Dentistry and COVID-19

Studies have shown that COVID-19 could be spread via droplets, by aerosols and by touching contaminated surfaces.

Aerosol Generating Procedures (AGPs)

You might have heard the term Aerosol Generating Procedure or AGP. This applies to any medical or dental procedure that results in the production of tiny airborne particles – known as aerosols. In dentistry these are mainly generated by high-speed rotary instruments like high speed dental drills and ultrasonic scalers. They can also be generated when coughing, sneezing or during the performance of CPR. The chance that the dental team will become exposed to aerosols containing virus particles is increased because of the close proximity of dental professionals to the patient during treatment.

Aerosols can become suspended in the air and inhaled by those close by, or fall as tiny droplets onto nearby surfaces, which can result in the spread of infection.

^{COVID-19 is spread by aerosols and droplets. (Source:Pixabay).}

AGPs in Dentistry

The use of high speed drills in dentistry is common, they are used every time someone has a filling or crown preparation or ultrasonic scaling. So AGPs in dentistry are an every day event. Normally in pre-COVID times the high volume suction used in dental practice together with the use of normal personal protective equipment consisting of fluid resistant masks, eye protection and gloves was sufficient to protect the dental team and their patients from the spread of infection. However, COVID is so infectious and easily spread via the aerosol route that additional measures are required to reduce infection in the dental setting.

Additional Measures for Dental Practices

To protect staff and patients against the spread of COVID-19 the following measures have been introduced in dental practices

• Patients need to arrange their appointment in advance even if they have a dental emergency and only attend at their allocated time. They may be asked to wait outside if they are early
• The number of appointments available has been reduced to limit the number of patients in the dental practice at any one time and to prevent crowding in the waiting rooms
• In healthcare settings like dental waiting rooms 2m distancing is recommended
• Ventilation in the practice needs to be as good as possible and so windows are often left open in dental surgeries but doors must remain closed when carrying out AGPs
• The number of people in the surgery while AGPs are being carried out should be limited to essential personnel only; that would normally be the dentist and the dental nurse
• All dentists need to wear enhanced Personal Personal Protective Equipment when undertaking AGPs.
• High volume suction and rubber dam should be used where possible to limit the dispersion of aerosols
• After an AGP has finished a fallow time needs to be observed. This is a time period that allows all of the aerosol to settle from the air onto surfaces. The surfaces are then thoroughly cleaned. In most healthcare settings the fallow time is now ten minutes.
• Cleaning needs to be even more intensive than normal and extends to all the surfaces in the surgery that aerosols may settle on
• COVID positive patients are encouraged where possible to postpone their treatment until they have completed their period of isolation
• Vaccination of healthcare workers is seen as very important