Dental Asia May/June 2020

Clinical Feature
printed over the respirator:
N - not oil proof
R - oil resistant
P - oil proof
Some respirators have a built-in valve
which functions as a simple exhalation port
with one-way valve mechanism. It reduces
expiration effort, reduces heat inside the
mask, dissipates humidity and reduces the
level of carbon dioxide within the mask.
To ensure the quality of mask, we should use
a mask which is certified by:
NIOSH (National institute for occupational
safety and health) or
NPPTL (National personal protective
technology laboratory)
WHO recommendations for using masks are:
• For the normal population, any type
of mask is not required, maintaining
the social distance and hand hygiene
are enough.
• A sick person should wear a surgical
mask.
• Any person who is taking care of a sick
person should also wear a surgical
mask.
• An N95 mask should be used by
a person who might be exposed
to the respiratory secretions of
an infected patient, for example,
during endotracheal intubation,
cardiopulmonary resuscitation,
ventilation, bronchoscopy, and
tracheostomy.
The only additional thing to remember is that
the recommended wear time for N95 masks
is four hours.
Conclusion
Since 2020, COVID-19 information had been
widely disseminated in social media related
to dentistry. McGrath from the University of
Hong Kong analysed the content of postings
on 687 anonymous Facebook accounts and
screened by PRISMA framework. He found
over 50% posted by dental professionals
with background information and 61%
on prevention, while 49.4% were posted
with guidelines, with only 7.2% on how to
diagnosis the virus. In a summary listed by
the Health Authorities, an evidence-based
prevention protocol is recommended for
effective prevention in dental setting:
1. The mandatory patient triages include
temperature taking, travel and contact
history, signs and symptoms must be
reported honestly by each patient.
2. Restrict all aerosol procedures to pain
relieve and infection control.
3. Cease elective procedures such as
scaling and cosmetic procedures.
4. Use of rubber dam.
5. Use of mouth rinse.
6. Use high volume intra or extra-oral
suctions.
7. Use Class B autoclave to sterilise all
instrument including high-speed hand
pieces with spore test at least weekly.
8. Anti-retraction high-speed dental
handpiece can reduce the backflow 2 .
9. Any confirmed or suspected cases
should not be treated and refer to
special clinics for management and
report to Health Authority immediately.
10. Treat all patients with high alert as
signs and symptoms may not appear
in infected cases in early stages. DA
References
1. https://www.who.int/emergencies/diseases/
novel-coronavirus-2019/technical-guidance/
naming-the-coronavirus-disease-(covid-
2019)-and-the-virus-that-causes-it
2. Peng X, Xu X, Li Y, Cheng L, Zhou X and Ren B.
Transmission routes of 2019-nCoV and controls
in dental practice. International Journal of Oral
Science 12:9 2020.
3. https://www.ada.org/en/publications/adanews/2020-archive/february/ada-releasescoronavirus-handout-for-dentists-based-oncdc-guidelines
4. https://www.ada.org.au/Campaign/COVID-19
5. Huang, C. et al. Clinical features of patients
infected with 2019 novel coronavirus in Wuhan,
China. Lancet 395, 497–506 (2020).
6. Cleveland, J. L. et al. Transmission of bloodborne
pathogens in US dental health care
settings: 2016 update. J. Am. Dent. Assoc.
(1939) 147, 729–738 (2016).
7. Wei, J. & Li, Y. Airborne spread of infectious
agents in the indoor environment. Am. J. Infect.
Control 44, S102–S108 (2016).
8. Otter, J. A. et al. Transmission of SARS and
MERS coronaviruses and influenza virus in
healthcare settings: the possible role of dry
surface contamination. J. Hosp. Infect. 92,
235–250 (2016).
9. 9. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong
Y et al.
Early transmission dynamics in Wuhan,
China, of novel coronavirus-infected
pneumonia N Eng J Med 10.1056/
NEJMMoa2001316GoogleScholar (2020).
10. Carlos WG, Dela Cruz CS, Cao B Pasnick S, Jamil
S. Novel Wuhan (2019-nCoV) coronavirus. Am
J Respir Crit Care Med 2019(4) pp7-8 2020.
11. Lei J, Li J,Li X, Qi X. CT imaging of 2019 novel
coronavirus (2019-nCoV) pneumonia. Radiology,
p.200236 10.1148/radiol.2020200236 Google
Scholar (2020).
12. Lu H. Drug treatment options for 2019-new
coronavirus (2019-nCoV). Biosci. Trend (2020)
10.5582/bst.2020.01020GoogleScholar.
13. Hantak, M. P., Qing, E., Earnest, J. T. & Gallagher,
T. Tetraspanins: architects of viral entry and exit
platforms. J. Virol. 93, e01429–e01417 (2019).
About the Authors
Dr. Kevin Ng has been
a visiting lecturer on
oral surgery and
cariology at Hong
Kong University
since 1981. His
post-graduate
qualifications include Membership of the
Faculty of Dental Surgery (MFDS) of The
Royal College of Surgeons of Edinburgh.
He runs a private practice in Hong Kong.
After graduating from
Singapore in 1991,
Dr. How Kim Chuan
went on to specialise
in orthodontics in
London in 1993. He
has served as the
president of the Malaysian Dental
Association, and is a founding member of
the Malaysian Oral Implant Association
and the Malaysian ITI Association. His
special interests in dentistry include
oral surgery, implantology, laser, and
aesthetic dentistry.
MAY / JUNE 2020 DENTAL ASIA 47