22 April 2020

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Preventive Measures for COVID-19 transmission adopted in Italian dental practices: a brief summary from the study published on JDR

Authors: Graziani F, Izzetti R, Gabriele M, Nisi M

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Oral care professionals are undoubtedly on the front line during this pandemic. Dentists are among the most exposed categories to the risk of SARS-CoV-2 infection as reported in early March by an article on the New York Times.
The swift outbreak of the contagion and the relative complexity of the management of COVID-19 have risen unimaginable difficulties. In particular, concerns regarding the practice of dentistry are constantly arising. Thus, the search for adequate measures to prevent COVID-19 is becoming of crucial importance.
In the early moments of European diffusion of SARS-CoV-2, Italy has been heavily affected by COVID-19, registering extremely high numbers of both infected and deceased patients.
Our work, recently published on JDR, aims at reviewing the practices adopted both in Mainland China, where initially the virus diffusion happened, and discusses the recommendations of our representative societies in Italy, in order to inform the dental professional on the risks related to our work. Dealing with COVID-19 appears at the moment extremely challenging and unclear. It is well-known that the viral diffusion happens through airborne particles, making thus all the  aerosol generating procedures at risk of contagion.

In this sense, we stratified patients according to four categories:
i) patients currently infected with COVID-19,
ii) patients recovered from COVID-19,
iii) asymptomatic patients who have an history of contacts with infected or quarantined patients,
iv) patients at unknown risk.

It is likely that during the re-opening each patient should be treated as potentially infective unless some diagnostic progresses will arise. It becomes then crucial identifying the risk related to potential exposure to SARS-CoV-2 by performing a targeted set of questions which aims at excluding potential infection. In particular, we identified two moments of patient triage, a preliminary one on the phone, and a second one when the patient enters the dental office.
Therefore, the repetition of the questionnaire in two different moments could highlight the potential exposure occurred between the patient call and the day of the appointment. Moreover, temperature measurement on entering the dental practice appears feasible for the exclusion of the presence of fever. The management of the dental office needs to take into account several factors, from the management of the patient list and the organization of the waiting room to the use of PPE for both clinical and non-clinical staff.
 However, it is still soon to predict how our profession will evolve. We advocate then the need for guidelines, which at this point appears mandatory to better indicate the correct management of the patients and the dental office, in order to provide a safe treatment both for the patient and the dental workers.

For additional information: COVID-19 Transmission in Dental Practice: Brief Review of Preventive Measures in Italy