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Researchers stress importance of appropriate PPE selection during COVID-19 pandemic

By Dental Tribune International
February 10, 2021

OPORTO, Portugal: A recently published paper, which is the second of a three-part series on the management of COVID-19 in clinical dental care settings, aims to describe the selection and use of personal protective equipment (PPE) by dental care professionals, based on the level of risk associated with the planned procedures. The researchers emphasise the importance of properly putting on and removing PPE, as well as choosing the appropriate equipment because it can be associated with a risk of infection.

As more research is done, scientists are able to better understand how the SARS-CoV-2 virus spreads and how transmission can be contained. PPE in dental care settings is important in this regard, which is why dental professionals should continuously work towards optimizing universal precautions and adopt measures that ensure protection for them and their patients against viral infection. As explained in the first part of the series, the researchers, who are from the University of Porto, University Institute of Health Sciences and University Fernando Pessoa in Portugal, reiterated that PPE selection depends directly on the local epidemiological setting, the patient’s characteristics, and the level of risk of the planned procedures (low, moderate, high).

The higher the transmission risk during any given dental procedure, the more PPE is needed in terms of quantity to protect dental staff from catching the virus. (Image: University of Porto)

Mouthwash might reduce transmission risk

On top of suiting up properly, there is another step that is being recommended. Before the start of the dental treatment, patients should perform a pre-procedural rinse with a disinfectant mouthwash to help reduce the contamination risk for the dental care professional. Even though there is no clinical evidence that this step could prevent SARS-CoV-2 transmission, scientists do know that SARS-CoV-2 is vulnerable to oxidation. Pre-procedural mouthrinses containing oxidative agents such as 1% hydrogen peroxide have been suggested to reduce the salivary viral load.

Protection against SARS-CoV-2 depends on many factors

As long as a vaccine is not widely available, there is no alternative to taking as many protective measures as possible. However, availability of PPE differs from country to country. In case of limited access to PPE, the researchers encourage dental professionals to perform only absolutely necessary and minimally invasive treatments, using manual instruments or instruments that do not generate aerosols, along with reinforcing disinfection measures. Furthermore, training of all healthcare professionals should be promoted and reinforced regarding basic protocols for hand hygiene, respiratory etiquette, social distancing and knowledge of COVID-19 symptoms, among others.

The basics

A proper PPE kit should include the following: body protection (long-sleeved, fluid-resistant gown and a cap/bonnet), eye protection (glasses or a face shield), masks, gloves and clinical footwear.

Also, the donning and doffing of PPE is important and healthcare professionals should be instructed on this. Before putting on PPE, the researchers recommend that dental professionals should ensure that they have removed all jewellery, drunk water, if necessary, to prevent dehydration and checked equipment conformity. During treatment, adjustments to the protective equipment should not be made. Furthermore, PPE has to be put on in the correct order (hand hygiene, gown, respirator, cap/bonnet, protective glasses/face shield and gloves). PPE should be removed according to the standard sequence and without rapid movements. To avoid the risk of infection, contaminated hands should never touch clean areas or the skin. Doffing PPE should be performed carefully, and disposable materials should be discarded in the usual way established for highly infectious waste.

The study, titled “COVID-19 management in clinical dental care Part II: Personal protective equipment for the dental care professional”, was published online in the International Dental Journal on 18 January 2021, ahead of inclusion in an issue.

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