AUTHOR : DR. SAUMYA LAL

The ongoing pandemic is one of the biggest issues in the healthcare industry. The COVID-19 clinical features are yet not fully established. In terms of oral problems, dental treatment and emergency care, the dental management of these individuals might occasionally be problematic. The examination and care of these individuals is one of the problems facing dental experts today. It is crucial to remember while treating patients during a pandemic, as patients must limit their time spent outside their homes.

During a pandemic, providing endodontic care should include measures that limit the potential of virus transmission among patients, employees, and clinicians. This entails using tele-dentistry to reduce needless patient visits, being prepared to give same-day treatment, shortening treatment durations, and minimising the creation of contaminated aerosols and air droplets. Patients, dental employees, and the survival of your dental business all benefit and are protected when you do so.

• Prepare to treat a patient who has merely come in for a consultation in order to decrease the number of patient visits. This planning should begin well in advance of the appointment. 
• Patients should be educated on why restricting their excursions outside of their “safe” residences and receiving same-day treatment, if necessary, is beneficial to their safety during a pandemic. As a result, whether it’s decided that a patient needs emergency or non-emergency therapy, you and your team should be ready to act quickly.
• Immediate action involves front-desk personnel rearranging the schedule to accommodate the unexpected treatment, as well as phoning and shifting the next scheduled patients a “few minutes” later, as you may be running late due to the unscheduled emergency. It also entails putting in place logistical clinical processes that allow for quick treatment. Patients’ and staff’s safety, as well as the practice’s efficiency and output, would all benefit from a reduction in patient visits.

• The increased risk of coronaviral transmission and usage of valuable costly and perhaps restricted PPE supplies may be increased by the addition of patient visits. 
• When contacting your office with a tooth discomfort, you should try to remotely and virtually telemedicine and triage people. 
• Consider excluding non-ended symptoms such dentin hypersensitivity (i.e., brushing or sweating brief acute pain) and parafunction (i.e. non-localized pressure tenderness waking patients up at night or present upon waking up in the mornings). 
• Encourage your patients to use  smartphones to deliver intraoral and extraoral photographs.
• More extraoral imaging, such as CBCT or panorex, should be used to diagnose patients whenever possible. This reduces the need for intra-oral radiography, which are associated with a higher risk of patients coughing or choking, resulting in contaminated droplets. 
• A CBCT scan can frequently substitute the requirement for invasive exploratory endodontic access and/or surgery, both of which entail contact with contaminated saliva and/or blood.
• Keep in mind the necessity of conclusive therapies while organising your therapy. Explain to patients that heroic endodontics are not appropriate during a pandemic. Due to postoperative problems or failures, treatments with a poor prognosis are more likely to have follow-up visits. For example, when compared to extraction and implant replacement, retreatment of a complicated molar case with questionable restorability may have a bad prognosis.
• When endodontic treatment is judged to be essential, bear the few points in mind. Reduce the virus’s airborne transmission by employing rubber dam isolation to reduce, if not eliminate, the generation of infected aerosols and droplets.
• Rubber dam isolation is an unmistakable standard of care and it must be used for all non-surgical root canal procedures. The removal of contact with contaminated saliva during drilling and file handling, as well as the avoidance of air droplets in the event that patients cough during the process, is a COVID-related advantage of its use.
• Not only do we have to employ rubber dam isolation, but it’s also possible that it makes non-surgical endodontic therapy one of the least probable methods to create contaminated aerosols and air droplets. Oral washing with an antiviral solution, as well as rinsing the isolated tooth’s crown with an antiviral solution, are recommended before endodontic access preparation.
• Reduce the time spent in the chair for the patients by using the following procedures and armamentaria to complete the process as quickly as feasible.
• To detect canals, particularly calcified and MB2 canals, use increased magnification and light. High-powered loupes, an overhead light, and/or a dental microscope are used to do this. Face shields may be required depending on the regulations in your jurisdiction. When using dental loupes, it may be simpler to wear a face protection than when using a dental microscope. Incorporating shields into your practise may need a little innovation.
• To determine working lengths, use a good electronic apex finder. This will minimise the number of intra-oral radiographs required, which will expose you and your assistant to contaminated saliva, as well as the danger of the patient coughing while taking x-rays, and will make the process more efficient overall.
• Use endodontic NiTi filing systems instead of conventional NiTi filing systems, which need fewer files and processes. As a result, the operation will be more efficient, and you will be able to handle endodontic emergencies and same-day procedures.
• For teeth with necrotic pulps, multi-visit root canal procedures were once frequent. However, as previously said, root canal procedures should be completed in one visit whenever feasible. This may be accomplished by more effectively conducting root canals and using certain techniques. When specific protocols are used, studies demonstrate that there is no difference in the result of single and multi-visit root canals. Improved intracanal medicament and activation are some of them. Single-visit root canal treatments have also been proven to have no higher risk of postoperative discomfort compared to multi-visit root canal treatments.
• In the same appointment, try to repair the endodontically treated tooth permanently. Especially while the rubber dam is still in place and right after root canal treatment. By decreasing coronal bacterial microleakage, this improves the result. While the tooth is not completely repaired, it also helps to minimise the chance of tooth and/or temporary restoration fracture. 

Endodontic care was as critical as ever during the COVID-19 epidemic. But because of this constant epidemic, we must adapt our practise with the adoption of particular procedures, as we encounter never before seen clinical problems. We should focus on the fast and successful endodontic treatment and a decrease in viral dental hazards is to be adapted to COVID-related issues.

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