INTRODUCTION

Wuhan, the provincial capital of Hubei, is the largest city in central China, with a population of over 11 million people. Many people were affected by a severe form of pneumonia in December 2019 [1]. This pathology had no recognized cause. SARS-CoV 2/human/Wuhan/X1/2019, a novel coronavirus, was discovered on January 9, 2020, after being isolated in pharyngeal and respiratory swabs of hospitalized patients [2-4]. This virus will be remembered as the causal agent when the World Health Organization declares a pandemic on March 11, 2020 [5].

The World Health Organization (WHO) has designated the SARS-CoV-2 virus-caused illness as COVID-19 (an abbreviation generated from the terms CO-rona VI-rus Disease and the year of identification, 2019) [6]. A sore throat or diarrhea might also be a symptom for certain persons. In 80% of patients, the symptoms are not too severe, but in 15%, the symptoms are so powerful that hospitalization is necessary. The last 5% of patients who develop severe dyspnea are sent to the nearest critical care unit [7]. There needs to be more definitive information on the surface stability of SARS-Cov-2 and its capacity for transmission from person to person. Therefore, the same methods used to contain earlier coronaviruses have been implemented.

COVID-19 is transferred largely through respiratory droplets produced after a sneeze or cough [8]. Transmission from an infected person to person occurs mainly through close contact with symptomatic individuals. Infected people may spread the virus to others more quickly when they have symptoms. Still, there is mounting evidence that the virus can be spread from person to person, even when symptoms are minimal or nonexistent [9]. It has also been acknowledged that the virus may be able to live outside of living creatures, either in aerosol or on inanimate surfaces [10]. The virus was found to be alive up to 72 hours after being treated with stainless steel and plastic, where it has a longer half-life (about 5.6 h and 6.8 h, respectively). The quick globalization of the Chinese epidemic emergency was facilitated by the high degree of globalization in our day, the unique transmissibility of SARS-CoV-2, and the pathophysiology aspects of the COVID-19 illness.

Several healthcare facilities, including dentistry offices and clinics, have severely restricted patient access by limiting clinical activities to urgent and non-delayed treatment in an effort to slow the spread of COVID-19. Dentists are at a very high risk of getting SARS-Cov-2 due to the close quarters needed for dental work (often no more than one meter) and the interaction of saliva, blood, and other bodily fluids during surgical operations. Additionally, various dental treatments can result in the production of aerosol [11].

The goal of this study is to offer dentists useful advice based on current understanding that may help them stop the spread of COVID-19, particularly during the post-epidemic phase. The following search terms were used in PubMed to look for a recently published article on the clinical and epidemiological characteristics of SARS-CoV-2 and the spread of COVID-19: "SARS-CoV-2 or 2019-n-CoV" or "COVID-19," "COVID-19 in Dentistry," "Spread of COVID-19," "Surface Stability of SARS-CoV-2," "SARS-CoV-2 and aerosol," "Prevention of COVID-19 Spread"

MATERIALS AND METHODS

This scoping review utilized studies from the databases such as PubMed, Mediline, ScienceDirect and Web of Science. A comprehensive search was conducted using keywords such as COVID-19; Dentistry; SARS-CoV-2; prevention procedures; Guidelines; coronavirus infection.

RESULTS AND DISCUSSION

Examination of Patients

In their routine practice, dentists use air-water syringes, water-cooling systems, handpieces, and ultrasonic scalers. Large droplets of water, saliva, blood, and pathogens are discharged from these devices in the form of a visible spray. The creation of these aerosols has the potential to be harmful and is notoriously difficult to control [12]. Because of these risks, comprehensive patient screening is required at any dental office or clinic entrance. The most straightforward strategy to stop the transmission of COVID-19 within a dental office is to identify infected individuals with weak symptoms using a telephone survey before they enter the facility.

According to research by Chinese researchers that was published in the New England Journal of Medicine (NEJM), 88% of COVID-19-positive patients have a fever with a body temperature over 37.5 degrees [13]. Even if only a small fraction of apyretic cases have been identified, a telephone survey might be conducted using a questionnaire that takes into account the most prevalent SARS-CoV-2 infection symptoms, potentially dangerous epidemiological ties, and the time period of transmission.

Treatments that are not essential need to be delayed for at least 14 days. If a patient has experienced a fever within the previous 14 days, there are positive epidemiological correlations, or they exhibit clinical COVID-19 signs or symptoms, they should be urged to see their primary care physician (even with an average body temperature). The patient should start measuring their temperature every 8 hours starting the day before the appointment; if the fever exceeds 37.3 degrees Celsius, the appointment should be delayed for at least 14 days (Figure 1).

Treating a confirmed, potential, or suspected case of COVID-19 at a public hospital with staff who have received the necessary training and have access to the required equipment is preferable. Dental treatments that generate aerosols should be postponed until the end of the day (maybe in a negative pressure or well-aerated environment), and a dental rubber dam should be used.

The Patient's Entrance

Patients are strongly advised not to bring any personal goods with them and to attend alone (no partners or family members), as well as to always wear a surgical mask. For the patient's treatment length, nannies and carers must be given the same rights as the patient and a seat in the waiting area.

These recommendations ought to be given to the patient at the anticipated appointment via a thorough recommendation. The operator will enter the room and, while donning gloves, a filtering facepiece particles 2 (FFP2) respirator, a visor, and a protective gown, take the patient's temperature using an infrared thermometer. If a patient has a temperature greater than 37.3 degrees Celsius and it is not an emergency, the appointment should be rescheduled.

The next step is for the patient to deposit their outerwear, luggage, and backpacks in designated storage areas. After removing the surgical mask, he will be instructed to dispose of it in a sealed container and wash his hands in a hydroalcoholic solution (Figure 2). After being fitted with protective eyewear, shoe covers, a gown, a cap, and a mask, the patient waits in the waiting room until they are summoned to the clinical area. The patient must continue to wear the protective equipment supplied until the clinical procedure is complete.

Appointment Planning and Waiting Room Organization

Since respiratory droplets are the principal means of SARS-CoV-2 transmission, appointments should be scheduled to keep the number of patients in the waiting area to a minimum of two meters [14]. Every treatment should be scheduled with a minimum of 30 minutes to ensure that the waiting area can be kept under control. Create a plan that takes the delay into consideration. Patients above the age of 65 and those who have many chronic systemic diseases are more at risk of contracting COVID-19. It is therefore advisable for them to hold their scheduled meeting as early in the day as possible [15]. For up to 48 hours, SARS-CoV-2 may survive on paper and cardboard [10]. As a result, decluttering the waiting room of ornaments, magazines, newspapers, and posters will aid in cleaning.

Plexiglass walls should be utilized to keep the receptionist and other employees dry if a desk is located in the lobby. The receptionist is required to wear a surgical mask and disposable gloves, which must be thrown away and replaced after each patient. Sterilization is required for all tools used in the billing and administrative procedures that come into contact with patients.

Methods of Obtaining Information at a Dental Office or Clinic

 It is against company policy to send an employee into the workplace with a temperature of more than 37.0 degrees Celsius without activating sanitary observation.

• Upon entering the clinic or office, dental staff members must take off their masks, put them in a closed container, and wash their hands for at least one minute with a disinfectant hydroalcoholic solution (Figure 2) or soap and running water.
• Workers with individual lockers must change into washable clothes and shoes before entering the facility. After the operation, they must re-sanitize with the hydroalcoholic solution (Figure 2). When working in a dental office or clinic, all employees must keep a minimum of 1.5 meters of separation and always wear a surgical mask. Except when required, they should occupy different dining and relaxing spaces at other times.
• Except when required, they should share different food and sitting places, etc., simultaneously.
• Before a patient enters a clinical area, staff members wear single-use PPE (PPE).
• It has been known from the early Chinese findings that COVID-19 might be spread by the contaminated secretions of eyes, mouths, and noses [16]. Use of personal protective equipment, including visors or protective glasses, disposable gowns with full coverage, respirators or masks, gloves, and headpiece caps, is therefore strongly encouraged.
• Before and while putting on protective equipment, operators should wash their hands thoroughly. Spanish research found that routine surgical cleaning with soapy disinfectant solutions may modify the bacterial flora, leading to staphylococcal and Gram-negative bacterial colonization. After numerous hand washes, hydroalcoholic gel with a concentration of 62% to 70% also seems to be well tolerated. Additionally, compared to alcoholic hand sanitizers, soapy solutions are connected to much more instances of contact dermatitis [17].

Before a surgical procedure, the World Health Organization (WHO) advises applying 5 mL of an alcohol-based gel to the palm of your hand and rubbing it into the skin surfaces of both palms and forearms for about 60 seconds, or until the gel has entirely evaporated. If you have cuts or scrapes on your hands, the emollients and alcohol in them could sting or burn a little (Figure 3).