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 Table of Contents  
Year : 2020  |  Volume : 7  |  Issue : 3  |  Page : 216-217

Management considerations for the patient and the prosthodontist during coronavirus disease-2019 pandemic

1 Department of Restorative and Prosthetic Dental Sciences, College of Dentistry, King Saud bin Abdul Aziz University of Health Sciences, Riyadh, Saudi Arabia
2 Restorative and Prosthetic Sciences Department, College of Dentistry King Saud bin Abdul Aziz University of Hsciences King Abdulaziz Medical City, National Guard Health Affairs Riyadh, Riyadh, Saudi Arabia

Date of Submission10-Jun-2020
Date of Decision01-Aug-2020
Date of Acceptance14-Aug-2020
Date of Web Publication12-Nov-2020

Correspondence Address:
Dr. Rajkiran Chitumalla
Department of Restorative and Prosthetic Dental Sciences, College of Dentistry, King Saud bin Abdul Aziz University of Health Sciences, BIN, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjos.SJOralSci_48_20

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How to cite this article:
Chitumalla R, Aljarrah A, Munaga S. Management considerations for the patient and the prosthodontist during coronavirus disease-2019 pandemic. Saudi J Oral Sci 2020;7:216-7

How to cite this URL:
Chitumalla R, Aljarrah A, Munaga S. Management considerations for the patient and the prosthodontist during coronavirus disease-2019 pandemic. Saudi J Oral Sci [serial online] 2020 [cited 2021 Apr 20];7:216-7. Available from: https://www.saudijos.org/text.asp?2020/7/3/216/300593

  Introduction Top

The first known case of coronavirus disease (COVID-19) was reported in Wuhan, China, in December 2019 and after a few more months, the World Health Organization declared it as a pandemic disease on March 11, 2020.[1],[2] COVID-19 is fomites-transmitted through surfaces, respiratory droplets, and saliva from infected humans.[1] Wuhan university school and hospital of stomatology did confirm COVID among dental students. This situation puts dental health professionals in potential stress and significant fear for performing their regular duties. Infected patients report with signs/symptoms such as cold, cough, fever, and shortness of breath, which may appear 4–14 days after exposure to the virus.[3] Older age and the presence of underlying comorbidities such as hypertension, diabetes, cardiovascular, and cerebrovascular disease are now appreciated to be commonly correlated with worse prognosis. A recent study indicates that copper and paper can allow the virus to survive for 4 to over 24 h whereas the infectious charge can be drastically reduced only after at least 48 h for steel and 72 h for plastic Therefore, the virus remains longer on steel instruments, or disposable material exposed to the flows of contaminated air, than on a magazine in the waiting room.[4] To date, six quarter of a million cases have been reported, and more than 3 million and 67,000 patients have died around the world.[5]

COVID-19 is claiming human lives at a rapid rate and also posing as a major threat for all health-care front line workers including dentists because of the lack of vaccine for the cure. Preventive measures are therefore very compelling during this raging pandemic especially when emergency restorative dental treatments become necessary.

  General Management Etiquette Top

The American Dental Association proposed on March 16, 2020, that dentists should defer all elective procedures and offer just dental emergency treatments.[6]


Primary telephone screening to recognize suspected patients or probable COVID-19 infection can be remotely done during scheduling appointments. Questions related to primary telephone screening could be travel history if any, to COVID-19-infected regions and the existence of febrile respiratory illness sign/symptoms such as cough and fever.[7]

Preprocedural mouth rinse impact on coronavirus

Patient mouth rinse with 1% hydrogen peroxide before each appointment is highly recommended. Since coronavirus is vulnerable to oxidation; mouth rinse will reduce the salivary load of oral microbes.[8]

Removal/filter of contaminated air

There are several methods to remove/filter contaminated air in treatment areas. The two most commonly used devices are the inexpensive high-volume evacuator and the expensive high efficiency particulate arrestor filters.

  Management Etiquette of the Operating Area Top

The management etiquette of the operating area should be similar to what happens with other patients infected by other infectious and highly contagious diseases. Personal protective equipment can form an effective barrier against most hazards of aerosols generated from the operative site.[9]

Protective eyewear and face shields

There is clinical evidence that COVID-19 may also be transmitted through contact with the mucous membranes of the eyes, as infectious droplets could easily contaminate the human conjunctival epithelium.[9] To protect the eyes from aerosols and debris created during dental procedure, protective eyewear, or face shield should be worn throughout the treatment and disinfected between patients.

Face masks

A 3-ply surgical mask should be used if working at a distance of <1 meter (approx. 3ft.) from the patient. When performing aerosol generating procedures, a particulate respirator National Institute for Occupational Safety and Health-certified N95 is recommended and EU FFP3 respirators conforming to European Standard 149 should be used with suspected COVID-19 cases.

  Management Etiquette for the Prosthodontic Treatment Top

Rubber dam

Using a rubber dam reduces splatter production. It should be used during fixed partial denture or single-crown preparation as in the preparation of a supragingival margin for the posterior bridge or applying a split dam technique.

Anti-retraction handpiece

Anti-retraction dental handpiece with specially designed anti-retractive valves or other anti-reflux designs are strongly recommended as an extra preventive measure against cross infection.[9] Therefore, the use of high-speed dental handpieces without anti-retraction function should be prohibited during this pandemic period of COVID-19 as they may aspirate and expel the debris and fluids during the dental procedures.

Removable partial or complete denture

During try-in, there should not be the touching of other items in the dental workplace after contacting the saliva of the patient. All prosthodontics material such as bite registration and whatever has been removed from the patient's mouth (e.g., dental prosthesis and impressions) should be completely disinfected by an intermediate level disinfectant with surface sanitizers such as 62%–71% ethanol, 0.5% hydrogen peroxide, and 0.1% (1 g/L) sodium hypochlorite to disinfect inert surfaces and keep a dry atmosphere to mitigate the 2019-nCoV spread.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): Emerging and future challenges for dental and oral medicine. J Dent Res 2020;99:481-7.  Back to cited text no. 1
Shiao JS, Koh D, Lo LH, Lim MK, Guoet YL. Factors predicting nurses' consideration of leaving their job during the sars outbreak. Nursing Ethics 2007;14:5-16.  Back to cited text no. 2
Wu P, Hao X, Lau EH, Wong JY, Leung KS, Wu JT, et al. Real-time tentative assessment of the epidemiological characteristics of novel coronavirus infections in Wuhan, China. Euro Surveill 2020;25:1-6.  Back to cited text no. 3
Odeh ND, Babkair H, Abu-Hammad S, Borzangy S, Abu-Hammad A, Abu-Hammad O. Present and future challenges for dental practice. Int J Environ Res Public Health 17:3151.  Back to cited text no. 4
Coronavirus Disease 2019 (COVID-19) Centre for Disease Control and Prevention. Available from: https://www.cdc.gov/coronavirus/2019-ncov/abou/symptoms.html. [Last accessed on 2020 Mar 06].  Back to cited text no. 5
ADA releases coronavirus handout for dentists based on CDC guidelines. Published: February 24, 2020. Available from: https://www.ada.org/en/publications/ada-news/2020-archive/february/ada-releases-coronavius-handout-for-dentists-based-on -cdc-guidelines. [Last accessed on 2020 Mar 08].  Back to cited text no. 6
Ather A, Patel B, Ruparel NB, Diogenes A, Hargreaves KM. Coronavirus disease 19 (COVID-19): Implications for clinical dental care. JOE 2020;46:584-96.  Back to cited text no. 7
Available from: https://www.prosthodontics.org/covid-19/????? American college of prosthodontists. [Last accessed on 2020 Jun 06].  Back to cited text no. 8
Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci 2020;12:1-6.  Back to cited text no. 9


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