Measures and suggestions for the prevention and control of the novel coronavirus in dental institutions

© Frontiers of Oral and Maxillofacial Medicine. All rights reserved. Front Oral Maxillofac Med 2020;2:4 | http://dx.doi.org/10.21037/fomm.2020.02.01 Since the first cases of pneumonia of an unknown origin were identified in Wuhan, the capital city of Hubei province, China in December 2019, Chinese scientists have urgently and persistently worked to determine the causative agent. This novel coronavirus was officially termed as 2019nCoV or SARS-CoV-2 (1-3). Although the pathogen was quickly identified, the characteristics of its transmission were not initially estimated accurately. The highly contagious nature of SARS-CoV-2 further exacerbates the situation, as does the population’s general susceptibility to it. The result of this is frequent human-human transmission among close contacts, including medical workers. By the end of January 2020, coronavirus disease 2019 (COVID-19) outbreak had escalated into a serious public health emergency in China, leading to the level I emergency response, the highest level, across the entire country (4,5). In the face of this rapidly spreading disease, the Chinese government has exerted itself to introduce a series of swift and effective targeted measures. Underpinning all of these actions are early detection, early isolation, and early treatment (6). By February 14, 2020, the number of confirmed COVID-19 cases in China had exceeded 60,000, of which 1,716 cases (including 6 deaths) were medical workers. Although the number of new COVID-19 cases is reducing day by day, the total number of confirmed cases remains high, and the situation remains serious. The rapid spread of COVID-19 is closely related to the manner in which SARS-CoV-2 is transmitted. However, the transmission modes of the virus have not been completely defined. At present, the respiratory droplet transmission mode and the contact transmission mode have been confirmed (7,8). Whether the virus spreads through the fecal-oral route, aerosol or other methods is uncertain, and this poses greater challenges to the Chinese government in its efforts to prevent transmission. COVID-19’s infectiousness during the incubation period further complicates its prevention and control. According to the latest reports, the longest incubation period so far is 24 days (9). In addition, the virus was detected in a sample from a Canadian patient who had been discharged from the hospital 14 days previously (10), although it is not clear whether the virus was still infectious. In the process of preventing and controlling the disease, hospitals, as places where large numbers of people are brought close together, are especially important. Dental departments, in particular, face a higher risk of disease transmission by the very nature of dental treatment operations. The relevant characteristics of these operations are listed as follows: (I) the water mist generated by the airdriven high-speed handpiece, air polisher, and various other instruments mixes with the saliva and blood of patients, forming aerosols and diffusing into the surrounding air; (II) dental treatment is characterized by relatively long operation times, which results in the persistent existence of aerosols within a large area of the clinical office and introduces a potential risk of spreading disease; (III) conventional protective measures are not 100% effective, and patients have no protection during the treatment process; (IV) the incubation period and possibility of patients concealing medical history could easily lead to the spread of disease; and (V) saliva, blood, and mixed water droplets carrying the virus Editorial