SEMBACH KASERNE, Germany – The recent outbreak of COVID-19 across Europe and the rest of the world has created new and unique challenges in the way dental and medical care is delivered. The staff of Dental Health Activity Italy is confronting these challenges head on.Dental Health Activity Italy conducted a one-day COVID-19 response validation exercise with their dental providers and staff April 15. The training exercise offered the dental clinic staff a chance to practice using their dental equipment while wearing personal protective equipment, and to review proper dental procedures for treating positive, or suspected positive, COVID-19 patients.“As with any military training, there are always lessons to be learned,” said Lt. Col. (Dr.) Christopher Chang, an oral surgeon with the Vicenza Army Dental Clinic. “We learned it is paramount to have the proper equipment in place, set up and ready prior to starting a procedure. Doing so ensures the minimizing of traffic (and cross contamination) during a procedure.”Another important part of the training focused on ensuring the dental process is free of COVID-19 contamination.“It is also critical that all dental clinic staff, to include maintenance and housekeeping personnel, understand the contamination zone and stay clear until the procedure is finished and decontamination is complete,” Chang said. “We also learned that communication across language and cultural barriers, especially among local national employees, is a must.”“We all have to maintain our capability and readiness at all times by adhering to personal protective equipment guidelines and ensuring we have enough PPE supplies on hand.”Chang says that performing dental procedures under normal circumstances requires total concentration by the dentist. Adding the element of additional personal protective gear makes performing those tasks even more of a challenge.“Everything is different,” Chang said. “For example, you don't have access to all the familiar equipment such as an upright treatment chair. You basically have to perform the dental procedure on a supine (horizontal) patient and the height of the gurney is not adjustable. So, there are some significant ergonomic challenges.”“Another significant challenge is simply breathing. Breathing through two layers of protective mask is difficult,” Chang added. “Vision can also be a real problem. For example, wearing loupes (telescopic lenses) and attempting to see through a plastic face shield that continually fogs up makes seeing difficult. Another challenge is, I may not be working with my own dental assistants, and they don't know how to help me. All of these challenges, when combined together, downgrade the efficiency of the procedure and it will take twice as long, if not more.”Col. (Dr.) Manuel Pozo-Alonso, commander of Dental Health Command Europe, says that this type of training is crucial to ensuring the safety of staff and patients.“The training our team conducted in Italy not only broadened their skills, but will prove invaluable if and when we need to treat a COVID-19 positive patient,” Poza-Alonso said. “This type of training is crucial in maintaining mission readiness of the fighting force and the readiness of our dental professionals.”With the recent reduction, or elimination, of routine or elective services in Army dental clinics across Europe, the only dental procedures currently being provided are for urgent or emergency type cases. Army dental clinics recommend certain actions individuals can take to ensure their oral health until dental services return to normal.“I encourage everyone to maintain good oral hygiene, which includes regular brushing and flossing,” Chang said. “People should also reduce their intake of sugary foods/drinks, and take care of their wisdom teeth, etc. In the interim, the focus should be on prevention.”“We understand that emergencies can, and will, happen to include trauma or infection arising from teeth and gums. The bottom line is, we are here to take care of our Soldiers and families if something like that happens,” added Chang.Beneficiaries who are experiencing severe pain, or have a dental emergency, should contact their local Army dental clinic to be examined and treated at the earliest possible time.