions,
remote consultations and follow-up
visits, reducing the risk to move to
the dental office.
 RELEVANT STUDIES
The impact of oral health status on COVID-19 severity,
recovery period and C- reactive protein values-
British Dental Journal (2021)
Objectives:-

To derive the relationship between severity of Covid-19 symptoms, CRP levels and duration of
recovery with the oral health status.

Methodology:-

⮚ Cross sectional study based on a questionnaire.

⮚ 308 Egyptian patients with confirm positive PCR test included in the study after exclusion
criteria.
⮚ Questionnaire had 2 sections.
⮚ Assessment of effect of oral health on Covid -19 severity was performed using an oral
health score.
⮚ The effect of oral health on CRP and recovery period were evaluated as secondary end
points.
⮚ Data of CRP levels and Covid-19 PCR tests were confirmed by reviewing medical
records.

Results:-
The correlation between oral health and COVID-19 severity showed a significant inverse
correlation (p <0.001). Moreover, the correlation between oral health with recovery period
and CRP values also revealed a significant inverse correlation, showing that poor oral
health was correlated to increased values of CRP and delayed recovery period.
Effect of the Covid –19 pandemic on behavioural and
psychosocial factors related to oral health in adolescents- A
COHORT STUDY
International Journal of Pediatric Dentistry(2021)
Aim:-
This study evaluated the psychosocial and behavioural changes related to
oral health in adolescents immediately before and during the pandemic period of
COVID-19.
Methodology:-

• This cohort study evaluated 290 adolescents from November 2019 to February 2020 (T1—
before the pandemic) and from June to July 2020 (T2) in Brazil.

• The differences between the variables in T1 and T2, as well as the effect of social distancing, were
assessed using a multilevel-adjusted logistic regression model for repeated measures.
Results:-
A total of 207 adolescents were re-evaluated at T2 (a response rate of 71.3%). During the
pandemic, the frequency of tooth brushing, the use of dental services, and the self-perceived need
for dental treatment significantly decreased.
Whereas sugar consumption, bruxism, and quality of sleep did not change significantly.

Conclusion:-
Behavioural and psychosocial factors showed significant changes due to the COVID-19 pandemic
in adolescents.
A survey on knowledge, awareness and hygiene practices
among dental health professionals in an Indian scenario (2020)

Objective:
The aim of this study was to assess knowledge, awareness and hygiene practices
regarding COVID-19 among private dental practitioners practicing in
Tricity(Chandigarh, Panchkula and Mohali) in India during these critical times .

Results:

⮚Percentage of subjects who answered correctly regarding main symptoms of COVID-19

and primary mode of transmission was 87% and 82.5% respectively.
⮚One-third of the subjects were not aware regarding Personal Protective Equipment
(PPE) to be used while rendering dental treatment.
⮚75% of subjects were of the opinion that supportive care is the current treatment regime
for COVID-19.
INFERENCE-

 The findings showed some notable deficiencies in knowledge among dental

professionals regarding some vital aspects of COVID-19 mainly in rural areas.
Therefore, there is an urgent need for improving dentists’ knowledge via health
education and training programs keeping in mind those serving the rural population.
 Conclusion

► Dental health care personnel need to understand the implications of potential

transmission of the (SARS)-CoV-2 virus in a clinical setup. Hence, they need
to keep themselves updated with any new information regarding this disease.
New approaches such as The recent state of affairs obligates the need to strike
a balance between the safety of the healthcare professionals yet providing
optimum dental care to the patients requiring emergency intervention.
PRESENTED BY- Intern Batch A (2016-2017)
• Aparna Singh
• Apurva Rathore
• Eva Mishra
• Harshita Singh
• Ravindra Tripathi
• Sabhya Kulshreshtha
• Shubham Patel
• Sukaina Haider

PRESENTED UNDER THE GUIDANCE OF-

• Dr. B.S. Goutham
• Dr. Pooja M. Sinha
• Dr. Abhishek Verma
• Dr. Shreya Singh
• Dr. Jyoti Advani
• Dr. Faiz Anwar
Thank you!