The last two months have perhaps been the longest break I have ever taken in my career as a dental surgeon. I run a chain of dental clinics in Bangalore, and needless to state, my practice has been severely impacted by the Coronavirus

pandemic and the ensuing lockdown. The Karnataka state government issued a directive on the 18th of March announcing mandatory closure of all dental practices in a preemptive and wise move. Two months down the line, the state has now ruled that dental clinics can resume operations to support emergency procedures. This gives me some hope as an entrepreneur about the future of my clinics, and about the lives and livelihoods of the many that we employ. As a healthcare professional, however, what I feel is anything but relief. There is a deep sense of foreboding and trepidation that holds me back from throwing open the doors to my clinics just yet. Here’s why.

As India enters Lockdown 4.0, we are witnessing the steepest rise yet in coronavirus cases, surging past the 1,00,000 mark in the last week (See Figure 1) and currently at 1,12,000 cases. These numbers seem very conservative, not accounting for the largely asymptomatic population and huge proportion of untested cases. With the lockdown restrictions being relaxed in most zones, we can fully expect these numbers to surge and swell in the coming weeks. Karnataka, where I live, has been consistently reporting our highest numbers thus far in the last four days. Let us understand the risk and responsibility dentists face against these statistics, as we prepare to resume practice to support emergencies. The New York Times reported in March 2020 that dentists were at the highest risk of exposure to the virus, and consequently of contracting and transmitting the infection. How much risk to dental care professionals is acceptable during the COVID-19 pandemic? And for those dentists willing to risk their lives for the sake of their livelihoods, is this risk worth the long-term complications and the other lives that we will likely endanger in the process?

Preparing for the new normal in dental practice
Dental drills including oral surgery drills cause the formation of aerosol and splatter commonly contaminated with bacteria, viruses, fungi and blood. Aerosols are liquid and solid particles (size ranging from 3-100nm) suspended in air for protracted periods. Splatter is a mixture of air, water and/or solid substances (50 μm to several millimetres diameter). Both pose a serious health risk to the dental team even under regular circumstances. The COVID-19 measures around 120 nm (0.12 μm) and requires the use of a FFP3 respirator that offers a filtration rate of 99% of all particles measuring up to 0.6 μm. However, this still isn’t fool proof and leaves us with an element of risk of contracting the infection. Should we then risk our and other’s lives with a deadly virus lurking in the air?