Providing Assistance to Physicians

Dentists assisted physicians by participating in the general treatment and monitoring of patients with mild pneumonia, including antiviral and antimicrobial therapy, maintaining fluid and electrolyte balance, and monitoring vital signs, biochemical indicators and imaging.

Radiological Diagnosis

Dental radiologic technicians who specialized in imaging tests like X-ray, Computed Tomography (CT), and Magnetic Resonance Imaging (MRI) participated in the screening and diagnosis of the COVID-19 by High-Resolution Computed Tomography (HRCT). They diagnosed and classified patients according to the scope and type of lesions (early, advanced, and critical stage) displayed by HRCT, which allowed physicians and ICU intensivists to carry out the corresponding treatments.

Specimen Collection

Dentists also participated in the collection of sputum and nasopharyngeal swab specimens for viral nucleic acid detection, which provided valuable diagnostic information. For specimen collection, ambient light, collection sites, collection methods, collection dwell time, cotton swab disposal, and test tube storage had to be in accordance with regulations. Due to specimen collection being very dangerous work, collection personnel had to take strict tertiary protection measures, including wearing N95 masks, rubber gloves, isolation protective clothing, and goggles.

Nursing Work

Dental nurses were involved in the care of mild cases of COVID-19, including closely monitoring body temperature, breathing rhythm and frequency, blood oxygen saturation, and other vital signs. They also followed physician orders, helped reduce fever, and monitored fluid, electrolyte and acid-base balance; liver and kidney function; nutritional status; and clinical symptoms. In addition, after training, they also participated in medical work, such as venous access care, oxygen therapy preparation, assisting patients who required mechanical ventilation with non-invasive ventilators, assisting physicians in establishing artificial airways, and so on.

Online Consulting and Prescribing

The demand for medical care has increased due to the coronavirus pandemic, but it was not convenient for patients to go to the hospital for medical treatment. Dental professionals conducted medical consultations through online consultation platforms, including answering patients’ questions, relieving patients’ anxiety, and prescribing required medications. In this way, they helped reduce the admission of mild cases to the hospital, and reduced the risk of cross infection.

Collecting and Distributing Medical Supplies

Dental professionals participated in the collection of medical protective equipment such as masks, goggles, and disposable protective clothing. They also assisted hospital logistics personnel with counting and handing out protective equipment and medicines.

Medical Evacuation and Transfer

Dental professionals participated in the medical evacuation and transfer of suspected and confirmed cases of COVID-19 with negative pressure ambulances, paying special attention to the airway management and vital signs of patients during transit. Moreover, the dentists comforted the patients with good communication skills and disinfected the vehicles after transit.

Community Volunteering

Dentists were well-versed in community infection control. They helped quarantine suspected cases, monitored temperature by infrared thermometer, registered personal information, provided COVID-19 prevention knowledge, assessed the management of community personnel and vehicles, recycled used masks, and disinfected the community environment.

Psychological Comfort

The outbreak of COVID-19 had the potential to cause panic and trigger overblown anxiety in the population. Dental professionals participated in sharing knowledge about COVID-19, comforting people over the phone or online, relieving their stress and anxiety, and enhancing their confidence in successful resolution of the COVID-19 pandemic.

Emergency Management of Oral and Maxillofacial Trauma

Oral and Maxillofacial Surgeons (OMS) could carry out treatment of mandibular fractures, temporomandibular joint injuries, and other injuries of the hard and soft tissues of the oral and maxillofacial region, as well as post-operative rehabilitation. Dentists could also deal with dental trauma such as tooth dislocation, fracture, shock, and contusion, and oral mucosa trauma caused by disaster, and provide follow-up dental treatment.^{Reference Dai, Zhao and Li16–Reference Li, Wang and Guo18}

Participating in First Aid

In China, dentists are trained in surgery and medicine at the undergraduate level, so they were capable of giving surgical treatment to patients with mild injuries, apart from dentoalveolar injuries. They could provide field first aid treatments including needle cricothyroidotomy, cardiopulmonary resuscitation, hemostasis, bandaging, fixation, and transportation. Symptomatic and supportive treatment could also be provided, according to medical condition, on site. During treatment, dentists who had experience in sedation dentistry could reduce the patients’ anxiety, discomfort, and pain, by sedation. In scenarios like this, all measures including emotional support should be taken to reduce mortality and disability, if possible.^{Reference Li, Wang and Guo18}

The Triage and Medical Evacuation of the Injured

A large number of casualties could occur in an earthquake, leading to a shortage of medical personnel and supplies. As a result, not all the injured may be immediately treatable. Triage could help determine the medical priority of the injured, and increase the number of survivors. Dentists could provide assistance in triage procedures, and classify the injured into five categories based on the principles and methods of classification.^{Reference Wang, Wei and He17,Reference Tang, Zhu and Zhou19}

Red tags (immediate) indicated the injured who had a chance of survival if they were treated immediately. They required high priority treatment or transfer.

Yellow tags (delayed) indicated the injured who were not in danger of death at the moment, but required hospital care later. They were of medium priority.

Green tags (minor) indicated ambulatory patients in stable condition, who needed medical care.

Black tags (deceased/expectant) indicated dead or moribund patients.

White tags (dismiss) indicated people with minor injuries who could recover without medical care.

Trauma Care

Dentists could participate in nursing and vital signs monitoring before and after surgery, establishing venous access for anti-shock and anti-microbial treatment. They could also assist surgeons in debridement and disinfection to promote wound healing due to their Infection prevention and control training and daily work.^{Reference Wang, Wei and He17}

Providing Wards for the Injured

The department of oral and maxillofacial surgery could provide vacant wards and beds to the injured, and dentists could assist surgeons with taking in and managing postoperative patients.^{Reference Wang, Wei and He17}

Provision of Oral Health Services

Oral health is also difficult to maintain for rescuers and earthquake victims in temporary shelters. The poor oral health due to harsh living conditions and psychological stress can easily cause gingivitis, pulpitis, periodontitis, ulcers, and lichen planus. The normal medical infrastructure and dental facilities were seriously damaged in the earthquake. Dentists could deal with the oral disease with portable dental equipment, relieving the suffering of the patients.^{Reference Wang, Wei and He17}

Donation of Dental Care Products and Provision of Oral Health Education

Prevention is very important. A lack of medicines and dental care products such as toothpastes, toothbrushes, floss, and mouthwashes may lead to poor oral health, and oral diseases might occur easily as a result. In these natural disasters, dentists could procure and donate medicines and dental care products to rescuers and victims, helping to reduce oral diseases. Dentists could also provide guidance to maintain the oral health of individuals with pre-existing conditions, through educational materials, lectures, posters, and dental counseling.^{Reference Wang, Wei and He17,Reference Tang, Zhu and Zhou19}

Strengthening the Legal System

With the improvement of China national public health emergency management system, the Chinese Stomatological Association can promote a “Dental Emergency Responder Act,” similar to the United States.^{Reference Colvard, Lampiris and Cordell7} The law and regulations can authorize dental professionals to participate in emergency responses, and regulate their duties, participation methods, and processes in the national public health emergency management system.^{Reference More, Phelan and Boylan20,Reference Glotzer, More and Phelan21}

Regular Training Plan

Public health emergency training could also be made a necessary skill for dental students in universities, and incorporated into curriculum assessments. Targeted training could also be carried out on regional emergency responses like major epidemics or disasters. The National Health Commission of the People’s Republic of China, and the Chinese Medical Doctor Association, could provide free and regular public health emergency courses and training at different levels, serving as a national continuing medical education project for in-service dental professionals. In addition to professional training in oral first aid and oral health, emergency management training such as Core Disaster Life Support (CDLS), Basic Disaster Life Support (BDLS), Advanced Disaster Life Support (ADLS), infection control, triage, and so on, should also be added.^{Reference Coule and Horner22,Reference Chmar, Ranney, Guay, Haden and Valachovic23}

Organizing Emergency Drills

Regional just-in-time (JIT) emergency drills could be carried out from time to time to help dentists apply the knowledge and skills they have learned in practice. Team communication and cooperation among dentists, physicians, surgeons, and logistical personnel could be strengthened by the emergency drills.^{Reference Chmar, Ranney, Guay, Haden and Valachovic23}

Immunizations

During epidemics, pathogens could spread easily from person to person and cause serious illness locally and even worldwide. Everyone is at risk of contracting illnesses that humans have little or no immunity to. Large numbers of vaccinators are therefore needed to carry out rapid population immunization. Dental professionals should receive regular immunization training to ensure that they can participate in mass immunization programs at short notice. Dental hospitals and clinics can also be temporarily requisitioned as immunization sites.^{Reference Galligan24}

Identification

Disaster Victim Identification (DVI) plays an important role in disasters, especially with the large number of casualties caused by floods and earthquakes. One of the most reliable identification methods of identifying individual victims is through dental evidence. Dental identification is even superior to other methods, as teeth are the hardest substances in the human body, and a good reservoir of DNA material that can withstand hostile environments. There is however still a long way to go in the forensic odontology of China, and the ability of these professionals to participate in DVI is limited. In the future, forensic dentistry committees could be set up to develop the discipline and train personnel. A database of dental models could also be established, which could be helpful in dental identification, including DVI.^{Reference Brannon, Morlang and Smith25–Reference Morlang and Wright27}