To minimize the impact of the pandemic generated by the coronavirus, the disinfection protocols that all professionals in dental clinics should use must be clearly defined.
In the absence of regulation, there is much discussion about the necessary measures to apply to guarantee the safety of patients and professionals. There is a lot of confusion and many dentists are investing heavily in equipment, acquiring ultraviolet equipment, ozone, etc.
However, based on the recommendations of the ADA we can conclude that the following precautions/materials constitute a safe list to prevent the risks of contagion in the dental clinic, provided that they are used in a protocolized and appropriate way:
Air quality: Ensure that the air drawn from the cabinet and the equipment goes directly to the outside and does not go to the compressor room, where it is concentrated and re-circulated.
Universality: treat all patients equally. It is advisable to take the patient’s temperature before his treatment. In the event that the patient has symptoms (high temperature, dry cough, shortness of breath, etc.), we will put on a mask and avoid treatment at the clinic until recovery.
Prevention: Before starting the examination and treatment of each patient, they should be asked to rinse because it has been proven that the use of certain mouthwashes greatly reduces the viral load, in case of infection. 1% hydrogen peroxide, 0.2% povidone, or 0.12% cetyl-pyridinium should be used for 1 minute. Chlorhexidine is not indicated as SARS-CoV-2 is not sensitive.
Barriers: Use of barriers to treat patients. The following procedures and materials are used routinely and carefully, sufficient barriers to prevent infection by the SARS-CoV-2 virus. It is neither necessary nor convenient to exceed these elements, making it difficult for the professional to work, unnecessarily increasing the cost, and increasing the risk and time of cleaning and disinfection of the ‘uniform’:
Personal cleaning: A good cleaning of hands at the beginning, end of the day, and between patients, with a nail brush with a virucidal solution, guarantees good protection against contagion and cross-contamination. It is not advisable to use nail polish as it presents irregularities that can retain germs. Nails must be well-trimmed. It is recommended not to wear rings, bracelets, watch, etc.
Uniform: use uniforms with simple lines and long marl, with minimal seams, pockets, folds, or any design that may increase the retention of dirt or germs.
When examining patients, the gown should be resistant to fluids. For procedures in which aerosols can be generated, the gown must be waterproof with long sleeves (if it is not waterproof, a plastic apron must be added).
- Latex or nitrile gloves: It is recommended to change them every 15-30 minutes as they lose their barrier effect, or earlier if the consultation with the patient lasts less.
- Mask: FFP2 is recommended for exploration (if it is used surgically, it must be changed whenever it is wet or damaged). For procedures where aerosols can be generated, precautions must be increased, using an FFP3 mask or, if it is not available, an FFP2. They must necessarily be changed with each patient and should never be kept in the pocket or moved from their position of use. If they get wet, they lose their effectiveness.
- Glasses: as indicated, the eyes are a possible route of infection, so their use should be mandatory.
- Rubber dam: the greatest risk of contagion from an intensivist is when he intubates a patient as an extremely contagious aerosol is formed. This is the reason why the rubber dam should be used whenever possible. It not only protects the professional from infection, but also protects the patient, keeping the operative field clean and dry from saliva, cough, and blood, and preventing broncho-aspiration and swallowing of foreign bodies.
Ventilate the room between patients as long as possible. Also, the waiting room and all the dependencies of the clinic. If there are difficulties in ventilating the cabinets between patients, a disinfectant spray should be used to ensure disinfection of the environment.
Sterilization process. Of course, extreme precautions must be taken when sterilizing all ‘dirty material:
Appropriate personal protective equipment (PPE) must be used: clothing, cap, glasses, plastic apron, and special thick gloves over latex gloves.
Instruments should be immersed in disinfectant immediately after use. It must be ensured that the disinfectant used is indicated and that it is used according to the recommended concentrations, time, and temperature.
Cleaning must be thorough, and the material must always be submerged to avoid contaminating aerosols.
Drying must also be careful as humidity can invalidate the sterilization process.
A type B autoclave must be used to sterilize, taking care not to stack the material to guarantee the desired sterilization. It is advisable to carry out the Helix test daily and the spore test weekly.
Cabinet surfaces must be protected with surface protectors and disposable materials.
The dental chair must be thoroughly cleaned after removing its protections with a suitable surface disinfectant. An alternative may be a sodium hypochlorite solution with 1,000 ppm active chlorine (1:50 dilution of a freshly prepared 40-50 g / l bleach).