Precauzioni per odontoiatri e strutture odontoiatriche in epoca di pandemia COVID-19

OBJECTIVES At the beginning of January 2020, a new coronavirus was isolated, a potentially lethal respiratory infectious agent called SARS-CoV-2. The disease it causes was called COVID-19 (COronaVIrusDisease 2019). From a microbiological point of view, coronaviruses (CoV) are a family of RNA microorganisms causing respiratory diseases with a wide spectrum of intensity, from the common cold to severe respiratory syndromes (SARS-Severe Acute Respiratory Syndrome, MERS-Middle East Respiratory Syndrome). DISCUSSION As for other respiratory viruses, the transmission pathways is the airborne one (through the drop-lets by the infected patient) and direct contact. Experimental data demonstrate that SARS-CoV-2 re-mains active in aerosols for a long time, and droplets can settle contaminating the surfaces of the operating room. Dental professionals have consequently been classified as highrisk subjects. Among the guidelines for the control of cross-infection in dentistry, a common denominator appears to be the triage. The aim of this procedure is to avoid the treatment of asymptomatic or pre-symptomatic patients in unequipped health facilities. The triage applies a set of questions on the patient’s state of health in two specific moments, spaced over time, in order to per-form a double-check. A first triage is be carried out by telephone and a second during the arrival at the dental practice. From the disinfection point of view, ethanol at a concentration higher than 78% appears to be able to inactivate the virus in 60 seconds as well as 0.1% sodium hypochlorite and 1% povidone io-dine. Furthermore, the use of anti-microbial mouthwashes seems useful to reduce the contamination by aerosols produced by dental handpieces. From the mouthwashes point of view, 0.5% hydrogen peroxide is active in 60 seconds, 1% povidone iodine in 15-60 seconds, while benzalkoni-um chloride and chlorhexidine demonstrated a reduced efficacy against coronaviruses. CONCLUSIONS From the point of view of aerosol contamination, the risk for the Dentist appears real. CLINICAL SIGNIFICANCE The results of recent research demonstrate how the spray emit-ted by the turbine, multiplier contra-angle, and ultrasonic scaler is able to contaminate the whole operatory room, including the walls and the ceiling, up to a maximum distance of 360 cm. We do not have direct experimental evidence, but it seems useful to replace mains water of the hand-pieces spray with 0.5% hydrogen peroxide. This measure could significantly reduce SARS-CoV-2 spreading by the aerosol produced by the handpieces. In this way, the infectious agent would leave the oral cavity of the positive patient with the disinfectant agent. The risk of cross-infection should be significantly reduced.