Sir, paediatric patients presenting with irreversible pulpitis and related afflictions need urgent care delivered through the use of aerosol-generating rotary instrumentation and air/water syringes. These procedures increase the probability of airborne microbial transmission, such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Two recently published articles in your journal highlighted the utility of silver diamine fluoride (SDF) and potassium iodide (SDF/KI) application, and paediatric patients audit attending emergency care for irreversible pulpitis symptoms during the current coronavirus disease 19 (COVID-19) pandemic.1,2

Children are believed to exhibit only mild SARS-CoV-2 symptoms or they could be asymptomatic carriers and hence, the care pathway has been sensibly devised to treat every child as a potential COVID-19 positive patient.2 Thus, to limit bioaerosol risks, the contemporary treatment algorithm includes the use of pre-procedure oral rinse with 1% hydrogen peroxide or povidone-iodine3 and the use of dental dam, as well as high-volume suction.

Nevertheless, the use of mouthwash is contraindicated in children younger than six-years-old owing to their immature, fine-motor control and oral muscle reflexes, required to properly spit out mouthwashes.4 Additionally, both in young and older children, the saliva laden expectorate laced with the virus itself may pose a threat of SARS-CoV-2 transmission, if it is not properly collected, contained, and disposed of.

It is known that the cavitated dental lesion is a thriving biome of bacterial, fungal, and viral flora. Thus, pre-treatment of the cavitated lesions with an antimicrobial, prior to high speed instrumentation, is likely to diminish the aerosolisation of viral particles and their inhalation by dental personnel. There is now ample data to indicate the viricidal potential of both silver and iodide containing formulations.3,5,6 Hence, we wish to propose that, for children younger than six years of age, the swabbing of the procedure site with gauze soaked in povidone-iodine should be followed by application of SDF and KI. The latter, while potentiating the antimicrobial effect, can also be an extremely effective dentine desensitiser.1

In addition, desensitising the exposed operative focus of highly sensitive dentine could mitigate stress, and increase compliance and facilitate paediatric patient management.