Strategies for prevention of coronavirus disease 2019 in the dental field

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The coronavirus disease 2019 (COVID‐19) pandemic, which began in Wuhan, China in December 2019, has become a huge public health issue in China and worldwide, spanning across Asia, including South Korea, Europe, North America, South America, and Oceania (Phelan, Katz, & Gostin, 2020). The fatality rate is 0.2 deaths per 100,000 persons per week globally. On March 11, 2020, the World Health Organization declared COVID‐19 outbreak a pandemic of international concern.

The COVID‐19 outbreak started with animal‐to‐human transmissions, followed by sustained human‐to‐human transmissions (Del Rio & Malani, 2020). The 2019 novel coronavirus (2019‐nCoV) predominantly spreads among humans via respiratory droplets and contact routes (Chan et al., 2020;Li et al., 2020). 2019‐nCoV also can infect or enter the body through the conjunctiva via aerosol exposure or hand‐to‐eye contact (Guan et al., 2020). Furthermore, live 2019‐nCoV in saliva was detected in over 90% of patients (To et al., 2020). According to the latest update, 2019‐nCoV can be transmitted via aerosols because it can remain viable and infectious in aerosols for several hours and on surfaces for days (van Doremalen et al., 2020). Aerosol transmission might be associated with the pandemic nature of the disease and the super rapid‐spreading event. Since no definitive drugs or vaccines have been approved by the Food and Drug Administration for COVID‐19, prevention may be the only plausible strategy for management.

How should the dental field set strategies to recognize and respond to information on mitigation or prevention of COVID‐19? Based on the potential transmission pathway of 2019‐nCoV, we present the following. First, routine prechecking of the general health status and travel history to epidemic areas is needed (Guo et al., 2020). We recommend that patients with suspected or known COVID‐19 be isolated or postpone their non‐emergency dental care during the COVID‐19 pandemic. Second, the use of basic personal protective equipment is recommended for treating asymptomatic potential carriers. During dental procedures, gowns, face shields, masks, goggles for eye protection, and gloves must be worn, and hand washing is essential (Peng et al., 2020). Furthermore, as dental procedures commonly produce abundant saliva, droplets, and aerosols, dental professionals must avoid or minimize procedures that can produce droplets or aerosols or stimulate salivary secretion or coughing. The use of high‐volume saliva ejectors with the four‐handed technique, minimization of the use of the three‐way syringe, acquisition of extraoral radiographs rather than intraoral radiographs, and the use of oxidative or antimicrobial mouth rinse before dental procedures might be helpful. Treatment in an isolated and well‐ventilated environment is recommended, and environmental cleaning is strongly recommended after dental procedures. Finally, as viruses are viable on surfaces for several days, disinfecting the surface of equipment with 62%–71% ethanol before and after dental procedures is recommended (Baseer et al., 2016).

The COVID‐19 pandemic is still progressing. The abovementioned routine procedures and precautions are easy, cost‐effective, and enforceable. The efforts to prevent the spread of the 2019‐nCoV in the dental field along with the efforts of the population, healthcare workers, scientists, researchers, and governments will significantly help combat this pandemic. We will continue to identify infectious threats that can change the current infection control protocols.

CONFLICTS OF INTEREST

The authors declare no conflict of interest.

AUTHOR CONTRIBUTIONS

Yeon‐Hee Lee: Conceptualization; Investigation; Methodology; Project administration; Resources; Supervision; Writing – original draft; Writing – review & editing. Q‐Schick Auh: Investigation; Writing – review & editing.