Patient evaluation
First of all, dental professionals should be able to identify a suspected case of COVID-19. To date that this paper was drafted, the National Health Commission of the People’s Republic of China has released the 5th edition of the Guideline for the Diagnosis and Treatment of Novel Coronavirus Pneumonia. In general, a patient with COVID-19 who is in the acute febrile phase of the disease is not recommended to visit the dental clinic. If this does occur, the dental professional should be able to identify the patient with suspected 2019-nCoV infection, and should not treat the patient in the dental clinic, but immediately quarantine the patient and report to the infection control department as soon as possible, particularly in the epidemic period of 2019-nCoV.
The body temperature of the patient should be measured in the first place. A contact-free forehead thermometer is strongly recommended for the screening. A questionnaire should be used to screen patients with potential infection of 2019-nCoV before they could be led to the dental chair-side. These questions should include the following: (1) Do you have fever or experience fever within the past 14 days? (2) Have you experienced a recent onset of respiratory problems, such as a cough or difficulty in breathing within the past 14 days? (3) Have you, within the past 14 days, traveled to Wuhan city and its surrounding areas, or visited the neighborhood with documented 2019-nCoV transmission? (4) Have you come into contact with a patient with confirmed 2019-nCoV infection within the past 14 days? (5) Have you come into contact with people who come from Wuhan city and its surrounding areas, or people from the neighborhood with recent documented fever or respiratory problems within the past 14 days? (6) Are there at least two people with documented experience of fever or respiratory problems within the last 14 days having close contact with you? (7) Have you recently participated in any gathering, meetings, or had close contact with many unacquainted people?
If a patient replies “yes” to any of the screening questions, and his/her body temperature is below 37.3 °C, the dentist can defer the treatment until 14 days after the exposure event. The patient should be instructed to self-quarantine at home and report any fever experience or flu-like syndrome to the local health department. If a patient replies “yes” to any of the screening questions, and his/her body temperature is no less than 37.3 °C, the patient should be immediately quarantined, and the dental professionals should report to the infection control department of the hospital or the local health department. If a patient replies “no” to all the screening questions, and his/her body temperature is below 37.3 °C, the dentist can treat the patient with extra- protection measures, and avoids spatter or aerosol-generating procedures to the best. If a patient replies “no” to all the screening questions, but his/her body temperature is no less than 37.3 °C, the patient should be instructed to the fever clinics or special clinics for COVID-19 for further medical care.