Coronavirus Disease 2019 (COVID-19): Emerging and Future Challenges for Dental and Oral Medicine

Abstract

The epidemic of coronavirus disease 2019 (COVID-19), originating in Wuhan, China, has become a major public health challenge for not only China but also countries around the world. The World Health Organization announced that the outbreaks of the novel coronavirus have constituted a public health emergency of international concern. As of February 26, 2020, COVID-19 has been recognized in 34 countries, with a total of 80,239 laboratory-confirmed cases and 2,700 deaths. Infection control measures are necessary to prevent the virus from further spreading and to help control the epidemic situation. Due to the characteristics of dental settings, the risk of cross infection can be high between patients and dental practitioners. For dental practices and hospitals in areas that are (potentially) affected with COVID-19, strict and effective infection control protocols are urgently needed. This article, based on our experience and relevant guidelines and research, introduces essential knowledge about COVID-19 and nosocomial infection in dental settings and provides recommended management protocols for dental practitioners and students in (potentially) affected areas.

Keywords: dental education; dental practice management; dental public health; infection control; transmission; virology.

Figure 1.

Location of staff and student confirmed with coronavirus disease 2019 (COVID-19) in the main buildings in the School and Hospital of Stomatology, Wuhan University. There are 3 main buildings in our hospital. Building 1 mainly contains outpatients, classrooms, and a library. Its air renewal system depends on air conditioners. Building 2 contains outpatients, wards, and administrative regions. This building was equipped with central air conditioners and a fresh air system. Building 3 is a research laboratory, and it also depends on air conditioners. See Table for details.

Figure 2.

Number of outpatients treated at the School and Hospital of Stomatology, Wuhan University (WHUSS), and cumulative number of confirmed cases with coronavirus disease 2019 (COVID-19) in Wuhan city from December 30, 2019, to February 25, 2020. *Weekends and national holidays (including the extended spring festival holiday). ^#Huanan Seafood Market was closed in Wuhan city after the majority of the earliest COVID-19 cases were linked to the Huanan Seafood Wholesale Market. ^&Lockdown of Wuhan city started. According to the epidemic situation, the notification of city lockdown was made to stop any transportation, including airplane, train, and bus, from Wuhan city to prevent COVID-19 transmission, especially because of population movement during Chinese Spring Festival. Before January 21, WHUSS staff had only medical masks and gloves. On January 22, we started to use disposable surgical masks, N95 masks, and gowns. Goggles and protective suits were not available until January 28.

Figure 3.

The personal protective equipment (PPE) diagram for divisions in the emergency care area at the School and Hospital of Stomatology, Wuhan University, during the coronavirus disease 2019 (COVID-19) outbreak. Yellow: triage and waiting area. Orange: dental clinic. Red: isolation clinic. Green: resting area for staff only. As shown in the diagram, our triage staff in the yellow area wear disposable surgical mask, cap, and work clothes. In the orange area, dental staff is provided with PPE, including disposable N95 masks, gloves, gowns, cap, shoe cover, and goggles or face shield. The area is disinfected once every half day. Before February 21, all the patients were treated in this area. The isolation clinic in the red area was set up on February 21. It is designed for patients who are suspected with COVID-19, who are recovering from COVID-19 (but <1 mo after they are discharged from hospital), or who need dental procedures producing droplets and/or aerosols. Separate entrances for patients (red arrow) and staff (blue arrow) are provided in the area. Dental staff should wear protective clothing besides the aforementioned PPE. In addition, the entire isolation area is disinfected immediately after the treatment is over and the patient has left. The grid area behind the red line is for staff only. Staff can have a rest in the room (green area). They are recommended to enter the room by turn and to keep wearing medical masks unless they are eating or drinking.