Pandemics past, present, and future: Their impact on oral health care

Mycobiology of Dental Unit Water: A Systematic Scoping Review

Fungi present in Dental Unit Water (DUW) can pose a health hazard to patients and dental personnel. Yet, the issue of fungal contamination of DUW and their conduits, DUW Lines (DUWLs) has been poorly addressed despite a growing body of data on the subject. In this comprehensive review, we aim to address this gap by examining the diverse fungal contaminants found in DUW, the challenges associated with controlling their growth within waterline biofilms, and the various measures employed for fungal decontamination. The review underscores the intricate fungal ecosystems that exist within DUWLs and emphasizes the importance of implementing targeted antimicrobial strategies to uphold waterline hygiene. However, it is important to note that complete eradication of fungi in DUWLs has proven elusive, even with the application of disinfectants at varying concentrations, types, and frequencies. This highlights the pressing need for continued research efforts to develop new and optimized treatment protocols that are specifically tailored to eradicate fungi from DUWLs. Finally, it was notable that there are currently no specific regulations by any dental authority on permissible levels of fungi, as opposed to bacteria, in DUWLs. Legislation developed based on our findings can contribute to the standardization of practices and the formulation of effective control strategies for fungal contamination in DUWLs. It can also guide dental professionals in implementing regular monitoring, proper maintenance, and targeted disinfection protocols to minimize fungal contamination and ensure optimal water quality for patient safety.

Dental Unit Waterlines: Disinfection and Management

Dental unit waterlines (DUWLs) are the conduits within the dental chair through which water derived from the municipal or other peripheral supply systems flows through the dental chair to reach the dental patient. The quality of the water so delivered must have a low pathogenic microbial burden so as to be safe for the patient and the dental personnel. Regulatory bodies have therefore set minimum standards for the quality of water that exits from DUWLs as part of routine infection control. Adopting a comprehensive approach that combines physical, chemical, and automated methodologies is recommended to effectively decontaminate DUWLs. This review discusses the complexities of DUWL decontamination in terms of (1) Best Practice Guidelines in dental healthcare settings to mitigate DUWL contamination, (2) origins of DUWL contamination and biofilm formation and the associated infectious risks, (3) contemporary approaches for minimizing DUWL contamination, and (4) constraints in combating biofilms in DUWLs. Compliance with regional and national regulations on DUWL decontamination is a legal obligation for all dental practitioners and fundamental to protecting public health.

Mucormycosis of the Mandible and Tongue: A Systematic Scoping Review

AIM

Mucormycosis is a rare human infection associated with Mucorales, a group of filamentous moulds found in different environmental niches. Its oral manifestations may occur in the mandible and tongue despite being rare. We aimed to systematically review the data on clinical manifestations, risk factors, diagnostic approaches, treatment options, and outcomes of mandibular and tongue mucormycosis.

METHODS

An electronic search of articles published between January 1975 and November 2022 in PubMed, Web of Science, and EMBASE databases was performed. A total of 22 articles met the inclusion criteria and reported 27 cases of oral mucormycosis in total.

RESULTS

Fourteen patients had mandibular mucormycosis signs unrelated to COVID-19 infection, 6 had SARS-CoV-2-related mandibular mucormycosis, and 6 had manifestations in the tongue. All published case reports during the COVID-19 pandemic were from India. Patient ages ranged from 4 months old to 82 years, and most patients had important comorbidities, such as blood dyscrasias related to immune deficiency and uncontrolled type 2 diabetes mellitus. The signs and symptoms of mandibular and tongue mucormycosis varied from dental pain, loose teeth, and nonhealing sockets to dysphagia and paraesthesia of the lip. Some patients also reported trismus, draining sinus tract, and facial pain. The diagnosis of oral mucormycosis was based on a combination of clinical, radiographic, and histopathologic findings by demonstrating fungal hyphae in tissue specimens. In most cases, mucormycosis was managed with systemic amphotericin B, strict glycaemic control, and aggressive surgical debridement of infected tissue, minimising the progression of the fungal infection and thus improving the survival rate. In some cases, combined antifungal therapy, antibiotic therapy, and chlorhexidine mouthwashes were used successfully.

CONCLUSIONS

Recognition of the signs and symptoms by oral care providers is pertinent for the early diagnosis and treatment of tongue and mandibular mucormycosis, and providers should be aware of the possibility of this opportunistic fungal infection in patients with COVID-19. A multidisciplinary approach is recommended for the management of this lethal infection.

Application of artificial intelligence (AI) to control COVID-19 pandemic: Current status and future prospects

The impact of the coronavirus disease 2019 (COVID-19) pandemic on the everyday livelihood of people has been monumental and unparalleled. Although the pandemic has vastly affected the global healthcare system, it has also been a platform to promote and develop pioneering applications based on autonomic artificial intelligence (AI) technology with therapeutic significance in combating the pandemic. Artificial intelligence has successfully demonstrated that it can reduce the probability of human-to-human infectivity of the virus through evaluation, analysis, and triangulation of existing data on the infectivity and spread of the virus. This review talks about the applications and significance of modern robotic and automated systems that may assist in spreading a pandemic. In addition, this study discusses intelligent wearable devices and how they could be helpful throughout the COVID-19 pandemic.

Recrudescence of Scarlet Fever and Its Implications for Dental Professionals

A significant increase in the incidence of scarlet fever, mainly in Europe, has been noted during the COVID-19 postpandemic period. Scarlet fever is caused by a pyrogenic exotoxin-producing streptococcus-Streptococcus pyogenes-responsible for more than 500,000 deaths annually worldwide. Superantigens (SAgs) secreted by this Group A streptococcus (GAS) usually overstimulate the human immune system, causing an amplified hypersensitivity reaction leading to initial symptoms such as sore throat, high fever, and a sandpaper-like skin rash. There could be concurrent oral manifestations known as "strawberry tongue" or "raspberry tongue," which may be first noted by oral health professionals. The early diagnosis and treatment of this disease is critical to obviate the development of local and systemic sequelae such as acute rheumatic fever, endocarditis, and glomerulonephritis. Antibiotics should be prescribed early to mitigate its duration, sequelae, and community spread. Dental practitioners should be aware of the early symptoms of scarlet fever for infection detection, emergency patient management, and appropriate referral. This concise review outlines the prevalence, pathogenicity, oral and systemic manifestations, as well as the dental implications of scarlet fever.

Teledentistry and management protocol in a pediatric dental department during the first COVID-19 lockdown

BACKGROUND

During the first COVID-19 lockdown, from March 12 to May 15, 2020, private dental practices in France and in many other countries remained closed. Dental emergencies were therefore partly redirected to hospital dental departments. The aim of this article is to describe the modalities of remote management of emergencies during this period, by the pediatric dentistry department of Nancy University Hospital (France), via an oral telemedicine protocol.

PATIENTS AND METHODS

All parents of children in difficulty were invited to contact the department by phone. Initial triage was managed by externs, interns, or dental practitioners following a management protocol specifically adapted to pediatric dentistry for this context. Depending on the situation (type of complaint, geographical location of the patients, possibility of travel, availability of digital equipment, etc.), an oral telemedicine solution was proposed using the Covotem® software (Maincare Society, Canejan, France) via the Pulsy platform (public interest grouping validated by the Grand Est Regional Agency for Health) and possibly using an intraoral photographic protocol suggested by the team.

RESULTS

During this period, 176 patients used the pediatric dental department, 40 of whom were managed via oral telemedicine. Of these children, 57% (23/40) required an appointment in the department during the lockdown, 30% (12/40) did not require follow-up, and 13% (5/40) required a post-lockdown appointment. This teledentistry protocol resulted in a diagnosis in most cases (93%).

CONCLUSION

Patient management through oral telemedicine appears to be an effective tool for planning and organizing oral healthcare. It should be more widely considered in dentistry in the current context of pressure in medical emergencies, significant medical needs, and medical desertification.

Human Monkeypox: Oral Implications and Recommendations for Oral Screening and Infection Control in Dental Practice

The World Health Organization declared the spread of the human monkeypox virus (MPXV) an "emerging threat of moderate health concern" on 23 June 2022. Although about 20,000 cases of Monkeypox (MPX) were recorded in Europe and more than 28,000 in the United States from May to October 2022, their number is still small compared to the number of dental patients treated annually. Therefore, the likelihood of oral healthcare workers encountering an MPX case is relatively low in not endemic regions. In addition, MPX-positive individuals are considered contagious only during the prodromal or acute phase. However, the exact shedding and transmission routes of MPX and the associated risk of transmission in the dental setting remain unclear. Moreover, infected subjects whose disease is confined to the head and neck may require oral and dental care because they complain of lymphadenopathy involving the cervical lymph nodes. Furthermore, MPX lesions may first appear in the oral cavity or perioral area. Therefore, given the recent spread of MPXV in non-endemic areas where dentists are not used to considering this disease in the differential diagnosis and taking appropriate preventive measures, all oral healthcare providers nowadays should be aware of the oral presentation of MPX for adequate oral screening and appropriate preventive measures for infection control in the dental practice.

Teledentistry Implementation During the COVID-19 Pandemic: Scoping Review

BACKGROUND

COVID-19 spreads via aerosol droplets. The dental profession is at high risk of contracting the virus since their work includes treatment procedures that produce aerosols. Teledentistry offers an opportunity to mitigate the risk to dental personnel by allowing dentists to provide care without direct patient contact.

OBJECTIVE

The purpose of this scoping review was to examine the implementation, challenges, strategies, and innovations related to teledentistry during the COVID-19 pandemic lockdown.

METHODS

This scoping review evaluated teledentistry use during the pandemic by searching for articles in PubMed and Google Scholar using the search terms teledentistry, tele-dentistry, covid-19, coronavirus, telehealth, telemedicine, and dentistry. Inclusion criteria consisted of articles published in English from March 1, 2020, to April 1, 2022, that were relevant to dentistry and its specialties, and that included some discussion of teledentistry and COVID-19. Specifically, the review sought to explore teledentistry implementation, challenges, strategies to overcome challenges, and innovative ideas that emerged during the pandemic. It followed the 2020 Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR). This approach is organized into 5 distinct steps: formulating a defined question, using the question to develop inclusion criteria to identify relevant studies, an approach to appraise the studies, summarizing the evidence using an explicit methodology, and interpreting the findings of the review.

RESULTS

A total of 32 articles was included in this scoping review and summarized by article type, methodology and population, and key points about the aims; 9 articles were narrative review articles, 10 were opinion pieces, 4 were descriptive studies, 3 were surveys, 2 were integrative literature reviews, and there was 1 each of the following: observational study, systematic review, case report, and practice brief. Teledentistry was used both synchronously and asynchronously for virtual consultations, often employing commercial applications such as WhatsApp, Skype, and Zoom. Dental professionals most commonly used teledentistry for triage, to reduce in-person visits, and for scheduling and providing consultations remotely. Identified challenges included patient and clinician acceptance of teledentistry, having adequate infrastructure, reimbursement, and security concerns. Strategies to address these concerns included clinician and patient training and utilizing Health Insurance Portability and Accountability Act-compliant applications. Benefits from teledentistry included providing care for patients during the pandemic and extending care to areas lacking access to dental care.

CONCLUSIONS

Pandemic lockdowns led to new teledentistry implementations, most commonly for triage but also for follow-up and nonprocedural care. Teledentistry reduced in-person visits and improved access to remote areas. Challenges such as technology infrastructure, provider skill level, billing issues, and privacy concerns remain.

"New Normal" Radiology

COVID-19, the most recent and globally impactful zoonotic viral pandemic in the last 20 years, has now entered its third year. As the global dental profession returns to providing as full a range of services as possible, in addition to embedding the new infection-control processes that were developed for this pandemic, it should also take full advantage of digital conventional radiology (intraoral, extraoral, and panoramic radiography) and cone-beam computed tomography. Regardless of vaccinations, new or yet-to-manifest variants, and testing, some dentists may be working in communities where the asymptomatic but potentially infectious patient poses a real risk. This needs to be met with not only the whole COVID-19 panoply the dentist is already too familiar with but also the need to minimise aerosol generation production by dental radiography. A flowchart and a table that compares the attributes of the above modalities are included.

Open Debates Conducive for Vaccination Rate Flatlines: A Scoping Review and Convergent Cross Mapping

COVID-19 pandemic is fueling digital health transformation-accelerating innovations of digital health services, surveillance, and interventions, whereas hastening social contagion of deliberate infodemic. The USA and many other countries are experiencing a resurgent wave of the COVID-19 pandemic with vaccination rate slowdown, making policymaking fraught with challenges. Political leaders and scientists have publicly warned of a "pandemic of the unvaccinated," reinforcing their calls for citizens to get jabs. However, some scientists accused elites of stigmatizing the unvaccinated people and undermining the moral pillars of public health. Following the PRISMA-ScR guidelines, we first reviewed the nuances of stakeholders involved in the ongoing debates and revealed the potential consequences of divisive pronouncements to provide perspectives to reframe extensible discussions. Then, we employed the convergent cross mapping (CCM) model to reveal the uncharted knock-on effects of the contentious tsunami in a stakeholders-oriented policymaking framework, coupled with rich metadata from the GDELT project and Google Trends. Our experimental findings suggest that current news coverage may shape the mindsets of the vaccines against the unvaccinated, thereby exacerbating the risk of dualistic antagonism in algorithmically infused societies. Finally, we briefly summarized how open debates are conducive to increasing vaccination rates and bolstering the outcomes of impending policies for pandemic preparedness.