Preventive guidelines for dental care providers during COVID-19 outbreak

Following measures can be taken to reduce the chance for exposure in a dental clinic:

• Dental clinics should have a signboard at pasted at the entrance, instructing the patients to reschedule their dental appointment and call their physician if they have any respiratory symptoms such as cough, sore throat, fever, cold or shortness of breath.
• You may also reschedule the appointment if your patient had any of the respiratory symptoms 2 days ago. Ask them to consult their physician first and then take the dental appointment.  
• If any of your patients have travelled outside the country to an area affected by the coronavirus disease, reschedule their appointment until they self quarantine themselves at home for at least 2 weeks. 
• Only take care of the emergent procedures such as severe toothache or formation of an abscess or a fracture. Do not provide non-emergent or cosmetic treatment to any patient.
• Before taking up any case do not forget to take a detailed travel and health history. Do ask the patients if they have started noticing any respiratory symptoms lately. 
• Note down the address and phone number of all the patients that you treat.
• If possible keep a glass barrier between your receptionist and the patient to prevent their exposure to potentially infectious patients.
• Check the blood pressure and temperature of the patient before making them sit on the dental chair.
• The entire staff in the dental clinic should have proper personal protective equipment (gown, gloves, mask and face shield/goggles) to protect themselves while performing any procedure on a patient. 
• The dentist should use a rubber dam (a rubber sheet which exposes only the infected area of the mouth) to decrease possible exposure to infectious agents. 
• Avoid all dental procedures that may require the use of airotor such as root canal treatment or filling a cavity, as they create aerosols in the environment.
• High-speed suction should be used for dental procedures that may produce an aerosol. 
• Autoclave all the hand-pieces and reusable equipment after each patient. 
• Make sure that the entire clinic especially the door handles, the dental chair and bathroom are cleaned with a disinfectant frequently. 
• Instruct patients on how they should use tissues to cover nose and mouth when coughing or sneezing and how and when to perform hand hygiene. 
• The clinic should have plenty of liquid soap and adequate water for cleaning of hands after every patient. The clinic should have alcohol-based hand rub with 60-95% alcohol, tissues, and no-touch wastebaskets for the disposal of waste at the entrances, waiting rooms, and working area.
• The medical waste contaminated with blood, body fluids, secretions and human waste should be discarded properly in a closed bin. The waste should be discarded as per the bio-medical waste regulations. 
• The used syringes should be disposed of in a needle incinerator which burns the tip of the needle. The rest of the body should then be disposed of in the biomedical waste bin.
• The clinic should have exhaust fans to flush out air from the clinic throughout the day. 

Dentists should have proper ways to protect themselves from the COVID-19 infection which can possibly transfer from an infected patient while performing any procedure:

• Use of PPE is a must while performing any procedure on a patient. 
• The dentist must wear a surgical mask (if possible, wear N-95 mask), surgical gloves and face shield or goggles to protect the mucous membranes of the eyes, nose, and mouth from the possible splashes or sprays of blood, body fluids and secretions. 
• Dental staff should use N-95 respirators instead of a facemask while performing an aerosol-generating procedure. (Read more: Can masks protect against COVID-19?)
• To protect the skin and clothes, wear a fluid-resistant gown which should cover most of the body. 
• Once the procedure is complete remove the soiled gown, gloves and mask and discard them in the bio-medical waste bin. 
• Wash your hands with soap and water for 20 seconds after removing all the soiled protective equipment or use an alcohol-based hand sanitizer with at least 60% alcohol if soap and water are not available. 
• Hands should be washed:
  • Before and after making direct contact with the patient. 
  • After removing gloves
  • Before working with an invasive device such as UV light. 
  • After handling blood, body fluids, secretions and contaminated items
  • After touching any objects that are in the immediate environment of the patient.