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 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 26-28

Simple infection control to dental radiology against to COVID-19 in a dental school in the Northern of Brazil


1 Department of Dentistry, School of Dentistry, Federal University of Pará, Belém, PA, Brazil
2 Department of Endodontics, School of Dentistry, University Brazil, São Paulo, SP, Brazil

Date of Submission07-Jan-2021
Date of Decision19-Feb-2021
Date of Acceptance20-Feb-2021
Date of Web Publication20-May-2021

Correspondence Address:
Pedro Luiz de Carvalho
Rua Augusto Corrêa, 01 – Guamá, CEP 66075-110, Belém, PA,
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jomr.jomr_1_21

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  Abstract 


The present work aims to produce a simple protocol, which can be integrated into the services provided by dental school in the Northern of Brazil to avoid contamination against COVID-19. A bibliographic search was carried out in the MEDLINE (National Library of Medicine, USA-NLM) database, with the keywords COVID-19 and biosafety dentistry. The inclusion criteria were articles in their full and free versions available for download. Proposed protocol for dental radiology recommends the cleaning and adequate protection of equipment and surfaces, personal protective measures, which may be obtained by simple procedures such as cleaning and covering of materials and equipment with plastic barriers. Infection control protocol in the dental radiology proposes simple and effective measures for to minimize the potential for disease transmission including COVID-19.

Keywords: Biosafety, COVID-19, dentistry


How to cite this article:
de Carvalho PL, Barbosa Freitas LV, Valente LG, de Medeiros JF. Simple infection control to dental radiology against to COVID-19 in a dental school in the Northern of Brazil. J Oral Maxillofac Radiol 2021;9:26-8

How to cite this URL:
de Carvalho PL, Barbosa Freitas LV, Valente LG, de Medeiros JF. Simple infection control to dental radiology against to COVID-19 in a dental school in the Northern of Brazil. J Oral Maxillofac Radiol [serial online] 2021 [cited 2021 Sep 27];9:26-8. Available from: https://www.joomr.org/text.asp?2021/9/1/26/316481




  Introduction Top


In the past 20 years, coronavirus has been responsible for two pandemics, Severe Acute Respiratory Syndrome (SARS)-CoV, in 2002 and Middle-East Respiratory Syndrome-CoV in 2012.[1] In December 2019, an outbreak of pneumonia caused by a new strain of coronavirus started in the city of Wuhan, Hubei Province, China, and quickly spread to another 24 countries. At the end of 2019, the novel coronavirus was named SARS-CoV-2. This novel coronavirus produces the disease classified as COVID-19, being the causative agent of a series of pneumonia cases in the city of Wuhan (China).[2] The nature and perfect measures for clinical management of human cases of SARS-CoV-2 infection have not yet been reported, and there are still many details to be clarified.[3]

Biosafety is a set of techniques that should be employed by health professionals to prevent accidents and cross-contamination in clinical environments. The prevention of cross-contamination is a crucial aspect in dental practice. Professionals working in this area should adopt basic prevention routines during their work, since they are responsible for protecting the team, patients, and the oral health-care environment, minimizing the risk of disease transmission.[4]

In dental radiology, the dental radiographer is under constant risk of contracting diseases in of this function in the face of the daily presence of infectious agents. Contamination with the patient's blood or saliva may occur in the equipment used if the asepsis techniques and biosafety standards are not adequately applied.[4] Some microorganisms can stay alive or with activation potential for more than 48 h and still survive inside the radiographic processing liquids.

To elaborate this protocol, the existing protocols were analyzed, and relevant information was gathered so that an adapted protocol could be used for the dental radiology. A bibliographic search was carried out in the MEDLINE (National Library of Medicine, USA-NLM) database, with the keywords COVID-19 and biosafety dentistry. The inclusion criteria were articles in their full and free versions available for download.


  Protocol for Dental Radiography Top


The purpose of this protocol is to standardize procedures and to promote cross-contamination control in the dental school of the Northern of Brazil, in order to avoid contamination against COVID-19, in addition to avoiding virus transmission to health professionals.

Dental radiographer

The 4-handed method is indicated for clinical environments with a dental image, both dressed in protective equipment: surgical cap, medical mask, disposable latex gloves, eye protector, and lab coats.

The mask should be used to avoid the contamination of the mouth and nose by respiratory droplets when the professional operates at <1 m from the patient.

The gloves of nonsurgical procedures should be worn when there is a risk of contact of the hands with blood, body fluids, secretions, excretions, mucous membranes, nonintegral skin, and contaminated articles or equipment, to reduce the possibility of transmission of microorganisms to the workers.

The face shields should be worn when there is a risk of the dental radiographer being exposed to blood splashes, body secretions, and excretions. It is suggested for disinfection, the use of sodium hypochlorite, or other disinfectant recommended by the manufacturer of the protective equipment. The use of glasses should be systematic, in clinical environments that include operative practice and radiographic examination.

The apron should be waterproof and worn during procedures where there is a risk of blood splashes, body fluids, secretions, and excretions, to avoid contamination of the dental radiographer's skin and clothing. It should have long sleeves with elastic cuffs. Furthermore, it must be made with good quality material, nonallergenic and resistant, providing an effective antimicrobial barrier, besides allowing the execution of activities with comfort and being available in several sizes. The dirty apron must be removed and discarded after the procedure and before leaving the service area. After the removal of the apron, hygiene of the hands should be immediately performed to avoid the transmission of microorganisms to the professional, patients, and environment.

X-ray equipment

The tubehead, position-indicating device, control panel, and exposure button must all be covered or disinfected. The bite block, frontal support, and chin support of the panoramic apparatus should be cleaned and decontaminated with alcohol and covered with a plastic barrier, exchanged between each patient.

The next step should be to clean and decontaminate the lead apron and thyroid protector with alcohol. In addition, the cleaning and decontamination with alcohol of all the supporting surfaces should be done before the beginning of the activities, covering them with plastic film.

Image receptor

At each exposure, the plastic protector is carefully removed so that the contaminated glove does not touch the image receptor and it falls into a clean disposable cup.

Film holder

The film holder, after their use in the radiographic procedures, should be submitted to chemical disinfection with immersion in enzymatic detergent. The quick wash should be done in running water to remove the disinfectant solution, followed by drying with paper towels. Sterilization should be done in an autoclave with a suitable container, according to the manufacturer's instructions.

Film processing

After all the radiographs should remove and dispose in an appropriate container, all the plastic protecting the equipment. Radiographic processing is carried out in a darkroom or a small daylighter loader after execution of the radiographic technique and, disposal of the contaminated protective barriers used.

Digital radiography

Solid-state sensors with cable must be protected with long plastic bags that cover the sensor and the whole portion of the cable that will be handled. Phosphorus plate sensors must be covered with appropriate wrappers, generally those recommended by the manufacturer. The central processing unit monitor and keyboard of the computer should be protected, if possible, with plastic cover and preferably handled without gloves, with decontaminated hands.


  Discussion Top


The virus is transmitted through direct contact with respiratory droplets from an infected person (produced during coughing and sneezing). Individuals can also be infected by touching surfaces contaminated with the virus and the face (e.g., eyes, nose, mouth). It is well known that mouthwash before treatment reduce the number of microorganisms on surfaces and the environment.[5] Thus, it was noted that it is important to define the role of dental services in the management and control of COVID-19 infection, as well as the disposition of instruments and how they should be handled in clinical environments for oral health professionals in Brazil.

Cross-contamination may occur frequently during routine intraoral radiographic examination. The X-ray equipment can become contaminated with the oral flora now it is positioned for each exposure by the professional, who handles the image receptor at each exposure. Therefore, there should be an infection control that is not distinct among the patients, among those who know or do not know to be infected.[6]

Intraoral image receptors must be packed with plastic material and have their ends sealed with a sealing machine, reducing, or eliminating their contamination.[5] These wrappings should be removed as soon as the films are removed from the oral cavity, bearing in mind that the contaminated glove should not meet the film. Despite the new guidelines for film and film processing, in our geographic region, we still use a darkroom equipped with a stopwatch, thermometer, and other resources to ensure processing.

Digital radiography should also receive the same attention regarding cross infection control. Intraoral phosphor imaging should be protected with disposable plastic cover before each exposure and exchanged between each patient. Wenzel et al.[7] recommend that the ultraviolet light from a scanner be used for the disinfection of the phosphor-coated plates of the indirect digital system between the care of each patient.

The computer monitor should be covered in heavily touched areas, and if the screen does not have a protector, it should be disinfected with an intermediate level disinfectant. If there is a printer in the operating field, it should be covered by a plastic barrier. In and the central processing unit must be protected by plastic barriers.


  Conclusion Top


Simple infection control protocol in the dental radiology proposes simple and effective measures for to minimize the potential for disease transmission including COVID-19.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci 2020;12:8.  Back to cited text no. 1
    
2.
Shamszadeh S, Parhizkar A, Mardani M, Asgary S. Dental considerations after the outbreak of 2019 novel coronavirus disease: A review of literature. Arch Clin Infect Dis 2020;15:e103257.  Back to cited text no. 2
    
3.
Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci 2020;12:9.  Back to cited text no. 3
    
4.
Hamedani S, Farshidfar N. The practice of oral and maxillofacial radiology during COVID-19. Oral Radiol 2020;36:400-3.  Back to cited text no. 4
    
5.
Yu J, Ding N, Chen H, Liu XJ, He WJ, Dai WC, et al. Infection Control against COVID-19 in Departments of Radiology. Acad Radiol 2020;27:614-7.  Back to cited text no. 5
    
6.
Paul N, Jackie B. DJR and DBT. Recommendations for Diagnostic Imaging during COVID-19 Pandemic; 2020. Available from: https://www.rcsen g.ac.uk/-/media/files/rcs/fds/guidelines/dental-radiography-covid19.pdf. [Last accessed on 2020 Dec 12].  Back to cited text no. 6
    
7.
Wenzel A, Kornum F, Knudsen M, Lau EF. Antimicrobial efficiency of ethanol and 2-propanol alcohols used on contaminated storage phosphor plates and impact on durability of the plate. Dentomaxillofac Radiol 2013;42: doi.org/10.1259/dmfr.20120353.  Back to cited text no. 7
    




 

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