Dental Tribune International

How diseases change standards in dentistry

By Monique Mehler, Dental Tribune International
March 31, 2021

LEIPZIG, Germany: In the 1980s, HIV—which causes Aids—modified the practice of oral healthcare. Now 40 years later, the COVID-19 pandemic has brought on similar changes, such as the improved use of personal protective equipment (PPE).*

A 2020 study by researchers from the University of British Columbia in Canada has investigated the parallel effects of HIV and SARS-CoV-2 on dentistry. Among other things, they looked at changes in PPE measures. To do that, they interviewed 45 local dental professionals, who all stated that, without a question of a doubt, dentistry could currently not be practised without the use of protective gloves and masks as a minimum.

One of the study participants, a certified dental assistant, explained that barehand dentistry was the norm until the arrival of HIV: “When I first started we didn’t use masks or gloves. But that all changed—we were all tested for HIV. And we were very mindful of that and that was when we started wearing glasses, and masks and gloves. Now you would never consider working on somebody without any of it.”

“Today, I could not even imagine thinking about treating a patient without gloves, but back then, it was normal”–Prof. Lior Shapira

In an interview with Dental Tribune International, European Federation of Periodontology President-Elect Prof. Lior Shapira shared his experiences during his long and successful career in dentistry: “When I was a student many years ago [laughs], I was working without gloves, masks or gowns and then HIV appeared. And then we learned how to protect ourselves from that virus through improving PPE measures. Today, I could not even imagine thinking about treating a patient without gloves, but back then, it was normal.”

“And now the same is happening with the coronavirus, and I think the most important lesson we have learned from it is the realisation that dental professionals need to fully protect themselves. Especially when performing aerosol-generating procedures, we will use gowns and caps, N95 masks—which we didn’t use before—and a face shield on top of it all. All these improved measures are probably here to stay and will become the new standard of care,” he added.

COVID-19 pandemic more difficult to handle

During the height of the HIV/Aids pandemic, oral healthcare providers were especially cautious of avoiding contact with blood during procedures. Now, with COVID-19, the concern is heightened because the virus is airborne and spreads through droplets and aerosols, which are everywhere whenever care is provided. The Canadian scientists explain that this concern is chiefly influenced “by a lack of a full understanding about transmissibility and the perceived impact of the virus on the cost and time associated with minimising or eliminating the risk of transmission within a dental setting”.

Like many other governmental bodies around the world, the Occupational Safety and Health Administration (OSHA), which is part of the US Department of Labor, has released guidance for dentistry workers and employees on its website. OSHA’s PPE standards are not a new legal obligation but include recommendations that should be executed in the workplace to protect patients and staff from potential transmission. As mentioned by Prof. Shapira, OSHA also lists disposable N95 filtering face piece respirators, gowns and face shields certified by the National Institute for Occupational Safety and Health as appropriate PPE ensemble.

A glimpse of what is to come

The general public is hoping that the coronavirus pandemic will be over at some point—preferably sooner rather than later. However, a recent survey conducted and published by Nature put a damper on that. It showed that “scientists expect the virus that causes COVID-19 to become endemic, but it could pose less danger over time”.

In the article, Dr Jesse Bloom, an evolutionary biologist at Fred Hutchinson Cancer Research Center in Seattle in the US, suggested that SARS-CoV-2 will probably become “a less serious problem and something like [the] flu”. Nevertheless, he also said that some people will still develop serious symptoms.

Just like HIV or any other disease that has heavily struck society, the coronavirus is here to stay in one way or another and will therefore have a lasting impact on the use of PPE in dentistry.

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