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A number of facial protection measures to mitigate the spread of COVID-19 is available to clinicians. Here, we comprehensively explore the pros and cons of different types of face masks including N95 respirators, face shields, and powered, filtering-facepiece respirators (FFRs) currently used to reduce airborne infection transmission in the dental clinic. The controversial issue of the `fit test` prior to the use of N95 masks, and the related, current, UK and US recommendations are additionally discussed. The article concludes with a section on facial skin health, and practical measures for circumventing the adverse skin effects due to prolonged mask wearing.
CPD/Clinical Relevance: Post-COVID-19, ‘new normal’ entails significant re-adaptations of infection control in dentistry, including facial protection measures that are required for mitigating airborne infection transmission in the dental operatory. A strategic understanding of the theory and practice of facial protective measures, and the underlying technology of the various face masks and respirators available for dentistry, will be valuable for safeguarding the health of patients as well as the whole dental team.
Article
Healthcare workers (HCWs) are the frontline combatants in the current battle against the SARS-CoV-2 pandemic. Personal protective equipment (PPE), including face masks, remains as their most trusted and pivotal ally in this conflict, fought on many fronts against an unseen enemy that mainly manifests in the form of an airborne pathogen. Surgical mask wearing was hitherto considered to provide adequate universal protection against such pathogens in the dental operatory, and yet the advent of the readily transmissible SARS-CoV-2 has led to a re-examination of the classical facial protection paradigms in dentistry. Consequently, the profession is now confronted with new guidelines, and an array of novel respiratory protective equipment (RPE), such as N95 masks, and powered air-purifying respirators (PAPRs), that were not routinely used for facial protection. Here we review the current guidelines regulating RPE use and their management in dental practice.
The practice of dentistry is rather unique in that the patient cannot be masked during any dental procedure, and the dentist is in extremely close proximity to the oral operative site, which renders both the operator and the assistant highly vulnerable to airborne infection.1 Even though the rubber dam insertion might provide some degree of protection against aerosolizing oral fluids, many obligatory emergency procedures, such as surgical removal of teeth and drainage of intra-oral abscesses, preclude the use of such a barrier. Moreover, many dental procedures require the use of a handpiece with irrigant coolants, which generate significant virus-infested aerosols that may remain suspended in the air for prolonged periods. Due to these reasons, a high level of facial protection is required in dentistry, such as surgical masks and filtering-facepiece respirators (FFRs), in addition to eye protection, head caps, disposable gowns, shoe covers, and meticulous disinfection of all surfaces between patients, particularly if aerosol generating procedures (AGPs) are performed.
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