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Discussions and Recommendations

Dental practitioners have an important role in the global fight against pandemics like COVID-19. They are experienced in cross-infection control procedures and barrier techniques. They are competent in suture placement, hemostatic procedures, and in many countries, they can perform parenteral drug administration. They are also constructive members in multidisciplinary professional groups and experienced in managing patients in pain. They are well adapted to management of vulnerable patients including children, pregnant women, and elderly people. On the other hand, dentists should recognize the importance of following the regulations for delivery of oral healthcare so as to protect their patients and members of the dental healthcare team.

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Treatment

So far no definitive treatment is adopted for COVID-19. A number of antiviral drugs as well as other drug categories were used so far with variable success rates. Some of these drugs have direct relevance to dental practice including analgesics, hydroxychloroquine, and azithromycin. 

Azithromycin is a macrolide antibiotic that is particularly important in dental practice. It is a recommended antibiotic in the empiric treatment of odontogenic infections mainly in penicillin-allergic patients.

Chloroquine is an antiparasitic drug that is primarily used as antimalarial drug since the 1930s. It has recently attracted a lot of attention due to its use in the treatment of COVID-19. However, its use in the treatment of some oral diseases has been recognized for a long time.

Since the recognition of the COVID-19 pandemic, professional regulatory bodies advised against provision of dental treatment except for emergency cases. It became essential that dental patients will rely on supportive therapy such as analgesics, and non-steroidal anti-inflammatory drugs (NSAIDs) for the control of dental symptoms of pain. Among these patients, some may be asymptomatic for COVID-19. Furthermore, supportive analgesic, antipyretic therapy remains the backbone for the treatment of mild to moderate cases of COVID-19. This may eventually lead to the increased demand on analgesics. There was a warning against the use of ibuprofen in the treatment of COVID-19 due to the increased expression of angiotensin-converting enzyme-2, which is believed to be the binding receptor of the virus to the cells. Consequently, the accelerated expression of this protein would theoretically potentiate and enhance the infection

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Prevention

The ADA has maintained a consistent stand since the pandemic was recognized. They called upon dentists to postpone elective dental procedures for all dental patients, and to provide dental treatment only for urgent or emergency cases.  The main aims were to minimize potential for healthcare transmission of COVID-19, and to avoid shortage of PPE for healthcare personnel caring for those with COVID-19, or dental healthcare personnel providing urgent dental care in emergency cases. They further clarified the meaning of dental emergencies as “potentially life-threatening conditions that require immediate treatment to stop ongoing tissue bleeding, alleviate severe pain, or infection”; therefore, the emergency conditions indicated for treatment include cellulitis, uncontrolled bleeding, or trauma. 

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The teeth and their nerves. Practical information about the teeth. 1879.

Internet Archive

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Information

COVID-19 was declared a pandemic by the World Health Organization (WHO), with substantial numbers of infected cases and deaths reported in many countries.  The disease is caused by one of the coronaviruses, which are a large family of viruses that may cause severe illnesses, such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).  These viruses are common in animals with the potential of transmission to humans.  Dentists are among the highest risk categories for transmission and contraction of the coronavirus, with many routine dental procedures having the potential to transmit the virus through aerosols. Asymptomatic (carrier) patients as well as patients with an acute respiratory illness may present for dental treatment at outpatient dental settings. While it is important to provide treatment for patients who present with urgent or emergency dental procedures, the primary goal should be to prevent transmission of infection to patients and dental healthcare personnel.