Clinical Considerations for Endodontic Treatment during the COVID Pandemic- ICPA

1. CLINICAL CONSIDERATIONS FOR ENDODONTIC TREATMENT DURING THE COVID PANDEMIC The study titled ‘Pandemic-Minded Endodontics: Clinical Tips and Considerations’ was originally published by Dentistry Today. Endodontic care during the COVID pandemic is now more important than ever. As clinicians face challenges due to the pandemic, practices must be adjusted by adopting specific protocols. In this article, we will provide some tips on how to adapt to the pandemic, provide efficient endodontic treatment, and reduce transmission risk in your dental office. Reducing transmission risks must include the use of PPE and droplet barriers. It can also include the following: •Enhanced patient diagnosis, screening, and triage •Reducing visits to perform treatment •Improving treatment efficiency to reduce patient time in the dental office •Mitigate the production of contaminated aerosols PRETREATMENT (COVID-RELATED SCREENINGS AND DIAGNOSES) Increasing patient visits may risk the spread of the COVID and also use up PPE resources. A good idea would to virtual telescreen and triage your patients when they visit you at the dental office with oral issues.

2. For instance, you can start by ruling out non-endo-related symptoms. You can also encourage patients to send extraoral and intraoral photos taken from their smartphones. You can also incorporate extraoral imaging like Panorex x-rays or CBCT scans for diagnosis. This can help mitigate the need for intraoral radiographs as it can entail the risk of patients gagging or coughing. Instead of an invasive exploratory endodontic access, a CBCT scan is recommended as it does not involve contact with blood or saliva. TREATMENT PLANNING To reduce patient visits, you must be prepared to treat patients who come for consultation only. This preparation can start before the patient’s appointment. Your staff must also educate patients on accepting same-day treatments for the benefit of their safety during the pandemic. After determining that the patient requires non-emergency or emergency treatment, you and your staff can be prepared to provide immediate treatment if needed. This can include having specific logistical clinical systems in place which can help with immediate treatment. Your front desk staff can also rearrange the schedule to accommodate unscheduled treatments. These steps would improve efficiency and improve the safety of your staff and patients. TREATMENT CONSIDERATIONS After determining that the endodontic treatment is necessary, keep the following things in mind: Mitigate airborne transmission of the virus by reducing or eliminating the production of contaminated droplets and aerosols by using a rubber dam isolation.

3. A benefit of using it during COVID times is the elimination of saliva contact during the drilling and file handling process. It also helps in the prevention of air droplets. Also, before the endodontic access, an antivirus oral rinse is recommended, along with bathing the tooth’s crown with the rinse solution. Reduce the patient’s time in the chair by performing the procedure as efficiently as possible with the following protocols and armamentaria. You can also reduce patient’s visit time by implementing the following protocols: •Make use of good illumination and enhanced magnification to effectively locate canals. •Use a dental microscope or loupes with an overhead light to achieve this. •Face shields are important. However, using them with a microscope could be a challenge. A creative way to use it would be to have the face shield come up from your chin instead of coming down from the forehead. •Use an electronic apex locator. This will decrease the need for numerous intraoral radiographs. •Implement endodontic NiTi filing systems. These require fewer steps and files than traditional NiTi filing systems. Following these protocols will help make the treatment efficient. It could also enable you and your staff to accommodate same-day treatments and endodontic emergencies. It is recommended to perform root canal treatments in a single visit. You can also attempt to restore the endodontically treated tooth in a single visit. This can be carried out immediately after a root canal, while the rubber dam isolation is present. This will help reduce coronal bacterial microleakage and mitigate the risk of tooth restoration fractures. Conclusion By following the above-mentioned protocols, you can not only provide effective endodontic care during the pandemic but also decrease the risk of viral spread among staff and patients. Also, by reducing patient visits, providing same-day treatments, and reducing the production of air droplets and aerosols, you will safeguard the viability of your dental practice.