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Table of Contents
REVIEW ARTICLE
Year : 2022  |  Volume : 8  |  Issue : 1  |  Page : 5-8

Omicron And Its Implications In Dentistry


Department of Orthodontics and Dentofacial Orthopedics, Santosh Dental College and Hospital, Ghaziabad, Uttar Pradesh, India

Date of Submission12-Mar-2022
Date of Decision20-Apr-2022
Date of Acceptance25-Apr-2022
Date of Web Publication21-Jul-2022

Correspondence Address:
Palak Kulshreshtha
Department of Orthodontics and Dentofacial Orthopedics, Santosh Dental College and Hospital, Ghaziabad, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sujhs.sujhs_5_22

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  Abstract 


Due to its contagiousness and vaccine-escape mutations, the latest severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant Omicron (B.1.1.529) has sparked worldwide fear. The SARS-CoV-2 variant's critical infectivity and antibody resistance are determined by mutations in the Spike (S) protein receptor-binding domain (RBD). A comprehensive experimental study of Omicron, on the other hand, could take weeks or even months. For a hygienic and healthy work environment and treatment modality, we propose a standard operating protocol and protocols that all dental practitioners and staff should adhere to.

Keywords: COVID-19, dentistry, Omicron, personal protective equipment, standard protocol


How to cite this article:
Kulshreshtha P, Ahluwalia R, Chugh T. Omicron And Its Implications In Dentistry. Santosh Univ J Health Sci 2022;8:5-8

How to cite this URL:
Kulshreshtha P, Ahluwalia R, Chugh T. Omicron And Its Implications In Dentistry. Santosh Univ J Health Sci [serial online] 2022 [cited 2022 Dec 8];8:5-8. Available from: http://www.sujhs.org/text.asp?2022/8/1/5/351573




  Introduction Top


A new latest severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variation of concern (VoC), Omicron, was revealed on November 25, 2021, roughly 23 months after the first recorded case of COVID-19 and after an estimated 260 million infections and 5.2 million deaths worldwide.[1] Omicron was born into a COVID-19-weary world, replete with rage and resentment at the pandemic's extensive detrimental social, emotional, and economic consequences. This fifth VOC occurs at a time when global vaccine immunity is developing, whereas earlier VOCs occurred in a world where natural immunity to COVID-19 infections was frequent.

On November 11, 2021, the first sequenced omicron case was reported in Botswana, and a few days later, another sequenced case was discovered by a visitor from South Africa in Hong Kong. Many sequences from South Africa followed after the early revelation that the novel variant was associated to an S-gene target failure on a specific PCR assay due to a 69–70del deletion, comparable to the alpha version.[2] Although there are likely unexplained examples in numerous locations throughout the world before then, the earliest recorded case of Omicron in South Africa was a patient diagnosed with COVID-19 on November 9, 2021.

In South Africa, the average number of COVID-19 cases per day jumped from 280 cases per day the week before Omicron was discovered to 800 cases per day the following week, owing in part to greater surveillance.[3] COVID-19 cases are rapidly increasing in South Africa's Gauteng area; the fourth wave's early doubling time is faster than the prior three waves [Figure 1].
Figure 1: SARS-CoV-2 cases in the first, second, third, and fourth waves in South Africa's Gauteng province. *Time is doubled for the first 3 days following the ten instances per 100,000 population wave threshold. Up to December 1, 2021, 7-day moving average cases per 100 000 people. The data come from the South African Government's Department of Health.[3] SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2

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  Current Management of the Dental Patient Top


A flowchart regarding the standard operating protocol for patients seeking dental help has been shown in [Figure 2].
Figure 2: Flowchart of SOP for patient seeking dental treatment. SOP: Standard operating protocol

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Patient screening

Dentists employ rotating devices such as handpieces or ultrasonic scalers with water cooling systems and air–water syringes in their regular practice. These tools produce a visible spray of water, saliva, blood, and germs in huge particle droplets. This aerosol creation has the potential to be hazardous and is extremely difficult to control.[4] As a result, a thorough patient screening is required before entering the dentist's office or clinic.

Patients' arrival

At the dentist's office/clinic, patients must always wear a surgical mask and, if feasible, must be unaccompanied (no partners/relatives); personal items must be avoided. Nannies and caregivers of the patients must be treated similarly and must wait in the waiting area for the duration of the patient's treatment. These regulations must be communicated to the patient in the form of a thorough recommendation made at the planned visit. Upon entering, an operator should wear gloves, preferably a filtering facepiece particles 2 (FFP2) respirator/ N-95 mask, visor, and a protective gown that will screen the patients for all parameters as per the protocol.

If the patient's body temperature is above 99.14°F, the appointment should be rescheduled, especially if it is for nonurgent care. The patient will then be instructed to place any overcoats, bags, or backpacks in designated boxes or areas. He will be instructed to dispose of the surgical mask in a sealed container and sanitize his hands with hydroalcoholic solution. The patient is then given goggles, disposable shoe covers, a gown, headgear, and a surgical mask and is instructed to stay seated in the waiting room until called to enter the clinical area. Patients must wear the specified personal protective equipment (PPE) until the clinical procedure is completed.

Appointment scheduling and waiting room management

Because SARS-CoV-2 is mostly transmitted through respiratory droplets, appointments should be organized, so that the number of patients in the waiting room allows for a minimum interpersonal distance of 2 m. The predicted time of every procedure should exceed 30 min to avoid a significant number of patients sharing the waiting room. This extra time should be factored into the scheduling process. Patients who are elderly or have several chronic systemic disorders are thought to be more sensitive to COVID-19 infection.

As a result, it is best to plan their appointment at the start of the working day. To improve cleaning, ornaments, magazines, newspapers, and posters must be removed from the waiting area, as SARS-CoV-2 can live for up to 48 h on paper and cardboard.[5] If there is a desk at the reception, plexiglass dividers should be used to shield the personnel from drips. A surgical mask and disposable gloves must be worn by the receptionist, which must be replaced after each patient. During administrative and payment procedures, he or she is responsible for cleaning all things that come into contact with patients.

Dental office/clinic staff access modalities

All dental office/clinic employees (dentists, dental hygienists, assistants, receptionists, and others) are required to take their body temperature twice a day, in the morning and evening. If the operator's body temperature is above 98.6°F, he or she should not go to work, and sanitary observation should be initiated. Dental employees must wear a surgical mask before entering the dental office/clinic, then put on shoe coverings, throw the mask in a designated closed container, and wash their hands for at least 1 min with a disinfectant hydroalcoholic solution or running water and soap.

Staff members must keep their clothing and other personal goods in individual lockers and wear washable clothing and footwear in a personalized locker room. They must sanitize their hands again with hydroalcoholic solution after the process. All dental office/clinic employees must maintain a social distance of at least 1.5 m and wear a surgical mask at all times. They must avoid congregating in common eating and relaxing spaces, etc., unless it is required.

Nonsterile procedures personal protective equipment

The proper donning and doffing of PPE must be followed. The operators prepare themselves with disposable PPE as the patient prepares to enter the clinical areas (PPE). Before and during the PPE dressing procedures, operators must sanitize their hands. Surgical handwashing with soap and running water is required in the event of contamination with blood or biological material.

Clinical procedure

Patients must remove their surgical masks at the start of the procedure and reapply them at the conclusion. The use of a rubber dam during clinical operations is strongly suggested to prevent the spread of aerosols and potentially infectious biological material. Due to the possibility of virus and bacterium aspiration in the air and water tubes, which might potentially cause cross-infection for the contamination of the dental unit, using high-speed handpieces without any antiretraction valves should be limited during the epidemic. Air–water syringes should be used with caution and only when essential. Sensors must be double-covered to prevent perforation and cleansed properly after use to avoid cross-contamination when intraoral imaging is necessary. All dental and surgical operations should be carefully performed to avoid coughing and gag reflexes. During interventions, the treatment room door must be closed to prevent aerosol dispersion in adjacent areas, especially if the air conditioning systems are turned on. The treatment room should be properly ventilated and equipped with an exhaust system. The operator should also avoid being in the way of exhaust while the treatment is in progress.

Removal of personal protective equipment

After the clinical intervention, the operator must place all disposable PPE inside special double-layered garbage bags that have been sprayed with a 0.5% hypochlorite solution, knotted, and temporarily stored in a closed container with a pedal opening.[6] The abandoned equipment will then be disposed of by all medical waste disposal guidelines.

Treatment room considerations

The patient must remove his or her disposable gown and other PPE after the dental treatment, which must be handled and disposed of in the same manner as the dental operators. Strict sanitization is required on all surfaces of the dental unit, particularly in the spittoon region, as well as the dentist and assistant's stool. Spray and leave an aqueous solution of hypochlorite at 1% or alcohol at 70% for at least 1 min, working your way from cleanest to dirtiest parts. Wipe with disposable towels, being careful not to touch surfaces that have already been treated.

Other precautions include cleaning the dental unit's water lines with a 0.5% hypochlorite solution before each usage, as the remaining water could be contaminated with viruses and germs. After each intervention, a full air change in the clinical environment is required to decrease the danger of airborne infection, particularly if high-speed or ultrasonic devices were used. Air suction, filtration, and sanitary systems, such as fixed devices with plasma cluster ion technology or UV lights, portable air cleaners with High-Efficiency Particulate Air (HEPA) filters [this air filter can potentially eliminate 99.97 percent of dust, pollen, mold, germs, and any other airborne particles smaller than 0.3 microns][7] can be installed, or dedicated negative pressure rooms could be used as they allow for continuous air exchange.

In rooms or dental offices/clinics without direct windows, the usage of this equipment is required. Furthermore, an extra high-volume evacuation device could aid in the reduction of aerosol generation and droplet emissions during dental procedures, especially those involving the use of an ultrasonic scaler. It is required to disinfect anything handled by patients or workers regularly. Sanitizing the floors and other surfaces with 1% hypochlorite solutions can be done at the end of the working day. Alternative sanitizing processes, such as ozone disinfectant technologies, should be investigated because they combine a similar antiseptic ability to a liquid sanitizer with the improved surface distribution.


  Conclusion Top


In the last two years, research and advancements around the world have aided dentistry in evolving and formulating a strategy for performing normal dental work in the face of a pandemic. To summarise our understanding of the omicron variant, it spreads faster than any other currently known virus variant, and preliminary findings from a study conducted in the United Kingdom show that COVID-19 infections with the Omicron variant are less likely to result in hospitalization than infections with the Delta strain. In addition, the omicron virus strain spreads faster than the delta virus strain.[8]

Person-to-person contact, staggered appointments, and a complete sterilization procedure between patients must all be adhered to. Routine dental work should be continued, keeping the aforementioned precautions in mind. Only patients with comorbidities, cancer patients taking steroidal medications, and immunocompromised patients should be examined for urgent dental care. Rapid antigen test is currently recommended to be done for patients seeking dental treatment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
WHO Coronavirus (COVID-19) Dashboard; 2022. Available from: https://covid19.who.int/. [Last accessed on 2022 Feb 19].  Back to cited text no. 1
    
2.
Volz E, Mishra S, Chand M, Barrett JC, Johnson R, Geidelberg L, et al. Assessing transmissibility of SARS-CoV-2 lineage B.1.1.7 in England. Nature 2021;593:266-9.  Back to cited text no. 2
    
3.
COVID-19 South African Coronavirus News and Information Portal. SA Corona Virus Online Portal; 2022. Available from: https://sacoronavirus.co.za/. [Last accessed on 2022 Feb 19].  Back to cited text no. 3
    
4.
Harrel SK, Molinari J. Aerosols and splatter in dentistry: A brief review of the literature and infection control implications. J Am Dent Assoc 2004;135:429-37.  Back to cited text no. 4
    
5.
van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med 2020;382:1564-7.  Back to cited text no. 5
    
6.
Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect 2020;104:246-51.  Back to cited text no. 6
    
7.
What is a HEPA Filter? | US EPA. US EPA; 2022. Available from: https://www.epa.gov/indoor-air-quality-iaq/what-hepa-filter-1. [Last accessed on 2022 Feb 19].  Back to cited text no. 7
    
8.


    Figures

  [Figure 1], [Figure 2]



 

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