1. Have patience

2. Conduct emergency treatment till countries have some control over pandemic

3. Follow WHO guidelines for infection control and community spread

4. For all patients to undergo an aerosol related procedure, conduct Covid test one week before procedure.

5. PPE , hand hygiene and other infection control - should be efficient

I am preparing a presentation for that subject and I am working on it,

tell now there no hope to start our practice normally

Due to the unique characteristics of dental procedures

where a large number of droplets and aerosols could be generated,

the standard protective measures in daily clinical work

are not effective enough to prevent the spread of COVID-19,

reference is: Journal of Dental Research 2020, Vol. 99(5) 481-487

© International & American Associations for Dental Research 2020

DOI: 10.1177/0022034520914246

journals.sagepub.com/home/jdr

1. Have patience

2. Conduct emergency treatment till countries have some control over pandemic

3. Follow WHO guidelines for infection control and community spread

4. For all patients to undergo an aerosol related procedure, conduct Covid test one week before procedure.

5. PPE , hand hygiene and other infection control - should be efficient

Such a great question, I agree with what Khurshid A Mattoo said, I may add these following steps:

Shyam Kaji Maharjan

I think using molecular iodine is better to rinse the patient mouth with preoperatively

With appropriate Personal protective equipment and surface disinfectant.

After lock down we must have to take strict care of infection control as in the lock down. Use of hand sanitizers for every patient, mask, face shield, gloves, protective eye wears(for rotary instruments and scalers), PPE, while mouth rinse for patient (before starting any dental procedure) as well as use of sterilized instruments must be used to avoid any infectious disease including coronavirus which mostly spread through aerosol and splatters.

Thanks for your question that we all have in our minds. In my opinion, I think the number of employees will be reduced to minimize the risks, for example, instead of having dental hygiene doing the cleaning, you as a dentist can do it along with the recall and polishing. Proper PPE is the key to control the infection. also, there will be a limitation in the number of patients per day as we have to use more time preparing the room for the next patient.

Limitation of patient s number , use face shield and mask ,gloves

https://www.researchgate.net/publication/341089893_Avoid_MEN_to_Avoid_2019-nCoV_Infection_in_Dental_Pactice

For the time being conduct only emergency treatment with special attention to PPE. Take enough time for proper disinfection between each patient

As of now, the following are the recommendations, to be modified for practicality.

Step 1 - Screen patient for travel and contact history and also that he has no signs and symptoms (drawback, does not eliminate asymptomatic carriers)

Step 2

A. Protection for dentist and assistant/s in room

1. Aerosol procedures - Full PPE includes N95 mask, face and eye protection

2. Rest of procedures and for consult less than 30 minutes - surgical mask and eye protection.

B. Protection of rest of patients

1. Well ventilated room, away from operatory with aerosol

2. Generous sitting (currently 1m apart but unlikely practical on long-term. Query 0.6m(?)

C. Protection of healthcare workers

1. Avoid sharing food

2. Mask up in crowded places (hard to sustain long-term)

3. Trust between employer and employee - if sick, don't show up for work. No need to go infect everyone to get your official "medical certificate of sickness"

D. Culture of masking when unwell

During the lock down period, we can do some structural modifications in our present clinic or give a thought for shifting it to a place with more square feet.

1. We should have ample space for reception, separate consulting room, treatment room, sterilising room and lab.

2. Patient should always be wearing a mask before/ after entering a clinic with clean hands. Also they should not spit or wash their mouth anywhere out of clinic except chair spittoon.

3. The doctor should wear a scrub, a certified PPE over it before treatment.

4. After treatment, entire area should be fumigated with an organic base.

5. Dr s, pt s and Assistant s PPE should be discarded in a sealed thick plastic bag.

6. Entire surface of the clinic should be disinfected with 1% sodium hypochlorite.

solution.

7. At the end of the day.. the enitre clinic should be irradiated with UV C light.

As others say infection control and protection are mandatory during the out break of this pandemic infection. A very restrictive rules for patient treatment should be followed nowadays because still there is no definitive treatment and vaccine for this disease. In brief, emergency dental treatment with precaution should be given only during this disaster outbreak disease.

It may be so.

in Iraq Mosul, we start to open our clinics under the guidance of WHO recommendation and work emergency cases with no aerosols work.

disinfection gates, face shields together with the masks, air purifiers, high vacuum suction, in addition to the rest of PPE

as low as possible ,low speed,low patient flow,lowest air accompained in contra angle main suuply and air for water coolant must be zero or off, use no sonic nor u sonic shift to manual scaling , no polishing ,less is more

Some structural modifications might be helpful in our clinic . provide enough space for reception and treatment . Room and lab need to be sterilize .Follow and display WHO guide line in clinic.

Wait for guidelines from local dental governing authorities, procure necessary supplies when available, include 'urgent' treatment to start.

We follow local and international guidelines. Some structure modifications could be necesary in the office in order to provide security to patients as well as profesionals.

Triage (medical health status) of the patient before they attend the clinic is very important (telephone or video call)

At the moment the infection is quite control in Uruguay but the control measures are kept very closely.

We are at the moment giving emergency attendance and preparing for the decision of the goverment authorities for the application of the protocols of attention.

The patients are sugessted in a general condition to: first of all it is an specific cuestionaire that the patients must sign about possible symptoms of covid.

Measure temperature, keep distance, use of alcohol, Mouth cap, and avoid crowdings at the office.

The office need to provide all the prevention items for patients, staff and doctors.

As from the beginnig, preventive education continues to be strengthened in the environment.

Cheers

Luis

From a hospital perspective - Undertaking oral surgery or aerosol generating procedures - use of scopes / use of powered handpieces etc.

We are using Level 3 PPE - FFP3 Mask / Visor / Fluid Resistant Gown / Surgical Gloves.

Following the procedure - Allow the surgery room to "rest" for 1 hour so any aerosol can settle. Then clean down the surgery room. It should then be ready for the next patient.

A very slow process and it is limiting the number of patients that can be treated with aerosol generating procedures.

Follow.

It is obvious that major changes have to be made. It is necessary to follow the obligations emanating from the competent authorities. You can also find out what steps you can add to a proper management protocol that you will follow routinely for your protection and that of your patients. There are several scientific studies and several recommended process videos. You will find several key elements: disinfecting shoes at the entrance, wearing appropriate masks for all concerned, using virucidal products to avoid contamination on objects, instruments and between people. Good ventilation, the obligation to be on time to avoid people crossing each other in the waiting room, contactless payment, etc. As you can see, there is no shortage of ideas to prevent the virus. In the end, it will all be beneficial and less painful, because it will remain a positive habit.

I agree with Khurshid A Mattoo

We can use different lines of protection to decrease exposure to covid 19 infection..

I mention it in my page on research gate as presentation ..ppt.. ..you can getback and read it carefully.

Best regard

Face shield, Surgical masks, Temperature test or tell the patient to do Covid-19 test to ensure he/she is not infected. and follow other WHO advises.

Dear Shyam Kaji Maharjan one should just stick to the protocols and guidelines given by one's country, which are almost universal globally.

Dear Shyam Kaji Maharjan,

I think nothing will ever be the same again. COVID 19 will change the doctor's practice from the oral sphere. We need to be more careful and take more precautions. Aseptic and hygienic conditions are the rule. We need to improve protective equipment for ourselves and the patient; review the waiting room arrangements.

I think we will now live with COVID 19.

Follow local guidelines and for more detail description CDC parameters are idea!!

Hi, thanks for your question. There are a lot of guidelines out there for re-structuring dental practices to account for the risk of COVID-19 transmission. Ideally, you should follow your countries advice, as new evidence emerges and local infection levels change, guidelines can be amended.

I have recently worked in a team to publish a rapid review of international guidelines, full text available here: Article Recommendations for the re-opening of dental services: a rap...

Dear Dr. Shyam Kaji Maharjan

Besides the cautions that we take for our selected treatments during COVID-19 outbreak, any condition that induces gag reflex in our patients should be highly concerned and urgently manageable. we have recently highlighted the importance of management of gag reflex during COVID-19 outbreak and reviews the current evidences that have verified feasible strategies to control this common problem in dental practice.

Article The Predicament of Gag Reflex and its Management in Dental P...

Best regards,

Nima Farshidfar