A Way to Combat COVID-19 in Large Dental Institutions
Lisa R. Antonoff, DDS; and Ilser Turkyilmaz, DMD, PhD
Dentists are educated and practice in close proximity to their patients and are exposed to the aerosols, saliva, and blood products produced while working.1-3 In addition, dentists work with sharp instruments that become contaminated. Since the late 1980s and the advent of HIV/AIDS and the rise of the hepatitis viruses, the standard of care as recommended by the CDC includes the use of personal protective equipment, disinfection of operatories, and steam sterilization of instruments by autoclave.4 Steam contact, as in an autoclave, at the required temperature and pressure for the recommended time (121°C for 30 minutes with 15 psi of pressure) warrants sterilization. Infection control and prevention of cross-contamination has become a natural and vital part of the dental profession.
With the arrival of the new coronavirus, or COVID-19, additional workplace controls have been suggested, such as high-speed suction for every aerosol-producing procedure.5 Disinfection methods require re-evaluation and improvement, where possible. Large dental institutions, especially, need workplace controls in position that are simple and easy to use to reduce cross-contamination.
COVID-19 is an airborne pathogen causing severe respiratory inflammation that can lead to significant illness and death.1-3 A person may be a carrier without presenting any symptoms. Airborne droplets have been found to contain the virus, and human-to-human contact can be the cause of contamination. However, other viruses, specifically hepatitis B and C, are known to be transmitted through blood and saliva. As such, there is concern that the novel coronavirus can be transmitted similarly. COVID-19 has been found alive on paper for up to 24 hours and on steel and plastic up to 72 hours later. Prevention of cross-contamination becomes paramount and should include frequent handwashing and disinfection of surfaces.1-3
In dentistry, this will apply to waiting areas as well as operatories. High-speed suction, in addition to low-speed suction, will become the benchmark. A 1% hydrogen peroxide oral rinse prior to a dental procedure may be helpful in reducing the viral load, as COVID-19 is susceptible to oxidation.2 Laboratories are also a concern because traditional dental impressions are fabricated in the mouth and poured in laboratories as part of the workflow process.
Traditional dental impressions utilize a tray loaded with an impression material. When the tray is removed from the mouth, the impression is contaminated by saliva, blood, and the microorganisms found in dental plaque.6-8 The impression may be brushed then disinfected with an appropriate solution, but although protocols for disinfecting the many impression materials exist, the procedures are not followed consistently.6-8
Clinical ultraviolet light (UV) chambers have been considered as an alternative disinfection method. However, in one study UV chambers were shown to be most effective for flat surfaces, and crevices in dental impressions continued to have infectious materials.9 As it stands, the dental institution-laboratory workflow for traditional dental impressions presents the potential for cross-contamination between dental facilities.
The use of digital impressions using intraoral optical scanners (IOSs) can help minimize cross-contamination.10,11 Because the impression is obtained digitally, the data is transmittable between the dental institution and the laboratory. No casts need to be poured, nor is there any handling of contaminated impression material.
Most IOSs, however, utilize tips that are wiped with disinfectants prior to use. With the onset of COVID-19 this is of particular concern, especially in high-volume institutions such as dental schools. More recently, IOSs have become available that offer autoclavable tips.12 Large dental institutions using these tips may benefit from the disruption of the cycle of cross-contamination caused by lack of consistency in disinfection of conventional impression materials. Traditional dental impressions would no longer be a source of cross-infection.
In this post-COVID-19 environment, the use of autoclavable intraoral scanner tips as part of a digital impression workflow may be an effective means of helping decrease the transmission of this virus in large dental institutions.
About the Authors
Lisa R. Antonoff, DDS
Clinical Associate Professor, New York University
College of Dentistry, Department of Prosthodontics,
New York, New York
Ilser Turkyilmaz, DMD, PhD
Clinical Associate Professor, New York University
College of Dentistry, Department of Prosthodontics,
New York, New York
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