Dental Healthcare Amid the COVID-19 Pandemic

A scoping review of the impact of COVID-19 on dentistry: financial aspects

BACKGROUND

The technological advancements of the past few decades in various aspects that are directly or indirectly related to health, along with the emphasis on public health in societal development, have improved the quality of life. However, the occurrence of pandemics and crises underscores how various aspects of individual life can be impacted. The financial consequences resulting from the COVID-19 pandemic have particularly affected the field of dentistry and public oral health. This study aims to investigate the financial effects of the COVID-19 virus on dentistry through a scoping review.

METHODS

A comprehensive literature search was conducted across four databases (Medline through PubMed, Embase, Scopus, and Cochrane Central) using keywords such as COVID-19 and its equivalents, dentistry, oral health, dental education, dental services, dental clinics, financial impact, financial opportunities and economic impact. Articles addressing the financial impact of COVID-19 on dentistry and oral health were then screened and reviewed.

RESULTS

Out of 1015 articles related to COVID-19 and dentistry, 84 were focused on the financial impact of COVID-19 on dentistry. The majority of these articles originated from the United States, Brazil, and Saudi Arabia, with a prevalence of cross-sectional and review articles. The review categorized the articles into two main themes: financial problems and proposed solutions. Moreover, the following themes were extracted: the effects of practice closure on dentists and staff, increased treatment costs and impacts on oral health, personal protective equipment and unforeseen costs, psychological effects of financial issues, and financial challenges within the dental education system.

CONCLUSIONS

While many high-income countries seem able to mitigate COVID-19-induced financial problems, the economic effects on dentistry might persist despite the pandemic's end. These financial challenges have spurred new opportunities and infrastructure development but can pose significant risks to community oral health. This study aimed to highlight these problems and propose solutions, contributing to efforts to improve the oral health of communities globally. Further research is needed to understand long-term impacts.

Reconstruction of Nasal Deformity Resulting from Mucormycosis Using a Chin Silicone Implant

The clinical manifestations of mucormycosis vary depending on the location of the infection. In general, sepsis begins within the oral cavity or nose and then spreads to the central nervous system through the eyes. It is typically seen in immunocompromised patients, including those who have been exposed to high doses of cortisone, such as corona virus disease 2019 patients. The infection can lead to severe destruction of the bones of the palate, nose, and maxillary and sinusoid areas. Treatment may require both medical and surgical intervention. In the secondary stage of recovery from mucormycosis, various methods of reconstructive surgery for the external nasal structure can be used. To my knowledge, this is the first case that compares to secondary nasal restoration. A former patient with mucormycosis was treated using an autologous bone graft from the ilium, and after 2 years, the restoration was done using a silicone implant due to the absorption of the bone graft. The restoration using the silicone implant led to satisfactory results for the patient and the surgeon from an aesthetic standpoint, and we did not notice any inflammatory or infectious symptoms during the 11-month follow-up period.

Pragmatic Return to Effective Dental Infection Control through Triage and Testing (PREDICT): an observational, feasibility study to improve dental office safety

BACKGROUND

During the COVID-19 pandemic, there was a substantial interruption of care, with patients and workers fearful to return to the dental office. As dental practice creates a highly aerosolized environment, the potential for spread of airborne illness is magnified. As a means to increase safety and mitigate risk, pre-visit testing for SARS-CoV-2 has the potential to minimize disease transmission in dental offices. The Pragmatic Return to Effective Dental Infection Control through Testing (PREDICT) Feasibility Study examined the logistics and impact of two different testing mechanisms (laboratory-based PCR viral testing and point-of-care antigen testing) in dental offices.

METHODS

Dental healthcare workers (DHCWs) and patients in four dental offices within the National Dental Practice-based Research Network participated in this prospective study. In addition to electronic surveys, participants in two offices completed POC testing, while participants in two offices used lab-based PCR methods to detect SARS-CoV-2 infection. Analysis was limited to descriptive measures, with median and interquartile ranges reported for Likert scale responses and mean and standard deviation for continuous variables.

RESULTS

Of the total 72 enrolled, 28 DHCWs and 41 patients completed the protocol. Two patients (4.9%) tested positive prior to their visit, while 2 DHCWs (12.5%) tested positive for SARS-CoV-2 infection at the start of the study. DHCWs and patients shared similar degree of concern (69% and 63%, respectively) for contracting COVID-19 from patients, while patients feared contracting COVID-19 from DHCWs less (49%). Descriptive statistics calculations revealed that saliva, tongue epithelial cells, and nasal swabs were the most desirable specimen collection method; both testing (LAB and POC) protocols took similar amounts of total time to complete; and DHCWs and patients reported feeling more comfortable when both groups were tested.

CONCLUSIONS

While a larger-scale, network study is necessary for generalizability of results, this feasibility study suggests that SARS-CoV-2 testing can be effectively implemented into dental practice workflows and positively impact perception of safety for DHCWs and patients. As new virulent infectious diseases emerge, preparing dental personnel to employ an entire toolbox of risk mitigation strategies, including testing, may have the potential to decrease dental practice closure time, maintaining continuity of dental care services for patients.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05123742.

An Ethical Analysis Regarding the COVID-19 Pandemic Impact on Oral Healthcare in Patients with Mental Disorders

During the COVID-19 pandemic, restrictive measures were imposed that significantly impacted the healthcare system in general, and the dental healthcare system in particular. The literature cites a possible association between mental and oral health, as psychiatric patients have decreased awareness of their oral health and, therefore, poor dental status. Moreover, several studies have found a positive association between SARS-CoV-2 infection and oral health conditions, as well as between SARS-CoV-2 infection and mental health status. This context generated multiple ethical dilemmas in the case of persons with mental health disorders who require dental treatment because they are more vulnerable in this respect. This article aims to analyze the ethical issues in dental care for patients with mental disorders concerning the COVID-19 restrictive measures. The ethical aspects involved here are the basic principles of bioethics and the related elements of accessibility, equity, consent, and confidentiality.

Pragmatic Return to Effective Dental Infection Control through Triage and Testing (PREDICT): A feasibility study to improve dental office safety

Background

The COVID-19 pandemic highlights the need for practitioners to enhance workflows to increase safety and mitigate risk. As dental practice creates a highly aerosolized environment, pre-visit testing for SARS-CoV-2 has the potential to be an effective mitigation strategy to minimize disease transmission in dental offices. The Pragmatic Return to Effective Dental Infection Control through Testing (PREDICT) Feasibility Study examined the potential, logistics, and impact related to laboratory-based PCR viral testing and point-of-care (POC) antigen testing.

Methods

Dental healthcare workers (DHCWs) and patients in four dental offices within the National Dental Practice-based Research Network participated in this prospective study. In addition to electronic surveys, participants in two offices completed POC testing, while participants in two offices used lab based PCR methods to detect SARS-CoV-2 infection. For this feasibility study, analysis was limited to descriptive measures. Median and interquartile ranges were reported for Likert scale responses and mean and standard deviation for continuous variables.

Results

Forty-one of forty-three consented patients and twenty-eight of twenty-nine DHCWs completed the protocol. Descriptive statistics calculations including median and interquartile ranges revealed (1) saliva, tongue epithelial cells and nasal swabs were the most desirable specimens for testing for groups (2) both LAB and POC protocols took similar amounts of total time to complete the full testing protocol and (3) DHCWs and patients reported feeling more comfortable when both groups were tested.

Conclusions

This feasibility study suggests that pre-visit SARS-CoV-2 testing can be effectively implemented into dental practice workflows and positively impact perception of safety for DHCWs and patients, though a larger scale, network study is necessary for generalizability of results. As new virulent infectious diseases continue to emerge, preparing dental personnel to employ an entire toolbox of risk mitigation strategies, including testing, may have the potential to decrease dental practice closure time, maintaining continuity of dental care services for patients.

Trial registration

This trial was registered on ClinicalTrials.gov: NCT05123742.

Physical activities pre- and post-COVID-19 vaccination and its implementations: A narrative review

Coronavirus disease 2019 is a severe communicable pulmonary medical problem that has been a challenging disease for everyone in the globe, but vaccines development and administration against this severe acute respiratory syndrome-inducing disease (coronavirus disease 2019) are currently yielding fabulous results. The mean duration of the coronavirus disease 2019 pandemic for this study spanned from 2020 until 2022. These manifestations are accompanied by symptoms of respiratory tract illnesses such as non-productive cough, sore throat, and nasal discharge. Relevant reviews on coronavirus disease 2019 manifestations and outcomes, consisting mainly of the infections/outbreaks, experimental information, and pre- and post-serovaccination details that occurred, were described. After a typical vaccination course, the study aims to summarize and understand more about the effectiveness of exercise on the pre-and post-coronavirus disease 2019 vaccination and its implementations. Physical activity is an immunological function adjuvant to decrease communicable disease risk and enhance immunity post-viral infection vaccination. Moderate-intensity resistance exercisesession directly before getting the influenza vaccine decreases vaccine responses in older adults, such as redness, pain, or inflammation at the injection spot or other adverse consequences compared to the inactive circumstance. However, it was reported that exercise after a shot is generally safe as long as vaccinated people feel well enough. Though exercise before or after vaccination has no negative impact on the protection afforded by the vaccine, people can exercise immediately after receiving the vaccine, as any changes in blood flow will not affect the vaccine's response. One episode of light-to-moderate-intensifying exercise after vaccination may improve the antibody reactions to influenza or the coronavirus disease 2019 vaccine. Vaccination administered pre- and post-regular exercise is an effective approach for boosting antibody responses due to its immunostimulant effects. Future research should investigate how different vaccine antibodies respond to low, moderate, and high physical activity levels.

Opportunities and threats of e-learning in dental education in viewpoints of faculty members: A Mixed method study

BACKGROUND

The aim of the study was to assess the opportunities and threats of e-learning in dental schools and explore the experiences of dental faculty members in the coronavirus disease-19 (COVID-19) epidemic conditions.

MATERIALS AND METHODS

The present study was a sequential exploratory mixed method study (quantitative-qualitative). In the quantitative phase, a survey study was conducted to investigate the perspectives of faculty members regarding the opportunities and threats of e-learning during the COVID-19 epidemic. The data were analyzed by descriptive indicators (frequency, percentage, mean, and standard deviation) and analytical tests (t-test and analysis of variance). In the qualitative phase, data were collected through semi-structured interviews. In the qualitative phase, the inductive content analysis approach of Graneheim and Lundman was used to analyze the interviews.

RESULTS

In this study, 213 faculty members of dental schools of Iran participated; among whom 100 were men (46.9%) and 133 were women (53.1%). The results indicated the mean scores of the perspectives of faculty members regarding the opportunities and threats of e-learning in dentistry (4.05 ± 0.49 out of 5). Experiences of the participants in the qualitative phase were explored in the theme of "ups and downs of e-learning in dentistry" with three categories "unaccountability of e-learning in dental education," "challenges of human resource empowerment in the e-learning process," and "planned education."

CONCLUSION

The majority of the faculty members agreed with the use of e-learning in dental education and considered it as an opportunity. However, educational design for blended learning, creation of appropriate infrastructures, and empowerment of human resources as e-teacher and e-student were emphasized as key requirements for e-learning development in dental schools.

Evaluation of flavonoids as potential inhibitors of the SARS-CoV-2 main protease and spike RBD: Molecular docking, ADMET evaluation and molecular dynamics simulations

The 3CLpro main protease and the RDB spike (s) protein of SARS-CoV-2 are critical targets in the treatment of coronavirus 19 disease (COVID-19), as they are responsible for the COVID-19 replication and infection. With this in mind, Molecular docking of 26 natural compounds belonging to the flavonoid family with the 3CLpro and RBD sites of SARS-CoV-2 has been performed. The docking results revealed that the ligands Silibinin, Tomentin A, Tomentin B, 4′-O-methyldiplacone, Hesperidin Amentoflavone and Bilobetin act as a potential inhibitor of SARS-CoV-2 3CLpro, and that the ligands Herbacetin, Morin, Silibinin, Tomentin E, Amentoflavone, Bilobetin, Baicalein and Quercetin can be potential inhibitors of SARS-CoV-2 RBD. It has been noticed that three ligands can inhibit both sites of SARS-CoV-2, indicating a great potential of these compounds to combat COVID-19. Moreover, molecular docking has been validated by a new validation method based on visual inspiration. Evaluation of ADMET pharmacokinetic properties and the drug likeness in silico revealed that six compounds could be effective drugs against COVID-19. Finally, the docking results were verified by molecular dynamics simulations and MM-GBSA calculation to confirm the stability of hydrogen bonding interactions with crucial residues, which are essential to overcome SARS-CoV-2. These results could direct researchers toward plant-derived compounds that could be further investigated as therapeutic targets against COVID-19 replication and infection.

COVID-19 Impact on Public Dental Healthcare in Bosnia and Herzegovina: Current Situation and Ongoing Perspectives

BACKGROUND

As the pandemic time went by in Bosnia and Herzegovina (B&H), various patterns toward COVID-19 itself and its impacts, implementation of prescribed preventive measures among the team members, and those of their patients, including immunization process, have been revealed. These patterns were of both empirical and evidence-based kind and consequently formed dental personnel behavior. The aim was to evaluate and compare the COVID-19 status of dentists in B&H, implementation of prescribed preventive measures, and usage of various kinds of PPE, at the beginning of the pandemics and now, 2.5 years later, including dentists' current vaccination status, and their opinions and attitudes toward the national COVID-19 economic impact on dental practice.

METHODOLOGY

Study research was in a form of a cross-sectional longitudinally designed online survey and was conducted in two parts.

RESULTS AND CONCLUSIONS

Dental professionals in B&H had a high frequency of COVID-19 symptoms in the second pandemic year. The vaccination status of dentists in B&H was in line with the global average values of vaccinated professionals. Dentists used patient management preventive measures and PPE recommended by WHO, but some preventive measures have been changed and prioritized recently. The economic impact of pandemics on dentistry was predominantly negative.

Dental and Oral Manifestations of COVID-19 Related Mucormycosis: Diagnoses, Management Strategies and Outcomes

It has been nearly two years since the pandemic caused by the novel coronavirus disease (COVID-19) has affected the world. Several innovations and discoveries related to COVID-19 are surfacing every day and new problems associated with the COVID-19 virus are also coming to light. A similar situation is with the emergence of deep invasive fungal infections associated with severe acute respiratory syndrome 2 (SARS-CoV-2). Recent literature reported the cases of pulmonary and rhino-cerebral fungal infections appearing in patients previously infected by COVID-19. Histopathological analysis of these cases has shown that most of such infections are diagnosed as mucormycosis or aspergillosis. Rhino-orbital-cerebral mucormycosis usually affects the maxillary sinus with involvement of maxillary teeth, orbits, and ethmoidal sinuses. Diabetes mellitus is an independent risk factor for both COVID-19 as well as mucormycosis. At this point, there is scanty data on the subject and most of the published literature comprises of either case reports or case series with no long-term data available. The aim of this review paper is to present the characteristics of COVID-19 related mucormycosis and associated clinical features, outcome, diagnostic and management strategies. A prompt diagnosis and aggressive treatment planning can surely benefit these patients.

Knowledge and Attitude of Polish Dental Healthcare Professionals during the COVID-19 Pandemic

Objectives: This study analyzed Polish dentists’ knowledge of the SARS-CoV-2 virus and the main problems in their work during the early phase of the pandemic. Methods: Dentists responded to an online anonymous survey consisting of 57 questions relating to socio-demographics, knowledge about COVID-19, and office procedures. The obtained data were analyzed using basic descriptive statistics, significance of dependencies and Chi square and Mann–Whitney tests; p < 0.05. Results: Ultimately, responses from 730 dentists were included. The mean age was 43.62 ± 11.57. Almost 3/4 of the respondents followed the information on COVID-19. A total of 95.5% had knowledge about COVID-19. Genetic testing was the basic test according to 69.2%. Further, 56.0% were concerned about the pandemic, and 23.6% were significantly anxious. In addition, 42.1% considered a risk of infection with the SARS-CoV-2 in the workplace as very high. A total of 84.0% admitted patients performing a triage and using personal protective equipment (PPE). Further, 44.5% planned to become vaccinated. Continuing the work during the pandemic was strongly correlated with age, sector, and location and duration of work. Conclusions: Most Polish dentists follow the information on the COVID-19 protocol and have sufficient knowledge about COVID-19. Dentists are concerned and anxious about the situation. The vast majority admitted patients during the pandemic and use PPE. Only almost half plan to be vaccinated.