Table 6.

Prevention and control of COVID-19 during dental healthcare.

1—Teledentistry and Triage Protocols	(a)Teledentistry involves using the telephone, SMS, WhatsApp, Skype, Facebook Messenger, Zoom, Microsoft Teams, or emails [108]. (b)Ascertain identity and medical history of the patients along with confirmation of COVID status. (c)Focus on providing appropriate advice, analgesics, and antimicrobials (the three A’s) [109]. (d)Determine the urgency of treatment and defer non-emergency treatment. (e)Limit the number of visitors accompanying the patient. (f)Patients and visitors should wear masks [110].
2—Screening Zone	(a)Provide face masks and monitor temperature, preferably with a contact-free thermometer. (b)Cough etiquette and hand hygiene instructions. (c)Sanitizers (ABHR) with at least 60% alcohol. (d)If the patient is in emergency conditions for COVID-19, refer him/her to a medical facility and avoid all sorts of dental treatment in a confirmed positive case [111].
3—Waiting Area	(a)The waiting area should be well ventilated, and chairs should be at least 2 m apart. (b)Remove frequently touched objects (magazines, etc.). (c)Hand sanitizer should be available. (d)Schedule appointments to minimize patient load [112,113].
4—Donning Zone	Clean area PPE wearing sequence including the hand disinfection: Put on gloves in case of double gloving. Wearing covers of shoe, gown, mask/respirator, eye protection and head cap. Perform hand disinfection [114].
5—Doffing Zone	Dirty area PPE removing sequence: Remove outer gloves in case double gloving, shoes cover, head cap, gown, inner gloves. Perform hand hygiene (for at least 20 s, use ABHR with alcohol (60%) or wash hands with soap). Remove eye wear and mask/respirator [115].
6—Dental Surgery Room for Aerosol Generating Procedures	A closed room. Patients should wear a gown and protective eyewear. Furniture and other non-essential items should be removed. All materials, instruments, paper records, etc., should be outside the surgery. During aerosol procedures, 1 or 2 small openings into the dental surgery, for air inflow, and passing of materials into the surgery. Door should possess a self-closing device [116].
7—Procedure Infection Control	Adequate ventilation [117] Masks favoured for dental procedures with aerosol generation are FFP2/N95, FFP3/N95, and NI00 [101]. Valved expirators filter the entering air but releases the unfiltered expired air. Thus, they must be covered with a surgical mask [97,118]. Non-valved expirators are favoured more because they filter both inspired and expired air. Rubber dam isolation. Aseptically set up the instrument tray and the required materials before the procedure. Apply protective barriers. Preprocedural rinse with mouth wash containing 1% hydrogen peroxide for 1 min or 0.2% povidone-iodine for 30 s or chlorhexidine gluconate may reduce the microbial contamination. HV suction with an 8 mm wide suction tip should be held 6–15 mm from an aerosol producing device [119]. Ideally high-speed rotary instruments and handpieces must be avoided. If necessary to use, such instruments must be fitted with anti-retraction system [118].
8—Dental Surgery Disinfection	Procedure must be scheduled at the end of day. The clinic must not be accessed for at least 180 min following the procedure. The waste produced by the patient’s treatment with suspected/confirmed COVID-19 is comprehended to be infectious; therefore, yellow coloured double-layer clinical waste bags and “gooseneck” ligation should be used. On the next day or after at least after 180 min, the entire dental surgery should be disinfected meticulously [120].
9—Dental Surgery Ventilation	aIn-line exhausts with ducts. bThrough the wall exhausts. cHVAC systems with HEPA filters can be used for disinfection. The dental clinic might be converted to a negative pressure room, with >12 air changes an hour [116].
10—Dental Equipment Maintenance	Follow the guidelines of IFU for the maintenance of dental unit water-lines, autoclave, compressors, radiography equipment, and suctions [116].