Eia Marie Dingding Canangca-an

DDM 4 – D1 OPD LECTURE (NOTES)

PDA’s Interim Guidelines on Infection OTHER UDC:

Prevention During COVID-19 Pandemic  Extensive dental caries/
DENTAL EMERGENCY defective restorations causing
 Dentists should use their pain
professional judgement in  Manage with interim restorative
determining patient’s need for techniques
emergency care.  Suture removal
 Life threatening and require  Denture adjustment on radiation
immediate treatment to stop tissue  Denture adjustments
bleeding, alleviate severe pain or  Replacing temporary filling on
infection, and include: endo access openings
- Uncontrolled bleeding  Snipping or adjustment of an
- Cellulitis or a diffuse soft tissue orthodontic wire ulcerating the
bacterial infection with intra-oral oral mucosa
or extra-oral swelling (may DENTAL NON-EMERGENCY
compromise the pt’s airway) PROCEDURES
- Trauma involving facial bones Routine/ non-urgent dental procedures
(may compromise the pt’s include but are not limited to:
airway)  Initial or periodic oral examinations
URGENT DENTAL CARE  Routine dental cleaning and
 focuses on the management of preventive therapies
conditions that require immediate  Orthodontic procedures
attention to relieve severe pain/risk  Extraction of asymptomatic teeth
of infection, to alleviate the burden  Restorative dentistry including
on hospital emergency departments. treatment of asymptomatic carious
 These should be treated as lesions
minimally invasive as possible.  Aesthetic dental procedures
EX.
- Severe dental pain from pulpal PDA INTERIM GUIDELINES IN DENTAL
inflammation PRACTICE
- Pericoronitis or third-molar pain
- Surgical post-operative osteitis,  These recommendations aim to help
dry socket dressing changes dental professionals and their staff
- Abscess, or localized bacterial resume practice after the ECQ is
infection results in localized pain relaxed or lifted, without overriding
and swelling any existing laws or directives from
- Tooth fracture resulting in pain or government health authorities
causing soft tissue trauma related to the COVID-19 health
- Dental trauma with crisis. Dentists are professionally
obligated to adhere to government
avulsion/luxation
health guidelines.
- Dental treatment required prior to
critical medical procedures
- Final crown/bridge cementation if
the temporary restoration is lost,
broken or causing gingival
irritation
- Biopsy of abnormal tissue
Eia Marie Dingding Canangca-an
DDM 4 – D1 OPD LECTURE (NOTES)

A. PREPARATION OF THE DENTAL  Self-monitor for worsening

FACILITY AND TEAM symptoms (fever, pain, cough, sore
throat, shortness of breath,
1. WORKFLOW PROCESS AND CLINIC gastrointestinal issues). If symptoms
INFRASTRUCTURE worsen, report to the nearest
hospital ER immediately.
 Develop and implement a workflow
tailored to your practice's scope,
location, size, and available
infrastructure.

 Adjust clinic layouts to ensure 3. PATIENT APPOINTMENTS

effective infection control and
maintain clean areas. Do a two-phase triage.

 Provide the patient screening area  First, screen cases by phone for
with hand disinfection facilities urgency, residence area, and
potential COVID contact. Explain
 Maintain physical distancing in the treatment options and infection
waiting area (2 meters apart) control protocols.

 Remove difficult to disinfect items  Second, at the appointment,

provide a symptom and contact
 Train your staff exposure questionnaire. Have
patients sign informed consent
 Develop a way to isolate your and waiver forms.
operatory from other areas of the
clinic Inventory your PPE supplies, and
schedule patients based on
 Provide a clean area for donning availability. NO PPE, NO
and doffing the PPE away from TREATMENT.
treatment area
Practice scheduled appointments
 Provide two receptacles with covers only except for emergencies.

2. DENTAL TEAM MONITORING Screen patients 1-2 days before

their appointment by phone or other
 All dental healthcare personnel must non-contact methods. If unavailable,
be encouraged to receive seasonal designate an area for in-person
flu vaccinations. screening (triaging).

 Personnel exhibiting CoVid or flu-like Schedule your patients apart to give

symptoms should not report to work. enough time for disinfection of work
areas.
 Dental healthcare personnel with
these symptoms are classified as Post reminders for patients to wear
"Suspect" cases under revised DOH masks, avoid touching their face,
guidelines. sanitize hands, practice cough
etiquette, and maintain physical
distancing.
Eia Marie Dingding Canangca-an
DDM 4 – D1 OPD LECTURE (NOTES)

B. INFECTION CONTROL 1. NAGP Treatment - involves standard

infection control procedures and droplet
a. Standard Infection Control precautions to prevent COVID-19
Precaution (SICP) transmission.

SICP is a set of infection control a. Oral Examination

practices to prevent disease b. Periapical Radiographs
transmission through blood, body c. Denture records taking, prostho try-in,
fluids, non-intact skin, and mucous occlusal adjustments (extra-oral)
membranes, applicable to all d. FPD try-in and cementation (no in mouth
individuals, symptomatic or not. All adjustment with hand piece)
urgent dental clinics must follow e. Impressions
standard and transmission-based f. Uncomplicated extractions and tissue
precautions to reduce coronavirus excision
risk, applicable to all staff, in all g. Use of saliva ejector
settings, at all times, for all patients.
2. AGP Treatment - requires adherence to
b. Transmission-based precaution standard droplet and aerosol precautions,
including wearing fluid-repellent coveralls or
Transmission-based precautions (TBP) are isolation gowns, head caps, eye protection
additional measures focused on specific (goggles or face shields), masks, and
modes of transmission of SARS-CoV-2: gloves by both the operator and assistants.

a. Contact precautions – most common a. Use of high and low speed dental hand
RoT; are used to prevent infection spread pieces
through direct contact or bodily secretions. b. 3-way syringes
They are essential for known or suspected c. Ultrasonic scalers and similar equipment
infectious patients. d. Prophy-jet and similar equipment

b. Droplet precautions - prevent infection 1. LEVELS OF PPE PROTECTION

transmission through respiratory droplets Level One: Recommended for reception
(>5 µm) over short distances, necessary for staff with minimal patient contact
infected individuals, especially during includes scrub suit/shirt, surgical mask,
procedures like coughing or sneezing. protective eyewear, and head cap.
Level Two: Recommended for staff
preparing instruments in non-
c. Aerosol precautions - are required for
contaminated areas or providing non-
patients known or suspected to spread
AGP to patients includes
microorganisms via airborne routes, such as
undergarment/scrub shirt, water-
during dental procedures involving high-
repellent gown, surgical mask,
speed handpieces or low-speed
protective eyewear, head cover, and
micromotors.
non-sterile examination gloves.
Level Three: For staff involved in direct
c. Aerosol and non-aerosol procedures patient care and AGP procedures.
and treatment Includes undergarment/scrub shirt,
water repellent surgical gown, N95 or
*AGP- Aerosol Generating Procedures KN95 respirator mask, protective
**NAGP-Non-Aerosol Generating eyewear or goggles, head cover, face
Procedures shield, sterile surgical gloves, and non-
sterile gloves.
Eia Marie Dingding Canangca-an
DDM 4 – D1 OPD LECTURE (NOTES)

Level Four: Not necessary for dental - Should seal well to the face, with a
offices. Includes full waterproof flexible PVC frame for a snug fit,
coveralls, sealed goggles, face shield, clear lenses resistant to fog and
fitted respirator mask, and gloves. scratches, adjustable bands for
security during activities, and indirect
2. MASKS venting to prevent fogging.
a. Respirator Masks: N95, KN95 or higher
- Filters 95% of 0.3-micron particles - Reusable with proper
decontamination or disposable
- Rigid masks fit-tested to create a
sealed barrier for healthcare c. FACE SHIELDS
workers.
- Face shields are crucial for
- Due to shortages, the CDC now protecting the face and mucous
advises disinfecting and reusing membranes from airborne body
these masks, though they are fluids during medical and dental
typically meant for single use. procedures, covering from at least
the chin to the forehead with
b. Surgical Masks adequate space for additional
protective equipment.
- Surgical masks are loose-fitting, Considerations include choosing
made of pleated melt-blown fabric between disposable and reusable
that allows breathing while blocking models, with some industrial shields
tiny particles carrying microbes. viable but often heavier and more
expensive for infection control
- Not airtight and do not fit as snugly purposes.
as respirator masks.
Process of Cleaning of Face
- Suitable for NAGP or brief AGP but shields
offer lower protection than
respirators.  Step 1 wipe the eye protection,
goggles or face shields using a
disinfectant wipe or a soft wet clean
3. EYE & FACE PROTECTION
cloth
 Step 2 add neutral detergent
a. PROTECTIVE LENSES solution
 Step 3 rinse with clean running
- Should fit snugly around the temples water to remove residue
and rest securely on the nose  Step 4 Air dry or use absorbent
bridge. towels
 Step 5 Disinfecting solution will
- Made of scratch-resistant depend on the eye/face protection
polycarbonate, can withstand material
repeated disinfection with alcohol or
diluted hypochlorite using a soft 4. GLOVES and GLOVE USE
cloth.
- Latex Surgical or examination or
b. GOGGLES Nitrile and should be powder free,
STRICTLY FOR SINGLE USE
Eia Marie Dingding Canangca-an
DDM 4 – D1 OPD LECTURE (NOTES)

5. COVERALLS / ISOLATION GOWN 3.) Goggles or Face Shield: Place

over face and eyes, adjust for fit.
Contaminated Areas of PPE:
 Outside front 4.) Gloves: Extend over gown cuffs to
Clean Areas of PPE: cover wrists.
 Inside
 Outside back HOW TO SAFELY REMOVE
 Ties on head and back PERSONAL PROTECTIVE
EQUIPMENT (PPE)
Definition:
1.) Gown and Gloves: Remove gown
Contaminated: Areas of PPE likely to
first, then gloves. Discard gloves.
have been in contact with infectious
organisms.
Clean: Areas of PPE not likely to have 2.) Goggles or Face Shield: Remove
been in contact with infectious goggles or face shield.
organisms.
3.) Mask or Respirator: Remove mask
or respirator last, handling only by
the straps or ties.

4.) Wash Hands or Use Hand

Sanitizer: Immediately clean hands
Where to Remove PPE:
after removing all PPE.
 At the doorway, before leaving the
patient room or in an anteroom.

 Remove respirator outside the room,

after closing the door.
WASTE MANAGEMENT AND
DISINFECTION
SEQUENCE FOR PUTTING ON
PERSONAL PROTECTIVE
EQUIPMENT (PPE) 1. Infectious waste, classified as
Biohazard, must be disposed of in a
Ensure the type of PPE matches the yellow plastic bag marked with the
required precautions (standard/contact, specific symbol.
droplet, or airborne). Procedures should 2. All infectious waste, including used
be adjusted accordingly for putting on gloves and single-use PPE, must be
and removing PPE. stored in a designated area during
the workday and placed in a covered
bag. At day's end, ensure it is
1.) Gown: Fully cover torso, arms, and
deposited in a suitable location away
wrap around the back. Fasten at
from the clinic, addressing proper
neck and waist.
disposal procedures.
2.) Mask or Respirator: Secure ties or
3. Used infectious PPE intended for
bands around head and neck, fit
reuse, such as gowns, goggles,
snugly over nose and chin, perform
eyewear, face shields, and respirator
fit-check.
masks, should be collected in a
Eia Marie Dingding Canangca-an
DDM 4 – D1 OPD LECTURE (NOTES)

separate bag for disinfection after - Access potential presence of fever

hours. via contactless thermometer
- Use of hydroalcoholic solution for
4. Reusable gowns can be disinfected hand disinfection when entering the
by washing them separately from dental office
personal clothing. Use a 0.1%-0.5% - Provide adequate ventilation
chlorine bleach solution to spray or - Removal of all objects that could
soak the gowns for 5 minutes before favor cross-infection
washing with detergent and water. 3.) Preparation to dental treatment
(dentist and patient)
5. Goggles, protective eyewear and - Use of disposable shoe covers
face shields may be disinfected with - 1 min mouth rinse with 0.2% to 1%
0.1%-0.5% chlorine bleach solution, povidone, 0.05% to 0.1%
rinsed, wiped and dried. cetylpyridinium chloride, or 1%
hydrogen peroxide
6. Respirator masks can be reused if - Hand washing for at least 60s and
not heavily soiled or exposed to then 60% hydroalcoholic solution
aerosols. Disinfect them by dry application prior to wearing gloves
heating at 70°C for 1 hour, ensuring 4.) Dental treatment
they are test-fitted before each use, - Preparation of all instruments in
and can be reused up to three times advance
using this method. - Total protection through disposable
covers
- Avoid, when possible, use of
handpieces/ultrasonic instrument
- Use of rubber dam
- Surgical aspiration system
- If possible, prefer 4-hands technique
5.) After dental treatment
- 5-min air change strongly advised
- Removal of disposable protections
from the surfaces
- Disinfection of shields and glasses
General recommendations checklist with 70% isopropyl alcohol hand
for dental clinics washing for at least 60s and then
60% hydroalcoholic solution
Guidelines Adopted in Italy for Dental application
Practitioners during COVID-19
Emergency RECOMMENDED DISINFECTION AND
STERILIZATION PROTOCOLS FOR
1.) Prior to dental treatment (patients DENTAL CLINICS TREATING
at home) PATIENTS DURING COVID-19
- Provide limitations to dental office PANDEMIC
access A. Treatment area/patient care area
- Book appointments to avoid - Clean and sterilize or discard all
contemporaneity of patients critical, heat-resistant semi-critical
2.) Prior to dental treatment (patients instruments and handpieces after
entering the practice) each use.
Eia Marie Dingding Canangca-an
DDM 4 – D1 OPD LECTURE (NOTES)

- Process heat-sensitive semi-critical

items with high-level disinfectants
like 2% Glutaraldehyde.
- Cover high-touch/clinical surfaces
with barriers or disinfect between
patients with 0.1% Sodium
hypochlorite or 70% alcohol.
- Use moistened wipes with freshly
prepared disinfectants like 0.1%
Sodium hypochlorite or 3%
hydrogen peroxide for surface
cleaning, and discard leftover
solutions.
- For floors, use the multi-bucket
technique: water, detergent, and
then a low-level disinfectant.
- Regularly decontaminate mop heads
and cleaning cloths by laundering at
80°C.
- Avoid disinfectant fogging.
B. Reception and patient waiting
area
- Avoid sweeping with broom

- Use wet mop with warm water and

detergent or hospital disinfectant
(eg. 0.1% Sodium hypochlorite).

- Frequently touched surfaces must

be disinfected frequently