Risk Stratification Tool to Develop Framework for Infection Control in Spectrum of Dental Procedures during COVID-19 Pandemic

Objective: To develop a framework for infection control in the spectrum of dental procedures during the COVID-19 pandemic. Methodology: The study was conducted from Oct to Dec 2021 after approval for ethical review board of Foundation university college of dentistry Ref no (    ). Patients undergoing various dental procedures were enrolled after written and verbal informed consent. Risk Stratification of each procedure was done applying novel risk assessment scoring system, according to the level of risk contact with saliva was given score 1, contact with blood scored as 2, production of aerosol (low level) through triple syringe was given score 3, high aerosol production by ultrasonic piezoelectric instruments was scored as 4. If the complete duration of the dental procedure was >60 min score assigned was 0.75, for procedures with 30 to 60 mins duration score specified was 0.50, if the duration of the procedure was less than 30 min score for that procedure was 0.25. For each patient total score of all these parameters was accumulated to grade risk of SARS -CoV-2 transmission as low (score <4), medium (score 4 to 6), or high (score >6) depending upon the accumulative score of each procedure. Results: Nine hundred and fifteen patients with a gender distribution of 163 (17.9%) males and 748 (82.1%) females with an age range < 18 – 45 years undergoing the dental procedure were enrolled. Out of 915, 436 (47.6%) procedures were found to be low risk, 38 (4.1%) moderate risk, and 437 (47.7%) high risk. Out of 174 maxillofacial procedures, only 18 (10.3%) were of high risk, similarly out of 113 orthodontics procedures, only 1 (0.9%) was of high risk and for 147 prosthodontic procedures, there were 55 (37.4%) high-risk procedures. On the other hand, for operative dentistry procedures (n=181), majority of 128 (70.7%) posed a high risk, among pediatrics procedures (n=92) there were 62 (67.4%) high-risk procedures and for periodontics (n=204) about 173 (84.8%) were of high-risk nature. Therefore, the majority of the high-risk procedures belonged to operative, pediatrics, and periodontics specialty as compared to other specialties (p<0.001). Conclusion: The majority of the high-risk dental procedures belonged to operative, pediatrics, and periodontics specialty as compared to other specialties.