COVID-19 Pandemisinde Diş Hekimliği
Özet
COVID-19 pandemisi, yüksek bulaşıcılık riski nedeniyle diş hekimliği uygulamalarında köklü değişiklikleri zorunlu kılmıştır. Virüs, özellikle hava yolu, damlacıklar ve kontamine yüzeylerle temas yoluyla yayılmakta; ağız mukozası ve tükürük bezlerindeki yüksek ACE-2 reseptör konsantrasyonu nedeniyle dental ortamlarda ciddi risk oluşturmaktadır. Diş hekimliğinde aerosol üreten işlemler bulaşmanın en temel kaynağıdır. Bu riskleri en aza indirmek için klinikten önce temassız ateş ölçümü ve triaj anketleri uygulanmalı, riskli hastaların randevuları ertelenmelidir. Kliniklerde el hijyenine dikkat edilmeli, işlem öncesi povidon iyot veya hidrojen peroksit içerikli gargaralar kullanılmalıdır. Personel için valfsiz FFP2/N95 veya FFP3 maskeler, siperlikler, çift kat eldiven ve su geçirmez önlükler gibi gelişmiş kişisel koruyucu ekipmanların kullanımı şarttır. Havayı filtrelemek için HVE ve HEPA cihazlarından, yüzey dezenfeksiyonu için ise ozon ve UV sistemlerinden yararlanılmalıdır. Rubber-dam ve aerosol azaltıcı manuel teknikler tercih edilmeli, ölçüler laboratuvara gönderilmeden sodyum hipoklorit ile dezenfekte edilmelidir. İlaç reçetelerinde ibuprofen yerine parasetamol; azitromisin yerine ise direnç riskine karşı amoksisilin seçilmelidir. Bu dönemde acil olmayan vakaların triajı ve takibi için tele-diş hekimliği uygulamaları yaygınlaşmıştır. Diş hekimleri, güvenli tedavi sunabilmek amacıyla dinamik ulusal ve uluslararası kılavuzları yakından takip etmelidir.
The COVID-19 pandemic has necessitated radical changes in dental practices due to the high risk of transmission. The virus spreads primarily through the airborne route, droplets, and contact with contaminated surfaces, posing a significant risk in dental settings due to high ACE-2 receptor concentrations in the oral mucosa and salivary glands. Aerosol-generating procedures in dentistry are the main source of transmission. To minimize these risks, non-contact temperature measurement and triage questionnaires must be implemented before clinic entry, and appointments for risky patients should be deferred. Hand hygiene must be strictly maintained in clinics, and pre-procedural mouthrinses containing povidone-iodine or hydrogen peroxide should be utilized. The use of advanced personal protective equipment, such as non-valved FFP2/N95 or FFP3 masks, face shields, double gloves, and water-resistant gowns, is mandatory for staff. HVE and HEPA devices should be utilized to filter the air, while ozone and UV systems should be preferred for surface disinfection. Rubber-dam isolation and manual aerosol-reducing techniques are preferred, and impressions must be properly disinfected with sodium hypochlorite before delivery to the laboratory. Regarding drug prescriptions, paracetamol should be preferred over ibuprofen, and amoxicillin should be chosen over azithromycin against the risk of antibiotic resistance. During this period, teledentistry applications have become widespread for the screening and follow-up of non-emergency cases. Dentists must closely follow dynamic national and international guidelines to deliver safe dental care.
Referanslar
Checchi V, Bellini P, Bencivenni D, et al. COVID-19 Dentistry-related aspects: A literature overview. Int Dent J. 2021;71(1):21–26. doi: 10.1111/idj.12601
Peng X, Xu X, Li Y, et al. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci. 2020;12(1):9. doi: 10.1038/s41368-020-0075-9
Zhou P, Yang X Lou, Wang XG, et al. Addendum: A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;588(7836):E6. doi: 10.1038/s41586-020-2951-z
Balla M, Merugu GP, Patel M, , et al. COVID-19, modern pandemic: A systematic review from front-line health care providers’ perspective. J Clin Med Res. 2020;12(4):215-229. doi: 10.14740/jocmr4142
Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507–513. doi: 10.1016/S0140-6736(20)30211-7.
Giacomelli A, Pezzati L, Conti F, et al. Self-reported olfactory and taste disorders in patients with severe acute respiratory coronavirus 2 ınfection: A cross-sectional study. Clin Infect Dis. 2020;71(15):889–890. doi: 10.1093/cid/ciaa330.
Eastin C, Eastin T. Clinical characteristics of coronavirus disease 2019 in China. J Emerg Med. 2020;58(4):711-712. doi: 10.1016/j.jemermed.2020.04.004
Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): Emerging and future challenges for dental and oral medicine. J Dent Res. 2020;99(5):481–487. doi: 10.1177/0022034520914246.
Mizumoto K, Kagaya K, Zarebski A, et al. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan. Euro Surveill. 2020;25(10):2000180. doi: 10.2807/1560-7917.ES.2020.25.10.2000180
Duran İ. COVID-19 pandemisi ve diş hekimliği. Turkiye Klin J Dent Sci. 2021;27(2):307–317. doi: 10.5336/dentalsci.2020-76141
Villani FA, Aiuto R, Paglia L, et al. COVID-19 and dentistry: Prevention in dental practice, a literature review. Int J Environ Res Public Health. 2020;17(12):4609. doi: 10.3390/ijerph17124609.
Veena HR, Mahantesha S, Joseph PA, et al. Dissemination of aerosol and splatter during ultrasonic scaling: a pilot study. J Infect Public Health. 2015;8(3):260–265. doi: 10.1016/j.jiph.2014.11.004
Cleveland JL, Gray SK, Harte JA, et al. Transmission of blood-borne pathogens in US dental health care settings: 2016 update. J Am Dent Assoc. 2016;147(9):729–738. doi: 10.1016/j.adaj.2016.03.020.
Ather A, Patel B, Ruparel NB, et al. Coronavirus disease 19 (COVID-19): Implications for clinical dental care. J Endod. 2020;46(5):584–595. doi: 10.1016/j.joen.2020.03.008.
Shamszadeh S, Parhizkar A, Mardani M, et al. Dental considerations after the outbreak of 2019 novel coronavirus disease: A review of literature. Arch Clin Infect Dis. 2020;15(2):103257. doi: 10.5812/archcid.103257
Ge ZY, Yang LM, Xia JJ, et al. Possible aerosol transmission of COVID-19 and special precautions in dentistry. J Zhejiang Univ Sci B. 2020;21(5):361-368. doi: 10.1631/jzus.B2010010.
Yuen KS, Ye ZW, Fung SY, et al. SARS-CoV-2 and COVID-19: The most important research questions. Cell Biosci. 2020;10:40. doi: 10.1186/s13578-020-00404-4.
Marui VC, Souto MLS, Rovai ES, Romito GA, Chambrone L, Pannuti CM. Efficacy of preprocedural mouthrinses in the reduction of microorganisms in aerosol: A systematic review. J Am Dent Assoc. 2019;150(12):1015-1026.e1. doi: 10.1016/j.adaj.2019.06.024.
Razmara F, Khayamzadeh M, Shabankare G. Dental practice in the era of COVID-19: A review of literature. J Fam Med Prim Care. 2021;10(1):41-47. doi: 10.4103/jfmpc.jfmpc_1008_20.
Eggers M, Koburger-Janssen T, Eickmann M, et al. In vitro bactericidal and virucidal efficacy of povidone-ıodine gargle/mouthwash against respiratory and oral tract pathogens. Infect Dis Ther. 2018;7(2):249–259. doi: 10.1007/s40121-018-0200-7.
Kampf G, Todt D, Pfaender S, et al. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect. 2020;104(3):246–251. doi: 10.1016/j.jhin.2020.01.022.
Challacombe SJ, Kirk-Bayley J, Sunkaraneni VS, et al. Povidone iodine. Br Dent J. 2020;228(9):656–657. doi: 10.1038/s41415-020-1794-1
Peskersoy C, Gürlek Ö. Dişhekimliğinde Covid-19 Pandemisinde koruyucu önlemler ve acil dental tedaviler hakkında bir derleme. J Ege Univ Sch Dent. 2020;41(Supp:1):27–36. doi: 10.5505/eudfd.2020.76768
Zhu N, Zhang D, Wang W, et al. A Novel Coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–733. doi: 10.1056/NEJMoa2001017.
Verbeek JH, Ijaz S, Mischke C, et al. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane database Syst Rev. 2016;4(4). doi: 10.1002/14651858.CD011621.pub2.
Checchi L, Montevecchi M, Violante F, et al. Management rules for a dental practice: biological risk and safety at work. Dent Cadmos. 2012;80(3):140–146. doi: 10.1016/j.cadmos.2011.11.003
Barabari P, Moharamzadeh K. Novel coronavirus (COVID-19) and dentistry–A comprehensive review of literature. Dent J. 2020;8(2):53. doi: 10.3390/dj8020053.
Samaranayake LP, Peiris M. Severe acute respiratory syndrome and dentistry: a retrospective view. J Am Dent Assoc. 2004;135(9):1292–1302. doi:10.1590/s1806-83242005000100008
Van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020;382(16):1564–1567. doi: 10.1056/NEJMc2004973.
Martinelli M, Giovannangeli F, Rotunno S,et al. Water and air ozone treatment as an alternative sanitizing technology. J Prev Med Hyg. 2017 ;58(1):48-52. PMID: 28515631; PMCID: PMC5432778.
Qureshi Z, Yassin M. Role of ultraviolet (UV) disinfection in infection control and environmental cleaning. Infect Disord Drug Targets. 2013;13(3):191–195. doi: 10.2174/1871526511313030007.
Dar-Odeh N, Babkair H, Abu-Hammad S, Borzangy S, Abu-Hammad A, Abu-Hammad O. COVID-19: Present and future challenges for dental practice. Int J Environ Res Public Health. 2020;17(9):3151. doi: 10.3390/ijerph17093151.
Sodhi M, Etminan M. Safety of ıbuprofen in patients with COVID-19: Causal or confounded? Chest. 2020;158(1):55-56. doi: 10.1016/j.chest.2020.03.040.
Baghizadeh Fini M. What dentists need to know about COVID-19. Oral Oncol. 2020;105:104741. doi: 10.1016/j.oraloncology.2020.104741.
Vinayachandran D, Balasubramanian S. Salivary diagnostics in COVID-19: Future research implications. J Dent Sci. 2020;15(3):364. doi: 10.1016/j.jds.2020.04.006
Chapper A, Catão VV, Oppermann RV. Hand and ultrasonic instrumentation in the treatment of chronic periodontitis after supragingival plaque control. Braz Oral Res. 2005;19(1):41–6. doi: 10.1590/s1806-83242005000100008.
Zafar MS. Comparing the effects of manual and ultrasonic instrumentation on root surface mechanical properties. Eur J Dent. 2016;10(4):517. doi: 10.4103/1305-7456.195162
Amid R, Kadkhodazadeh M, Fekrazad R, et al. Comparison of the effect of hand instruments, an ultrasonic scaler, and an erbium-doped yttrium aluminium garnet laser on root surface roughness of teeth with periodontitis: a profilometer study. J Periodontal Implant Sci. 2013;43(2):101–105. doi: 10.5051/jpis.2013.43.2.101.
Özdede M, Bağcı N, Peker İ. COVID-19 Pandemisi döneminde tele-diş hekimliği. Turkiye Klinikleri J Dent Sci. 2021;27(3):482–489. doi: 10.5336/dentalsci.2020-76630
Jampani ND, Nutalapati R, Dontula BSK, et al. Applications of teledentistry: A literature review and update. J Int Soc Prev Community Dent. 2011;1(2):37–44. doi: 10.4103/2231-0762.97695.
Maret D, Peters OA, Vaysse F, Vigarios E. Integration of telemedicine into the public health response to COVID‐19 must include dentists. Int Endod J. 2020;53(6):880-881. doi: 10.1111/iej.13312
Tonkaboni A, Amirzade-Iranaq MH, Ziaei H, Ather A. Impact of COVID-19 on Dentistry. In: Rezaei N, editor. Advances in Experimental Medicine and Biology. Springer; 2021. p. 623–36. https://link.springer.com/chapter/10.1007/978-3-030-63761-3_34
Machado RA, de Souza NL, Oliveira RM, et al. Social media and telemedicine for oral diagnosis and counselling in the COVID-19 era. Oral Oncol. 2020;105:104685. doi: 10.1016/j.oraloncology.2020.104685.
