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GUIDELINES FOR DENTAL EMERGENCIES DURING A PANDEMIC
Khayitova Mokhinur Dzhuraevna
Asian International University
https://doi.org/10.5281/zenodo.14720345
Abstract. Due to the complications of the pandemic, dental clinics are being transferred to
an emergency care mode. Of course, this makes patients with acute pain nervous if they are not
considered an emergency. In the meantime, we need to learn from the experience of foreign
colleagues and carefully consider what constitutes an emergency in dentistry and how to provide
treatment during a pandemic. This is based on the recommendations of the WHO, the Ministry of
Health, the American Dental Association, and the guidelines for emergency admissions in
pandemic conditions of the Royal College of Dental Surgeons of Ontario.
Key words: Pandemic, quarantine, covid-2019, dentistry, emergency, emergency medical
care.
РУКОВОДСТВО ПО ОКАЗАНИЮ НЕОТЛОЖНОЙ СТОМАТОЛОГИЧЕСКОЙ
ПОМОЩИ ВО ВРЕМЯ ПАНДЕМИИ
Аннотация. Из-за осложнений пандемии стоматологические клиники переводятся
в режим оказания неотложной помощи. Конечно, это нервирует пациентов с острой
болью, если они не считаются неотложной ситуацией. В то же время нам необходимо
перенять опыт зарубежных коллег и тщательно продумать, что является неотложной
ситуацией в стоматологии и как оказывать помощь во время пандемии. Это основано на
рекомендациях ВОЗ, Министерства здравоохранения, Американской стоматологической
ассоциации и руководстве по оказанию неотложной помощи в условиях пандемии
Королевского колледжа стоматологов Онтарио.
Ключевые слова: пандемия, карантин, covid-2019, стоматология, неотложная
помощь, экстренная медицинская помощь.
The category of emergency medical care includes maxillofacial injuries requiring surgical
treatment, maxillofacial inflammatory-infectious diseases, prolonged bleeding and pain that
cannot be eliminated with over-the-counter medications.
Materials and methods.
Emergency procedures include:
Severe toothache due to pulp inflammation.
Pericoronitis or pain in the third molar.
Postoperative ostitis.
Abscess or localized bacterial infection, causing local pain and swelling.
Teeth causing pain or damage to soft tissues
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Tooth damage / dislocation.
Optional procedures (not possible during quarantine):
Primary or periodic examinations and repeat visits.
X-rays.
Teeth cleaning and other preventive procedures.
Orthodontic procedures, in addition to procedures aimed at solving acute problems (e.g.
pain, infection, trauma)
Aesthetic dental procedures.
The patient should be explained the seriousness of the situation. Patients are nervous, afraid
and think about what will happen with the pain in their teeth. At this time, it is very important to
calm them down. Therefore, many specialists are in regular contact with their patients. Doctors
communicate by phone or video call, give advice and recommendations. In such a situation, remote
communication becomes the main method of communication between the patient and the doctor.
When the patient complains of pain, discomfort and asks to be seen in the clinic or at home,
do not rush to make an appointment or go to his home. Ask in detail about the symptoms. Perhaps
with pharmacological treatment of the problem it is possible to at least temporarily eliminate the
unpleasant symptoms. A recent study published in the British Medical Journal showed that some
emergencies can be treated with appropriate analgesics or antibiotics. If pharmacological treatment
alone does not help, then consultation about admission is possible. The most important thing here
is to strictly adhere to the sanitary standards and rules established by SanPiN. Contact with various
patient div fluids, such as blood or saliva, is completely impossible. Each room should have
bactericidal agents that sterilize the air. All staff use disposable personal protective equipment:
masks, gloves. Anything that comes into contact with the patient is disposable or thermally
sterilized in an autoclave. All reusable autoclavable instruments are packed in sealed Kraft bags,
each of which must have a color indicator of sterility.
Results.
Before accepting the patient, do not forget to ask about the symptoms of the
disease (sore throat, cough, fever, shortness of breath) by phone. As a rule, they are similar to the
symptoms of ARVI, so you should not take risks. It is necessary to measure the temperature of all
patients upon entering the clinic. If the div temperature exceeds 37, call an ambulance and do
not accept the patient. In addition, many experts recommend replacing the turbine handpiece with
hand tools, if possible. Or use them at low speeds. If the turbine handpiece must operate at high
speeds, the doctor should increase precautions. That is, the procedure should be performed with
gloves, a mask, eye protection, and protective clothing covering all areas of the skin. If your dental
practice cannot provide the necessary precautions to receive patients during a pandemic, you
should still first advise the emergency patient by telephone, and then contact the nearest dental or
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specialty practice that provides such care. Increase the amount of disinfection. While disinfection
is usually carried out before and after the start of work, in a pandemic, WHO recommends that
individual disinfection measures be taken for each patient. Due to disinfection, the viral titer (the
amount of virus per unit volume of material) is reduced. Use a rubber dam for emergency
endodontic intervention. After providing medical care, contact the patient after 7-10 hours, ask
about his health after the procedure, whether he has any symptoms of the disease. The patient may
not have symptoms of the disease at the time of the visit, but may have been infected during the
trip.
Remember the picture when a bright ray of sun shines into the office and you can see all
the dust and suspended matter in the air - there’s always a whole cloud around the dentist’s face!
This fine suspension always contains saliva with the virus! The doctor inhales, like a
medicine for inhalation.
The same thing happens when an ultrasonic tip is used during professional hygiene - the
smallest and most dangerous micro-suspension of water with saliva is obtained there. When using
a piezotome in surgery, the same applies.
Of course, the maximum level of contamination by water-air spray occurs when working
with Air-Flow type hygiene devices, as well as when sandblasting the hard tissues of teeth without
proper protection.
Yes, the virus will be contained by an FFP3 class mask.
But she also has her own working conditions - a DRY environment.
When moistened, it stops “breathing”, anyone who has tried it will confirm. And the
electrostatic membrane of a wet mask does not work, which retains viruses not mechanically, but
due to the electrical charge that is lost when moistened.
This is why you need to choose masks with an exhalation valve - they can work for 8 hours
or more - one mask is enough for the entire shift. Not to mention that it would be good to change
them after each patient (if the mask is without an exhalation valve, it works for about 2 hours) or
as they become moisturized, but at their current cost, not everyone can afford it.
And I don’t know where to buy them now at the peak of demand, and I can’t advise you on
anything.
Admit it - how many of you work in FFP3 and sealed glasses? That's the same...
All kinds of technical multi-layer respirators do not protect against the virus - given the
size of the pores, the virus can easily fly through - protection is allocated to separate categories of
respirators for a reason and they are expensive for a reason. A shield and eye glasses closed on all
sides reduce the risk of infection only when working in an FFP3 mask. The use of a rubber dam
also significantly reduces the risk, but does not eliminate it.
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Conclusion.
If your clinic is closed during the quarantine, donate supplies and personal
protective equipment to clinics and health centers that are holding emergency appointments.
During the quarantine, there will be an acute shortage of supplies and your help can be crucial.
Follow the established restrictions. Let's be careful and stop scheduled patient admissions. This is
a bit difficult for everyone, but the spread of the disease must be stopped, and to do this, you must
follow the rules. Do not risk your health, as well as the health of colleagues and patients.
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