In May 2009, the Harvard School of Dental Medicine, USA, was closed due to S-OIV infection in dental students.37,38 It is unknown how much dental clinical settings are and will be affected by this influenza. Strict adherence to infection control guidelines is therefore essential.
However, the guidelines are changeable, depending upon update information. One should follow the websites of health authorities. In this review, we pursue the recommendations by the California Dental Association (CDA) and the Interim Centers for Disease Control and Prevention (CDC) Guidance for Clinicians and Healthcare Professionals. These guidelines suggest early detection of known or suspected cases with S-OIV infection: fever and influenza-like illness.
The ill person should be isolated. He should be kept in the private room with the doors closed. A disposable surgical mask, towel paper and no-touch receptacles must be offered.17,22,39,41
Masking the coughing patient, when tolerated, stops the detection of the virus 20 cm away.42 Elective dental treatment must be postponed and the patients should be advised to seek appropriate medical care.
Viral transmission occurs until 7 days after symptoms resolve. If urgent dental care is needed,then there is a specification that an airborne infection isolation room with negative pressure air handling with 6 to 12 air change per hour is necessary. High-risk aero solgenerating dental procedures require a ‘fit-tested’ disposable respirator (N95, P2 mask or equivalent), eye protection (goggles or face shield), impervious gown and gloves. This personal protection equipment (PPE) is pivotal to prevent direct skin, conjunctival and inhaling exposure. During PPE removal, self-inoculation should be avoided.
Maintaining an arm's length from other persons whenever feasible is helpful because the virus can survive on inanimate surfaces and is transmitted through direct human contact. Hand washing with antimicrobial soap or solution or some alcohol based hand rub or antiseptic hand wash should be used after coming in cantact with contaminated material along with routine cleansing and disinfection. In areas with established transmission, dental staff should have access to chemoprophylaxis and early treatment if symptoms develop.
Non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided because they may enhance viral virulence, aggravate symptoms, and subsequent multi-organ failure.
However, this requires further confirmation. Antipyretics may risk the patients on decreased immune response and prolonged illness. Good knowledge and attitude does not guarantee strict adherence to infection control practices. The CDC calls for attention of healthcare providers, institutions and organisations to barriers to adherence to its infection control guidelines.
We summarises an algorithm for managing dental patients in the era of S-OIV influenza in Fig. 1.
S-OIV is the newly emerging RNA virus, even though it remains unknown where and how it evolved. Genetic mutations, which may results in ‘antigenic shift’ (major genetic rearrangements between strains, associated with pandemics) and antigenic drifts (more minor genetic variations associated with epidemics), helps the virus escape the human natural immunity. Clinically, the manifestations are not different from those of contemporary human seasonal influenza, requiring particular tests for the definite diagnosis. Neuraminidase inhibitors are effective in most cases. Strict adherence to infection control guidelines is critical to control the disease. Unless it is urgent, dental treatment in ‘suspected’ or ‘confirmed’ patients should be deferred to ‘at least’ 7 days after symptoms resolve. Close vigilance and early viral therapy for the presumed infection in dental staff are pivotal, especially in areas affected by this novel virus.
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