safe dentistry C D A J O U R N A L , V O L 5 0 , Nº 2
C.E. Credit
Safe Dental Care During the COVID-19 Pandemic Eve Cuny, MS
AUTHOR Eve Cuny, MS, is executive associate dean at the University of the Pacific, Arthur A. Dugoni School of Dentistry. She is an internationally recognized expert in patient safety and infection control. Conflict of Interest Disclosure: None reported.
T
he COVID-19 pandemic has challenged the world in unprecedented ways. Never in our lifetime have we seen such massive shutdowns of businesses, waves of illness followed by waves of deaths periodically overwhelming the most advanced medical systems in the world and a near halt to global travel that all occurred during the spring and summer of 2020. Dentistry in the U.S. was profoundly impacted during the early months of the pandemic. According to a survey conducted by the American Dental Associate (ADA) Health Policy Institute, 19% of dental offices were completely shut down by March 23, 2020, and 76% offered only emergency care.1 As the profession began planning a return to patient care, dental health care personnel (DHCP) and patients had many questions about maintaining infection control in the midst of a pandemic. Of particular concern were procedures that are known to generate aerosols, such as ultrasonic scaling, highspeed handpieces and air/water syringes.2
Evolution of Infection Prevention Practices in Dentistry
DHCP who were part of the profession in the 1980s will remember the uncertainty and fear of that time due to another emerging viral disease, HIV. Despite numerous clusters of hepatitis B viral infection associated with dental settings, standards and guidelines for
infection control practices in oral health care settings were very limited before the mid-1980s.3–9 Particularly alarming to patients was the report of a possible transmission of HIV from an infected dentist to one of his patients in 1990.10 Follow-up investigation by the Centers for Disease Control and Prevention (CDC) in 1991 resulted in an additional four patients being identified as HIV positive.11 At least three of these five patients had viral strains that were closely linked to that of the HIV-infected dentist who had performed extractions and other routine dental procedures for these three patients. A review of the dental team’s infection control practices revealed some lapses in recommended practices. These included sometimes washing gloves instead of changing between patients, handpieces wiped with alcohol rather than heat sterilized and single-patientuse items occasionally disinfected for reuse on subsequent patients. The investigation also pointed out that the dentist received prophylactic treatment from the dental hygienist in the practice. The dentist did not keep records of accidental percutaneous injuries, so it was unclear whether he had potentially sustained a sharps injury that could have caused bleeding while working intraorally or if a handpiece or other device or instrument used during his prophylaxis could have spread contamination from him to subsequent patients.11 FEBRUARY 2 0 2 2
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