04 February 2021

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Chemical disinfectants in dentistry in the COVID-19 era: ‘common sense’ versus ‘COVID-19 sense’

Author: SJÖGREN PETTERI, DDS, PHD AND ZIMMERMAN MIKAEL, DDS, PHD, ASSOCIATE PROFESSOR

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A new coronavirus, subsequently named Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in December 2019, in China, causing a previously unknown pneumonia in humans. This novel disease was named Coronavirus Disease 2019 (COVID-19), that rapidly progressed into a pandemic. Among dental practitioners this new situation raised many questions, on how to effectively protect Themselves, their patients, and their surrounding from being infected. This led us to consider the major differences in ‘common sense’ versus ‘COVID-19 sense’ when it comes to this novel situation in dentistry. During many dental procedures, we are constantly surrounded by a plenitude of potentially infectious microorganisms, and it is of fundamental importance to be able to control them, and their locations. For this purpose, chemical disinfectants remain an important part, set in relation to the potential risks for infection, linked to the intended use of dental instruments, medical devices, and other equipment.

In this paper, we summarize a number of chemical disinfectants that are commonly used in dental practices, focusing on alcohols, hydrogen peroxide, halogens, hypochlorite, chlorhexidine and quaternary ammonium compounds. These chemical disinfectants are discussed from an antimicrobial perspective, and in relation to COVID-19, and SARS-CoV-2.

• Dental patients are less likely to be acutely ill than inpatient

• The likelihood of encountering an infected person is reduced in a dental setting

• Emphasis on hand hygiene, equipment and environmental disinfection, and routine PPE usage in dental practices, prevent the risks for cross contamination

• Dentistry not included in the top 10 high-risk occupations

Introduction

A new coronavirus, that was subsequently named Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in December 2019, in China, after causing a pneumonia of unknown origin in humans. In February 2020 the respiratory disease caused by SARS-CoV-2 infection was named Coronavirus disease 2019 (COVID-19) (Izzetti et al., 2020; Lu et al., 2020).

Like other coronaviruses, SARS-CoV-2 is an enveloped virus, spherical in shape and approximately 60-140 nm in diameter (Yan et al., 2020). The SARS-CoV-2 viral membrane holds the spike (S) glycoprotein which contains the receptor-binding domain (RBD), responsible for binding to the host cell surface (Wan et al., 2020; Zhang et al., 2020). The cellular receptor for SARS-CoV-2 RBD is the peptide domain of angiotensin-covering enzyme 2 (ACE2) (Li et al., 2020).

The mean incubation period of COVID-19 is estimated to about five to six days (Backer et al., 2020), but seems typically to be between two to fourteen days (Ortiz-Prado et al., 2020). Individuals of all ages and both genders seem to be susceptible to COVID -19, but older people with underlying diseases are more prone to become severely ill (Dhama et al., 2020). Individuals without symptoms have also been shown to be able to act as transmitters of COVID- 19 infection, especially to susceptible individuals (Dhama et al., 2020; Lin et al., 2020).

Common symptoms of COVID-19 include fever, dyspnoea, cough, fatigue, myalgia, sore throat, headache, and gastrointestinal symptoms (Cevik et al., 2020; Pascarella et al., 2020). Taste or olfactory alterations, including anosmia have also been commonly observed (Giacomelli et al., 2020).

The transmission pathways of COVID -19 are mainly direct transmission, through droplets expelled from sneezing or speaking within a two-meter distance, and contact transmission from mucous membranes, or from contact with virus covered surfaces (Ortiz-Prado et al., 2020; Peng et al., 2020). Transmission may also occur from asymptomatic people, where some individuals with infection of COVID-19 may present anosmia as sole symptom, without nasal obstruction (Ortiz-Prado et al., 2020).

The rapidly developing COVID-19 pandemic raised many questions among dental clinicians, on effective methods to protect themselves, their patients, as well as their friends and families. In clinical dentistry, we are constantly surrounded by a plenitude of potentially infectious microorganisms, and it is of fundamental importance to be able to control them.

You can read the full article here:
 https://www.dropbox.com/s/u25fnxmj6ub5tgd/Chemical%20disinfectants%20in%20dentistry%20in%20the%20COVID-19%20era-%20%E2%80%98common%20sense%E2%80%99%20versus%20%E2%80%98COVID-19%20sense%E2%80%99%20NOV2020.pdf?dl=0