In the wake of the COVID19 pandemic, the healthcare and frontline workers are visiting their clinics and hospitals, and are also seeing patients. Dentistry is one field where direct contact with mouth and saliva is a major part of the practice, hence, a major source of infection is happening through aerosols particles. To address the challenges, dentists are taking best precautionary steps to provide safe dental care and reduce risk of virus transmission.
Let us hear it out from some of the top dentists and dental surgeons of Kolkata.
The Government of India has already laid down protocols to ensure the safety of patients and doctors. Dr. Kabita Chatterjee ,Consultant Oral and Maxillofacial Pathologist,
‘Smile and Profile’ advanced talks about the difficulties that dentists come across on a regular basis while visiting chambers. Being an oral maxillofacial pathologist, she regularly visits her patients and remains concerned about safety issues. “We are exposed directly to the patients and have to take special protection to ensure safety. We maintain social distancing with patients, while our daily wear now includes two masks (n95 and a surgical mask), face shield and special spectacles to cover eye, head cap, PPE kit and shoe cover which are all disposable . The patient also wears sterile gowns and other essentials before entering the clinic and disposes them off in a box before leaving; dealing with this has become an additional responsibility of hospital staff. We are also reducing our time with patients and the clinic rooms are sterilized with UV Radiation and most items are now disposable. Even, the PPE kits, gloves, caps and masks we wear are sterilized every time before wearing. Two sets of PPE kits are made available, floors are cleaned with sodium Hypochlorite(1%) and silver nitrate combination with absolute alcohol, and doors remain open despite the chamber being centrally AC, to ensure good air circulation.”
Talking about virtual consultation she says, “We are also trying to do virtual consultations as much possible for patients who do not have any emergency. We advise that patients should send reports online so that we do not have to touch the papers. We issue them new prescriptions after their visit.”
Surgical procedures like biopsy taking is preferably done after getting COVID test report. Also before any physical examination of the patient, a thorough interrogation is done on existing medical conditions. Physical examination involves some amount of exposure and we try to finish it fast. After every patient leaves, chambers are sterilized to reduce spread of infection,” adds Dr Chatterjee.
Challenges of wearing PPE
According to Dr Chatterjee it is a big challenge to wear PPE and see patients because being covered from top to bottom makes it difficult to breathe properly. “I would advise that everyone takes a break between work and have some liquid or solid food to avoid indigestion or similar ailments,” she advocates.
Due to COVID19 dentist chambers now look different. Patient’s family members are allowed to wait outside to maintain social distance. Dr Chitrita Gupta Mukherjee, a pediatric dentist, has been dealing with adults and young kids throughout the period of COVID19 and shared some insights about the safety measures. “When the patient books and appointment, there is a set of questions bring asked to the patient whether he/she is safe or not. Also their Arogya Setu app is checked. When the patient enters the chamber they sit. But when they enter into an operatory, patients are given protective gear, eye protection and are asked to gurgle with Betadine for 30 secs, since this reduces the viral load. Their oxygen saturation is checked by pulse Oxymetre. Also this has been a standardized protocol by the Indian Government.
“Mostly we use disposable items to prevent cross contamination. Our daily routine includes wearing disposable gowns, 2 gloves, an n95 and surgical mask along with head cover. The patients are given the same set too. Also we have no liberty of putting down our masks. Therefore our sessions have been curtailed. For instance I am doing 3 sessions just. Also when a patient moves from 1 operatory to the other, each operatory is sanitized thoroughly. Everybody needs to be clean to do a safe practice ” says Dr Mukherjee
Dr Mukherjee has already done few online consultations, but she points out it cannot be a permanent solution for patients. “Online or virtual consultation is acting as the new normal for dentists since it minimizes physical contact. I have been doing telemedicine since quite a while, as it is a good way of keeping ourselves and our patients safe. Many patients prefer online consultation as well and send reports over the phone for advice. However, the most important thing is to keep ourselves updated with the guidelines and protocols to understand how the virus behaves. Every other thing has to be done accordingly.”
The COVID19 guidelines clearly indicate that children can be asymptomatic and can be potential carriers of the disease. It is advised that children are given the same set of protective gear while undergoing any kind of procedure. They too should gurgle with Betadine before any procedure or treatment. “Being a pediatric dentist I have realized that while adults have become accustomed to the situation and have adjusted accordingly, children seem to be anxious about seeing docs in PPE kits. What is important for us is to create a comfort zone for them. It is also important to converse continuously with children to help them communicate freely, which makes it easier for us to conduct the examinations,” says Dr Mukherjee.
According to Dr Uday Mukherjee, an oral and Maxillofacial Surgeon talks about emergency treatments and how surgeries are done only after conducting COVID19 tests. “COVID19 will stay and like everyone is adapting to the new normal, and like everyone else even we have to hop back onto our daily routine with double protection. Every equipment and medical instrument should be washed in a disinfectant solution and sterilized before surgery. Keeping the pandemic in mind, all the staff members assisting the doctors are covered. Local anesthetics must wear double masks and gloves and be more careful than before. Also being a surgeon I have to conduct certain surgeries because some surgeries like tumors and cancers cannot be left pending for a long time. I wear my PPE and OT gown. Also, every healthcare worker must take necessary steps to ensure that infections are kept at bay,” advises Dr Uday Mukherjee.
We wish the dentists and dental surgeons all the best for their critical services and also to all other healthcare workers who are risking their lives for us every day.