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References

Andersen KG, Rambaut A, Lipkin WI, Holmes EC, Garry RF. The Proximal Origin of SARS-CoV-2. Virological. 2020; (ii)1-7
To KK-W, Tsang OT-Y, Chik-Yan Yip C, Chan K-H, Wu T-C, Chan JMC Consistent detection of 2019 novel coronavirus in saliva. Clin Infect Dis. 2020; 1-14
Sabino-Silva R, Jardim ACG, Siqueira WL. Coronavirus COVID-19 impacts to dentistry and potential salivary diagnosis. Clin Oral Investig. 2020; 13-15
Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci. 2020; 12
Nejatidanesh F, Khosravi Z, Goroohi H, Badrian H, Savabi O. Risk of contamination of different areas of dentist's face during dental practices. Int J Prev Med. 2013; 4:611-615
Marquardt N, Greenberg S. Informing the design of proxemic interactions. IEEE Pervasive Comput. 2012; 11:14-23
Reddy S, Prasad MGS, Kaul S, Satish K, Kakarala S, Bhowmik N. Efficacy of 0.2% tempered chlorhexidine as a pre-procedural mouth rinse: a clinical study. J Indian Soc Periodontol. 2012; 16:213-217
Lim KS, Kam PCA. Chlorhexidine – Pharmacology and clinical applications. Anaesth Intensive Care. 2008; 36:502-512
Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect. 2020; 104:246-251
National Health Commission of the People's Republic of China. Criteria of Diagnosis and Treatment of Novel Coronavirus Pneumonia. 2020;
Eggers M. Infectious disease management and control with povidone iodine. Infect Dis Ther. 2019; 8:581-593
Kanagalingam J, Feliciano R, Hah JH, Labib H, Le TA, Lin JC. Practical use of povidone-iodine antiseptic in the maintenance of oral health and in the prevention and treatment of common oropharyngeal infections. Int J Clin Pract. 2015; 69:1247-1256
Béji S, Kaaroud H, Moussa F Ben, Abderrahim E, Zghidi S, Hamida F Ben Insuffisance rénale aiguë secondaire à la povidone iodée. Press Medicale. 2006; 35:(1)61-63
Murugesan GS, Venkat MP. The effect of iodine in patients using povidone-iodine mouth wash on thyroid function. Int J Otorhinolaryngol Head Neck Surg. 2019; 5
Lai MM, Cavanagh D. The molecular biology of coronaviruses. Adv Virus Res. 1997; 48:1-100
Galván M, Gonzalez S, Cohen CL, Alonaizan FA, Chen CTL, Rich SK Periodontal effects of 0.25% sodium hypochlorite twice-weekly oral rinse. A pilot study. J Periodontal Res. 2014; 49:696-702
Rich SK, Slots J. Sodium hypochlorite (dilute chlorine bleach) oral rinse in patient self-care. J West Soc Periodontol Periodontal Abstr. 2015; 63:99-104

Letters to the Editor

From Volume 47, Issue 4, April 2020 | Page 374

Authors

Dave Ching Yeung Liu

BDS (HKU)

Articles by Dave Ching Yeung Liu

Tracy Chui Yi Ho

BDS (HKU)

Articles by Tracy Chui Yi Ho

Vinson Yeung

BDS (Birmingham)

Dental Core Trainee, University Dental Hospital Cardiff/Cardiff and Vale University Health Board, Cardiff CF14 4XY

Articles by Vinson Yeung

Article

Dentists' risk in COVID-19 times

Coronavirus Disease 2019 (COVID-19) originates from a virus currently identified as SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2).1 The coronavirus is most abundant in the nasopharyngeal region and the salivary secretions in infected individuals.2,3 The virus may be transmitted via droplets or direct contact, including or even from asymptomatic patients.4

Dental professionals are particularly susceptible due to the nature of the occupation, working within intimate distances of patients.4,5 The Inverse-Square Law dictates that a dentist at 50 cm from a patient's mouth would be exposed to nine times more aerosol droplets (Figure 1) compared to a social distance of 150 cm6 (the calculation is based upon the intensity ratio calculated by the inverse-square law: (1/0.502) ÷ (1/1.502). This has not yet accounted for any increase in aerosol emission as a result of dental treatment.

Figure 1. The Inverse-Square Law dictates that a dentist at 50 cm from a patient's mouth would be exposed to nine times more aerosol droplets.

0.2% pre-treatment chlorhexidine mouthwash has been used to reduce the dental team's risk of contracting infectious diseases.7 Chlorhexidine has been shown to reduce intra-oral bacterial load, reducing the bacterial load of aerosol produced.7,8 However, its efficacy in preventing the spread of the SARS-CoV-2 virus may be questioned considering that it is an antibacterial with weak virucidal properties.4,9,10

Povidone-iodine can reduce the viral load in the oral cavity and oropharynx significantly, it was found to be potent against Middle-East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) coronaviruses.11,12 1% Povidone-iodine mouthwash was shown to reduce the viral titre of MERS and SARS coronavirus by 99.99%.11 However, its use should be excluded in those with iodine hypersensitivity, thyroid disease, impaired renal function, pregnant and breastfeeding women.13,14

The coronavirus envelope contains a lipid bilayer, which makes the virus highly susceptible to oxidizing agent disinfectants.15 0.5% Hydrogen peroxide at 0.5-1% and 0.21% sodium hypochlorite have been shown to be effective against coronaviruses.4,9 0.25% sodium hypochlorite mouthwash has been used in periodontal treatment.12,16,17 The use of these agents under dentist supervision, as pre-treatment mouthwash as an alternative to chlorhexidine, may be prudent in the current circumstances surrounding COVID-19.