Middle East respiratory syndrome in children: Dental considerations

Al-Sehaibany, Fares S.

In pediatric dental practice, effective infection control measures for the prevention or minimization of viral infection transmission can be implemented by a) controlling the gag or cough reflex; b) reducing aerosol/ splatter generation; c) managing contaminated air and; d) improving personal protection. The gag or cough reflex may be stimulated by certain procedures, such as posterior intraoral and bite-wing radiographs and taking impressions. Orthopantomographs or oblique lateral views may be considered instead of intraoral radiographs for screening, 40 whereas oral mucosa in very sensitive patients may be anesthetized before taking impressions. 41 Sedation may also be considered to control gag reflex. 42 Varying levels of physical, intellectual, emotional and social development of children and adolescents are major challenges for dentists especially attending to their psychological needs within adequate infection control regimen. Toys provided for pediatric patients may be a potential source of cross-infection. Soft toys are more likely to be contaminated, difficult to disinfect and may re-contaminate quickly compared to hardsurfaced toys. Furthermore, restraining devices used to control movements of pediatric patients such as Velcro fasteners may also be contaminated and should be disinfected accordingly. 43 Extra-oral evacuation devices and special aerosol reduction devices may be used in combination with ultrasonic scalers to reduce the amount of aerosol produced. 44, 45 In high-risk cases, chemomechanical caries removal 46 or the atraumatic restorative technique 47, 48 may be utilized to prevent or reduce aerosol and splatter generation. In addition, high-volume evacuation removes infectious droplets at the source as they are emitted; thereby, minimizing, or preventing their dispersion in the air. To maintain their efficacy, the filters in the suction apparatus should be cleaned every day, and the exhaust air should be vented outside to prevent the recirculation of contaminated air. 38 Contaminated air can be managed by improving dental clinic ventilation and/or by disinfecting the air. An ideal airflow pattern combined with a minimum of 3 air changes per hour has been recommended for dental clinics. [49] [50] [51] Moreover, although its use in dental clinics is unconfirmed, ultraviolet germicidal irradiation may be installed and is effective against fungi, viruses, and bacteria, namely, tubercle bacilli and anthrax. 38, 49 On the other hand, measures of improving personal protection include washing hands frequently before and after treatment, using disposable barriers, dispensing instruments and materials just before treatment (thereby preventing particles from settling on the surfaces), and sterilizing soiled instruments. 38 After each patient visit, surfaces may be disinfected using hospital-grade disinfectants, which are effective against coronavirus. 52 Personal protective equipment, such as gowns, hair covers, masks, gloves, shielded face masks and shoe covers, should be used as appropriate. 51 A higher level of respiratory protection should be considered, especially with aerosol-generating procedures. The use of N95 respirators offers a certain level of protection against the airborne transmission of SARS-CoV, although the exact level of protection offered by these respirators for individuals may vary. 53 Examples of personal protective equipment such as face mask with plastic shield (Figure 1 ) and N95 respirator (Figure