Telephone or video conference triage |
Perform anamnesis for assessment of the patient for the presence of signs and symptoms of COVID-19, with careful tracking of all professionals who were in contact with a COVID-19 positive individual.(33 Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. J Dent Res. 2020;99(5):481-7.,55 Alharbi A, Alharbi S, Alqaidi S. Guidelines for dental care provision during the COVID-19 pandemic. Saudi Dent J. 2020;32(4):181-6.–99 Gugnani N, Gugnani S. Safety protocols for dental practices in the COVID-19 era. Evid Based Dent. 2020;21(2):56-7.,1111 National Health Service (NHS). COVID-19 guidance and standard operating procedure. For the provision of urgent dental care in primary care dental settings and designated urgent dental care provider sites. Version 3 (updated 28 August 2008). United Kingdom: NHS; 2020 [cited 2020 Aug 8]. Available from: https://bda.org/advice/Coronavirus/Documents/covid-19-urgent-dental-care-sop.pdf https://bda.org/advice/Coronavirus/Docum...
,1919 Clarkson J, Ramsay C, Aceves-Martins M, Brazzelli M, Colloc T, Dave M, et al. Recommendations for the re-opening of dental services: a rapid review of international sources (substantial update 16 May 2020). Cochrane Database Syst Rev. 2020. p. 6-45.) In this context, attention should be drawn to the suspicious signs of COVID-19: fever >37.8°C, conjunctivitis, chill, cough, shortness of breath, fatigue, muscle or body pain, headache, loss of taste or smell, sore throat, congestion or runny nose, nausea, or vomiting, diarrhea, which appear 2 to 14 days after exposure to the virus. The presence of indicative signs of severity for COVID-19 should be assessed, including breathing difficulties, persistent pain or pressure in chest, confusion, difficulty keeping awake and bluish lips(33 Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. J Dent Res. 2020;99(5):481-7.,66 Centers for Disease Control and Prevention (CDC). COVID-19 (Coronavirus disease). Healthcare Workers. Guidance for dental settings. Interim Infection prevention and control guidance for dental settings during the coronavirus disease 2019 (COVID-19) Pandemic. Atlanta: CDC; 2020 Dec 4 [cited 2020 May 21]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html#PPE https://www.cdc.gov/coronavirus/2019-nco...
,99 Gugnani N, Gugnani S. Safety protocols for dental practices in the COVID-19 era. Evid Based Dent. 2020;21(2):56-7.,2525 Loffredo L, Pacella F, Pacella E, Tiscione G, Oliva A, Violi F. Conjunctivitis and COVID-19: a meta-analysis. J Med Virol. 2020;92(9):1413-14.,3131 Hu K, Patel J, Swiston C, Patel BC. Ophthalmic Manifestations Of Coronavirus (COVID-19). 2022 Jan 8. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.,3232 Scalinci SZ, Trovato Battagliola E. Conjunctivitis can be the only presenting sign and symptom of COVID-19. IDCases. 2020;20:e00774.) |
Check the real need for a face-to-face consultation, through a history taking focused on the basic concepts of:
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Emergency: situations involving the risk of death of the patient, such as airway obstruction and uncontrolled hemorrhage
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Urgency: refers to cases of severe pain and/or infection
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Elective procedure: refers to the scheduled consultation where there is no setting that requires emergency(33 Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. J Dent Res. 2020;99(5):481-7.,66 Centers for Disease Control and Prevention (CDC). COVID-19 (Coronavirus disease). Healthcare Workers. Guidance for dental settings. Interim Infection prevention and control guidance for dental settings during the coronavirus disease 2019 (COVID-19) Pandemic. Atlanta: CDC; 2020 Dec 4 [cited 2020 May 21]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html#PPE https://www.cdc.gov/coronavirus/2019-nco...
,77 American Dental Association (ADA). As dental practices resume operations, ADA offers continued guidance: recommendations include changes before, during and after appointments to protect patients and dental team. Chicago: ADA; 2020 May 21[cited 2020 Aug 8]. Available from: https://www.ada.org/en/press-room/news-releases/2020-archives/may/as-dental-practices-resume-operations-ada-offers-continued-guidance?utm_source=cpsorg&utm_medium=cpsalertbar&utm_content=cv-continuedguidance-statement&utm_campaign=covid-19# https://www.ada.org/en/press-room/news-r...
,99 Gugnani N, Gugnani S. Safety protocols for dental practices in the COVID-19 era. Evid Based Dent. 2020;21(2):56-7.,1111 National Health Service (NHS). COVID-19 guidance and standard operating procedure. For the provision of urgent dental care in primary care dental settings and designated urgent dental care provider sites. Version 3 (updated 28 August 2008). United Kingdom: NHS; 2020 [cited 2020 Aug 8]. Available from: https://bda.org/advice/Coronavirus/Documents/covid-19-urgent-dental-care-sop.pdf https://bda.org/advice/Coronavirus/Docum...
,2626 Iyer P, Aziz K, Ojcius DM. Impact of COVID-19 on dental education in the United States. J Dent Educ. 2020;84(6):718-22. Review.)
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If available, use teledentistry, which includes remote patient assessment and medication prescription. This remote prescription includes analgesics, anti-inflammatory and/or antibiotics, according to the disease condition, patient preferences, possible complications, and the possibilities coming from the local public health departments(55 Alharbi A, Alharbi S, Alqaidi S. Guidelines for dental care provision during the COVID-19 pandemic. Saudi Dent J. 2020;32(4):181-6.,1111 National Health Service (NHS). COVID-19 guidance and standard operating procedure. For the provision of urgent dental care in primary care dental settings and designated urgent dental care provider sites. Version 3 (updated 28 August 2008). United Kingdom: NHS; 2020 [cited 2020 Aug 8]. Available from: https://bda.org/advice/Coronavirus/Documents/covid-19-urgent-dental-care-sop.pdf https://bda.org/advice/Coronavirus/Docum...
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Special attention should be given to elderly individuals and/or with comorbidities: if asymptomatic for COVID-19, only urgent or emergency care should be prioritised, and, if available, the possibility of home care should be considered. In turn, if infected with COVID-19, the elderly patient and/or with comorbidities should be referred to a hospital to assess the risk and benefit of urgent or emergency dental care(1111 National Health Service (NHS). COVID-19 guidance and standard operating procedure. For the provision of urgent dental care in primary care dental settings and designated urgent dental care provider sites. Version 3 (updated 28 August 2008). United Kingdom: NHS; 2020 [cited 2020 Aug 8]. Available from: https://bda.org/advice/Coronavirus/Documents/covid-19-urgent-dental-care-sop.pdf https://bda.org/advice/Coronavirus/Docum...
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History-taking should be repeated for each new patient consultation request(1111 National Health Service (NHS). COVID-19 guidance and standard operating procedure. For the provision of urgent dental care in primary care dental settings and designated urgent dental care provider sites. Version 3 (updated 28 August 2008). United Kingdom: NHS; 2020 [cited 2020 Aug 8]. Available from: https://bda.org/advice/Coronavirus/Documents/covid-19-urgent-dental-care-sop.pdf https://bda.org/advice/Coronavirus/Docum...
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Care in the face-to-face appointment |
Patient must wear a face mask and perform hand hygiene with soap or alcohol 70°(33 Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. J Dent Res. 2020;99(5):481-7.,66 Centers for Disease Control and Prevention (CDC). COVID-19 (Coronavirus disease). Healthcare Workers. Guidance for dental settings. Interim Infection prevention and control guidance for dental settings during the coronavirus disease 2019 (COVID-19) Pandemic. Atlanta: CDC; 2020 Dec 4 [cited 2020 May 21]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html#PPE https://www.cdc.gov/coronavirus/2019-nco...
,77 American Dental Association (ADA). As dental practices resume operations, ADA offers continued guidance: recommendations include changes before, during and after appointments to protect patients and dental team. Chicago: ADA; 2020 May 21[cited 2020 Aug 8]. Available from: https://www.ada.org/en/press-room/news-releases/2020-archives/may/as-dental-practices-resume-operations-ada-offers-continued-guidance?utm_source=cpsorg&utm_medium=cpsalertbar&utm_content=cv-continuedguidance-statement&utm_campaign=covid-19# https://www.ada.org/en/press-room/news-r...
,99 Gugnani N, Gugnani S. Safety protocols for dental practices in the COVID-19 era. Evid Based Dent. 2020;21(2):56-7.,1111 National Health Service (NHS). COVID-19 guidance and standard operating procedure. For the provision of urgent dental care in primary care dental settings and designated urgent dental care provider sites. Version 3 (updated 28 August 2008). United Kingdom: NHS; 2020 [cited 2020 Aug 8]. Available from: https://bda.org/advice/Coronavirus/Documents/covid-19-urgent-dental-care-sop.pdf https://bda.org/advice/Coronavirus/Docum...
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Measure temperature, and, if >37.8°C, consider fever(66 Centers for Disease Control and Prevention (CDC). COVID-19 (Coronavirus disease). Healthcare Workers. Guidance for dental settings. Interim Infection prevention and control guidance for dental settings during the coronavirus disease 2019 (COVID-19) Pandemic. Atlanta: CDC; 2020 Dec 4 [cited 2020 May 21]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html#PPE https://www.cdc.gov/coronavirus/2019-nco...
,77 American Dental Association (ADA). As dental practices resume operations, ADA offers continued guidance: recommendations include changes before, during and after appointments to protect patients and dental team. Chicago: ADA; 2020 May 21[cited 2020 Aug 8]. Available from: https://www.ada.org/en/press-room/news-releases/2020-archives/may/as-dental-practices-resume-operations-ada-offers-continued-guidance?utm_source=cpsorg&utm_medium=cpsalertbar&utm_content=cv-continuedguidance-statement&utm_campaign=covid-19# https://www.ada.org/en/press-room/news-r...
,99 Gugnani N, Gugnani S. Safety protocols for dental practices in the COVID-19 era. Evid Based Dent. 2020;21(2):56-7.,1919 Clarkson J, Ramsay C, Aceves-Martins M, Brazzelli M, Colloc T, Dave M, et al. Recommendations for the re-opening of dental services: a rapid review of international sources (substantial update 16 May 2020). Cochrane Database Syst Rev. 2020. p. 6-45.) |
Check oxygen saturation levels with pulse oximeter and, if <93%, refer to medical care due to the risk of silent hypoxemia(2727 Tobin MJ, Laghi F, Jubran A. Why COVID-19 silent hypoxemia is baffling to physicians. Am J Respir Crit Care Med. 2020;202(3):356-60.–2929 Dondorp AM, Hayat M, Aryal D, Beane A, Schultz MJ. Respiratory support in COVID-19 patients, with a focus on resource-limited settings. Am J Trop Med Hyg. 2020;102(6):1191-7. Review.) |
Repeat the triage history for COVID-19 before appointment(55 Alharbi A, Alharbi S, Alqaidi S. Guidelines for dental care provision during the COVID-19 pandemic. Saudi Dent J. 2020;32(4):181-6.,1111 National Health Service (NHS). COVID-19 guidance and standard operating procedure. For the provision of urgent dental care in primary care dental settings and designated urgent dental care provider sites. Version 3 (updated 28 August 2008). United Kingdom: NHS; 2020 [cited 2020 Aug 8]. Available from: https://bda.org/advice/Coronavirus/Documents/covid-19-urgent-dental-care-sop.pdf https://bda.org/advice/Coronavirus/Docum...
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Consider the use of a rapid test for COVID-19 since it has high specificity and sensitivity(66 Centers for Disease Control and Prevention (CDC). COVID-19 (Coronavirus disease). Healthcare Workers. Guidance for dental settings. Interim Infection prevention and control guidance for dental settings during the coronavirus disease 2019 (COVID-19) Pandemic. Atlanta: CDC; 2020 Dec 4 [cited 2020 May 21]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html#PPE https://www.cdc.gov/coronavirus/2019-nco...
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Use of FFP2, N95 or FFP3 respirators for procedures with no generation of aerosols. However, in suspected or confirmed cases of COVID 19 and/or for any aerosol-generating procedure, it is ideal to use respirators, FFP3, N99 or N100 without exhalation valves(33 Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. J Dent Res. 2020;99(5):481-7.,66 Centers for Disease Control and Prevention (CDC). COVID-19 (Coronavirus disease). Healthcare Workers. Guidance for dental settings. Interim Infection prevention and control guidance for dental settings during the coronavirus disease 2019 (COVID-19) Pandemic. Atlanta: CDC; 2020 Dec 4 [cited 2020 May 21]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html#PPE https://www.cdc.gov/coronavirus/2019-nco...
,88 Occupational Safety and Health Administration (OSHA). COVID-19 - control and prevention. Dentistry workers and employers. Occupational safety and health administration. Washington (DC): OSHA; 2020 [cited 2020 Aug 8]. Available from: https://www.osha.gov/SLTC/covid-19/dentistry.html https://www.osha.gov/SLTC/covid-19/denti...
,1111 National Health Service (NHS). COVID-19 guidance and standard operating procedure. For the provision of urgent dental care in primary care dental settings and designated urgent dental care provider sites. Version 3 (updated 28 August 2008). United Kingdom: NHS; 2020 [cited 2020 Aug 8]. Available from: https://bda.org/advice/Coronavirus/Documents/covid-19-urgent-dental-care-sop.pdf https://bda.org/advice/Coronavirus/Docum...
,1919 Clarkson J, Ramsay C, Aceves-Martins M, Brazzelli M, Colloc T, Dave M, et al. Recommendations for the re-opening of dental services: a rapid review of international sources (substantial update 16 May 2020). Cochrane Database Syst Rev. 2020. p. 6-45.,3030 Centers for Disease Control and Prevention (CDC). Healthcare Workers. Strategies for optimizing the supply of N95 respirators. CDC; 2020 Nov 23 [cited 2020 Aug 19]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/index.html https://www.cdc.gov/coronavirus/2019-nco...
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Priority should be given to emergency and urgent care, postponing elective procedures, avoiding adverse impacts on the patients’ conditions due to delayed care. If possible, carry out the entire treatment in a single consultation(33 Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. J Dent Res. 2020;99(5):481-7.,66 Centers for Disease Control and Prevention (CDC). COVID-19 (Coronavirus disease). Healthcare Workers. Guidance for dental settings. Interim Infection prevention and control guidance for dental settings during the coronavirus disease 2019 (COVID-19) Pandemic. Atlanta: CDC; 2020 Dec 4 [cited 2020 May 21]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html#PPE https://www.cdc.gov/coronavirus/2019-nco...
,99 Gugnani N, Gugnani S. Safety protocols for dental practices in the COVID-19 era. Evid Based Dent. 2020;21(2):56-7.,1111 National Health Service (NHS). COVID-19 guidance and standard operating procedure. For the provision of urgent dental care in primary care dental settings and designated urgent dental care provider sites. Version 3 (updated 28 August 2008). United Kingdom: NHS; 2020 [cited 2020 Aug 8]. Available from: https://bda.org/advice/Coronavirus/Documents/covid-19-urgent-dental-care-sop.pdf https://bda.org/advice/Coronavirus/Docum...
,1919 Clarkson J, Ramsay C, Aceves-Martins M, Brazzelli M, Colloc T, Dave M, et al. Recommendations for the re-opening of dental services: a rapid review of international sources (substantial update 16 May 2020). Cochrane Database Syst Rev. 2020. p. 6-45.) |
Preferably, perform minimally invasive procedures, such as using excavators, chemical agents for tooth decay removal, and rubber dam to minimize the spread of microorganisms(33 Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. J Dent Res. 2020;99(5):481-7.,55 Alharbi A, Alharbi S, Alqaidi S. Guidelines for dental care provision during the COVID-19 pandemic. Saudi Dent J. 2020;32(4):181-6.,77 American Dental Association (ADA). As dental practices resume operations, ADA offers continued guidance: recommendations include changes before, during and after appointments to protect patients and dental team. Chicago: ADA; 2020 May 21[cited 2020 Aug 8]. Available from: https://www.ada.org/en/press-room/news-releases/2020-archives/may/as-dental-practices-resume-operations-ada-offers-continued-guidance?utm_source=cpsorg&utm_medium=cpsalertbar&utm_content=cv-continuedguidance-statement&utm_campaign=covid-19# https://www.ada.org/en/press-room/news-r...
,88 Occupational Safety and Health Administration (OSHA). COVID-19 - control and prevention. Dentistry workers and employers. Occupational safety and health administration. Washington (DC): OSHA; 2020 [cited 2020 Aug 8]. Available from: https://www.osha.gov/SLTC/covid-19/dentistry.html https://www.osha.gov/SLTC/covid-19/denti...
,1111 National Health Service (NHS). COVID-19 guidance and standard operating procedure. For the provision of urgent dental care in primary care dental settings and designated urgent dental care provider sites. Version 3 (updated 28 August 2008). United Kingdom: NHS; 2020 [cited 2020 Aug 8]. Available from: https://bda.org/advice/Coronavirus/Documents/covid-19-urgent-dental-care-sop.pdf https://bda.org/advice/Coronavirus/Docum...
,1919 Clarkson J, Ramsay C, Aceves-Martins M, Brazzelli M, Colloc T, Dave M, et al. Recommendations for the re-opening of dental services: a rapid review of international sources (substantial update 16 May 2020). Cochrane Database Syst Rev. 2020. p. 6-45.) |
Avoid procedures that produce aerosol (e.g. dental turbines, micro motor hand piece, ultrasonic scalers, air/water syringe and sodium bicarbonate powder jet), or procedures that lead to increased salivation, retching or coughing, such as an intraoral radiographic examination and impression. Otherwise, tomography or extra oral radiographic technique should be used(33 Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. J Dent Res. 2020;99(5):481-7.,55 Alharbi A, Alharbi S, Alqaidi S. Guidelines for dental care provision during the COVID-19 pandemic. Saudi Dent J. 2020;32(4):181-6.–88 Occupational Safety and Health Administration (OSHA). COVID-19 - control and prevention. Dentistry workers and employers. Occupational safety and health administration. Washington (DC): OSHA; 2020 [cited 2020 Aug 8]. Available from: https://www.osha.gov/SLTC/covid-19/dentistry.html https://www.osha.gov/SLTC/covid-19/denti...
,1111 National Health Service (NHS). COVID-19 guidance and standard operating procedure. For the provision of urgent dental care in primary care dental settings and designated urgent dental care provider sites. Version 3 (updated 28 August 2008). United Kingdom: NHS; 2020 [cited 2020 Aug 8]. Available from: https://bda.org/advice/Coronavirus/Documents/covid-19-urgent-dental-care-sop.pdf https://bda.org/advice/Coronavirus/Docum...
,1919 Clarkson J, Ramsay C, Aceves-Martins M, Brazzelli M, Colloc T, Dave M, et al. Recommendations for the re-opening of dental services: a rapid review of international sources (substantial update 16 May 2020). Cochrane Database Syst Rev. 2020. p. 6-45.) |
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Use PPE, such as goggles, face shields, gloves, apron, long-sleeved disposable fluid repellent coverall, surgical cap and, foot cover, in addition to adoption of work uniform (consider washing the uniform using the hospital services or specialised laundry facilities).(33 Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. J Dent Res. 2020;99(5):481-7.,66 Centers for Disease Control and Prevention (CDC). COVID-19 (Coronavirus disease). Healthcare Workers. Guidance for dental settings. Interim Infection prevention and control guidance for dental settings during the coronavirus disease 2019 (COVID-19) Pandemic. Atlanta: CDC; 2020 Dec 4 [cited 2020 May 21]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html#PPE https://www.cdc.gov/coronavirus/2019-nco...
–99 Gugnani N, Gugnani S. Safety protocols for dental practices in the COVID-19 era. Evid Based Dent. 2020;21(2):56-7.,1111 National Health Service (NHS). COVID-19 guidance and standard operating procedure. For the provision of urgent dental care in primary care dental settings and designated urgent dental care provider sites. Version 3 (updated 28 August 2008). United Kingdom: NHS; 2020 [cited 2020 Aug 8]. Available from: https://bda.org/advice/Coronavirus/Documents/covid-19-urgent-dental-care-sop.pdf https://bda.org/advice/Coronavirus/Docum...
,1919 Clarkson J, Ramsay C, Aceves-Martins M, Brazzelli M, Colloc T, Dave M, et al. Recommendations for the re-opening of dental services: a rapid review of international sources (substantial update 16 May 2020). Cochrane Database Syst Rev. 2020. p. 6-45.) Change PPE at each appointment to avoid cross-contamination and spread of infection(77 American Dental Association (ADA). As dental practices resume operations, ADA offers continued guidance: recommendations include changes before, during and after appointments to protect patients and dental team. Chicago: ADA; 2020 May 21[cited 2020 Aug 8]. Available from: https://www.ada.org/en/press-room/news-releases/2020-archives/may/as-dental-practices-resume-operations-ada-offers-continued-guidance?utm_source=cpsorg&utm_medium=cpsalertbar&utm_content=cv-continuedguidance-statement&utm_campaign=covid-19# https://www.ada.org/en/press-room/news-r...
,1111 National Health Service (NHS). COVID-19 guidance and standard operating procedure. For the provision of urgent dental care in primary care dental settings and designated urgent dental care provider sites. Version 3 (updated 28 August 2008). United Kingdom: NHS; 2020 [cited 2020 Aug 8]. Available from: https://bda.org/advice/Coronavirus/Documents/covid-19-urgent-dental-care-sop.pdf https://bda.org/advice/Coronavirus/Docum...
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