Personal Protective Equipment in Dentistry during Coronavirus

Novel Coronavirus diseases or COVID-19 has taken over the world with all countries coming to a standstill having complete to partial lockdowns, Dentistry has been hurt the most as we have to deal directly with aerosols and are the most prone to be infected. This brings forward the need for proper PPE or Personal Protective Equipment in Dentistry which will become a norm coming forward to be incorporated into our daily dental practice. Guidelines on the rational use of Personal Protective Equipment for Dental or Medical staff should be followed strictly if you want to practice dentistry during or after the Coronavirus pandemic. With clear evidence seen of human to human transmission of SARS-CoV-2 (Coronavirus has been officially named as SARS-CoV-2) or COVID-19 virus which is seen to be transmitted through respiratory droplets when people speak, cough, sneeze or exhale. It is also transmitted by direct touch or touching contaminated surfaces or objects and later touching their own nose, mouth, eyes.

The aerosol formation is one of the major reasons for all dental clinics being closed, to prevent infection to Dental Staff, contamination of the working field which can lead to cross-infection to other patients. Dental Associations around the world have instructed all Dental Clinics to stop all Non-Essential Dental procedures and only perform Emergency Dental Procedures to reduce cross-contamination through Dental clinics. There are strict guidelines that need to be followed not just to treat a COVID-19 patient but to check non-COVID-19 patients as well.

How to find if PPE Kits are Fake?

An ideal PPE Kit which can help in providing complete protection to the wearer should be Punched and not Stitched. If you see that the PPE Kit is stitched together then it cannot provide complete protection from Aerosols.

  1. The PPE Kit should be provided in a sterilized package which are vacuumed and are sterile on opening
  2. Purchase 90+ GSM which are approved by the concerned association of your Country (In India SITRA and DRDO accreditation are recognized). As mentioned above the PPE Kit should be Punched together and not stitched.
  3. The Original PPE kits have Velcro above the Zipper which is not presend in a Fake PPE kit.

Guidelines on the use of Personal Protective Equipment in Dentistry:

What is PPE?

Personal Protective Equipment is a protective gear which is used to protect the health workers from the infective biological agents such as Virus, Bacteria, etc. It is the first line of defense against the Coronavirus or any microorganisms and your body.

Which GSM of PPE is ideal for Dentist use?

For Dentists and Dental Assistant or Hygienist use, a 90+ GSM is advised by all Dental Associations across the world.

Personal protection equipment for Dentists during coronavirus

What are the Components of PPE?

Personal Protective Equipment consists of the following:

  • Face Shield and Goggles
  • Masks – Triple-layer medical or Surgical mask or N-95 Respirator mask
  • Gloves
  • Coverall or Gowns
  • Head cap or covers
  • Shoe covers

Face Shield and Goggles:

A Face Shield and Goggles are a must for Dental treatments to prevent aerosols to come in contact with Eyes, Nose, Mouth, etc. The Splatter from the use of Aerotor handpiece, Two-way syringe, etc comes directly in contact with the face of the Dentist which needs to be protected by a Face Shield. Nose, Eyes, Mouth consists of mucous membrane, which when exposed to infected aerosols can lead to transmission of the Virus to the Dentist or Dental Staff. The Face Shield and Goggles should be either disposable or should be autoclavable to make sure that they are properly decontaminated after every patient.

Face Masks:

Note: The N95 Mask should be worn inside while the Surgical Mask should be worn on top of it and not the other way around. As N95 mask provided perfect seal which is not possible with a regular Surgical mask.

Coronavirus comes under Respiratory Viruses that target the upper and lower respiratory tracts and are transmitted through it. So protecting the Respiratory tracts from particulate matter such as aerosols or droplets is of utmost importance to prevent transmission of infection from patient to Dentist or Dental Staff. There are two types of Face masks which are recommended –

  • Triple-layer Surgical Mask: It is a fluid-resistant disposable mask that prevents infection from droplets from patients emitted during talking, sneezing or coughing or during dental procedures performed using a High-speed Aerotor.
  • N-95 Respirator Mask: It is termed as a Respirator mask which comes with high filtration capability and provides an Air-tight seal due to its close facial fit to the patients face. It comes with fluid resistance, breathability, duckbill/cup-shaped structure which should not collapse against the mouth. It has an advantage over the Triple layers surgical mask because it has a tighter air seal, better filtration efficiency which gives protection to wear from airborne particles.

An N-95 Respirator mask is preferred in Dental Clinic but in case of non-availablity a Surgical Mask is enough as well.

How to Check for a Fake N95 Mask?

Check for NIOSH (TC) number on the N95 mask in the international  market given by CDC

  • To get a proper seal N95 mask required a Head Strap, in fake N95 masks you get Ear loops or Straps which do not give proper Seal.
  • Wear the N95 mask, put your hand in front of the mask and try to blow air out forcefully. If you feel the air passing through and all over your hand it is not a Original N95 mask.

Dental Aerosols seen under UV light

Gloves:

It is very important to make sure that disposable gloves are used while examining every patient and to make sure that you do not touch your eyes, nose, or mouth with your contaminated hands. Gloves should be disposed off after every patient, while handling the patient make sure to not touch other surfaces with the used gloves, this can lead to contamination of the surface. Nitrile Gloves are preferred over Latex gloves as the Nitrile gloves are resistant to chemicals such as chlorine (disinfectants). In case of non-availability of Nitrile gloves, latex gloves are also preferred.

First layer of gloves should be worn inside before donning the PPR kit and later a second set of Gloves on top of the PPE kit to get complete protection.

Gowns or Coverall:

Note: While performing Aerosol producing procedures, it is better to wear a PPE with head and neck coverage. 

It is used to protect the whole body of the operator from exposure to the infected body fluids of the patients. An overall or gown protects the hands, legs, chest, back, torso and in some type even the head and neck are covered. By using Gowns the exposure of the operators clothes to aerosols is eliminated who work with patients in close proximity of less than 1 meter. There are disposable or Reusable Gown or Overalls which can be used in everyday practice for Dentists.

Head covers:

If you are using Coverall or Gowns which come with protection for Head and Neck, there is no need for a separate head cover or cap. In case it does not have, you need to wear disposable heal covers which can accomodate hair and hair extensions in case of female dentists or dental staff.

Shoe Covers:

These are used to provide personal protection and decontamination of the working field. Shoe covers should be made of impermeable fabric which should be disposed of after use.

PPE or Personal Protection Equipment should be must of Dentists and Dental Assistants while the Reception staff and others should wear a Surgical mask or N-95 mask and Gloves as they come under Moderate Risk category. As most Dental procedures are Aerosol generating it is must to wear a PPE Kit for treatment of such patients, in case of simple procedures like Suture removal which do not involve Ultrasonic scalers or high speed Aerotors Three layer surgical mask or N-95 mask along with Gloves can be sufficient.

Reference:

https://www.mohfw.gov.in/pdf/GuidelinesonrationaluseofPersonalProtectiveEquipment.pdf

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