Urgent Dental Care for Patients During the COVID-19 Pandemic

Abstract:

Following the WHO announcement on 30^th January 2020 of a world health emergency due to a novel coronavirus there was risk to continuing the practice of dentistry. Early in the pandemic there was no vaccine, uncertain immunity level, and whilst ‘standard infection control precautions’ were escalated to ‘transmission-based precautions’, this was no guarantee of preventing transmission. There has been universal agreement that it was wise to suspend routine care but little international consistency about what care would need to continue. Emergency Care may describe those conditions that require immediate attention as life-threatening emergencies but Urgent Care is more difficult to define.

 Introduction:

There has been agreement that it was wise to suspend routine care early in the COVID-19 pandemic
but little international consistency about what care would need to continue. Emergency Care may describe those conditions that require immediate attention as life-threatening emergencies such as spreading infection and swelling compromising the airway. These patients typically pre-COVID-19 have presented directly o Accident and Emergency departments or been immediately referred from dental practice.

Timely and major reorganisation of dental care services is challenging. Early management of acute dental emergencies is important to avert patients from Accident and Emergency services to avoid hospital admissions. One concern is that with the suspension of routine dental care, more patients than usual could need admission for the management of acute dental infections that threaten the airway and require intensive care. The range of conditions considered likely to be urgent is variable and may include, fractured teeth or tooth with pulpal exposure, dental and facial pain, and dental and soft tissue infections. The vast majority of dental disease requires physical treatments. Pain may be managed to some degree with systemic analgesics but this can only be a temporary short-term holding position.

Learning Objectives:

• Emergency and urgent care descriptions are presented and discussed
• Planning safe return to routine dental care is discussed.
• Natural history of oral disease progression is described.
• Limitations of analgesic and antimicrobial management of dental disease discussed.
• Concerns about the clinical consequences of reduced access to dental care are discussed.