Sir, whist we wait for a vaccine to control the spread of COVID-19 we need to be thinking about ways to reduce risk of transmission. Two strategies could be part of the solution, albeit yet to be developed into a recognised protocol: sorting patients and saliva testing.

Sorting patients free of COVID-19 from those who carry the disease, so that the majority of patients can safely return for dental treatment, might involve telephone triage to assess the risk before offering low risk patients an appointment. Low risk patients would then be tested in the dental setting to confirm that they do not have the virus. An agreed standard infection control protocol could subsequently be adopted without the need for a full-face respirator.

The development of a suitable rapid saliva test is desirable but a finger prick text might also be acceptable. Training would be required which could additionally allow the dental team to be further integrated into the management of COVID disease. For example, dental surgeries could provide convenient sites around the country where any patient could access testing as part of the anticipated testing and contact tracing protocols required until mass vaccination can be completed. Vaccination is another activity which the dental team might be able to support as well as generating an income stream for the dental surgeries involved. The GDC could facilitate the strategy by recognising COVID testing as part of the practice of dentistry, thereby allowing the existing indemnity arrangements to cover the dental team for the procedure.

The oropharynx and nasopharynx are targeted by the novel coronavirus with the result that saliva contains a high viral load of COVID-19 with up to 1.2×108 infective copies/ml.1 A recent paper has suggested that the use of Povidone-iodine (PVP) in a nasal spray and mouthwash might reduce cross infection and protect healthcare workers. This cheap and readily available substance in the form of 10% PVP (eg Videne)1 can be purchased from Amazon and elsewhere and diluted one part to 20 to be used as a mouthwash and gargle by both the patient and the clinical team. An aerosol should also be sprayed into the nostrils of the patient prior to face to face contact. The dental team can repeat the nasal spray during extended treatment sessions. Iodine is a particularly effective disinfectant when deployed against coronaviruses. Clinical studies have yet to prove the efficacy of the protocol - but with almost no risk and low cost, why wouldn't you want to use the approach on all dental patients?

PVP is currently used in ophthalmic surgery (often diluted to 5%) and occasionally during oral surgery at 10%. Anecdotally we hear that some UDC centres have already adopted the use of PVP off-label, whilst waiting for clinical trials to prove the efficacy. For those who would like to see the technique demonstrated a video is available online (https://vimeo.com/406479300).