Transmission Routes of 2019-nCoV and controls in Dental Practice
A novel coronavirus emerged in Wuhan, China in late 2019. Since the emergence of this new infectious disease scientists have worked diligently to identify transmission routes and highlight occupations at the highest risk. A study published in the International Journal of Oral Science suggests possible transmission routes in dental clinics and infection control recommendations to reduce person to person transmission.1
Coronaviruses are a family of viruses that have been infecting humans and vertebrates for many years. These viruses mainly infect the respiratory tract, gastrointestinal tract or central nervous system in humans and other mammals. Most coronaviruses cause mild symptoms except for SARS-CoV, MERS, and the new emerging coronavirus recently named SARS-CoV-2. These three can cause fatal severe respiratory diseases.
Common transmission routes for coronaviruses include direct transmission and contact transmission. Most coronaviruses are not implicated in an ocular transmission route, however with the newly emerging virus eye exposure may provide an effective route for infection. Some studies suggest that 2019-nCov (SARS-CoV-2) may be airborne through aerosols produced by medical and dental procedures. There is also evidence of fecal-oral transmission, though more studies on this transmission route are needed.
Dental professionals are at an increased risk of exposure to pathogenic microorganisms that infect the oral cavity and respiratory tract. The very nature of dental settings increases the risk of being exposed to 2019-nCoV (SARS-CoV-2). Face to face communications, frequent exposure to blood and saliva, and inhalation of pathogens that are airborne and suspended in the air for extended periods of time are all risk factors in dental settings for possible exposure to 2019-nCoV.
Droplet and airborne transmission from aerosols are the most important concern in a dental setting. Airborne spread of SARS-1 is documented in the literature, with the very close similarities of the two viruses it isn’t a stretch to assume the same is possible with 2019-nCoV. Most, if not all dental procedures produce aerosols, these aerosols are often small enough to stay airborne for extended periods.
Infection control measures highlighted in this study include patient evaluation, hand hygiene, specific disposable PPE, pre-procedural mouth rinse, rubber dam isolation, and anti-retraction handpieces. By mid-February, many healthcare providers have been infected leading to the need for better PPE and infection control. This article highlights some of the early information as it was emerging from Wuhan.
Since this study was published, more information about SARS-CoV-2 has come to light. This is an ever-evolving situation that is new to everyone. The more we learn, the better we can serve our patients and protect them as well as ourselves when providing dental treatment.
What changes would you like to see in PPE? Do you believe dentistry will be able to provide an environment that patients will feel safe visiting? Are you satisfied with current OSHA regulations; do you think they are enough in providing a safe working environment?
- Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci. 2020;12(1):9. Published 2020 Mar 3. doi:10.1038/s41368-020-0075-9
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