Volume 7, Issue 2, February – 2022 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Dental Considerations in Patient’s

with Infectious Disease
Dr. Kumari M Dr. Sai Charan K V Dr gayathri
2nd year post graduate student, Department of Oral Medicine Department of Oral Medicine
Department of Oral Medicine and and Radiology, Ragas dental and Radiology, Ragas dental
Radiology, Ragas dental college and college and hospital, 2/102, college and hospital, 2/102,
hospital, 2/102, ECR, Uthandi, ECR, Uthandi, ECR, Uthandi,
Chennai-199 Chennai-199 Chennai-199

Abstract:- The rapid transportation methods are I. INTRODUCTION

abundant in this century, so there islike hood of
increasing infections being imported into countries The oral cavity is a portal of entry for many pathogens
though, some infectious disease are under control by like herpes ,treponema pallidum ,HIV etc, these organisms
continuous research effort and vaccination ,the new getting locally proliferated in the oral cavity ,it causes
pathogens getting increased on other side. The dental damage of tissue in oral and pharyngeal region and enters
professionals come in close contact with infectious into bloodstream and gets proliferating rapidly to manifest
patients during the dental procedures. This paper symptoms of the systemic disease. The oral lesion could be
emphasizes about precautions to taken by the dentist to either primary symptoms are secondary manifestations of
prevent them, also preventing the transmission of systemic disease with common symptoms like fever,
infectious disease to other patients and adding sound malaise, headache, sore throat, respiratory disease, rash,
knowledge of viral, bacterial and fungal disease. pain, etc. The laboratory test are usually aids in definitive
diagnosis of the disease and classic presentation in which
Keywords:- Infection, Bacteria, Protocol, Sterilization, the patients symptoms correctly fit, it also helps in
Prevention. appropriate management for the patient.(1)

• CLASSIFICATION

VIRAL BACTERIAL FUNGAL

•Viral hepatitis •Actinomycosis •Aspergillosis
•HGY •Tuberculosis •Blastomycosis
•HIV •Syphilis •Coccidomycosis
•SARS COVID •Gonorrhea •Candidiasis
•Meningococcal •Mucormycosis
meningitis •toxomoplasmosis

Chart 1: classification of infectious disease

II. DENTAL CONSIDERATION IN HEPATITIS  PREVENTION

PATIENT  Three doses of Hepatitis B vaccine should be given
to all the dental health care providers
In dental practice ,HBV VIRUS infection remains  Proper history of hepatitis should be recorded
common as the HBV is concentrated in the gingival sulcus.  A carrier rate is high among patient with conditions
HBV virus is also found in blood and nasopharyngeal like lymphoma,lepramatous leprosy, down’s
secretions. Blood contamination is often found in aerosols syndromes.
produced by ultrasonic scaler,using antiseptic mouthwash  Most of the patients on immunosuppressive drugs
before the procedure can reduce contaminants.Hepatitis give positive history of HBV infection.
HCV possibly has salivary route of transmission. HCV
RNA is concentrated in gingival sulcus.

IJISRT22FEB871 www.ijisrt.com 925

Volume 7, Issue 2, February – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
 GUIDELINES produce a wide range of illnesses from pneumonia, to “strep
 Only emergency dental care procedures are provided throat” to meningitis, which is a risk.
to the patient.
 HBV virus remains in the person for about period of C. Tuberculosis
3 months ,though patient remain asymptomatic,in this Mycobacterium tuberculosis, is the bacteria which is the
scenario only emergency dental care should be cause for tuberculos is which. Aersolized bacteria may
provided. remain adjourned in the air for long periods of time and then
 HBsAG and HBs laboratory test are checked before inhaled into the lungs of person who is prone for infection.
the procedure. The transmission of tuberculosis is not only prevented by
 If HB antibodies tested negative,but HBV symptoms wearing a mask, it is important duty of the dentist to
are detected .The test should be repeated. identify patients at high risk. Before providing the dental
 Patient with anti HBs are positive.the patient is treatment the susceptible individuals must be referred to the
treated appropriate physician for treatment of the disease. In case of
 Patient with HBsAg arenegative,proceeded with emergency dental care is necessary for patients with active
treatment. tuberculosis, they should be referred to a dedicated
 Patient with HBsAg are positive (then patient is branches.
chronic carriers)then HbsAg degree of infectivity is
The detailed history taking and physical examination
determined.
of patients, particularly high risk groups will support the
 TREATMENT dentist in identifying the TB patients and referred
 Measuring the bleeding time and prothrombin time appropriately for medical treatment. For those who are
before the dental procedures is mandatory. already on anti-tuberculous treatment (ATT), sputum culture
 Full barrier technique is should be followed strictly. must be done to confirm that disease is not in active state.
 The headrest also should be covered properly. The liver function of the patient should be monitored
 Using of disposable gauze, gloves ,floss ,salivary properly because of hepatotoxic antituberculosis drugs and
ejectors , face masks, gowns, gloves are advised. prescribing certain drugs which are metabolized in the
 2% activated glutaraldehyde is used to wipe the liver should be avoided .Transmission of TB infection
surfaces. occurs very frequently in the dental clinics either from
 Chlorhexidine gluconate is recommended for doctor to patient or from patient to dental staff. The possible
prerinsing the mouth. routes of transmission are through direct contact either by
filthy instruments or mycobacteria on dentist’s fingers.
III. DENTAL CONSIDERATIONS IN BACTERIAL Hence it is important that proper office protocols are
DISEASE followed to prevent its transmission of the disease. The
guidelines for infection control in dental settings 2003 from
Several studies have observed the transmission of the CDC reinforcing the dentist regarding need for proper
bacteria in dental practice. Bacterial carriers remains handling and surface disinfection of instruments.
asymptomatic and risk of spread of disease to the dentist
from patients can prevented by following infection control D. Potential routes of transmission of infection include
measures, such as using hand gloves, face masks, protective  Getting direct contact with oral fluids, blood or other
eye wear and hand hygiene practices in order to prevent body fluids.
the bacterial contamination.  The contaminated instruments, equipment or
environmental surfaces are contacted indirectly.
A. Staphylococcus aureus
 Contact with eyes, nose, mouth and / or mucous
The S. aureus, including methicillin-resistant S.
membranes with droplets/splatter which contains the
aureus (MRSA) are commonest reason for nosocomial
microorganisms.
infections. These strains are no longer confined. The
 Inhalation of microorganisms that can remain
oropharynx is naturallocale of S. aureus, which are evident
suspended in the air for longer periods of time.
on denture bearing areas are identified. Failure of following
infection control protocol leads the dental professionals into E. Guidelines for dental management of tuberculosis
trouble.(4) patients;
B. Other Bacteria  Using the ultrasonic scalers and highspeed handpieces
In the mouth and throat of the people who hasinfected in TB infected patients should be avoided.
person who have no symptoms. Asymptomatic carriers can (Aerosolized M.tuberculosis can endure more than nine
transmit these bacteria to vulnerable people in whom hours). During the dental procedures the aerosol
infection can easily occur. The route of transmission is via production is reduced by using high volume suction .
droplet spread, which can be prevented by wearing a  The rubber dam isolation with high vacuum suction
facemask and washing or proper disinfection of hands, Only isperformed,if the patient has productive cough it is
10 to 20% of people are asymptomatic carriers. Bacteria that better to avoid using rubber dam.
canspread in aerosols include: group A  Maintenance of proper hand hygiene, personal
streptococci, Streptococcus pneumoniae, Haemophilus protective equipment like eye shields, facemasks, head
influenzae, Neisseria meningitidis, Corynebacterium caps, gloves and surgical gowns is essential.
diphtheriae and Bordetella pertusis. These bacteria can

IJISRT22FEB871 www.ijisrt.com 926

Volume 7, Issue 2, February – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
 Using a well constructed, soft pleated, high filtration V. DENTAL CONSIDERATIONS IN COVID
facemasks. The Standard face masks not ever protect
against TB transmission, hence particulate face masks The novel Corona virus is RNA virus which is single
must be used and often changed at regular intervals to stranded which belongs to family of Corona viridae, which
prevent infection. Face masks should have at least 95% infection through idroplets .Saliva plays most important role
Bacterial filtration efficiency (BPE) for particles 3μm in transmission among humans. In dentistry, procedures are
diameter. While treating patients with symptoms of TB done directly on the patient’s mouth and getting contact with
infection, the operator should wear respirator masks. saliva which is inevitable. Most of the procedures in
dentistry involve production of aerosols, thereby dentistslies
IV. DENTAL CONSIDERATIONS IN HIV PATIENT in a high-risk category with risk of 92.3%

The Human immunodeficiency virus (HIV)is etiology A. Guidelines by DCI

for AIDS . HIV infection is a communal threat and can Patient waiting area (previewing area):
easily be termed as expletive upon the human race. The  The previewing area is the initial pointof contact with
scientific community first perceived and recognized the the patient.
presence of AIDS as an actual disease following a growth in  Displaying the information about covid -19 as posters.
the incidence of very rare opportunistic infections and  Visual alerts at the entrance of clinical area about
cancers among homosexual men. respiratory hygiene, cough, social distancing is
mandatory.
AIDS is now chronic disease with new antiviral  Wearing of PPE is compulsory
strategies, HIGHLY ACTIVE ANTIRETROVIRAL  In the checkingarea,, the patient is counselled to get
THERAPY (HAART) has significantly reduced mortality tested for COVID-19 if patient haspositive travel
rate among HIV patients ,who can survive up to 20 years
history, epidemiological contact history, or feverand
with disease. Only 20% of HIV positive patients were
respiratory symptoms.
unaware of their infectivity.
 The triage area is disinfected immediately. The patients
The prevention of infection starts from recording areelucidated about theroute of spread of COVID-19,
proper history of the patient, using protection barriers like involved risks, and they are asked to sign
PPE ,sterilizing instruments and the laboratory materials. If obligatorily.(5)
HIV infection is suspected it is better for the patient is
VI. OPERATING ROOM GUIDELINES
analyzed by laboratory investigations. The CDC
recommends Enzyme immunoassay is standard technique to As per the modern suggestion given by the Ministry of
detect presence of HIV antibodies. Health and Family Welfare (MOHFW)on ventilation and air
quality management in dental clinics and central AC
The protection attires include wearing proper chin
buildings. In stand-alone dental clinics or single room
length plastic face shield or surgical masks along with
operatory, use of a ceiling fan should be avoided while
protective eyewear which protects the dentist during the
performing the dental procedures. The natural air must be
splatter ,to avoid contamination of blood latex vinyl
circulated in and out through frequent opening of windows
gloves should be used. The disinfection of chair should be
and using an exhaust blower to extract the room air into the
done properly. The handles of light in the dental chair
atmosphere. The table fan may be kept behind the operator
should be properly covered by plastic wrap or aluminum
to let air flow towards the patient. For operatory rooms that
foil. During the procedures, the needles, blades and scalpels
has central air-conditioning systems, blocking of return air
should be handled carefully, which must disposed in
vents in the patient area must be blocked and fresh air into
puncture resistant containers .The one handed scoop
the room must be allowed by opening of windows.
technique is advised during the needle recapping .All heat
 The dental water lines are disinfected with 0.01%
tolerant instruments should be autoclaved while hand piece
NaoCL is mandatory.
should be sterilized according to instructions of the
 Dental professional should wear PPE
manufacturer. The handpiece should run for 30 secs to clear
 Fumigation the operating room should be done regularly
the water lines. The laboratory supplies and materials are
 For changing PPE ,the private room should be provided
disinfected by tuberculocidal disinfectant The material
 The dentist are advised to wear googles/face shields for
received from dental laboratory should be cleaned and
protection.(6)
disinfected before using in patient’s mouth .In case of
 Triple-layer surgical mask or N95 respirator masks are
sending biopsy specimen ,the outer surface of the specimen
advised during the dental procedures.
container should not be contaminated.
 FFP3 standard mask are used while treating COVID-19-
The needles are used repeatedly they should be positive patients.
recapped and placed in a instrument tray which is sterile  During procedures the surgical gloves are advised
.There is a high chance of sharp injuries during dental  The proper disposal of coverall/gowns with
treatment ,it is suggested that most needle stick area should hood/waterproof lining are advised.
be washed immediately with washed with water and soap,  The covering of shoes are compulsory
any splashes in skin or mucosa must be flushed with water,  In a designated rooms , PPE wearing and removing
eyes must be cleaned with clean water. Any kind of protocol must be followed.
exposure should be treated with an hour.  The surgical mask must be disposed for every patients.

IJISRT22FEB871 www.ijisrt.com 927

Volume 7, Issue 2, February – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
A. Treatment Guidelines revised from time to time through an authorized biomedical
 The non aerosol-generating (non-AGP) and the aerosol- disposal agency by the State Pollution Control Board.
generating procedure (AGP) are types of types of dental
procedures. VII. INSTRUCTION FOR THE PATIENTS
 All the dental procedures are preceded by using
Before entering the clinic the patient are advised to
preprocedural oral rinse 1% hydrogen peroxide or 0.2%
wear mask. The hand should be properly sanitized. The
povidone iodine for 1 minute. Scrubbing of the face with
dentist has to maintain automated treatment records only.
antiseptic wipe.
Cashless/contactless payment methods is to been cougared.
 The AGP is to be done ideally in designated isolated
If patients develop covid symptoms after procedure ,He/she
rooms which is equipped with HEPA filters/augmented
should be guided to inform back to the dental clinic.
ventilation. To minimize aerosol contamination, during
the dental procedures using rubber dams and high- The dental practice stands regulated by the regulatory
volume saliva ejectors. authorities provided by DCI, should function accordingly
.The guidelines for dental management put forth by the DCI
B. According to Instrument Sterilization Guidelines :
will guarantee safe dental practice, which is the need of the
All the instruments pertaining to dental procedures are
hour. These guidelines may vary from time to time and
disinfected, cleaned, and sterilized as per the standard
regional need based on disease course. It is the
infection-control protocol (CDC, 2003). All the instruments
accountability of healthcare facilities and individual dentists
must be obligatorily sterilized in color-changing sterilization
to be aware of the updates and redefine their facilities and
autoclave pouches .The proper storage to be done in the UV
practice accordingly.
chamber.
 Route of transmission (7)
The UV sterilization of the instruments for minimum  Infection spread through hand – Hepatitis B,C,D
of 10 minutes between procedures is effective. The dental ,Meningitis
operatory room after the procedure, should be thoroughly  Infection from hand – Hepatitis B,C,D conjunctivitis
fumigated and sterilized under UV light overnight. ,Candidiasis ,Rhinitis
 Infection from splashed material -Diphtheria,Flu,Common
C. Biomedical Waste Management: cold Tuberculosis ,Candidiasis
All biomedical waste pertaining to patient care should be  Infection from inhalation of aerosol – Meningitis
carefully inclined as per the Bio-Medical Waste ,Rheumatic fever, Pneumonia, Candidiasis, Tuberculosis
(Management and Handling) Rules 1998, which is been

INCUBATION
MICRORGANISM PERIOD

HSV 2 YEARS
Varicella zoster
virus 2 weeks
Hepatitis B/C/D 6months
HIV months to years
Table 2: SHOWING INCUBATION PERIOD OF MICRORGANISMS(8)

Image 1: SHOWING TRANSMISSION OF INFECTIONS IN DENTISTRY(9)

IJISRT22FEB871 www.ijisrt.com 928

Volume 7, Issue 2, February – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
VIII. CONCLUSION

The dental surgeons should remain highly alert on the

infected patients and referring the mint ended for
satisfactory medical management. Infection control
measures are strictly followed to minimize the transmission
of infectious diseases. The dental practice is structured by
the regulatory authorities of DCI and should function
according to their DCI recommendations. The guidelines for
dental management by the DCI will ensure safer dental
practice, which is essential need of the hour. These
guidelines vary according to external circumstances,
depending on the course of the diseases of the era and local
needs. It is the obligation of healthcare amenities and
individual dentists to be aware of the dental practice
describes and redefine their facilities and practice
accordingly.

REFERENCES

[1.] Burket, L. W., Greenberg, M. S., Glick, M., & Ship, J.

A. (2008). Burket's oral medicine. Hamilton, Ont: BC
Decker
[2.] Dahiya P, Kamal R, Sharma V, Kaur S. "Hepatitis" -
Prevention and management in dental practice. J Educ
Health Promot. 2015 May 19;4:33. doi: 10.4103/2277-
9531.157188. PMID: 26097847; PMCID:
PMC4456879.
[3.] Krasteva A, Panov VE, Garova M, VelikovaR,
Kisselova A, Krastev Z. HEPATITIS B AND C IN
DENTISTRY. J of IMAB. 2008; 14(2):38-40.
DOI: http://dx.doi.org/10.5272/jimab.14-2-2008.38
[4.] A.M.G.ALaheij ,J.O.Kister ,G.N
.Beilbasakis,H.valimaa ,&J.Jdesoet.Risk of bacterial
transmission in dental practice journal of oral
microbiologist.2000, 66:550-552,.Available on
https://cda-adc.ca/jcda/vol-66/issue-10/550.html
[5.] Ilangovan K, Muthu J, Balu P, Devi S, Ravindran SK.
Recommendations for Dental Management during
COVID-19 Pandemic. J Basic Clin Appl Health Sci
2020;3(2):56–58.
[6.] Arvind, R., Roma, M. Risk of eye infections in dental
personnel and the need for its prevention: a case
report. J OphthalInflamm Infect 10, 21 (2020).
https://doi.org/10.1186/s12348-020-00211-5
[7.] S Rajasekar, P.L. Ravishankar, G. Balaji Babu.
Protocols and guidelines for management of
tuberculous patients in dental office - a review.
International Journal of Contemporary Medical
Research 2017;4(1):159-160
[8.] William D Browning ,& James P Mccarthy, A Case
Series: Herpes Simplex Virus as an Occupational
Hazard, February 2012, 24(1):61-6doi :10.1111/J.708-
8240.2011.00469.x
[9.] WH van Palenstein Helderman, Routes of transmission
of diseases in dental practice,
1992,https://www.ajol.info/index.php/tdj/article/view/1
12667/102416 (monograph in internet)

IJISRT22FEB871 www.ijisrt.com 929