Emergency dental specialists work daily despite extreme risk of COVID-19 transmission

Three UT Health SA doctors write new safety guidelines for dentists amid the pandemic

SAN ANTONIO – A group of specialized doctors are working right now in one of the most contagious places - a patient’s mouth.

Routine dental work has been suspended amid the COVID-19 pandemic, but emergencies need to be taken care of.

That's why emergency dental specialists, called endodontists, are continuing to work.

Three endodontists from UT Health San Antonio are leading the charge to keep doctors safe by writing and publishing new safety guidelines for everyone in their field.

"For specialists like ENTs, dentists, even ophthalmologists, we're at a very high risk of developing COVID-19. There have been a lot of reports that show physicians have died and they primarily belong to one of these specialties," said Dr. Nikita Ruparel.

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Three endodontists from UT Health San Antonio are leading the charge to keep doctors safe by writing and publishing new safety guidelines for everyone in their field.

Yet, the doctors continue to do this dangerous job every day, for two admirable reasons.

"First, we don't want patients to be in pain. The other bit is that we feel it's important to help our medical colleagues out working in the ER," said endodontist resident Dr. Biraj Patel.

"In this time of crisis we don't want to overburden the emergency room," said endodontist resident Dr. Amber Ather, acknowledging how overworked those healthcare providers already are.

The three doctors went a step further to protect their colleagues. They have written new guidelines on how dental workers can stay safe while treating potentially infected patients. Their work is about to be published in the Journal of Endodontics.

Most of the guidelines aim to avoid situations that cause saliva particles to be released into the air and onto surfaces, which means using less disruptive tools during procedures, most of which are handheld.

It also means avoiding the type of x-rays that require films to be placed in patients’ mouths, potentially causing them to cough or gag. If they have to do the x-rays, they have created a safety plan.

“We’re double-bagging everything so we use a plastic sleeve and a rubber cover over it, so we make sure we don’t have any leakage of saliva,” Ruparel said.

Another guideline is the use of more protective gear.

“The N95 masks are covered with a regular procedural mask and then we also wear a face shield over both of those mask,” Ruparel said.

The paper also lists the use of stronger cleaning chemicals.

“Some of the disinfectants that are effective in killing many bacteria, we’re finding are not effective on COVID-19,” Ather said. “So now we are finding out we have to disinfect surfaces with hydrogen peroxide and other chemicals approved by the CDC.”

They are also suggesting the covering of patients' noses during procedures.

“So especially in cases when we do a root canal, we have a rubber sheet that would be placed on a patient, as standard of care anyway. Now we’re recommending these sheets be put further up so the nose of the patient can be covered,” Ruparel said.

They have limited procedures strictly to emergencies, which is determined by two main factors. First, on a pain scale of one to 10, a patient must report a seven or above. Second, the infection must be causing swelling, either inside or outside the mouth, or the patient may not be able to open his/her eyes.

The guidelines also list screening criteria that doctors should ask patients over the phone or teledoc session before they go in for treatment. They include questions about symptoms and recent travel history.

All three doctors said they are proud to have created crucial changes that will keep people safer, all over the nation, if not the world.

COVID-19, the respiratory disease caused by the new virus, stands for coronavirus disease 2019. The disease first appeared in late 2019 in Wuhan, China, but spread around the world in early 2020, causing the World Health Organization to declare a pandemic in March.


About the Authors

Courtney Friedman anchors KSAT’s weekend evening shows and reports during the week. Her ongoing Loving in Fear series confronts Bexar County’s domestic violence epidemic. She joined KSAT in 2014 and is proud to call the SA and South Texas community home. She came to San Antonio from KYTX CBS 19 in Tyler, where she also anchored & reported.

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