COVID-19 outbreak: succinct advice for dentists and oral healthcare professionals

Activities of the oral health teams in primary health care: a time-motion study

BACKGROUND

Efficient planning of the oral health workforce in Primary Health Care (PHC) is paramount to ensure equitable community access to services. This requires a meticulous examination of the population's needs, strategic distribution of oral health professionals, and effective human resource management. In this context, the average time spent on care to meet the needs of users/families/communities is the central variable in healthcare professional workforce planning methods. However, many time measures are solely based on professional judgment or experience.

OBJECTIVE

Calculate the average time parameters for the activities carried out by the oral health team in primary health care.

METHOD

This is a descriptive observational study using the time-motion method carried out in five Primary Health Care Units in the city of São Paulo, SP, Brazil. Direct and continuous observation of oral health team members occurred for 40 h spread over five days of a typical work week.

RESULTS

A total of 696.05 h of observation were conducted with 12 Dentists, three Oral Health Assistants, and five Oral Health Technicians. The Dentists' main activity was consultation with an average duration of 24.39 min, which took up 42.36% of their working time, followed by documentation with 12.15%. Oral Health Assistants spent 31.57% of their time on infection control, while Oral Health Technicians spent 22.37% on documentation.

CONCLUSION

The study establishes time standards for the activities performed by the dental care team and provides support for the application of workforce planning methods that allow for review and optimization of the work process and public policies.

COVID-19 hospitalized patients and oral changes: a case-control study

OBJECTIVES

To investigate the association between hospitalization for COVID-19 and oral changes, and to evaluate whether oral changes can indicate a higher risk of disease progression to death.

MATERIALS AND METHODS

This case-control study analyzed patients hospitalized (university hospital), including those in intensive care unit and clinical wards. The study group comprised 69 COVID-19 positive patients (PCR-test), while the control group included 43 COVID-19 negative patients. A dentist performed oral evaluations, and salivary samples were collected for calcium, phosphatase, and pH analysis. Sociodemographic data, hospitalization information, and hematological test results were collected from electronic-medical records. The presence of oral changes was assessed using chi-square tests, and the predicted risk of death was analyzed using binary logistic regression.

RESULTS

COVID-19 positive patients had a significantly higher prevalence of oral changes compared to COVID-19 negative patients. The presence of any oral changes in COVID-19 positive patients indicated a 13-fold higher risk of mortality. "Bleeding ulcers," "pressure ulcers," and "angular cheilitis" were significantly associated with hospitalization for COVID-19.

CONCLUSION

There may be an association between hospitalization for COVID-19 and the development of oral changes, including bleeding ulcers, pressure ulcers. and angular cheilitis. These oral changes may serve as potential indicator for disease progression an increased risk of death.

CLINICAL RELEVANCE

COVID-19 hospitalized patients have a higher prevalence of oral changes, which indicate an increased risk of mortality. Oral medicine staff should be included in multidisciplinary teams to detect and treat these oral changes promptly.

Adaptations in dental public health services during the COVID-19 pandemic in municipalities of Southern Brazil: a grounded theory and collaborative research

The aim of this study was to analyze oral health actions in four municipalities in Brazil during the COVID-19 pandemic according to a theoretical framework model on oral healthcare management. It was a qualitative study carried out in two stages. A theoretical-empirical model on the significance of oral healthcare management was developed, following the Grounded Theory method. Fourteen dentists and five healthcare managers participated, through open interview. Subsequently, collaborative research was performed, and the model was applied to analyze the documents produced to address the pandemic by each of four municipalities in Santa Catarina State. The model provided a framework for analyzing actions for coping with the pandemic regarding oral health services. Actions were identified in all dimensions of the model: reduction in supply of dental care due to restricted access to elective services; search for biosafety care standards; dissemination of standardized science-based guidelines; attempt to maintain comprehensive dental assistance through re-adaptation of specialized services and collective actions; and relocation of oral health professionals to assist in other sectors. The oral health care management framework can serve as a reference for redesigning oral health actions and services in other municipalities during the COVID-19 pandemic, in a broader perspective.

Impact of the COVID-19 Pandemic on Paediatric Dental Treatment: A Retrospective Study in Banja Luka, Bosnia and Herzegovina

Dentists are at significant risk of COVID-19 infection. It was difficult to find a balance between dental care, especially preventive and other non-urgent dental procedures, and prevention of potential exposure to SARS-CoV-2 infection. The aim of the present study was to assess the influence of the COVID-19 pandemic on dental treatment in children in the Dental Clinic of the University of Banja Luka, and to compare it before and during the first and second years of the pandemic. All dental records of paediatric patients who attended the Dental Clinic (for the period March 2019 to March 2022) were analysed. The data on selected dental treatment procedures were divided into three groups per year and compared. The results during the first year of the COVID-19 pandemic showed a reduction in single treatments compared to the year before, while in the second year there was an increase in some interventions such as oral hygiene training and patient motivation, deciduous tooth extraction, and glass ionomer filling. Although the number of dental treatments in the clinic in the second year nearly returned to pre-pandemic levels, preventive and restorative interventions are the most appropriate strategy to improve the oral health of children after the COVID-19 pandemic.

Efficacy of dental evacuation systems for aerosol exposure mitigation in dental clinic settings

Dental personnel are ranked among the highest risk occupations for exposure to SARS-CoV-2 due to their close proximity to the patient's mouth and many aerosol generating procedures encountered in dental practice. One method to reduce aerosols in dental settings is the use of intraoral evacuation systems. Intraoral evacuation systems are placed directly into a patient's mouth and maintain a dry field during procedures by capturing liquid and aerosols. Although multiple intraoral dental evacuation systems are commercially available, the efficacy of these systems is not well understood. The objectives of this study were to evaluate the efficacy of four dental evacuation systems at mitigating aerosol exposures during simulated ultrasonic scaling and crown preparation procedures. We conducted real-time respirable (PM4) and thoracic (PM10) aerosol sampling during ultrasonic scaling and crown preparation procedures while using four commercially available evacuation systems: a high-volume evacuator (HVE) and three alternative intraoral systems (A, B, C). Four trials were conducted for each system. Respirable and thoracic mass concentrations were measured during procedures at three locations including (1) near the breathing zone (BZ) of the dentist, (2) edge of the dental operatory room approximately 0.9 m away from the mannequin mouth, and (3) hallway supply cabinet located approximately 1.5 m away from the mannequin mouth. Respirable and thoracic mass concentrations measured during each procedure were compared with background concentrations measured in each respective location. Use of System A or HVE reduced thoracic (System A) and respirable (HVE) mass concentrations near the dentist's BZ to median background concentrations most often during the ultrasonic scaling procedure. During the crown preparation, use of System B or HVE reduced thoracic (System B) and respirable (HVE or System B) near the dentist's BZ to median background concentrations most often. Although some differences in efficacy were noted during each procedure and aerosol size fraction, the difference in median mass concentrations among evacuation systems was minimal, ranging from 0.01 to 1.48 µg/m3 across both procedures and aerosol size fractions.

Impact of COVID-19 Pandemic on Dental Treatment in Children: A Retrospective Cross-Sectional Analysis in Jeddah City

Background/Purpose

The novel coronavirus disease (COVID-19) outbreak has affected individuals worldwide. Considering the nature of dental treatments and direct exposure to saliva, blood, aerosols, or droplets from infected individuals, dentists are at significant risk of COVID-19 infection. Therefore, to decrease aerosol-generating procedures, minimally invasive dentistry (MID) is recommended during this pandemic. The goal of this research was to compare the flow of patients during a pandemic at a single university hospital in Jeddah City, Saudi Arabia, and to retrospectively assess the impact of the COVID-19 pandemic on pediatric dental treatments including MID.

Materials and Methods

This study was a retrospective cross-sectional analysis of pediatric patient records, dental procedures performed, and minimally invasive techniques using the database of the King Abdul-Aziz University Dental Hospital (R4) system during the period of COVID 19 pandemic compared to the same period in the previous year.

Results

During the COVID-19 pandemic, pediatric dental patient flow included only 699 patients compared to 1151 patients during the same period in the previous year. The most common pediatric dental procedures performed during the pandemic period were simple restorative treatments, including fissure sealants, followed by dental extractions, and fluoride varnish applications. During the pandemic period, more minimally invasive treatments were performed, including the Hall technique, silver diamine fluoride, resin infiltration, and atraumatic restorative techniques.

Conclusion

Based on this data, the COVID-19 pandemic had an impact on dental patient flow and the type of dental procedures performed on children. Minimally invasive treatments that minimize air generation are recommended; however, to establish the long-term effectiveness of minimally invasive treatments in pediatric dentistry, more follow-up studies with bigger sample sizes are required. More recommendations regarding conservative pediatric dental management after the COVID-19 era are suggested.

Gustatory dysfunction in COVID-19 patients: a rapid systematic review on 27,687 cases

Objective: This is a rapid systematic review concerning taste alterations in 27,687 individuals infected with SARS-CoV-2, published in the worldwide literature.Material and methods: Of the 485 articles recovered, 67 eligible studies (27,687 confirmed COVID-19 cases) were included in this analysis. We analysed the prevalence of the taste alterations in patients considering the country of origin of the studies.Results: The results show strong important differences in the overall reported prevalence of taste alterations among the different countries (from 11% of Korea to 88.8% of Belgium).Conclusions: These data highlight that there is a different geographical distribution of taste alterations in COVID-19 patients. Gustatory dysfunction seems to be an understudied symptom of COVID-19 and this may explain the inconsistencies of diagnostic criteria for COVID-19 case definition. Furthermore, this diagnostic underestimation can lead to an increased risk of contagion for the whole population and for the working classes most at risk, including the dental one.

COVID-19 Pandemic impact on Brazil's Public Dental System

The present study aimed to estimate the impact of the COVID-19 pandemic on dental care procedures in the Public Health System in Brazil. A retrospective, ecological study was carried out, comprising 5,564 Brazilian municipalities. The number of dental procedures (per 100,000 inhabitants) performed in the Brazilian Public Health System (SUS) was the outcome. The impact of the pandemic was estimated by comparing the rate of procedures for each month of 2020 with the rates observed in the equivalent months in 2019, considering the period from March to August. Regulatory legislation regarding restrictions on dental care, issued by the state governments of 27 Brazilian federative units, was used for mediation analysis. A 55% reduction was observed in March for all procedures (IRR = 0.45, 95%CI 0.39-0.51), while in the other months, the rate of reduction remained ≥ 88%. The biggest decrease was observed in collective preventive procedures (reduction ≥99%) between April and August. Procedures that were less likely to generate aerosols (tooth extraction and prosthetic) and emergencies showed the smallest reduction. The reduction was not mediated by the restrictions imposed by state governments (p>0.05). The impact of the COVID-19 pandemic was noteworthy in terms of the decrease in the number of dental procedures carried out in the Brazilian Public Dental Service. The lack of access, the delay of elective procedures and the lack of preventive collective procedures could result in an overburdened system, post-Pandemic.

Taste alteration in COVID-19: Significant geographical differences exist in the prevalence of the symptom

Early detection of COVID-19 is important for reduction in the spread of the disease and gustatory disturbances (GD) are known to have a strong predictive value. In the present study, we aimed to map the geographical differences in the prevalence of GD in individuals infected with SARS-CoV-2 during the first wave of COVID-19 in order to improve case identification and to facilitate prioritization. We undertook a rapid scoping review of articles published in the repository of the National Library of Medicine (MEDLINE/PubMed) and medRxiv from their inception until 3^rd September, 2020. The minimum requirements for completing a restricted systematic review were fulfilled. Of the 431 articles retrieved, 61 studies (28,374 cases confirmed with COVID-19) from 20 countries were included in the analysis. GD were most prevalent in the Americas [66.78%, 95% CI 54.77–78.79%] compared to Europe [57.18%, 95% CI 52.35–62.01%], the Middle East [38.83%, 95% CI 27.47–50.19%] and East Asia [13.1%, 95% CI 0.14–26.06%]. No differences of GD prevalence were evident between February and August 2020. The data demonstrate that there is a marked geographical distribution of GD in COVID-19 patients which, possibly, might be explained by differences in diagnostic criteria for COVID-19 case definition during the early phase of the pandemic.

Saliva: Both a Threat and an Opportunity in Covid-19 Pandemic

Covid-19 pandemic, continues all over the world with the increasing number of confirmed cases and performed tests day by day. It has been shown that collecting nasopharyngeal samples, as the most commonly prefered method to perform RT-PCR, has disadvantages like causing discomfort and bleeding in patients. Sample collecting procedure also renders healthcare professionals by exposing them to the risk of transmission of the virus related to the direct contact with patients. These disadvantages make this procedure undesirable for the researchers and forces them to search for an alternative technique. At this point, saliva appears as an opportunity, regarding its high viral load. On the other hand, this high viral load poses a threat, especially for professions such as dental practitioners, with too much aerosol exposure. Since dentistry is a branch of health that constantly needs direct operations, it is necessary to be protected from the virus as much as possible while caring for the patient. A literature review was done using electronic databases "PubMed," "Google Scholar," and "Cochrane Database," on January 2021. Studies have proposed many different preventive measures in this regard. Therefore, the purpose of this review is to draw attention to the saliva by bringing together the recent research and also to provide information and a perspective to dental clinicians about both prevention and a potential diagnostic technique.

Dental Education in an Era of COVID-19: Kuwait's Experience

The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on dental education worldwide. Due to the rapid spread of COVID-19 across Kuwait, it was essential for the Faculty of Dentistry (FoD) at Kuwait University to make appropriate modifications to the functioning of the dental school. The FoD's goal was not only to ensure a safe environment for its staff, students, and patients but also to sustain the students' academic progression. The FoD adopted several measures including the establishment of a COVID-19 response team, adoption of a blended-learning model, and phase-wise re-opening of the dental center. This paper discusses on the strategies that the FoD adopted, in response to the challenges posed by the pandemic.

A preparedness model for the provision of oral health care during unfolding threats: the case of the covid-19 pandemic

BACKGROUND

The aim of this study was to appraise a recently developed preparedness model for the provision of oral health care during a threat such as the COVID-19 pandemic from the perspectives of oral health care providers, administrators/staff, and patients.

METHODS

An exploratory qualitative inquiry via at-a-distance semi-structured interviews and group discussions engaged a purposefully selected sample of oral health care workers and patients in British Columbia (BC), Canada. Participants were asked to appraise a preparedness model by considering how to prepare for oral care during a pandemic, while answering open-ended questions about the model content and visual presentation. Interviews and group discussions occurred between April 2020 and January 2021, were audio recorded, and transcribed verbatim. An inductive coding process was used to identify themes, subthemes, and categories of information until saturation was achieved.

RESULTS

Seventy-four participants, including 19 dentists, 15 dental hygienists, 10 certified dental assistants, 9 administrators, and 21 patients, suggested modifications to the recently developed preparedness model. Individual interviews (41 participants) and group discussions (33 participants in groups ranging from 2 to 9 attendees each) lasted for an average of 53 min. Eighty-four hours of audio recordings led to more than 1110 single-spaced pages of transcripts. The thematic analysis identified 82 codes, 12 categories, and four main themes: life-long learning, critical thinking, personal and professional risk, and patient-centred care. These themes were understood within provider characteristics and social and environmental contexts. Participants highlighted the need for the model to focus on information and communication, developing awareness and understanding, inferring risks, and performing oral health care during a threat such as a pandemic or disease outbreak. A modified portrayal of the model was suggested to better represent participants' perspectives.

CONCLUSION

A recently developed preparedness model for the provision of dental care during an unfolding threat like the COVID-19 pandemic was appraised and modified by oral health care workers. Future studies are warranted to evaluate the modified model for use in the event of another unfolding threat collaboratively with providers, patients and stakeholders.

Oral Symptoms Associated with COVID-19 and Their Pathogenic Mechanisms: A Literature Review

Since the worldwide spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, management of coronavirus disease 2019 (COVID-19) has been challenging for healthcare providers. The oral cavity is referred to as a target of SARS-CoV-2. The aim of this study was to review oral symptoms specific to COVID-19 patients from the point of view of symptom prevalence and pathogenesis and to speculate the pathogenic mechanisms underlying them. Scientific articles were retrieved by searching PubMed/MEDLINE, Google Scholar, medRxiv, and bioRxiv from 3 February 2020 to 31 December 2020, and they were reviewed by title, abstract, and text for relevance. The literature search indicated that COVID-19 patients frequently present with gustatory dysfunction, xerostomia, and oral mucosal lesions, while their prevalence is likely to vary by country, age, gender, and disease severity. Gustatory dysfunction and xerostomia appear at an early stage of SARS-CoV-2 infection and last relatively long. One of possible pathogenic mechanisms of both symptoms is attributed to the expression of viral cellular entry-relevant receptors in taste cells and salivary glands. Dental professionals who can first become aware of oral symptoms associated with COVID-19 will play a more active role in and make a greater contribution to diagnosis and prevention of COVID-19.

Global concerns of dental and oral health workers during COVID-19 outbreak: a scope study on the concerns and the coping strategies

BACKGROUND

Dental and oral health workers have direct contact with respiratory aerosols of patients during procedures. This study aimed to determine the main concerns of dental and oral health workers globally during COVID-19 outbreaks and the coping strategies that help the resilience of dental and oral healthcare system.

METHODS

This scoping study was conducted in August 2020. After adjusting the search strategy, a systematic search of five databases (PubMed, ISI Web of Science, Scopus, ProQuest and EMBASE) was conducted. Data was extracted using Microsoft Excel and the contents of retrieved articles were analysed through a qualitative thematic analysis applying MAX QDA₁₀.

RESULTS

Most articles were either editorial/letters to the editor/commentary formats (34%), or literature reviews (26%). About half of the articles belonged to three countries of Italy, China and the USA (each 16% and totally 48%). Thematic analysis of included papers led to the identification of four main global concerns and 19 sub-concerns. Economic, ethical, social and professional concerns are among dental and oral health concerns. Other results indicate on three main themes and 13 sub-themes as the coping strategies including patient management, infection control and virtual strategies.

CONCLUSION

Dental and oral health care workers have many concerns relating to COVID-19 including economic, ethical, social and professional factors. Resolution of concerns may involve enhancing coping strategies relating to patient management and infection control strategies as well as using new technologies for virtual contact with the patient without any risk of infection.

Getting Special Care Dentistry Ready for a Foreseeable Future. Reinstated Services and Mitigation Measures to Curb COVID-19 Disruption

In March 2020, dental care providers, including special care dentistry (SCD) services, had to face an extraordinary change of their standard operating procedures (SOP), with deferred domiciliary dental care, withholding conscious dental sedation services and disrupted routine care [...].

The influence of the SARS-CoV-2 pandemic on oral and maxillofacial surgery: a nationwide survey among 54 hospitals and 240 private practices in Germany

Objective

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic has created hitherto unknown challenges for healthcare systems and patient care. This study aimed to analyze its influence on patient care and healthcare management in oral and maxillofacial surgery (OMFS) in Germany.

Materials and methods

A nationwide survey of the German Association of Oral and Maxillofacial Surgery was performed. Individual questionnaires containing 10 questions for university as well as non-university hospitals and 15 questions for private practices (PPs) for OMFS were created to collect data for patient numbers and surgical procedures conducted, usage of personal protection equipment (PPE), SARS-CoV-2 tests, and economic aspects.

Results

Fifty-four hospitals and 240 PPs participated in the study. The reduction in ward capacities and number of surgical procedures ranged from 17 to 78%. PPE consisted of standard surgical masks (58% hospitals, 64% PPs) and FFP2/N95/KN95 respirators (45% hospitals, 48% PPs). Preoperative SARS-CoV-2 tests were more frequently performed in hospitals (34% vs 2%). At PPs, turnover for medical and dental procedures billed to the public insurance had reduced to 58.81% and 62.43%, respectively, of the corresponding values for 2019, and 58.75% of the PPs had applied for short-time allowances.

Conclusion

With the exception of some elective procedures, primary patient care in OMFS has been assured during the pandemic. However, the immense economic burden on hospitals and PPs cannot be conclusively assessed at this point.

Clinical relevance

For OMFS, the German healthcare system has shown the ability to adapt to emergency situations such as the SARS-CoV-2 pandemic. Adequate surgical capacities in OMFS are necessary even during pandemics.

Estimation of differential occupational risk of COVID-19 by comparing risk factors with case data by occupational group

BACKGROUND

The disease burden of coronavirus disease 2019 (COVID-19) is not uniform across occupations. Although healthcare workers are well-known to be at increased risk, data for other occupations are lacking. In lieu of this, models have been used to forecast occupational risk using various predictors, but no model heretofore has used data from actual case numbers. This study assesses the differential risk of COVID-19 by occupation using predictors from the Occupational Information Network (O*NET) database and correlating them with case counts published by the Washington State Department of Health to identify workers in individual occupations at highest risk of COVID-19 infection.

METHODS

The O*NET database was screened for potential predictors of differential COVID-19 risk by occupation. Case counts delineated by occupational group were obtained from public sources. Prevalence by occupation was estimated and correlated with O*NET data to build a regression model to predict individual occupations at greatest risk.

RESULTS

Two variables correlate with case prevalence: disease exposure (r = 0.66; p = 0.001) and physical proximity (r = 0.64; p = 0.002), and predict 47.5% of prevalence variance (p = 0.003) on multiple linear regression analysis. The highest risk occupations are in healthcare, particularly dental, but many nonhealthcare occupations are also vulnerable.

CONCLUSIONS

Models can be used to identify workers vulnerable to COVID-19, but predictions are tempered by methodological limitations. Comprehensive data across many states must be collected to adequately guide implementation of occupation-specific interventions in the battle against COVID-19.

Effects of cervical restorations on the periodontal tissues: 5-year follow-up results of a randomized clinical trial

OBJECTIVE

This study evaluated the effect of resin composite restorations of non-carious cervical lesions (NCCLs) on the occurrence/progression of gingival recession (GR), considering different tooth isolation techniques.

METHODS

A randomized controlled split-mouth and blinded trial was carried out. Patients (n = 38) with at least two NCCLs were included. Before the cervical restoration placement, the NCCLs (181 teeth) were randomly allocated into two treatment groups according to the tooth isolation techniques: cotton roll or rubber dam. Experienced, trained, blinded, and calibrated examiners performed periodontal evaluations at baseline and 5-year follow-up, using a periodontal probe. Restorations were assessed with the FDI criteria. Thirty-two patients (154 teeth) were evaluated at 5 years. The occurrence/progression of GR between baseline and follow-up was considered the primary outcome. The relative risk (RR) and 95 % confidence interval (95 %CI) were calculated by Poisson regression (α < 0.05).

RESULTS

After 5 year, 31 teeth (13.6 %) presented occurrence/progression of GR. In the multivariate analyses, the occurrence/progression of GR was associated with the use of rubber dam isolation (RR; 95 %CI: 2.65; 1.01-7.00) and a lack of marginal adaptation of the restoration (RR; 95 %CI: 10.98; 2.31-52.30). Toothbrush stiffness, use of abrasive dentifrice, tooth type, and the presence of biofilm or gingivitis did not present a statistically significant higher risk for occurrence/progression of GR.

CONCLUSION

The use of rubber dam isolation associated with retraction clamp and the lack of a proper marginal adaptation of the composite restorations are risk indicators for the occurrence/progression of GR in individuals who received a restoration for an NCCL.

CLINICAL SIGNIFICANCE

Isolation with a rubber dam and dental clamps may promote GR in sites with restored NCCLs. Moreover, clinical examinations for lack of marginal adaptations of the restorations may be included in a clinical setting.

Self-reported smell and taste alteration as the sole clinical manifestation of SARS-CoV-2 infection

Chemosensory dysfunction has increasingly been reported in patients with coronavirus disease 2019 (COVID-19). Here, we document a case of a patient with taste and smell alterations as the only clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In March 2020, a 36-year-old woman presented with self-reported hypogeusia/ageusia and hyposmia/anosmia in the absence of any respiratory symptom. The patient, who had no clinical and radiographic signs of sinusitis and was otherwise healthy, eventually had a positive test result for SARS-CoV-2. She did not develop any COVID-19–related symptoms throughout her 6-month follow up. Her self-reported chemosensory dysfunction lasted for 12 weeks. To the best of our knowledge, this is the first report that has accurately documented taste and smell alteration as the sole manifestation of COVID-19 in an otherwise healthy individual. Overall, analysis of current evidence supports the inclusion of gustatory and olfactory alterations as cardinal symptoms of COVID-19. Dentists’ awareness of the diagnostic criteria for case definition of COVID-19 can facilitate early detection of the disease.

A Pan-Canadian narrative review on the protocols for reopening dental services during the COVID-19 pandemic

The current coronavirus disease 2019 (COVID-19) pandemic is impacting the way in which dental services are provided. The aim of this narrative review was twofold: to summarize key areas from the Canadian protocols available for the reopening and restructuring of dental services across the country and to critically review these protocols based on existing evidence. A narrative review of the existing Canadian protocols, written in English and French, was undertaken between April 15 and July 13, 2020. The protocols were obtained by searching through regulatory bodies and websites from professional organizations, and from personal contacts through academic institutions and policy leaders. The data extraction form focused only on protocols related to dentistry, and the information was compiled by a hired assistant. Content was categorized via group discussions with the research team on eight areas: office management and procedures, patient and staff screening, treatment procedures, office layout, risk reduction, personal protective equipment, supporting information, and length and readability. Thirteen protocols were identified and offered substantial variation in the level of details provided. All but two protocols specified proper donning/doffing of personal protective equipment, while all protocols recommended daily monitoring of COVID-19 related signs and symptoms in staff and patients. They varied in terms of recommended mask types, eye and face shield protection, and head coverings. While all protocols aimed at restructuring emergency dental services, their recommendations were often not based on the published evidence. This narrative review summarized key areas from 13 provincial and territorial protocols in Canada to help oral health care providers plan the reopening of their services. The information conveyed across all documents was clear, but variance highlights the need for a coordinated effort to develop an evidence-based document for dental practitioners.

Knowledge and attitudes of Iranian dental students regarding infection control during the COVID-19 pandemic

COVID-19 is an emerging and rapidly-evolving situation. This study aimed to measure the level of knowledge and attitude of the Iranian dental students towards COVID-19 and its infection control strategies. This cross-sectional study was designed using a web-based method. The questionnaire associated with COVID-19 was sent to all Iranian students in the clinical course. The extracted data regarding the knowledge and attitude of the students were statistically analyzed. In this study, 531 dental students of the clinical course in 32 Iranian universities were included. The mean age of the participants was 23.13 ± 2.29 years. The average percentage of knowledge and attitude scores were 59.7% (moderate) and 66.0% (neutral), respectively. The association between the attitude of the students and their semesters was statistically significant (r = 0.183, p < 0.001). The age of the students was also significantly associated with their attitudes (r = 0.150, p = 0.001). The outbreak of COVID-19 might resurge due to re-opening of the dental faculties. Training courses on COVID-19 infection prevention strategies should be held for dental students, especially the junior ones, and the guidelines should be sent to all of them.

SARS-CoV-2 Infection: General Characteristics and Specific in Dental Practice

The transmission of the coronavirus and possible routes of infection are still unclear. The most common routes of infection in humans are direct transmission through respiratory droplets and salivа when coughing or sneezing and indirect transmission through contaminated surfaces. Most of the infected people after the incubation period have clinical manifestations with mild or moderate respiratory tract infections (RTIs). Physician of dental medicine performs aerosol procedures which transmit the virus directly from healthy people. Oral fluids, blood, conjunctiva, nasal, and oral mucosa are also a source of infection, so they are highly exposed to the virus, much more than other medical staff and therefore it is crucial to establish appropriate protocols and prevention strategies. Under conditions of a declared global pandemic, dentists are advised to stop their work of all cases that are not urgent. If the dental office is one of those that provide the necessary and urgent medical attention, it is necessary to strictly implement control measures to prevent infection. The basic protocols for the operation of the dental offices have been published by the Dental Chamber of Macedonia and they are recommendations regarding the procedures for the maintenance of the hygiene of the medical staff and the working space. Recent experience has shown that dental health-care services are often neglected and inadequately treated in epidemics. Dental workers are particularly exposed to RTIs due to their specific field and mode of operation, so the current experience will prepare them for future challenges.  

A prospective clinical pilot study on the effects of a hydrogen peroxide mouthrinse on the intraoral viral load of SARS-CoV-2

Objectives

SARS-CoV-2 is mainly transmitted by inhalation of droplets and aerosols. This puts healthcare professionals from specialties with close patient contact at high risk of nosocomial infections with SARS-CoV-2. In this context, preprocedural mouthrinses with hydrogen peroxide have been recommended before conducting intraoral procedures. Therefore, the aim of this study was to investigate the effects of a 1% hydrogen peroxide mouthrinse on reducing the intraoral SARS-CoV-2 load.

Methods

Twelve out of 98 initially screened hospitalized SARS-CoV-2-positive patients were included in this study. Intraoral viral load was determined by RT-PCR at baseline, whereupon patients had to gargle mouth and throat with 20 mL of 1% hydrogen peroxide for 30 s. After 30 min, a second examination of intraoral viral load was performed by RT-PCR. Furthermore, virus culture was performed for specimens exhibiting viral load of at least 10³ RNA copies/mL at baseline.

Results

Ten out of the 12 initially included SARS-CoV-2-positive patients completed the study. The hydrogen peroxide mouthrinse led to no significant reduction of intraoral viral load. Replicating virus could only be determined from one baseline specimen.

Conclusion

A 1% hydrogen peroxide mouthrinse does not reduce the intraoral viral load in SARS-CoV-2-positive subjects. However, virus culture did not yield any indication on the effects of the mouthrinse on the infectivity of the detected RNA copies.

Clinical relevance

The recommendation of a preprocedural mouthrinse with hydrogen peroxide before intraoral procedures is questionable and thus should not be supported any longer, but strict infection prevention regimens are of paramount importance.

Trial registration

German Clinical Trials Register (ref. DRKS00022484)

Impact of SARS-CoV-2 on orthodontic education and global practice guidance: A scoping review

The acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as COVID-19, has had unprecedented impact on orthodontic care and education. Dental schools and clinics have stopped their normal educational and clinical activities worldwide, while only accepting emergency cases. It is still unknown when students will return to clinics to resume patient care and receive training. This scoping review aims to examine, summarize, and reference current resources to analyze the impact of SARSCoV-2 on orthodontic practice recommendations and orthodontic education. This review summarizes recommended global guidelines to provide a better understanding of the current consensus for protocols of safe orthodontic care; this scoping review serves to help create concrete guidelines for orthodontists to deal with the current SARS-CoV-2 pandemic, and for future infectious diseases, and assessing the impact on orthodontic education. Using inclusion/exclusion criteria, 456 articles were screened by two independent screeners and data were extracted and charted from 50 relevant sources. These 50 sources conveyed similar guidelines for provider and patient safety in orthodontic practices, with some stressing certain protocols such as personal protective equipment over others. Impacts on orthodontic education conveyed changes in protocols for learning, competency, and clinical skills. As this respiratory illness progresses, the field of orthodontics needs cohesive universal clinical guidelines and further assessment of the impacts of SARS-CoV-2 on orthodontic education.

Dental Practice Infection Control Measurements: Coronavirus Disease (COVID-19) Outbreaks

A new coronavirus disease called COVID-19 has been considered to be a public health emergency of international apprehension by the WHO. This new disease includes multiple symptoms such as fever, cough, sore throat, and rhinorrhea. The disease is mild in most people; however, in some patients, it may develop to pneumonia, acute respiratory distress syndrome (ARDS), and multiple dysfunctions in the organs which may lead to death. There are two routes of transmission for this virus, the first route is the direct transmission, through cough or droplet inhalation, while the second route is through contact, for example, contact with oral and nasal mucous membranes; consequently, extensive and intensive measures should be taken to decrease the transmission of COVID-19 from person to person. Due to the nature of dental work and its procedures, the dental professionals are in a high risk of transmission. Hence, in this article, we wanted to highlight the clinical features, trajectories of spread, and infection control considerations to prevent and control the spread of this fatal disease.