Emerging Challenges and Threats for Dental Health Care Sector Attributable to COVID-19: Tale of a Developing Country

Optimizing Safe Dental Practice During the COVID-19 Pandemic: Recommendations Based on a Guide Developed for Dental Practices in China

The current global coronavirus disease 2019 (COVID-19) outbreak is still exerting severe global implications, and its development in various regions is complex and variable. The high risk of cross-infection poses a great challenge to the dental practice environment; it is therefore urgent to develop a set of pandemic prevention measures to ensure dental practice safety during the COVID-19 outbreak. Therefore, we combined the epidemiological characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), public emergency measures for COVID-19, characteristics of dental practice, and relevant literature reports to develop a set of dynamic practice measures for dental practices in high-, medium-, and low-risk areas affected by COVID-19. This will help dental practices to achieve standard prevention and ensure their safe and smooth operation during the pandemic. It is hoped that these measures will provide a reference basis for dental hospitals and dental clinics in their care and pandemic prevention work.

The Debate: What Are Aerosol-Generating Procedures in Dentistry? A Rapid Review

Introduction:

This article aims to review the current national and international dental guidance produced during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic to identify the level of consensus on aerosol-generating dental procedures (AGDPs). The outcomes intend to encourage increased collaboration with respect to dental guidelines in relation to the SARS-CoV-2 pandemic, as well as to improve decision making and safety for dental patients and staff.

Methods:

This rapid review was conducted by 2 authors (MKV and KD), with the support of a third author (SD), to assess current guidelines related to dental AGDPs. This streamlined review approach allowed synthesis of data in an efficient manner in the rapidly evolving environment associated with the SARS-CoV-2 pandemic.

Results:

The findings identified 1) a lack of consistency in reporting which procedures were deemed an AGDP; 2) that high-speed handpieces, air-water syringes, and mechanical scalers were consistently considered high-risk AGDPs; 3) a lack of consensus on the risk of coronavirus disease 2019 (COVID-19) transmission with the use of slow-speed handpieces; 4) a general agreement, when described, that rubber dam and high-volume evacuation can significantly reduce aerosol production; and 5) a lack of consistency in reporting whether procedures constitute a low, moderate, or high risk of COVID-19 transmission. The findings are discussed in relation to the guidance and future recommendations.

Conclusion:

It is recommended that future published guidance should indicate the risk stratification (low/moderate/high) of each procedure/exposure in a standardized international approach.

Knowledge Transfer Statement:

The results of this rapid review can be used by clinicians to increase their awareness of international guidance on aerosol-generating procedures in dentistry. It will also encourage those publishing future guidance to provide an internationally standardized, risk-stratified approach to describing aerosol-generating procedures. Currently, it allows clinicians to consider aerosol-generating procedures as a risk spectrum.

Strategic implementation of dental infection control in resource-poor jurisdictions during COVID-19 pandemic: a perspective from South Africa

BACKGROUND

The coronavirus disease-19 (COVID-19) pandemic caused by the severe acute respiratory syndrome Coronavirus -2 is unceasing, and the consensus is that the dental profession has to co-exist with this vicious foe for the foreseeable future. Dental professionals in resource poor countries, as opposed to those in developed countries, face additional challenges due to the lack of personal protective equipment, and chronic infrastructural impediments extant in such jurisdictions, such as regular and chronic interruptions to electricity and water supplies.

OBJECTIVES

To address this new 'normal' which dictates that dentistry has to 'adapt and adopt' in order to deliver care to the needy, particularly in resource poor nations, whilst care deliverers take appropriate precautionary measures to obviate cross infection.

METHODS

A review was preformed of the challenges to delivery of infection control measures in dentistry in resource meagre settings, and practical interventional measures proposed to mitigate these challenges, taking South Africa as a case study.

RESULTS

In reality, optimal infection control measures cannot be implemented in delivering dental care in resource poor settings, a challenge that has been ill addressed by the relevant authoritative bodies. A re-adaptation of infection control guidelines that could be simply implemented in such settings has been formulated.

CONCLUSION

We present practical infection control guidelines to lessen the burden of dental professionals in resource poor countries who dispense treatment under trying circumstance. The strategic infection control measures, including engineering and administrative controls outlined could be applicable in jurisdictions with a diminished capacity to respond to local, regional or national infection control guide-lines, due to financial, regulatory, or other infrastructural resource deficiencies.