Oral Surgery During Covid 19 Epidemic-Albanian Experience for the Management of Oral Surgery Patients

Esat Bardhoshi
Faculty of Dental Medicine, University of Medicine Tirane

Abstract

In December 2019 , in Wuhan City , a pneumonia of unknown cause was detected. This pneumonia infection has rapidly from Wuhan to other countries . Chinese researchers have quickly discovered and isolated a novel Coronavirus and announced a name for a new coronavirus decease and increased the assessment of the risk of spread to “ very high “. The whole world is fighting against the spread of this disease. The first two cases of Covid -19 in Albania were confirmed on 8 March 2020 by the Institute of Public Health in Tirana. Strict containment measures adopted by the Government establish the limitation of people circulating outside their home , social distancing , the closure of almost all commercial activities, remote working and home schooling using online Platforms. The Albanian Minister of Health decided to close all dental private clinic to decrease the risk of infection and all dental treatments during lockdown in Albania were performed by the specialised dental professionals of University Dental Clinic in Tirana. It has been widely documented in the literature that common transmission routes of 2019-nCoV include droplet diameter ≥5 μm inhalation generated from coughs and sneezes of infected patients, as well as direct contact with oral, nasal and eye mucous membranes. In addition, studies have shown that 2019-nCoV can be transmitted through saliva. Dentists routinely perform several aerosol-generating procedures due to the use of different tools, like dental high-speed turbine, spray handpiece, or piezoelectric scaler. These instruments largely increase the aerosol produced inside the work environment, thus exposing both clinicians and patient to the risk of infection. It is interesting to note that on 15 March 2020, The New York Times published a suggestive article describing that dentists are the most exposed workers to the risk of being affected by COVID-19. During dental procedures, inhalation of aerosols produced by instruments on patients with COVID-19 can determine a high infection risk, considering virus transmission routes. On behalf of these considerations , all dentistry operators must always be diligent in protecting against the spread of viral disease , as well as note the importance of providing clear and easy guidelines to manage patients and make dental practice safe from any risk. Objective The aim of the study is to share our two months experience in the management of different oral emergencies during Covid 19 pandemic time , in order to provide a successful treatment and positive impact in the prevention of infection. Material and Method We report in this publication our experience in the treatment of the patients in the Department of Oral Surgery of the University Dental Clinic , Tirana, Albania from 19 March to 18 May 2020. It is well known that the majority of dental restorative , prosthetic and periodontal procedures can be planed and scheduled in advance , but some dental pathologies require urgent treatment even during the epidemic. This study comprised 209 patients ( 90 females and 119 males ) , aged 1 – 85 years, with different urgent dental pathologies .There were 154 healthy patients and 65 compromised patients. According the recommendations of Minister of Health in Albania and in order to avoid the spread of infection we took our measurements for a safety treatment for the patients and operator . We classified the dental treatment that required the immediate management as following: - Uncontrolled bleeding - Soft tissue infection with intra and extra oral swelling patient s airway, absess and localized bacterial infection - Several dental pain from pulpal inflammation - Pericoronaritis - Surgical post operative osteitis - Dental trauma - Biopsy of abnormal tissue. No Covid 19 positive patients were treated . While following the guidelines for dental care provision during this epidemic time no Covid 19 new cases were detected among patients and staff. The data base of the patients treated during COVID-19 pandemic was prepared using the SQL programming language . The information was manipulated using the GROUP BY and COUNT functions to display the prevalence of disease dental conditions and treatments for those conditions . Based on the generated data , Excel was used to visualize the distributions of the aforementioned parameters using the built-in charts. Results In this study we share our 2 months experience in the treatment of 209 patients with different dental urgent pathologies. Our objective was to manage patients and make dental practice safe from any risk. All operators respected good personal hygiene . It was advised to wash hands with alcohol hand sanitizer for at least 20 s before and after each treatment , limited contacts with surface, computers as much as possible . Sterile preparations was applied on every step of the surgical practice , including dressing –undressing routine. Since airborne droplet transmission of infection is considered as the main route of spread particularly in dental clinics and hospital barrier protection equipment were strongly used for the operators and assistants during every surgical treatment ( protective eyewear, mask, gloves, caps, face shields, protective outwear ) Before the treatment each patient signed the declaration based into the following questionnaire. QUESTIONNAIRE - Have you had fever, cough, cold , breathing difficulties , muscle pain , lost of taste and smell , headache in the last 21 days ? - Have you have contacts with infected individuals in the last 21 days ? - Have you been in a previously quarantined area ? - Have you had contact with individuals coming from quarantined area ? Surgeons managed only one patient at a time avoiding contact with the other patients. The patients arrived at the University Dental Clinic and immediately they were admitted to a “ standby area “ under social distancing measures. We took also some rules for clinical areas. Everything that could come into contact with the patient had been disinfected . Every surface in the waiting room was considered at risk and for this reason it had been sanitized and properly ventilated before and after each appointment. A preoperational antimicrobial mouth rinse was used for every patient prior the treatment due to the fact that it generally believed to reduce the number of microbes. The patient discharged was performed under strict measurements , the prescription and advices were given into the discharge area.

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