**2.2 Hand hygiene and personal protective equipment (PPE)**

The WHO in 2012 recommends that hand hygiene should be performed before touching a patient, before any cleaning or aseptic procedure, after body fluid exposure risk, after touching a patient and after touching a patient's surroundings [12].

In the dental practice, the spread of micro-organisms is mainly radiated to the dentist's face, specifically to the eyes and around the nose [13] therefore personal protective equipment (PPE) should be used. PPE forms an effective barrier against most of the aerosols generated [14].

• Respirators.

Filtering facepiece respirators, also known as disposable respirators, are subject to different rules worldwide. Their use is recommended by dentists as they are continuously exposed to aerosols [15]. Before selecting one, users should consult their local regulations and requirements for respiratory protection.

The standardisation methods used in the different countries are as follows [16].

1.N95 (United States NIOSH-42CFR84).

2.Filtering facepiece particles 2 (FFP2) (Europe EN 149–2001).


Under no circumstances should they include an exhalation valve, as in this case the air is exhaled directly into the environment without any retention, favouring the diffusion of the virus We must bear in mind that these should not be sterilised and at most can be disinfected through different methods depending on the type, which will not increase the number of times or time we can use it [17, 18].

*Economic, Health-Care and Teaching-Learning Impact of COVID-19 (SARS-CoV-2) on Dentistry DOI: http://dx.doi.org/10.5772/intechopen.98387*

• Gloves.

They should always be used as usual in daily clinical activity. It is recommended to use gloves that protect against viruses (EN ISO 374-5) made of nitrile. For cleaning and disinfection tasks, it is recommended to use thicker, more break-resistant gloves.

• Eye and face protection.

The eye protectors certified according to the UNE-EN 166:2002 standard for protection against liquids can be integral glasses or face shields. They should always be used as COVID-19 can be transmitted through eye contact, as infectious droplets could contaminate the conjunctival epithelium [19].

• Protective clothing,

We should avoid using street clothes or shoes in the clinic, avoiding wearing earrings, rings, bracelets, watches and other elements, as they behave as reservoirs of COVID-19.

In **Table 1** we can see in what order we should put on and take off the PPE. With the PPE on we must keep our hands away from our face and avoid touching surfaces. When we remove the personal protective equipment, we must disinfect it. PPE must be kept in a proper place and different from the place where we leave our street clothes.

### **2.3 The patient in the cabinet**

The patient must pass with the mask on and it will be removed at the time indicated by the professional.

## *2.3.1 Rinses*

During dental practice, it is often difficult to avoid the generation of aerosols, which is why it is important to reduce their viral load. To this end, the preoperative use of antiseptic mouthwashes can be useful. SARS-CoV-2 is vulnerable to oxidation, so a pre-procedure mouthwash with oxidising agents such as 1% hydrogen peroxide or 0.2% povidone was initially suggested [1, 9], however, it was recently noted that there is no evidence to support the indication of hydrogen peroxide rinse to reduce viral load of SARS-CoV-2 [20]. A recently published systematic review


**Table 1.**

*In what order should the PPE be put on and taken off.*

has highlighted the lack of scientific evidence to support the virucidal activity of hydrogen peroxide rinse, associated with its lack of substantivity and and its indication in dental care protocols should be reviewed [21] . As for povidone-iodine, it can be an effective measure, having demonstrated 99.99% activity when used against enveloped and non-enveloped viruses such as influenza, Ebola, MERS and SARS coronavirus [22], and has strong bactericidal and virucidal properties against pathogens, which cause oral and respiratory tract infections.

Regarding chlorhexidine, a rinse often used in dental practice, several studies have suggested that it had little or no effect against the virus compared to other rinses [1, 23], but other authors have noted that its use could be beneficial [24].

With regard to Cetylpyridinium chloride (CPC), it could be effective against enveloped viruses such as Sars-Cov 2 [25].
