Can oral surgery be performed safely when COVID-19 status is unknown?

Abstract

Design Cross-sectional study/special report.Study population This paper presents the early experience of the oral and maxillofacial surgery department at Hadassah University Medical Centre in Jerusalem during the first wave of the COVID-19 pandemic in 2020. The study involved both medical staff and patients.Data analysis A retrospective analysis of an eight-week period (February-April 2020) collated 1,471 patient records and examined diagnoses, procedures performed and COVID-19 status of patients and staff. Any attempts made to access routine dental care before presentation in secondary care were recorded.Results In the study period, one member of staff was confirmed as COVID-19-positive. Sixty-three patients had formal COVID-19 tests; all were negative. Forty-three patients were admitted for drainage of odontogenic fascial space infections; 53% reported delayed or failed attempts to access dental care before their infection. Additionally, the authors describe a screening process, personal protective equipment (PPE) allocation and staff/patient testing protocols employed in their surgical unit throughout this period.Conclusions The authors suggest a series of triage and screening measures to limit the risk of unknowingly exposing clinical staff to the COVID-19 virus and offer advice on safely delaying non-emergency treatment where necessary. Recommendations for use of PPE for aerosol and non-aerosol generating procedures are made, but it is important to recognise that the efficacy of these measures cannot be determined by the methodology employed. This paper demonstrates an early example of complications developing from absent or delayed routine dental services resulting from lockdowns. This 'excess morbidity' is likely to have an impact on healthcare services as the pandemic recovery unfolds and services begin to return to normal.