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Oral health and hygiene tips in times of coronavirus

What basic and general considerations should be taken into account regarding SARS-Cov-2 infection?
Coronavirus infection has been considered by the WHO as a global pandemic. From its origin, it has been a threat to global health, not only due to its symptoms but also due to its rapid spread and contagion capacity, and the respiratory complications it produces in patients with other underlying chronic conditions. The main transmission mechanisms described are Pflügge droplets, aerosols, and direct contact with contaminated surfaces.

It is important that people’s oral hygiene routine prevents the viral load in their mouth and oral hygiene utensils from being very high.

Why should the dentist be specially prepared to prevent this infection?
The dentist in Pitampura is one of the professionals with the highest risk of infection due to COVID-19. The dental clinic in Pitampura, which already has very high-level biosafety protocols, must comply with them without fail and adapt them to the new situation.

Mouthwashes should be used pure, undiluted

Should oral health precautions be taken in the person with COVID-19?
As the US Center for Disease Control (CDC) has noted, “ The immune response to COVID-19 is still unknown. Patients with MERS-CoV (another coronavirus) infection are unlikely to re-become infected soon after recovering, but it is not yet known whether similar immune protection will be observed in patients with COVID-19. “However, it is important that Any person’s oral hygiene routine prevents the viral load from their mouth and oral hygiene utensils from being too high.

Having the brush free of bacteria and viruses helps to reduce the spread with the brushes of people who are close

If the patient has tested positive for coronavirus, a preliminary rinse should also be performed to reduce the viral load. Likewise, when finished, you should clean the toothbrush or brush head by immersing it in a glass with a solution based on sodium hypochlorite (bleach) for 30 minutes; once this time has elapsed, it should be rinsed with water and left to dry. Typical use of bleach is at a 1: 100 dilution of 5% sodium hypochlorite, resulting in a final concentration of 0.05%. Likewise, we must not forget that having the brush free of bacteria and viruses helps to reduce the contagion with the brushes of people who are nearby.

And once the disease has overcome it, should something more or different be done?
Go back to your normal oral hygiene routine, but we must not forget that it is essential to change the brush once the contagion period has passed, for your health and that of others.

The patient who has passed COVID-19 should change the brush after the contagion period has passed.

What impact is this pandemic having on your dental practice? How do you think dental practices/clinics should change after this pandemic?
The economic impact is evident and it will be difficult to overcome. After the pandemic, the biosecurity protocols of dental consultations must adapt to the new situation; however, this profession will know how to adapt and will be able to continue offering maximum safety to patients.

The biosafety protocols of dental consultations must be adapted to the new situation

In the case of dental consultations, should the same precautions be followed as in other health centres?
So is. The strategies that are recommended to prevent the spread of COVID-19 in health centres do not differ from the strategies that these centres use to detect and prevent the spread of other respiratory viruses such as influenza.

This virus is especially concentrated in the nose, mouth, throat and larynx, which would explain its high contagion capacity.

Specifically, workers with respiratory symptoms should consult to make an individualized assessment of the relevance of the continuity of their work activities. Regarding users, they should be contacted by messages or calls to indicate that it is currently advisable not to go to dental clinics if they present symptoms of acute respiratory infection; Currently, it is recommended that they contact their dental clinic in Rani Bagh to make an individualized assessment in the event that it is essential that they attend.

It is essential to ensure that the toothbrush is a safe distance from the toilet and close the lid before flushing the cistern.

What basic precautions should be taken?
The Dental Council of India, in the line of measures already advanced by other institutions, recommends taking the following precautions:

  1. Strengthen universal preventive measures regarding dental care, taking into account that in our professional practice the risk of aerosol aspiration is very high and the working distance is usually less than 1 meter.
  2. For healthcare professionals who are at risk of generating aerosols (as is the case in dentistry), the use of valved FFP2 masks is recommended.
  3. If you continue to use the usual surgical mask, it is recommended to change them every 2 hours to avoid deterioration and loss of effectiveness.
  4. Gloves, gown and tight eye protection should be worn.
  5. Thorough hand washing should be done before and after caring for the patient.
  6. All work surfaces and the environment of the patient must be immediately cleaned and disinfected. Cleaning and disinfection will be carried out with a disinfectant included in the clinic’s cleaning and disinfection policy or with a sodium hypochlorite solution containing 1,000 ppm of active chlorine (1:50 dilution of a bleach with a concentration of 40-50 gr/liter freshly prepared). These viruses are inactivated after 5 minutes of contact with normal disinfectants such as household bleach.
  7. It must be followed scrupulously with all the usual universal standards of disinfection and sterilization.

Furthermore, before taking care of a patient, the international clinical and epidemiological criteria of SARS-CoV-2 must be taken into account.

From the incipient research that is being carried out in this area, is there any aspect that is particularly striking in relation to your mouth and this infection? During the first days of SARS-CoV-2 infection, this virus is especially concentrated in the nose, mouth, throat and larynx, which would explain the high contagion capacity of COVID-19, since the patient can expel virus at high levels through the nose and mouth. Active virus replication in the upper respiratory tract adds a new perspective to COVID-19 containment strategies.

And to the general population, and as a dentist in Saraswati Vihar, what practical advice would you give to prevent coronavirus infection based on oral health and hygiene?
The following tips will help you avoid getting or spreading the coronavirus (COVID-19).

Never share a toothbrush. This is a common form of virus transmission. For the same reason, the toothbrush heads must be kept separate from each other.

Close the toilet lid before flushing the cistern. If the toothbrush is stored anywhere near the toilet, each time someone pulls on the chain part of the spray will fly out of the toilet and fall onto the brush. Various studies suggest that the virus can be spread through the stool. Therefore, it is imperative to ensure that the toothbrush is at a safe distance from the toilet and close the lid before flushing the cistern.

Change the toothbrush regularly, at least every three months and even sooner if the bristles wear out. This helps ensure that you are brushing your teeth effectively. A worn brush cannot do its job well. In addition, changing the brush regularly will also help prevent the spread of bacteria. And if you have had a coronavirus (or there is a suspicion that it may be), you should change it for a new one.

Oral cleaning (toothpaste and rinses). Brush daily with a fluoride toothpaste: late at night and at least one other time during the day, at least. Interdental cleaning should be carried out every day (with specific brushes or dental floss) and mouthwash must be used. Only mouth rinses containing: iodopovidone 0.2-1%, cetylpyridinium chloride 0.05-0.1%, hydrogen peroxide 1% and/or those containing essential oils and alcohol should be used; mouthwashes should be used pure, undiluted.

Visit to the dentist. Keeping regular visits to your dentist in Delhi will always be important, although during this uncertain period it is best to treat only emergencies.

Clean your bathroom regularly, because it is the usual place where brushes are stored and where oral hygiene is carried out. Therefore, it is important that your bathroom surfaces are cleaned regularly with a chlorine-based cleaning product (bleach).