Systemic Management of Pandemic Risks in Dental Practice: A Consolidated Framework for COVID-19 Control in Dentistry

Abstract

Dental teams and their workplaces are among the most exposed to airborne and bloodborne infectious agents, and therefore at the forefront of pandemic-related changes to how dental care is organized and provided to patients. The increasing complexity of guidelines makes is challenging for clinicians to navigate the multitude of COVID-19 guidelines issued by different agencies. A comparative analysis of guidance issued for managing COVID-19 in dental settings leading U.S. agencies was conducted, including documents of the Occupational Safety and Health Administration (OSHA), an agency of the U.S. Secretary of Labor, and of the U.S. Centers for Disease Prevention and Control (CDC), an agency of the U.S. Secretary of Health and Human Services. Details of infection control and other risk mitigation measures were reviewed for consistency, overlaps and similarities, then clustered according to thematic areas covering all domains of managing a dental healthcare setting. The analysis revealed five distinct areas of pandemic control, comprising (1) planning and protocols, (2) patient screening, (3) preparation of facilities, (4) PPE and infection control, and (5) procedures and aerosol control; thereby covering systematically all aspects requiring adaptation in a pandemic context. The “Pandemic-5 Framework for COVID-19 Control in Dentistry” provides an opportunity to simplify comprehensive decision-making from a clinical practitioner perspective. The framework supports a comprehensive systems-driven approach by using dental clinics as a setting to integrate pandemic clinical responses with the implementation of appropriate infection control protocols. Traditionally these two aspects are addressed independently from each other in separate concepts.

Dental safety net providers’ experiences with service delivery during the first year of COVID-19 should inform dental pandemic preparedness

“…Relatedly, our study results revealed how changing and often contradictory COVID-19 federal guidelines, also identified by other scholars, 26 often burdened oral health care providers, as did divergent recommendations from state public health agencies and trusted professional associations, including the American Dental Association, American Association of Public Health Dentistry, and American Public Health Association. Our study results also elucidated the limitations of dental preparedness frameworks that assume adequate and dependable material resources (for example, Benzian 26 ) or do not account for these resources (for example, Brondani and Donnelly 25 ). By contrast, our participants described using substandard PPE, reusing limited PPE beyond its recommended life, or delaying patients' needed care owing to unobtainable supplies.…”

“…Participants' concerns about infection control among patients, staff members, and personal contacts were unsurprising, given the characteristics of the SARS-CoV-2 pathogen, the centrality of infection control in dentistry, and emerging dental PHEPR. 12,25,26,41,42 Although participants felt confident about controlling blood-borne pathogens, their excess stress related to the novel risks of a highly infectious air-and droplet-borne pathogen in the dental space was exacerbated by 2 systemslevel and 1 patient-level concerns; that is, differences in guidance from governmental and professional bodies, the unpredictability of material resource pipelines (in particular PPE), and the urgency participants felt to return patients to in-person care to manage, halt, or prevent disease.…”

“…Newly proposed frameworks draw on the biological, communications, and systems sciences to situate infection control in the contexts of sharing information 25 and standardizing protocols and materials. 26 Experts also advocate translating dental care professionals' skills in leadership, data management, and patient care to strengthen extradisciplinary PHEPR. 14,[27][28][29][30] Yet, emerging dental PHEPR frameworks overlook key sociocultural, health service delivery, and policy considerations common to broader PHEPR scholarship and practice.…”

The Impact of the COVID-19 Pandemic on Dentistry and Dental Education: A Narrative Review

“…Similarly, for periodontal treatments, manual scaling was chosen over ultrasonic scaling. In cases of symptomatic irreversible pulpitis, biological methods, such as pulpotomy or pulpectomy, were recommended as much as possible [ 14 ]. On the other hand, in patients with extensive destruction of the hard dental tissue accompanied by severe pain, it was necessary to opt for the extraction of the affected tooth.…”

Dentistry after Omicron variant: Introducing a New Biosafety Protocol in Prevention of COVID-19 in Dental Care

“…The risk for transmission of pathogens in a dental office resulting in an infectious disease is still unknown; it seems to be limited in developed countries but it cannot be considered negligible [106]. The literature review revealed five distinct areas of pandemic control, comprising (1) planning and protocols, (2) patient screening, (3) preparation of facilities, (4) PPE and infection control, and (5) practices and aerosol control; thereby covering systematically all aspects needing adaptation in a pandemic context [107].…”