The globe is in a state of a prostration with the current COVID 19 pandemic in all its uproar. The viral breakout began in Wuhan, China in December, 2019 and since then it has spread to all the five continents in a relatively short span of time.
There has been a lot of speculation as regards to the spread of the virus. With the viral flare up in it’s second peak in the country, this is quite clear that person-to-person contact is the cardinal reason for its rapid progression. The viral particles can spread through coughing, sneezing and even speaking. This brings a major cause of distress to the dental profession as the contagion is widely transmitted through the mouth, mostly by way of saliva.
The saliva is an ultrafilterate of plasma. It can harbour viruses like SARS-CoV-2, due to the abundance of the ACE 2 receptor in the salivary glands. The transmission of this virus through salivary route is most likely. The virus may reach the oral cavity via multiple ways :
- The virus in the upper and lower parts of the respiratory tracts reaches the oral cavity through liquid droplets.
- The virus in the blood stream may reach the saliva through the gingival crevicular fluid.
The size of the salivary droplets determines how far in air they can travel, and in turn the range of transmission of the virus.
Although saliva does enable viral transmission from person to person, hyposalivation also, surprisingly as it may seem, is a cause for contracting the infection. The human saliva is a very strong antibacterial substance and houses varies salivary enzymes like lactoferrin, peroxidases, salivary agglutinins, alpha-defensins, beta-defensins, cystatins. These enzymes are responsible for impeding the normal replication of the SARS-CoV-2 virus, once it enters the oral cavity. Therefore, saliva can be considered an effective medium through which transmission occurs, but it’s not the causative factor.
Oral transmission of such a pandemic does limit dental treatment, however, it cannot omit the need for treatment for oral disorders. Dental professionals are at a huge risk for contracting the disease and therefore the times demand a strict in office regime which enables better practice protocols.
Outside the clinic
Scheduling minimum and high priority appointments (only those cases having dental pain) should be the goal.
Patients who have contracted COVID infection should be treated at least a month after recovery.
As far as possible, tele dentistry should be promoted.
Inside the clinic
Proper screening of the patients as well as the dental team at the office.
Effective sterilisation of the operatory and the equipment.
Maintenance of well ventilated spaces and proper donning and doffing zones for the PPE equipment.
Treatment is more exacting in terms of the precautions that need to be taken. It’s alright to lengthen the treatment time but not to compromise on the safety of the patient as well as the clinician. Oral route being the most common route for spread of infection does not underline negligence for dental treatment. There are different provisions for providing good dental care with maximum safety. It is imperative for all of us to understand to take a consult from a dentist in times of need.
Dr. Pooja Chaturvedi 