With strict guidelines being passed around the world by Dental councils that all dentist and dental clinics and hospitals avoid Non-Essential Dental procedures and only perform Essential Dental Procedures, it is important for everyone to know what are the Essential and Non-Essential procedures. This helps in preventing Dentists and Dental Staff from being endangered as we are exposed to contaminants directly. There was a recent article published in nytimes.com stating that Dentists are the most exposed profession in the world.
It is important to postpone Elective or Non-Essential Dental procedures in your practice and only attend to Essential procedures to protect yourself and your staff from any local contamination or spread of the disease due to aerosols. Let us look at the List of Elective or Non-Essential and Essential Dental Procedures from each branch of Dentistry.
Can Dentists Work during Covid 19 or Coronavirus Outbreak:
I would say, it is better that Dentists do not work during this pandemic. With the symptoms of Coronavirus not appearing the infected patient for up to 14 days, it makes them a carrier, without showing any symptoms. It becomes very difficult for the Aerosols to be controlled and as we dentists cannot follow the full protocol by wearing a full PPE kit for each and every case. Dental clinics can turn into a breeding ground for the Virus and aid in the spread of this pandemic by human to human transmission. So it is suggested that only Emergency cases should be performed by following strict protocols.
Image credit: Centers for Disease Control and Prevention (CDC) Alissa Eckert, MS, and Dan Higgins, MAM.
Essential or Emergency Dental Procedures: Which can be performed during Coronavirus outbreak
Restorative procedures:
Fillings and Restorations of Moderate to Severe Decay should be attended to by Interim restoration techniques
Fracture of Tooth:
Only if there is pain, if there is no pain postpone the appointment
Crowns:
- RCT treated tooth which is brittle with severe decay should be given a crown
- Replacement of Crowns for decayed tooth or missing teeth should be postponed
Laminates and Veneers:
Postponed
Cosmetic Procedures: Bleaching, etc
Should be postponed
Endodontics:
- Active infection with Pus and swelling associated with pain
- Swelling or cellulitis – Only access opening and medication has to be administered and appointment needs to be scheduled for a later date
- Change of Interim restoration in case of sever pain in pts with Access opening
Oral Surgery:
- Extractions or Pus drainage should only be performed in patients with Active infection associated with pain and Swelling or Cellulitis.
- Suture Removals can be done
- Pericoronitis or Third molar pain
- Post operative Osteitis or Dry Socket treatment
- Tooth Avulsion or Luxation
- Asymptomatic Third molar surgeries should be avoided and postponed
Orthodontics:
- Bracket or Wire fracture or loosening should be addressed only
- New patients for bondings, recall, consultations need to be postponed
Periodontics:
Scaling and Root Planning should only be done in patients with risk factors such as Diabetes and Cardiac Disease, appointments for all other patients need to be postponed
Prosthodontics:
- Patients who need Crowns and Bridges should be postponed
- Geriatric patients requiring Complete Dentures or Removable dentures need to be attended on a need basis
- Denture adjustments for oncology or radiation patients
Any Dental procedure or just Outpatient or Consultations need to be done following strict protocols. Every patient coming into the clinic needs to be seen as a potential contaminant and cleaning and sterilization protocols need to be followed strictly. Emergency vs Non-Emergency Dental Procedures must be properly categorized and sorted out to make sure that unnecessary exposure to infected patients is not done.
Classification of Dental Emergency:
Dental Emergency is classified into two types – Emergnecy and Urgent. – (Dental Council of India Advisory)
Emergency (Situations which increase the patients Death Risk):
- Uncontrolled Bleeding
- Cellulitis or diffuse bacterial infections leading to intra-oral or extra-oral edemas and potential risk of damage to airways
- Facial bones trauma, which may damage the patients airways
Urgent (situations which require priority care but do not increase the risk of patients death):
- Acute dental Pain (pulpitis)
- Alveolitis
- Pericoronitis
- Periodontal Abscess
- Cementation of FPSD
- Biopsies
- Adjustments of Ortho or Prostho prosthesis
- Change of intracanal medication
- Restoration in tooth with extensive dental caries
- Mucositis
- Dental Trauma with avulsion or luxation
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