Instructions for measures to prevent and treat dental problems in the pandemic

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The transmission of COVID-19 virus infection is estimated to be through the mucous membranes of the mouth, nose or eyes and with droplets that are excreted by an infected person through speech, coughing, sneezing, as well as through droplets and airborne droplets. produced during the preparation of a series of dental procedures.

The reason for this is that COVID-19 is found in nasopharyngeal and oropharyngeal secretions and in the saliva of patients infected with the coronavirus and therefore saliva plays an important role in the transmission of the virus from person to person. To date, no scientific data have been published on the risk of coronavirus transmission to dentists and dental patients.

The risk of cross-infection from a previous dental patient to the next one who will receive dental care is dealt with as long as the asepsis-antiseptic rules and modern infection prevention protocols are strictly observed.

It becomes clear that the dentist, as well as the staff of the dental units, are at high risk of becoming infected if they come in contact with patients with the virus, especially if they do not show symptoms.

The high risk of disease for those who provide dental care has required stricter measures to be followed by staff at each dental unit. Therefore, the high transmissibility of COVID-19 and the fact that there are an unknown number of patients who will never show symptoms make it necessary that all of us, patients and dentists, should be considered potential carriers of the virus.

The Dental School of EKPA and specifically the Infectious Diseases Control Committee is in continuous, close and productive cooperation with the Scientific Committee of the Dental Association of Attica to study the information regarding the pandemic from COVID-19, conducting scientific data from the findings. which come to light and inform scientists and patients on issues related to Dentistry.

For the operation of the dental clinics, the Dental Association of Attica adopted the proposal of the Scientific Committee and recently announced a protocol for increased vigilance in the dental clinic, as well as instructions and other information leaflets for the corona, including the guide for “Infectious Disease Prevention Measures” published by the School of Dentistry of the National and Kapodistrian University of Athens (Athens 2017).

In addition, the Hellenic Dental Federation, taking into account the instructions of the National Public Health Organization for the restriction of the spread of the COVID-19 virus and the Code of Dental Ethics (P.D. 39/2009, Government Gazette A55, 1-4-2009) published three times updated guidelines patients and dentists.

Unfortunately, the vast majority of dental procedures that require the use of devices and techniques that create droplets or aerosol and facilitate the spread of the virus CONTINUE to treat the dentist ONLY in emergencies. Urgent means, according to the American Dental Association (ADA), but also many European Dental Associations or co-competent bodies, the condition that requires immediate treatment and includes bleeding, severe pain, fracture, displacement and dislocation of teeth due to trauma, fracture , displacement of the temporomandibular joint, soft tissue injury (gums, lips, tongue, cheeks) and acute phase of infections (abscesses, soft tissue necrosis).

Restricting dental procedures to those deemed absolutely necessary if they are of an urgent nature, while avoiding any procedure that produces aerosol, has virtually halted the practice of Dentistry. As long as the pandemic lasts, all dental patients are suspended, with the inevitable result of increasing the number of our fellow human beings in need of dental care, increasing the number of dental procedures required per patient and burdening oral health. community level.

The need for individual responsibility, therefore, is not limited to avoiding coronavirus infection or avoiding actions and activities that could increase the number of cases that require hospital care and thus cause an additional burden on the Health System. Individual responsibility also includes the adoption of habits that protect the maintenance of general health and good physical condition. There is a lot of advice given by reputable scientists to avoid overeating, to avoid smoking and to exercise daily, combined with a balanced diet and adoption of attitudes and behaviors to avoid aggravation of the psychological state.

The National and Kapodistrian University of Athens has taken a series of actions in support of the academic, medical and nursing staff in the fight against coronavirus (relevant mail: March 31, 2020 – 2:55:56 PM EEST on: Updating its actions National and Kapodistrian University of Athens in the battle for Koronoi). Among them, important initiatives were developed, addressed to the general public for his psychological and medical support.

From a dental point of view, to date there have been no reports of the effects of coronavirus on the oral cavity. However, it is imperative that some guidelines be given to prevent the occurrence or worsening of dental problems in the general population, not by COVID-19, but by the changes in daily life that have been made in order to limit the spread of the epidemic. These changes include staying at home, limiting much of daily activities, avoiding social activities and contacts, and even restricting or even suspending work activities in the vast majority of the population. This affects people’s psychology, increasing anxiety and fear and causing feelings of frustration, loneliness and uncertainty. In addition, staying at home for a long time leads to a reduction in exercise, an increase in the number of meals, the amount of food taken and sweets, while the phenomenon of reducing the frequency and duration of oral hygiene is common.

Given that this situation may take several months, some instructions must be given to members of our university’s academic community, students and the general public, in order to avoid burdening the oral health of the population, which will prove to be the case. It also puts a strain on overall health in the long run.

Maintaining oral health is essential so that we do not experience a large increase in the incidence of caries and gum disease (gingivitis and periodontitis), which affects the entire population, regardless of age.

Important information for everyone is the following:

  • Infection by a dentist is extremely unlikely, as long as the necessary antiseptic, sterilization and disinfection measures are followed.
  • Caries is caused by microbes that metabolize carbohydrates and produce acids that destroy hard tooth tissue. Younger people develop caries in the part of the tooth that is covered by enamel (what is seen in the mouth), while older patients are more likely to develop caries of the root.
  • Applying meticulous oral hygiene with a toothbrush, at least twice a day, interdental cleaning with dental floss or interdental brushes and the use of fluoride toothpaste, are absolutely necessary practices to reduce the incidence of caries.
  • Gingivitis is an inflammation caused by germs and manifests as bleeding gums when eating or brushing. However, it is not the toothbrush that is responsible for causing the bleeding, but the neglect of oral hygiene. Daily application of interdental cleaning with dental floss (at least once a day) and a toothbrush (at least twice a day) is necessary to reduce bleeding gums, reduce inflammation and reduce the chance of developing gingivitis in its most severe form. periodontal disease called periodontitis.
  • Periodontitis is a disease that is also caused by germs and affects the gums and alveolar bone that holds and supports the teeth. In advanced conditions, bone damage leads to mobility and possibly tooth loss.
  • For patients undergoing periodontitis treatment that has not been completed, due to the onset of the pandemic, the application of effective oral hygiene is of particular importance, in order to avoid the worsening of the disease, until we return to normalcy and can be completed. the treatment.
  • Patients who attend a preventive program of visits to the dentist, whether they have been treated for gingivitis or periodontitis, are required to visit the dentist at regular intervals as determined by the dentist, depending on the case, to maintain oral health. Since these sessions have been postponed indefinitely due to the pandemic, the risk of recurrence is significantly higher. The only way to reduce this risk is to use meticulous oral hygiene again.
  • Horizontal brushing and high-strength exercise can only cause damage and should be avoided. What is needed is an increase in the time we spend applying the floss and toothbrush.
  • The toothbrush, manual or motorized, must have soft or medium-hardness nylon bristles, evenly spaced and with a dense layout.
  • Generally, despite the fact that this is individualized according to the needs of each patient and according to the dentist’s instructions, application of 10 vertical reciprocating movements of the thread or thread that is integrated in a retainer, which must embrace the adjacent (interdental) dental surface , are considered several. The corresponding number of movements of the interdental toothbrush is at least ten, but the movement is “inside-out” and throughout the brush.
  • Patients who carry implants Lifelong precautionary programs should be followed to maintain the health of the implant tissues and protect their implants. Visits to the dentist or periodontist should be made every 3-4 months, because the risk of developing implantitis is higher than the risk of periodontitis in the general population. Factors that increase the risk of developing implantitis are smoking, a history of periodontitis, diabetes, ineffective oral hygiene and more. Especially during this period and until the possibility of a visit to the therapist is restored after the outbreak of the epidemic, daily effective oral hygiene must be done as meticulously as for the teeth.
  • The risk of recurrence in patients treated for periodontitis is higher in smokers, and a significant increase in periodontal condition has been observed during periods of intense stress.
  • Periodontal patients with impaired general health should have increased care, given the correlation of their oral health with their systemic disease (eg cardiovascular disease, immunosuppressed patients, patients receiving osteoporosis treatment with antiseptics such as bisphosphonates or bisphosphonates). other injectable drugs, etc.).
  • Pregnant women should take extra care to avoid compromising the health of their gums during pregnancy.
  • Oral hygiene products are PROHIBITED to be used by another person, even of the same family.
  • Especially for children, parents need to explain the need and usefulness of oral hygiene, motivate older and younger children, and remember that the best way to convince children is by seeing their parents take care of their own teeth. and their gums.
  • Patients with an increased risk of caries (frequent caries, multiple heart attacks, dry mouth, people on orthodontic treatment, major prosthetic restorations, etc.) benefit from using mouthwashes or gels containing fluoride at high concentrations, in addition to the application of dental floss and toothbrush.
  • The use of oral solutions can NOT replace the mechanical removal of germs which is carried out with dental floss, toothbrush and interdental toothbrushes.
  • Demonstrating consistency with daily oral hygiene will help reduce the need for an urgent visit to the dentist, reduce the chances of requiring extraction, treating abscesses, endodontic treatments, etc. In addition, it reduces the likelihood of having to move to treat dental problems, the possibility of installing painful conditions, the need to take antibiotics, while ensuring prevention of conditions that will require time-consuming, time-consuming dental care.
  • In case of an emergency, we inform our Dentist immediately.
  • Taking drugs, especially antibiotics, which is done arbitrarily, without having been preceded and approved by the dentist, is a wrong and dangerous practice and is by no means permissible.
  • Prevention, especially during this time, is an expression of responsibility and protects individual and public health and the loss of teeth, time and money.

For more information on the means proposed to protect against the spread of coronavirus due to dental procedures and the emergency response algorithm, here are some published.

Professor Ioannis Tzoutzas Chairman of the Infectious Diseases Control Committee of the School of Dentistry, Chairman of the Scientific Committee of OSA.

Professor Vassilios Panis Deputy President of the School of Dentistry, Member of the Scientific Committee of OSA.

Assoc. Professor Ioannis K. Karousis President of the Dental-Matological Research Society, Member of the Official Committee of OSA.

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