Coronavirus Disease 2019 (COVID-19): Emerging and Future Challenges for Dental and Oral Medicine

Challenges and possible solutions in dental practice during and post COVID-19

The pandemic outbreak of coronavirus disease (COVID-19) created a significant impact on the oral healthcare profession, and dentists are reported to have a higher risk of transmission. Aerosols and droplets are considered as primary reasons for the transmission of this infectious disease. Quality dental treatment may not be possible without the interference of aerosols in daily dental practice. However, dental societies and healthcare communities around the globe developed various protocols and algorithms with standard infection control protocols. Nevertheless, many unanswerable questions strike in dentist minds to start the dental practice during or post COVID-19 pandemic. Hence, this review focuses on the common issues that raises in daily clinical practice and possible solutions.

Urgent dental care on a national level during the COVID-19 epidemic

OBJECTIVE

This paper aims to report and discuss the organization and statistics of dental care during the COVID-19 epidemics on the national level in Slovenia, providing helpful information to health policy planners worldwide.

MATERIAL AND METHODS

During an eight-week lockdown, Emergency Dental Centers (EDCs) were established and coordinated on the national level to treat patients' urgent dental conditions. Telemedicine was used on the first level of triage to reduce contacts between healthcare workers and patients. Weekly coordination between EDCs was supported by real-time data acquisition on the number of patient visits, prescribed medicine, the number and type of dental procedures, and the usage of personal protective equipment (PPE).

RESULTS

In EDCs, 27,468 patients were serviced, on average 235 patients per day/million people. The care was provided by 4798 man days of dental health care workers. Except for the first week, treatment and triage visits showed a slight increase. The number of incisions was nearly constant, while the number of extractions increased. A nearly threefold increase was found for emergency endodontic treatments (EET). The number of antibiotic prescriptions demonstrated an increasing trend. Analgesic prescriptions showed a decreasing trend from the beginning of lockdown.

CONCLUSIONS

The reorganization and centralization of dental care proved to be an efficient model in Slovenia for the provision of urgent dental care, and the management of the healthcare workforce and PPE. Data from this study may provide helpful information for planning the needs and corresponding resources for the next waves of epidemics of COVID-19.

Effect of COVID-19 Pandemic on the Levels of Empathy among Undergraduate Dental Students in Pakistan

Objective  The purpose of our study is to determine the effect of coronavirus disease 2019 (COVID-19) on the levels of empathy toward patients among undergraduate dental students in Pakistan.

Materials and Methods  A cross-sectional, survey-based study was conducted at Islamic International Dental College, Islamabad, Pakistan. After taking an informed consent, a validated and pretested Toronto Empathy Questionnaire (TEQ) was distributed amongst the undergraduate dental students at two points, one before the COVID-19 existed, and the other after August 7th, 2020, when the COVID-19 cases dropped in Pakistan. Responses were indicated on a five point Likert Scale.

Statistical Analysis  A one-way ANOVA (analysis of variance) was used to compare the TEQ scores between the different years of education at the dental school. Difference within the groups was analyzed using the post-hoc Tukey test. Pre- and post-COVID-19 comparison was done using the Chi-square test (significance level p < 0.05).

Results  A total of 221 out of 260 students in the pre-COVID-19 group, while 210 out of 260 students in the post-COVID-19 group enrolled in the dentistry program participated in the study. Significant difference in the empathy levels was observed in the pre- and post-COVID-19 groups of the same population, i.e., ( p < 0.05). The response rate was 85%.

Conclusions  This study showed an increase in mean empathy scores among the undergraduate dental students after COVID-19, indicating a significant improvement in their empathy levels during the time of COVID-19. It highlights the impact of the pandemic, whereby death and chaos seem to have brought about an improvement in interpersonal harmony.

Dental Treatments During the COVID-19 Pandemic in Three Hospitals in Jordan: Retrospective Study

Background

Cases of COVID-19 first emerged in December 2019. Since then, the virus has spread rapidly worldwide, with daily increases in the numbers of infections and deaths. COVID-19 spreads via airborne transmission, which renders dental treatment a potential source of virus transmission. Dental treatments require the use of handpieces, ultrasonic devices, or air–water syringes, which generate considerable amounts of aerosols. Jordan, being one of the affected countries, instituted preventive lockdown measures on March 17, 2020. Emergency dental treatments were only allowed in dental clinics of the Royal Medical Services of Jordan Armed Forces and Ministry of Health, and were prohibited in other sectors such as private clinics and universities.

Objective

The aim of this study is to investigate the dental treatments performed in three military hospitals during the 44-day lockdown period in Jordan. The investigation explores the impact of COVID-19 on the number of patients and types of performed dental treatments.

Methods

Data such as number of patients, patients’ age and gender, and performed dental treatments were collected retrospectively from the hospital records and were analyzed.

Results

Our results showed a 90% (17,591 to 1689) decrease in patient visits during the lockdown period compared to regular days. The total number of treatments (n=1689) during the lockdown period varied between endodontic cases (n=877, 51.9%), extraction and other surgical cases (n=374, 22.1%), restorative cases (n=142, 8.4%), orthodontic treatments (n=4, 0.2%), and other procedures (n=292, 17.3%). The differences in gender and age group among all clinics were statistically significant (P<.001 and P=.02, respectively).

Conclusions

The COVID-19 pandemic had a significant effect on the number of patients seeking dental treatments. It also affected the types of treatments performed. Endodontic treatment accounted for almost 50% of patient load during the lockdown compared to approximately 20% during regular days.

Are Dental Students Aware of and Knowledgeable about COVID-19? A Questionnaire-based Investigation

Background:

Coronavirus disease 2019 (COVID-19) is a major global concern.

Objective:

This study aims to evaluate the knowledge of dental students toward COVID-19 in a context of a health emergency.

Methods:

A questionnaire-based survey was drawn up in an online form, to investigate knowledge and awareness level about COVID-19 among dental students at Magna Graecia University of Catanzaro, Italy. The questionnaire contained socio-demographic questions and 12 questions about definition, contagiousness, symptoms, incubation, source of infection, routes of transmission, treatment and infection control practices related to COVID-19.

Results:

72 dental students responded to the questionnaire-based survey. The participants had 87.6% of the essential knowledge about COVID-19 and 56.9% of the participants had also already heard about similar respiratory diseases. However, only 50% of the responders perceived a greater risk of contagion for dentists than other health professionals.

Conclusion:

Italian dental students had a good level of awareness of COVID-19. The most positive attitude of participants was toward the period of incubation, route of transmission and treatment. The COVID-19 outbreak reminded us the importance of knowledge on cross-infection control. It is essential to further sensitize future dentists to not underestimate the risk of exposure to the virus in dentistry.

Anxiety, Practice Modification, and Economic Impact Among Iraqi Dentists During the COVID-19 Outbreak

Objectives: As health care workers on the front line during the coronavirus (COVID-19) pandemic, dental practitioners are amongst those at risk due to their close contact with potentially infected individuals. The aim of the current study was to assess the anxiety, awareness practice modification, and economic impact amongst Iraqi dentists whilst working during the outbreak.

Methods: This study was performed using an online survey questionnaire with aid of Google forms from 2nd to 23rd July 2020. A total of 484 clinicians responded. The questionnaire was composed of open end, closed end, and Likert five-point scale questions to assess anxiety, awareness and financial impact of COVID-19 on dentists. Mann–Whitney test was used to compare two groups, whilst Kruskal–Wallis was performed by post-hoc test for multigroup comparisons.

Results: The mean age of participants was 36.51 ± 9.164 years and the majority (75.2%) of these were graduate dentists only. More than 80% of participants reported anxiety of catching COVID-19. The recorded anxiety level was higher amongst younger dentists and females. Awareness and practice levels among these dentists of precautions and infection-control measures associated with COVID-19 (94%) was found to be high and to be statistically significantly affected by age, qualification and designation (except GP vs. Specialist). With respect to the economic impact, about 75% of practitioners, regardless of demographical variables, reported that their income had declined by about 50%.

Conclusions: The investigation provides clear insights into the anxiety, practice modifications and economic impact on dentists working in Iraq. Although there is a high level of knowledge and awareness of required practice regarding the COVID-19 outbreak among Iraqi dentists, they also reported a high level of anxiety.

Psychological status of TMD patients, orthodontic patients and the general population during the COVID-19 pandemic

Confronting the outbreak of COVID-19, this cross-sectional study was aimed to assess psychological status of temporomandibular disorders (TMD) patients, orthodontic patients and the general population in China during the pandemic. An online anonymous questionnaire was developed in Chinese, including the individual background information, the perception of the epidemic, and level of anxiety and depression through Kessler Psychological Distress Scale (K10). The respondents were divided into ORTHO group, TMD group and Control group. Descriptive analysis and multiple linear regression modelling were performed. In total, 1241 valid questionnaires were collected, covering 587 orthodontic patients and 220 TMD patients. It is shown that the overall mental health is not quite optimistic during the COVID-19 pandemic with the mean score of K10 being 18.65. TMD patients have higher level of anxiety and depression than orthodontic patients as well as the general population. Younger age, female gender, having close contact with individuals from Hubei province, higher self-rated infection possibility, concern about psychological barriers and distrust are negatively affecting patients' psychological status. Mental health care should be emphasized when hospitals and clinics reopen after the COVID-19 pandemic, especially to patients with these relevant characteristics.

Coronavirus Disease-19 and Dentistry: A Review

Novel coronavirus (nCoV) is a novel form of virus with a new strain identified recently in humans. Common clinical signs and symptoms primarily consist of fever, cough, and breathing difficulties. In severe cases, it can results in pneumonia, severe acute respiratory syndrome, kidney failure, and even death. It is important to follow all infection control measures in prevention of the nCoV from spreading and controlling the epidemic situation. The risk of cross infection can be high between dental practitioners and patients due to the features of dental clinical settings. Here, we are summarizing the nCoV related information and infection control measures to be followed in dental practice.

Knowledge and attitudes among dental students about COVID-19 and its precautionary measures: a cross-sectional study

Objective: This study aims to evaluate students' knowledge and attitudes about COVID-19 and its precautionary measures. Methods: A cross-sectional study was conducted among dental students in their clinical practice years in two Palestinian universities. An online questionnaire was sent out using students' in mid-May, 2020. The questionnaire assessed students self-reported knowledge about the COVID-19, and students' attitudes towards providing clinical care during the pandemic. Results: A total of 305 dental students completed the questionnaire. Fifty-nine percent (n = 180) reported having updated training on infection control measures in dental settings and 29% (n = 89) reported having attended a training course regarding COVID-19. Eighty-two percent of students (n = 250) preferred to avoid working with suspected COVID-19 patients. Almost 89% (n = 269) admitted fear of transmitting the virus to their families. This fear was related to their perception that using regular standard precautions is unsafe in dealing with COVID-19 patients and their perception of their schools' preparedness to update infection prevention measures (χ2 = 50.45, p < 0.001) (χ2 = 9.77, p = 0.021). Conclusion: Students in this sample are aware of COVID-19 and its precautionary measures. Adherence to new, stricter infection control protocols and periodic orientation of students to these protocols are ways to guarantee a safer environment for both patients and students.

COVID-19 and its impact in the dental setting: A scoping review

INTRODUCTION

The scoping review examined the evidence related to infection control and transmission measures of the SARS-CoV-2 virus in a dental setting during this pandemic. Dental practitioners are normally guided in practice by set ethical principles, thus the researchers wanted to determine how these rules are managed during this pandemic.

METHODS

A protocol specific for the objectives of this study was developed according to the criteria for a scoping review. Relevant databases (Pubmed, Scopus, Elsevier, Science Direct, Wiley), including online access to health/ dental organizations (World Health Organization/ American Dental Association), were searched to identify evidence which was restricted to the English language for the period 2015-2020. Predetermined eligibility criteria were applied, evidence was assessed and data extracted for each included article. Relevant outcomes assessed were: infection control measures, transmission of the SARS-CoV-2 virus, such as modes and sources of transmission and the ethical principles related to the dental setting with a focus on the COVID-19 pandemic.

RESULTS

Searches yielded a total of 402 articles: 387 from electronic databases and 15 from other sources. Of these, 231 were unrelated to the objectives of the current scoping review. The full text of 69 studies was assessed for eligibility, of which 26 were finalized for inclusion following the objectives and inclusion criteria set for the scoping review. Most of the included articles were reviews, recommendations and guidelines for dentists. A narrative explanation of the pre-specified outcomes is reported for the 3 areas covered for this review. There is no clinical evidence available that can support the recommendations by individuals, dental organizations or health authorities related to the objectives of this review, but these may be considered as the much needed guidelines during the unprecedented COVID-19 pandemic. A different ethical framework is required during a pandemic and these must be informed by evidence.

Infection Control Practices Among Private Practicing Dentists in Nairobi During the Pre-coronavirus Disease 2019 Period

Background: Cross-infection control is a dynamic field that requires frequent updates due to emerging diseases, advancement in technology, and scientific knowledge. Despite wide publication of guidelines, a laxity in compliance to the standard precautions for infection control by dental health-care personnel (DHCP) has been reported globally. Therefore, there is need to review previous shortcomings in order to adequately secure dental practices during the coronavirus disease 2019 (COVID-19) pandemic. The aim of the study was to determine knowledge and infection control practices by dentists in private practices. The study was done a few months before the first COVID-19 case was confirmed in Kenya. Materials and Methods: The study design was a descriptive cross-sectional study that was carried out in selected private dental clinics located in Nairobi. Data were collected using an interviewer-administered questionnaire. Convenience sampling method was utilized, while data were analyzed using SPSS 20.0.0.0. Results: A total of 71 private dentists participated in the study. Their mean age was 38 years with an age range of 27-55 years. Almost all (70, 98.6%) the dentists were able to define cross infection correctly. Majority (62, 87.3%) correctly differentiated between sterilization and disinfection, while 9 (12.7%) had difficulties. Most (68, 95.8%) of the respondents were aware of the standard precautions for cross-infection control. All participants used face masks and gloves. About half of them (38, 54%) practiced hand washing after removal of gloves and 31 (43.7%) before and after wearing of gloves, while 2 (2.8%) washed hands only before wearing gloves. Only 31 (42.3%) and 26 (36.6%) participants reported use of rubber dam isolation and impervious barrier, respectively. All the dentists reported disposal of sharps into especially labeled containers, while about half reported use of disposable suction traps and amalgam separators. Conclusion: The dentists had a good knowledge on various aspects of infection control measures that were studied. Use of basic personal protective equipment was widely practiced. There were irregularities in hand hygiene, use of rubber dam, surface barriers, and waste management. The work highlights that many dentists were unprepared to manage infectious risk during the COVID-19 outbreak, which justified the closure of the dental facilities. Development of strategies to promote adequate and safe practice is highly recommended.

Quantitative measurements of aerosols from air-polishing and ultrasonic devices: (How) can we protect ourselves?

AIM

To assess the distribution and deposition of aerosols during simulated periodontal therapy.

METHODS

A manikin with simulated fluorescein salivation was treated by four experienced dentists applying two different periodontal treatment options, i.e. air-polishing with an airflow device or ultrasonic scaling in the upper and lower anterior front for 5 minutes, respectively. Aerosol deposition was quantitatively measured on 21 pre-defined locations with varying distances to the manikins mouth in triplicates using absorbent filter papers.

RESULTS

The selected periodontal interventions resulted in different contamination levels around the patient's mouth. The highest contamination could be measured on probes on the patient's chest and forehead but also on the practitioner's glove. With increasing distance to the working site contamination of the probes decreased with both devices. Air-polishing led to greater contamination than ultrasonic.

CONCLUSION

Both devices showed contamination of the nearby structures, less contamination was detected when using the ultrasonic. Affirming the value of wearing protective equipment we support the need for universal barrier precautions and effective routine infection control in dental practice.

Correct Use of Facemask Among Health Professionals in the Context of Coronavirus Disease (COVID-19)

PURPOSE

Coronavirus disease (COVID-19) mainly spreads through respiratory droplets and close contacts. Wearing a facemask and other personal protective equipment (PPE) is essential in preventing the spread of COVID-19. However, the use of PPE alone does not provide a sufficient level of protection, and correct use and disposal are required. Hence, this study aimed to assess health professionals' practice regarding proper use of facemask in the perspectives of COVID-19 prevention.

METHODS

A web-based online survey was conducted from June 3, 2020, to August 11, 2020, to assess health professionals' practice regarding correct use of facemask. The survey tool was prepared in Google form and distributed to the health professionals through their emails and social media pages. Data were analyzed using STATA version 14. A descriptive result was reported using frequency tables and bar charts. Factors associated with correct use of facemask were assessed using binary logistic regression model.

RESULTS

A total of 368 health professionals have participated in this study. All of the participants' work involves direct contact with patients and 98 (26.6%) of them work in direct contact with COVID-19 patients daily. The level of overall correct use of facemask was 10.1% (95% CI: 7.4-13.6). Two hundred fifty-five (69.3%) do not perform hand hygiene before wearing a facemask and 238 (64.7%) do not perform hand hygiene after removing the facemask. Three hundred twenty-three (87.8%) of the study participants reuse disposable facemasks. The odds of practicing correct use of facemask were more than two times higher among health professionals who received training related to personal protective equipment utilization (AOR= 2.2, 95% CI: 1.1-4.5) compared to their counterparts.

CONCLUSION

This study revealed that health professionals' practice regarding the correct use of facemask in the context of COVID-19 prevention is very low. Receiving training related to proper utilization of personal protective equipment was found to favor the correct use of facemask. In this regard, health authorities should provide training to enable the rational and correct use of facemask among healthcare workers.

The world is its own best model: modelling and future pandemic planning in dentistry

The coronavirus SARS-CoV-2 pandemic has and continues to create a huge number of challenges to the global economy and its associated healthcare systems, including dentistry. In the early stages, we have had to rely on mathematical modelling and plans developed from previous healthcare emergencies. As the emergency develops, it is vitally important that policymakers understand the difference between the science and the real-world evidence so that policy can adapt rapidly to the changing environment. Effective management of future crises will require open channels of communication across the whole profession, not only to collect, clean, curate and evaluate data but also to assess the benefits and harms of any policy change.

The effects of the COVID-19 pandemic are not evenly spread throughout the population.

Errors in pandemic modelling are due to a combination of biased assumptions, and an underestimation of the variance and noise in real-world data.

Scientific research must be backed up by real-world evidence before it can be considered valid.

As evidence accumulates, policymakers should rapidly update guidance by keeping channels of communication open and frequently updated.

Efficacy of commercial mouth-rinses on SARS-CoV-2 viral load in saliva: randomized control trial in Singapore

Purpose

One of the key approaches to minimize the risk of COVID-19 transmission would be to reduce the titres of SARS-CoV-2 in the saliva of infected COVID-19 patients. This is particularly important in high-risk procedures like dental treatment. The present randomized control trial evaluated the efficacy of three commercial mouth-rinse viz. povidone–iodine (PI), chlorhexidine gluconate (CHX) and cetylpyridinium chloride (CPC), in reducing the salivary SARS-CoV-2 viral load in COVID-19 patients compared with water.

Methods

A total of 36 SARS-CoV-2-positive patients were recruited, of which 16 patients were randomly assigned to four groups—PI group (n = 4), CHX group (n = 6), CPC group (n = 4) and water as control group (n = 2). Saliva samples were collected from all patients at baseline and at 5 min, 3 h and 6 h post-application of mouth-rinses/water. The samples were subjected to SARS-CoV-2 RT-PCR analysis.

Results

Comparison of salivary Ct values of patients within each group of PI, CHX, CPC and water at 5 min, 3 h and 6 h time points did not show any significant differences. However, when the Ct value fold change of each of the mouth-rinse group patients were compared with the fold change of water group patients at the respective time points, a significant increase was observed in the CPC group patients at 5 min and 6 h and in the PI group patients at 6 h.

Conclusion

The effect of decreasing salivary load with CPC and PI mouth-rinsing was observed to be sustained at 6 h time point. Within the limitation of the current study, as number of the samples analyzed, the use of CPC and PI formulated that commercial mouth-rinses may be useful as a pre-procedural rinse to help reduce the transmission of COVID-19.

ISRCTN (ISRCTN95933274), 09/09/20, retrospectively registered

Manual vs Mechanical Oral Hygiene Procedures: Has the Role of the Dental Hygienist in Phase 2 Post-lockdown Really Changed?

Purpose: Some authors have highlighted the danger of intraoral use of rotating instruments which can produce droplets and aerosols. During the Covid lockdown phase, dental operators were limited to providing emergency treatment that could not be postponed. Therefore, it is necessary for the dental team to restart safely to treat neglected oral diseases that may also affect systemic health. The role of the dental hygienist has apparently changed for procedures performed close to the patient's oral cavity, particularly in terms of the droplets and aerosols produced during oral hygiene practices. Through an analysis of the most recent literature on the use of dedicated PPE and changed post-Covid 19 work processes, and a review of the differences between manual causal therapy and mechanical therapy in terms of outcome after oral hygiene treatment, we define how the role of the dental hygienist can change positively. Materials and Methods: Narrative reviews of the literature in terms of PPE adopted and oral hygiene procedures performed were carried out in Pubmed. Results: 188 articles from February 2020 to May 2020 using the search terms 'dentistry' and 'covid-19' were examined. 10 reviews of the literature were performed using the search terms 'mechanical procedures' and 'manual hygiene'. Conclusion: Only continuous update of evidence-based literature on the new standards in oral hygiene procedures and the different results yielded by different procedures can ensure a safe working environment for the dental hygienist while supporting the dentist in this phase of the pandemic.

Dental team and infection control for the COVID-19: (A short review of the current guidelines)

BACKGROUND

In December 2019, a series of unusual pneumonia has been reported in Wuhan, China. This pneumonia was related to beta-coronavirus cluster which was named COVID-19. The aim of this study is to review the published paper on COVID-19 protections guide lines and attempt to summarize different suggested guide lines in order to help dental/oral healthcare to have better protection against COVID -19.

MATERIALS AND METHODS

An electronic literature search was conducted via google scholar, PubMed, and dental associations' of different countries' website using the key word "COVID-19, Dental team, Guide lines and Recommendation".A total of seven guidelines were found suitable to be included in this review.

CONCLUSION

Individuals with 'possible' or 'confirmed' COVID-19 should not be seen for routine dental care. Multi-step approach should begin before the patient arrives on the office and includes guidance regarding their arrival and it should be completed duration of the affected patient's presence in the practice. Accurate travel history, fever or history of fever, acute respiratory infection and severe respiratory infection without fever requiring hospitalization should be checked by staff via patients telephoning to make an appointment and finally the primary infection control goal is to prevent transmission of disease. These treatment guidelines are based on very limited evidence from the literature and should be revised as soon as more evidence about the infection control advices for dental team regarding COVID-19.

Oral manifestations of COVID-2019-related multisystem inflammatory syndrome in children: a review of 47 pediatric patients

Background

Although much is still unknown about the full effects of COVID-19, literature from the early stages of the COVID-19 pandemic (spring and summer 2020) supports a postviral immunologic reaction resulting in a multisystem inflammatory syndrome in children (MIS-C). The purpose of this study was to report the rates of documented oral and oropharyngeal manifestations among these patients and to determine the association of these findings with other MIS-C symptoms.

Methods

The authors conducted a retrospective review of pediatric patients with COVID-19 who were admitted to the Morgan Stanley Children’s Hospital of NewYork-Presbyterian. Patients fulfilling the Centers for Disease Control and Prevention criteria for MIS-C were included in this study. The documented signs, symptoms, and laboratory values were collected and compared with the presence of oral or oropharyngeal findings.

Results

The mean (standard deviation) age of MIS-C patients was 9.0 (5.0) years (range, 1.3-20.0 years), and there was no obvious sex difference (51.1% male, 48.9% female). With respect to oral findings, 23 patients (48.9%) had red or swollen lips, whereas only 5 (10.6%) had a strawberry tongue. Oral or oropharyngeal findings were associated significantly with the presence of systemic rash (P = .04) and conjunctivitis (P = .02).

Conclusions

The presence of oral or oropharyngeal changes may be an early indicator of MIS-C and should be considered suggestive of MIS-C in the setting of COVID-19 infection.

Practical Implications

Dental care providers may play an integral role both in the early detection of oral manifestations of MIS-C and in the identification of oral lesions in hospitalized patients with confirmed MIS-C.

The Impact of the COVID-19 Epidemic on Orthodontic Patients in China: An Analysis of Posts on Weibo

Background: During the COVID-19 pandemic, many dental care services including orthodontic practice were suspended. Orthodontic patients turned to social media platforms to communicate, share experiences, and look for solutions. Our study aimed to investigate the attitudes and perspectives of orthodontic patients during the COVID-19 epidemic in China by analyzing orthodontics-related posts on Sina Weibo (a Chinese counterpart of Twitter). Materials and Methods: Potentially eligible posts on Sina Weibo platform were collected between December 30, 2019, and April 18, 2020. Posts related to both orthodontics and COVID-19 were included and then coded and classified into specific appliances and themes. Geographic and temporal distributions of the included posts were analyzed. In addition, time-lagged cross correlation was performed to explore the association between the number of daily posts and daily new COVID-19 cases/deaths in China. Chi-square tests were employed to compare the differences between fixed appliances and aligners in problems/difficulties and feelings during the epidemic. Results: Of the 28,911 posts identified, 4,484 were included in the analysis. The most frequently mentioned themes were appointments (n = 2,621, 58.5%), negative feelings (n = 2,189, 48.8%), and problems/difficulties (n = 1,155, 25.8%). A majority of posts were tweeted in regions with high levels of economic development and population density in eastern China and from February to March. The number of daily posts had a significantly positive correlation with daily new COVID-19 cases/deaths in China (P < 0.05). Compared with clear aligners, patients with fixed appliances reported more problems/difficulties (P < 0.001) and negative feelings (P < 0.001), but fewer positive feelings (P < 0.001). Conclusions: The analysis of Weibo posts provided a timely understanding of the impact of COVID-19 on orthodontic patients. Delayed appointments were their greatest concern, and negative feelings and untreated orthodontic problems increased during the suspension of dental care services. However, patients with clear aligners reported fewer negative feelings and problems than those with fixed appliances. The findings highlighted the need to consider both treatment- and psychology-related issues of orthodontic patients and how to handle them appropriately during the epidemic.

Recommendations by the Spanish Society of Epidemiology and Oral Public Health (SESPO) for the healthcare adaptation of public health dental clinics in Spain during the COVID-19 pandemic

Background

In March 2020, the World Health Organization (WHO) declared the COVID-19 pandemic and, a few days later, the Spanish Government declared a State of Emergency and the population lockdown. This crisis situation crisis forced deep changes in health care. At dental care level, it became necessary for both public health services and private consultations to plan changes to enable them to face this healthcare challenge.

Material and Methods

SESPO and the General Council of Dentists of Spain (CGDE) appointed a Working Group to prepare a protocol for dental clinics after the lockdown stage. Continuing with this teamwork task, a series of recommendations addressed to public health managers and the dental workforce were agreed, according to the COVID-19 protection protocols, with the evidence available at the time of their preparation.

Results

The SESPO Working Group prepared a schedule with recommendations to be taken. The CGDE presented this document to the Ministry of Health, Consumption and Social Welfare, and SESPO emailed it to all the Health Councils of the autonomous regions. The document was also uploaded to the CGDE and SESPO websites and was emailed to all SESPO associated members.

Conclusions

Keeping in mind the existing territorial variation, both at the organization level of dental public health services, and at the care level (especially in child preventive programs and care for pregnant women), this health crisis has highlighted the importance of teamwork. It is necessary to unify the standards for all dental health care units in the national territory in challenging times. Key words:COVID-19, Dental public health, dental care, dentistry, primary care, infection, SARS-CoV-2.

The Concept of Sustainable Development of Modern Dentistry

This paper concerns the assessment of the current state of dentistry in the world and the prospects of its sustainable development. A traditional Chinese censer was adopted as the pattern, with a strong and stable support on three legs. The dominant diseases of the oral cavity are caries and periodontal diseases, with the inevitable consequence of toothlessness. From the caries 3.5–5 billion people suffer. Moreover, each of these diseases has a wide influence on the development of systemic complications. The territorial range of these diseases and their significant differentiation in severity in different countries and their impact on disability-adjusted life years index are presented (DALY). Edentulousness has a significant impact on the oral health-related quality of life (OHRQoL). The etiology of these diseases is presented, as well as the preventive and therapeutic strategies undertaken as a result of modifying the Deming circle through the fives’ rules idea. The state of development of Dentistry 4.0 is an element of the current stage of the industrial revolution Industry 4.0 and the great achievements of modern dental engineering. Dental treatment examples from the authors’ own clinical practice are given. The systemic safety of a huge number of dentists in the world is discussed, in place of the passive strategy of using more and more advanced personal protective equipment (PPE), introducing our own strategy for the active prevention of the spread of pathogenic microorganisms, including SARS-CoV-2. The ethical aspects of dentists’ activity towards their own patients and the ethical obligations of the dentist community towards society are discussed in detail. This paper is a polemic arguing against the view presented by a group of eminent specialists in the middle of last year in The Lancet. It is impossible to disagree with these views when it comes to waiting for egalitarianism in dental care, increasing the scope of prevention and eliminating discrimination in this area on the basis of scarcity and poverty. The views on the discrimination of dentistry in relation to other branches of medicine are far more debatable. Therefore, relevant world statistics for other branches of medicine are presented. The authors of this paper do not agree with the thesis that interventional dental treatment can be replaced with properly implemented prophylaxis. The final remarks, therefore, present a discussion of the prospects for the development of dentistry based on three pillars, analogous to the traditional Chinese censer obtaining a stable balance thanks to its three legs. The Dentistry Sustainable Development (DSD) > 2020 model, consisting of Global Dental Prevention (GDP), Advanced Interventionist Dentistry 4.0 (AID 4.0), and Dentistry Safety System (DSS), is presented.

Emergency and urgent dental visits among Medicaid enrollees from 2013 to 2017

Background

Better understanding of the frequency of dental emergencies and the procedures performed during those emergency visits can help providers, insurers, and policymakers understand workforce and care provision needs.

Methods

Procedures performed at an emergency dental encounter and in the encounter following that encounter are assessed. Emergency dental encounters are those with a CDT code of D0140, D0160, or D0170. Data was analyzed from the IBM Watson Medicaid Marketscan data from 2013 to 2017, a nationally representative dental and medical claims database from 13 deidentified states in the United States.

Result

Consistently over time, about 10% of all dental encounters are due to a dental emergency. 28% of emergency dental encounters had no other procedure performed during those encounters. When other procedures were performed during the encounter, the majority were diagnostic in nature, primarily radiographs. Among patients who returned to the dentists following an emergency visit, 43% returned for more definitive dental treatment, most within 30 days.

Conclusions

The majority of dental emergency encounters do not result in definitive treatment, rather patients often return to the dentist at a later date for that treatment. Where possible, dental providers could utilize teledental services to triage patients to appropriate care.

Dental Care Access and the Elderly: What Is the Role of Teledentistry? A Systematic Review

A high level of unmet oral health needs is very common among elderly people. In a society that is getting older and that has been hit so hard by the coronavirus pandemic, the development of new strategies aimed at enhancing general and oral health status should be crucial in order to promote healthy aging. The aim of this systematic review is to assess the feasibility of Teledentistry in communities or in a domiciliary setting where elderly people live. A structured and systematic research was performed on the major electronic databases for studies published in English until 30 June 2020: the PubMed, Cochrane Library, Web of Science, Scopus, and CINAHL databases. A total of 13 articles were identified through database searching using combinations of keywords. Out of 13 papers, eight abstracts were reviewed to assess if they were coherent with the aim of the study, and full texts were retrieved. After abstract reviews, seven articles were selected for closer inspection. Of these, six were assessed for eligibility. Four papers were aimed at assessing patients and health practitioners experiences about Teledentistry, three studies reported a cost analysis and cost description of Teledentistry in residential aged care facilities, and two studies investigated the feasibility and accuracy of Teledentistry for diagnosis dental pathology. The implementation of Teledentistry in residential aged care facilities and in home-assistance programs could be a viable tool for the management of oral care in people who cannot access dental care.

Digital teaching with interactive case presentations of ENT diseases - discussion of utilisation and motivation of students

Introduction: Due to the circumstances of the Covid-19 pandemic, the teaching during the block internship at the Department for Otorhinolaryngology was switched to digital learning. Various online courses were created and the utilisation by the students was analyzed. Material & methods: Examination videos, surgical images and videos were created and live lectures were held. In addition, patient cases of common otorhinolaryngological diseases were reconstructed on an interactive platform. A total of 16 cases were offered in weekly rotation. These cases are provided with gap texts, open and selection questions, links and videos and thematically appropriate digression offers. The time-consuming creation was carried out as a HTML 5 learning package with the authoring program Exelearning 2.5. Each case was to be evaluated separately after being worked on by the students. Results: The direct feedback and the evaluation results of the students on the internship and case presentations were consistently positive. However, on average only 50.72% of the registered students took part in the weekly video meetings. In the course of the semester, the willingness to participate decreased. In addition, the willingness to evaluate the patient cases was low. Discussion: With the case presentation tool, concrete patient examples can be well presented, especially when patient contact is not possible (especially in an ENT clinic due to violation of distance and hygienic rules). Even though the evaluations were positive in terms of content, the frequency of utilisation and also the motivation for feedback seems disappointing. This seems to be associated above all with an increasing return to everyday life after the end of the lockdown.

Dentists' Knowledge, Attitudes, and Awareness of Infection Control Measures during COVID-19 Outbreak: A Cross-Sectional Study in Saudi Arabia

As antiviral vaccines are still pending for the COVID-19 disease, improving dentists’ knowledge and prevention measures is important. This study aimed to assess dentists’ knowledge, attitude, and perception of COVID-19 in Saudi Arabia during the early outbreak period. In addition, infection control measures for dental setting were also assessed. Online questionnaire was distributed to dentists in different regions of Saudi Arabia when COVID-19 outbreak in Saudi Arabia was at its beginning. The questionnaire was assessing demographic variables, knowledge, attitude, risk perception, and preparedness towards COVID-19. Questions regarding infection control measures were also included. The correct incubation period of the virus was recognized by 43% of participants. Fever, cough, and shortness of breath were the mostly recognized symptoms for COVID-19 (98.9%, 95.5%, and 93.3% respectively). Participants in age groups ≥60, 50–59, and 20–29 years old were more likely to perceive COVID-19 as a very dangerous disease compared to 30–39 and 40–49 age groups. Dentists in Saudi Arabia showed satisfactory knowledge and positive attitude towards COVID-19. Improving dentists’ level of knowledge could be achieved through increasing their accessibility to materials provided by dental health care authorities, which specifies the best and safest approaches for dealing with patients during and after the outbreak.

The impact of COVID-19 pandemic on dental practice in Iran: a questionnaire-based report

Background

The highly contagious nature of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), besides the fact that dental procedures commonly generate blood and saliva droplets that could lead to the contagion have resulted in the closure of many dental clinics. In the present study, we aimed to evaluate the impact of coronavirus disease 2019 (COVID-19) pandemic on dental practice by conducting an online questionnaire among the Iranian dental practitioners and finding their perspectives on the subject.

Methods

This report is based on a questionnaire that was conducted among Iranian dentists. The survey included questions that evaluate the dentists’ perceptions and attitudes toward the COVID-19 pandemic and its effect on their personal life, financial status, and the quality of dental services for patients.

Results

Overall, 240 dentists contributed to this study (214 general dentists and 26 specialists). The majority of the participants (n = 170, 70%) did not perform non-emergency procedures during the pandemic. The dental practitioners have suggested several strategies to decrease the risk of contagion, such as reducing treatment sessions (n = 90, 37%), strict triage of patients (n = 156, 64%), and using personal protective equipment (n = 108, 45%). However, most of the dentists (n = 210, 87%) had problems, providing personal protective equipment during the pandemic. Moreover, 97% (n = 234) of the participants reported that they encountered a decrease in their financial income since the eruption of the pandemic.

Conclusion

Dental health care workers are at the highest risk of contracting COVID-19. Thus, dental practitioners ought to execute the standard protocols more cautiously during the pandemic. They could also lower their work hours and limit dental procedures to emergency treatments to reduce the risk of COVID-19 transmission. Besides, the public organizations should provide proper equipment for the dental practitioners to decrease the risk of contagion.

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.

Bio-Inspired Systems in Nonsurgical Periodontal Therapy to Reduce Contaminated Aerosol during COVID-19: A Comprehensive and Bibliometric Review

BACKGROUND

On 30 January 2020, a public health emergency of international concern was declared as a result of the new COVID-19 disease, caused by the SARS-CoV-2 virus. This virus is transmitted by air and, therefore, clinical practices with the production of contaminant aerosols are highly at risk. The purpose of this review was to assess the effectiveness of bio-inspired systems, as adjuvants to nonsurgical periodontal therapy, in order to formulate bio-inspired protocols aimed at restoring optimal condition, reducing bacteremia and aerosols generation.

METHODS

A comprehensive and bibliometric review of articles published in English. Research of clinical trials (RCTs) were included with participants with chronic or aggressive periodontal disease, that have compared benefits for nonsurgical periodontal therapy (NSPT).

RESULTS

Seventy-four articles have been included. For probing depth (PPD) there was a statically significant improvement in laser, probiotic, chlorhexidine groups, such as gain in clinical attachment level (CAL). Bleeding on probing (BOP) reduction was statistically significant only for probiotic and chlorhexidine groups. There were changes in microbiological and immunological parameters.

CONCLUSIONS

The use of bio-inspired systems in nonsurgical periodontal treatment may be useful in reducing risk of bacteremia and aerosol generation, improving clinical, microbiological and immunological parameters, of fundamental importance in a context of global pandemic, where the reduction of bacterial load in aerosols becomes a pivotal point of clinical practice, but other clinical trials are necessary to achieve statistical validity.

COVID-19 Pandemic and Role of Human Saliva as a Testing Biofluid in Point-of-Care Technology

Novel coronavirus disease 2019 (COVID-19) outbreak has termed as a controllable pandemic, and the entire world has come to a standstill trying to mitigate the disease with health systems. Health care providers, around the globe, are fighting day and night. Currently, rapid testing is taking place with the help of nasopharyngeal, oropharyngeal swab, bronchoalveolar lavage, sputum, urine, and blood. All these approaches are invasive or embarrassing to the infected person. It is observed that salivary glands are hosting severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) because of angiotensin-converting enzyme 2 and the detection of high viral loads in the saliva and is playing a crucial role in virus transmission, especially from individuals showing absolutely no symptoms. Saliva is proving to be a promising noninvasive sample specimen for the diagnosis of COVID-19, thus helping to monitor the infection and prevent it from further spreading by prompt isolation.

Association of Personal Protective Equipment with De Novo Headaches in Frontline Healthcare Workers during COVID-19 Pandemic: A Cross-Sectional Study

OBJECTIVES

 This study aimed to determine the association of personal protective equipment (PPE) usage with new-onset headaches and exacerbation of pre-existing headache disorders among healthcare workers at the frontlines during coronavirus disease 2019 (COVID-19) pandemic.

MATERIALS AND METHODS

 A descriptive cross-sectional survey was conducted across Pakistan in June-July 2020. The study was approved by Ethical Committee, Armed Forces Institute of Dentistry, Rawalpindi (IRB form no.905/Trg-ABP 1K2). A qualitative questionnaire was developed and was shared via different social networks. The questionnaire was closed when 241 responses were received.

STATISTICAL ANALYSIS

 Descriptive analysis was performed on demographic data. Chi-squared analysis was performed between demographic data and PPE-usage patterns among participants with or without de novo headaches. Univariable and multivariable logistic regression models were used to compare variables with the development of new-onset headaches. Chi-squared test was also performed between demographic data and other factors that may be causing new-onset headaches. A p-value < 0.05 was considered significant.

RESULTS

 A total of 241 healthcare workers participated, of which 68 participants (28.2%) reported de novo headaches since the start of the pandemic. Incidence of pre-existing headaches (odds ratio [OR] = 1.91; 95% confidence interval [CI]: 0.99-0.37; p = 0.049) was associated with new-onset headaches. Post hoc multivariable logistic regression analysis stated that incidence of pre-existing headaches (OR = 1.88; 95% CI: 0.94-3.78; p = 0.75) and age (OR = 2.21; 95% CI: 0.47-10.33; p = 0.36) was independently associated with new-onset PPE-induced headaches but was not statistically significant. Chi-squared analysis showed a statistically significant relationship between other factors (sleep deprivation, emotional stress, etc.) and department of activity, gender, and occupation (p < 0.05).

CONCLUSION

 Healthcare workers with previous history of pre-existing headaches were found to be more susceptible to PPE-induced headaches during COVID-19 pandemic. However, age and the department where the healthcare workers performed may also be risk factors.

Do hydrogen peroxide mouthwashes have a virucidal effect? A systematic review

BACKGROUND

The presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in saliva has alerted health professionals to the possibility of contamination by aerosols generated in a number of procedures. The indication of preoperative mouthwash containing 1% hydrogen peroxide for reducing the viral load of SARS-CoV-2 in saliva prior to oral procedures has been significantly disseminated through several citations and influenced various dental associations in the elaboration of dental care protocols during this pandemic period, including patients admitted to hospital wards and intensive care units.

AIM

To Our aim was to perform a systematic review to answer the following question: does hydrogen peroxide mouthwash (at any concentration) have a virucidal effect?

METHODS

The Cochrane, LILACS, PubMed, Scopus, and Embase databases were searched by using the following key-words: 'hydrogen peroxide', 'mouthwash', 'mouth rinse', 'rinse', 'oral rinse', 'mouth bath', 'mouth wash', and 'mouth washes'. Reviews, letters to the editor, personal opinions, book chapters, case reports, congress abstracts, studies with animals and studies on mouthwash containing other compounds other than hydrogen peroxide were excluded.

FINDINGS

During the initial search 1342 articles were identified on the five electronic databases. After excluding some duplicates, 976 articles remained. Only studies assessing the virucidal effect of hydrogen peroxide mouthwash were selected, regardless of publication date.

CONCLUSION

After reading titles and abstracts, no article met the eligibility criteria. In conclusion, there is no scientific evidence supporting the indication of hydrogen peroxide mouthwash for control of the viral load regarding SARS-CoV-2 or any other viruses in saliva.

The Mental Health Consequences of Coronavirus Disease 2019 Pandemic in Dentistry

With the spread of coronavirus disease 2019 (COVID-19), strict isolation strategies to limit virus transmission have been applied worldwide. The lockdown has affected and challenged different medical areas. Doctors, nurses, dentists, and other health care workers are concerned about contagion, not only for themselves, but also for their families and colleagues. Furthermore, the oral mucosa has been accepted as a high-risk route of transmission for COVID-19. In many countries, dentists have been forced to stop working during quarantine until further notification. Isolation and its financial impact have produced physical and psychological pressure, depression, social anxiety, and other mental health concerns. This article aims to provide a comprehensive review of the consequences of past epidemics on mental health and to assess possible aspects that might be associated with mental implications in dentists during the COVID-19 pandemic. Finally, some concrete actions to avoid subsequent potential consequences are recommended.

Knowledge, attitudes and practices regarding COVID-19 among dental health care professionals: a cross-sectional study in Saudi Arabia

OBJECTIVES

With the increasing severity of the coronavirus disease (COVID-19) pandemic, it is essential that dental health care professionals (DHCPs) are prepared. The study aim was to assess the knowledge, attitudes and practices (KAP) regarding COVID-19 among DHCPs in Saudi Arabia.

METHODS

A cross-sectional study using a web-based survey was conducted. A validated and reliable questionnaire was developed that comprised 44 questions. Using Qualtrics survey software, DHCPs working in different settings were approached across five geographical regions of Saudi Arabia.

RESULTS

A total of 318 respondents voluntarily participated in the survey. Most DHCPs showed a moderate level of knowledge (51.6%), a positive attitude (92.1%) and adequate practice standards (86.5%). We found that 94.7% of DHCPs had an adequate overall level of KAP. DHCPs with a doctorate significantly outscored DHCPs with other educational levels with respect to knowledge and practice. Older (51-60 years) DHCPs reported significantly more knowledge than younger DHCPs.

CONCLUSION

DHCPs displayed an average level of knowledge that needs to be enhanced through continuing education programmes. However, they showed a positive attitude and an acceptable level of practice, as they were abiding by guidelines issued from various international and national health agencies.

SARS-CoV-2 and Dentistry-Review

SARS-CoV-2 (or 2019-nCoV) is the novel Coronavirus that affects humans. It originated in China at the end of 2019 due to the consumption of animals contaminated with this pathogen. SARS-CoV-2 causes the disease known as COVID-19 (coronavirus disease - 2019), and until May 21, 2020, approximately 213 countries and territories had been affected by SARS-CoV-2. The objective of this study was to review the origin and characteristics of this virus (SARS-CoV-2), symptoms and diagnosis of COVID-19, treatment of people with COVID-19, forms of transmission of the SARS-CoV-2, and precautions in dentistry. A literature search on PubMed/Medline was performed on the May 21, 2020, using the keywords (Mesh terms) "COVID-19" or "SARS-CoV-2" or "Coronavirus" associated with "dentistry" or "dental care" or "oral medicine." SARS-CoV-2 articles about the origin and characteristics of this virus (SARS-CoV-2), symptoms and diagnosis of COVID-19, treatment of people with COVID-19, forms of transmission of the SARS-CoV-2, and precautions in dentistry were included. The search was expanded according to necessity. Articles related to precautions in dentistry and SARS-CoV-1 or MERS-CoV were also selected, since precautions used in the dental clinic to avoid these viruses also apply to SARS-CoV-2. In addition, the references cited in the publications of articles included were also considered when appropriate. There was no limit in relation to the year of publication, and only articles written in English were included. In this study, suggestions for the safety of dental professionals were also included. Forty-seven articles and nine websites were included in this review.

Psychological Distress during COVID-19 Lockdown among Dental Students and Practitioners in India: A Cross-Sectional Survey

OBJECTIVE

 In response to the coronavirus disease 2019 (COVID-19) pandemic, the Indian Government imposed a countrywide lockdown of 21 days from March 25 to April 14, 2020, which was further extended to 60 days. The sudden draconian measures changed the delivery of dental education and practice throughout the country. The study aimed to screen for depression during the COVID-19 lockdown and the factors associated with it among dental students and practitioners in highly COVID-19 infected states of India.

MATERIALS AND METHODS

 The current study is an online cross-sectional survey performed in Delhi NCR, Maharashtra, and Tamil Nadu during May 2020. The participants were recruited by convenience sampling. The main outcome measure was the screening of depression using the Patient Health Questionnaire (PHQ-9), which was categorized as mild, moderate, and severe depression. The data analysis was performed with IBM SPSS Version 23.0. A multivariable logistic regression model was fitted to identify the independent predictors of depression.

RESULTS

 In total, 335 dental students and practitioners participated in the survey. Among this, a significant number of the dental students (54%) and practitioners (44%) scored moderate to severe depression in terms of depression severity according to the PHQ-9 scores. Those who were screened depressed were likely to be males and younger than 30 years old. The results of correlation analysis indicated that worry about the professional growth, concerns regarding setbacks in clinical and research experiences, previous history of mental health issues, and fear of contracting COVID-19 from patients were positively related to higher depression scores in students. Moreover, for practitioners, fear of contracting COVID-19 from the patients scored higher levels of depression. The practitioners who reported less concern about their practice/job post COVID-19 lockdown and those who were able to meet their financial expenses during the lockdown were the least likely to be depressed.

CONCLUSION

 The results of this study indicate a high level of depression among a significant number of dental students and practitioners. It is important to monitor and address the mental health needs of dental students and practitioners during and after the lockdown.

A cross-sectional multicenter survey on the future of dental education in the era of COVID-19: Alternatives and implications

PURPOSE

The coronavirus disease 2019 (COVID-19) pandemic has significantly challenged dental education. This study investigated the procedures outlined by dental faculty members to maintain quality dental education in a safe bioenvironment and adequately control the risk of cross-infection METHOD: Dental educators from dental schools around the world were invited to join an online survey considering different demographic factors. The survey consisted of 31 questions that were classified into separate sections, including academic characteristics, college size and facilities, action taken after announcement of the COVID-19 pandemic, perception of the pandemic, opinion regarding teaching, patient flow, possible facilities to implement for short- and long-term plans, and actions suggested to deal with the COVID-19 pandemic RESULTS: Two hundred-twelve responses were received. Respondents commonly agreed that COVID-19 will have major negative effects on dental education, adversely affecting all clinical disciplines. Shifting to virtual curricula, simulation labs, and distant learning were the prevailing actions taken in different dental colleges during the pandemic. Special attention was raised by the majority of respondents regarding dental aerosolizing procedures, preferring to postpone their training to a postpandemic/later phase. Coinciding opinions suggested adopting a future dynamic hybrid strategy analysis that combines online distant learning, virtual simulation, and haptic labs together with traditional direct clinical training on real patients CONCLUSION: The future of dental education will have far-reaching changes in strategies and tools to cope with COVID-19 pandemic and the postpandemic requirements of an effective, yet safe, dental learning environment. Dental colleges need to invest in infection precautions and in modern virtual education and training facilities.

Knowledge, Attitudes, and Clinical Practices of Dental Professionals during COVID-19 Pandemic in Pakistan

OBJECTIVE

 The aim of this study is to assess knowledge, attitudes, and clinical practices of dental professionals regarding the prevention and control of coronavirus disease 2019 (COVID-19) in Pakistan.

MATERIALS AND METHODS

 General dentists and dental specialists working in public and private dental practices, hospitals, and academic institutions participated in this cross-sectional study. A pilot-tested questionnaire was sent to dental professionals through an online link in Pakistan and data collection was completed in April-May 2020. The knowledge score was calculated from 22 variables about the COVID-19.

RESULTS

 The study included data of 343 dental professionals with 47.2% of males and 52.8% of females. The mean knowledge score was 16.78 ± 2.25, and it significantly differed between general dentists (16.55 ± 2.36) and dental specialists (17.15 ± 2.04) (p = 0.020), and those with up to 10 years of experience (16.58 ± 2.28) and those with more than 10 years of experience (17.05 ± 2.2) (p = 0.026). Only 15.5% of the participants were comfortable in treating patients during the COVID-19 pandemic. A workshop/seminar on the COVID-19 was attended by 23% of the participants. In multivariate analysis, being comfortable in treating patients (odds ratio = 3.31, 95% confidence interval = 1.63, 6.73) was associated with the attendance of workshop/seminar on COVID-19.

CONCLUSIONS

 Dental professionals had adequate knowledge about COVID-19, but a few of them were comfortable in treating patients during the pandemic. A minority of dental professionals attended a workshop/seminar on the COVID-19. Continuous education activities should be provided to dental professionals to enhance their role in the prevention of COVID-19 spread and promotion of oral health.

COVID-19 Pandemic: Oral Health Challenges and Recommendations

The aim of this article is to shed light on coronavirus disease 2019 (COVID-19) and its oral effects and risk of nosocomial transmission to update the knowledge of dental health care workers. A thorough literature search of the PubMed/Embase/Web of Science/Cochrane central database was conducted to identify the impact of COVID-19 on oral health. We reviewed the recommendations on the recent guidelines set by the Centers for Disease Control and Prevention infection control practices for dentistry, American Dental Association, and the World Health Organization. According to the available evidence, COVID-19 may have a negative impact on the oral health due to the infection itself and due to various other consequences such as therapeutic measures, xerostomia, and other complications of the COVID-19. In light of the above facts, dentists should be wary of the disease, its identification, mode of spread and impacts on the oral health. The dental personnel have been identified as at the highest risk of getting COVID-19 due to cross infection from contact with their patients and aerosols generated in routine dental procedures. As such, they should be aware of the modifications that need to be made to the practice to prevent transmission of the disease. It is evident that COVID-19 has a negative impact on the oral health and at the same time a significant transmission risk to the dental personnel and patients who visit the clinic. If the recommendations issued by the regulatory authorities are meticulously followed, the risk of disease transmission can be lessened.

COVID-19 and Oral Surgery: A narrative review of preoperative mouth rinses

OBJECTIVE

To provide a narrative review of the preprocedural mouth rinse protocols suggested for oral surgery in order to contrast the presence of SARS-CoV-2 in aerosol.

SOURCES AND METHODS

Electronic searches were performed in medical databases PubMed, Medline, CINAHN and Scopus to identify relevant studies published up until the third week of April 2020. This research was supplemented by exploration through a web-based search engine as well as a manual search for international and national guidelines. Studies and protocols which suggested preoperative mouth rinsing as a recommended measure during the COVID-19 outbreak were included. Given the small number of studies, a narrative literature review was conducted. In total, 15 references (11 articles and 4 guidelines) were considered relevant and were critically analysed.

CONCLUSION

The findings show a high heterogeneity in the protocols suggested. Further research is required to better understand the viral features and epidemiologic characteristics of this new virus and to test the efficacy of commonly used antiseptics against SARS-CoV-2 in future clinical trials. However, the use of chlorhexidine, hydrogen peroxide, PVP-I and cetylpyridinium chloride in contrasting the spread of Covid-19 is described as advisable and substantial in different publications.

The Assessment of Knowledge, Behaviors, and Anxiety Levels of the Orthodontists about COVID-19 Pandemic

OBJECTIVE

A new viral disease called Coronavirus disease-19 (COVID-19) affected the whole world because of its characteristics of spreading rapidly via respiratory droplets and aerosol. As one of the most aerosol-generating occupations, dentists are at high risk and are recommended to treat emergency cases only. We aimed to assess the general knowledge, emergencies, personal precautions, and avoided behaviors among the orthodontists and also their anxiety levels, during COVID-19.

METHODS

A survey research, including demographic information, general knowledge about COVID-19, treatment strategies, protective measures, and Generalized Anxiety Disorder (GAD) 7 test, was conducted via a web-based questionnaire (1 open-ended and 26 closed-ended questions). A total of 215 orthodontists older than 20 years of age and practicing in different regions of Turkey were included in this study. The answers received within the first 10 days were included.

RESULTS

Most of the orthodontists were aware of COVID-19 symptoms and transmission routes (n=159 and n=183, respectively). Almost all of them treated only emergency cases (n=209). Orthodontic emergencies were reported mostly as injury due to band/bracket failure, soft/hard tissue trauma, and problems in retention appliances (n=197, n=186, and n=81, respectively). The participants also avoided aerosol-generating procedures and used transmission-based protective equipment. The prevalence of GAD was 16.7% during COVID-19, and there was no statistically significant difference when it was stratified by gender, age, city, and COVID-19 related questions (p>0.05).

CONCLUSION

The orthodontists followed the guidelines and took protective measures during COVID-19, and the majority had subthreshold anxiety levels.

Coronavirus Disease 2019 Coexistence in the Daily Practice

The purpose of the present narrative review was to evaluate and discuss the actual available information regarding coronavirus disease 2019 and dental practice, and to share recommendations with the intent to help dentists in providing a safe and healthful workplace during pandemic. A step-by-step workflow is presented including prevention and measures to reduce risk for cross infections before, during, and after the dental treatments. Individualization of different risk-level zones and the establishment of a team-based chain control is also presented. The present manuscript may offer deeper knowledge and discussion regarding recommended procedures aimed to reduce risk for dental health care workers contamination and cross infections. Within these, infection prevention in dental settings, respect of general rules, containment measures, proper use of the personal protective equipments (PPE), and well-organized chain control of all the staff, with definition of risk zones and specific responsibility could be an adjunctive but important step to control the spread of the disease.

Knowledge, Attitudes, and Practices of Dental Patients Toward Cross-Infection and Economic Implications in View of Covid-19: An Online Survey

Aim:

To assess the knowledge, attitude, and practices of the patients regarding cross-infection in dental clinics in view of COVID-19, and its economic implications.

Materials and Methods:

The present study is a cross-sectional online survey done using Google Forms tool which was shared amongst 501 participants via e-mail and various social media platforms. It consisted of 42 structured questions regarding sociodemographics (seven questions), knowledge of COVID-19 (seven questions), practices regarding COVID-19 preventive methods (five questions), knowledge regarding cross-infection in dental clinics (nine questions), attitudes toward infection in dental clinics, and increased cost of treatment due to added disinfection protocols (14 questions). All the associations were tested using the chi-square test and with the P-value set at <.05. The significance level was taken as α = 0.05; therefore, a difference or association with P-value <.05 was considered statistically significant. The linear regression model was used to relate demographics with the knowledge attitude practices items, and Pearson’s correlation coefficient was used to evaluate the correlation between knowledge, attitudes, and practices.

Results:

A total of 478 responses were assessed. 92.2% of the respondents had high knowledge regarding COVID-19, and only 48.1% had a high knowledge score regarding infection control in dental clinics. The respondents exhibited high scores for practice related to COVID-19 (83.9%) and attitude toward infection control in dental clinics (91.9%). Using the Pearson’s correlation coefficient, knowledge attitude practices variables showed a significant correlation amongst each other ( P < .001). Only 60% responded that extra infection control protocols will increase the treatment charges, and approximately 30% responded that they will not pay or were not sure of paying the extra charges. The proportion of respondents who were agreeing about paying the increase cost were independent of age ( P = .226), gender ( P = .328), education ( P = .085), and profession ( P = .121).

Conclusion:

A significant percentage of patients today have a lot of knowledge of COVID-19. Also, they have higher expectations than before from their dental health care providers regarding infection control.

Analysis of anxiety-related factors amongst frontline dental staff during the COVID-19 pandemic in Yichang, China

BACKGROUND

Dental staff were characterized with the tolerance of enduring stress and they are at a high risk to respiratory infectious disease. This study compared the anxiety level of the frontline dental staff (FDS) to the general public in Yichang during the coronavirus disease of 2019 (COVID-19) pandemic and examined potential explanatory factors to the differences.

METHODS

Two online questionnaires were used separately to collect data from FDS and the general public. The Chinese version of Beck Anxiety Inventory (BAI) was included for the assessment of anxiety. Firstly, a Chi-square test was conducted to compare the anxiety state between these two groups. Then, a bivariate analysis using Cramer's V and Eta squared was conducted to find the potential factors. Lastly, a binary logistic regression was performed to examine the association between potential factors and the anxiety state of FDS.

RESULTS

In general, FDS were 4.342 (95% CI: 2.427-7.768) times more likely to suffer from anxiety disorders than the general public. The bivariate analysis showed that age, Level Three Protective Measures (PM-3), conflicts with patients and/or colleagues were moderately associated with the anxiety state of FDS. But the knowledge of COVID-19, the treatment to suspected or confirmed cases both had a weak association with the anxiety among FDS. Conversely, workload, the exposure to potential infectious substance and conducting aerosol generated performance were not significantly related to the anxiety of FDS. As the model indicated, an elder age and PM-3 protective measures could lower the anxiety state of FDS, whereas the conflict with patients or/and colleagues would worsen it.

CONCLUSIONS

During the COVID-19 pandemic, FDS were more likely to suffer from anxiety disorders than the general public. An elder age, sufficient personal protective measures and good relationships with colleagues and patients would help them to maintain good mental health.

Association of Salivary Content Alteration and Early Ageusia Symptoms in COVID-19 Infections: A Systematic Review

Coronavirus disease 2019 (COVID 19) is a major threat to the health and prosperity of human life at present. It has resulted in loss of thousands of lives globally and has brought countries to the brink of economic, social, and health collapse. A major issue of this infection is the ease with which it transmits through salivary droplets and its survival for long durations outside the body. Therefore, its early detection is critical in prevention, diagnostic, and management efforts of COVID-19 patients. Loss of taste and smell is one of the early symptoms reported in these patients and the virus is abundantly found in the salivary secretion of the infected symptomatic and asymptomatic patients. Infection and inflammation of salivary glands are common among viral infections, particularly in the early stages, which lead to salivary composition changes. Chemosensory sensation of taste is critically dependent on the salivary flow rate and its inorganic constituents, protein levels, specific 3',5'-cyclic adenosine monophosphate and 3',5'-cyclic guanosine monophosphate levels, ghrelins, pH levels, and enzymes. Therefore, the question arises, "Does COVID-19 infection alter the salivary components and composition leading to early transient symptoms of Ageusia and hypogeusia?" This review shows association of the COVID-19 and Ageusia, in addition to the early viral infection of salivary glands and possible changes in salivary flow and content. Therefore, suggesting a potential association between early ageusia in COVID-19 infection and salivary compositional changes.

Pivoting Dental Practice Management during the COVID-19 Pandemic-A Systematic Review

Background and Objectives: The aims of this systematic review were to identify additional infection control measures implemented in dental practice globally to prevent cross-infection and evaluate the psychological impacts of the pandemic among dental professionals. Materials and Methods: A sequential systematic literature search was conducted from December 2019 to 30 April 2020 through PubMed, CINAHL, Scopus, Google Scholar, Embase, and Web of Science databases. The search yielded the following results: "COVID-19" (n = 12,137), "Novel corona virus" (n = 63), "COVID-19 and dentistry" (n = 46), "COVID-19 and oral health" (n = 41), "Novel Corona virus and Dentistry" (n = 0), "dental health and Novel Coronavirus" (n = 26), and "dental practice and Novel Coronavirus" (n = 6). Results: After a careful review and eliminating articles based on inclusion and exclusion criteria, the final review included 13 articles. Management of infection control is discussed extensively in the literature and remains the main theme of many Coronavirus Disease 2019 (COVID-19) articles on dentistry. Telephone triage using a questionnaire, hand hygiene, personal protective equipment (PPE) for clinical and nonclinical staff, a preprocedural mouth rinse, and aerosol management have been discussed and implemented in few countries. Three studies recommended that elective treatments for patients with a temperature of >100.4 F or 38 °C should be postponed or performed in an airborne infection isolation room (AIIR) or negative-pressure room. Limiting the number of patients in the waiting area, the removal of shared objects, proper ventilation, and physical distancing were highly recommended. Psychological distress among dental professionals in relation to existing medical conditions and self-efficacy has been discussed. Conclusions: Although the COVID-19 pandemic has had a substantial impact on the dental profession worldwide, our review highlights many practice management approaches to adopt the new norm. More research highlighting evidence-based safety practices and multisectoral collaboration is required to help dental professionals make informed decisions and make the profession safe, both for the patient and dental professionals.

S, Johnson IG, Al-Yaseen W, Jones R, McGregor S, Robertson M, Harris R, Innes N, Wade WG. A systematic review of contamination (aerosol, splatter and droplet generation) associated with oral surgery and its relevance to COVID-19

INTRODUCTION

The current COVID-19 pandemic caused by the SARS-CoV-2 virus has impacted the delivery of dental care globally and has led to re-evaluation of infection control standards. However, lack of clarity around what is known and unknown regarding droplet and aerosol generation in dentistry (including oral surgery and extractions), and their relative risk to patients and the dental team, necessitates a review of evidence relating to specific dental procedures. This review is part of a wider body of research exploring the evidence on bioaerosols in dentistry and involves detailed consideration of the risk of contamination in relation to oral surgery.

METHODS

A comprehensive search of Medline (OVID), Embase (OVID), Cochrane Central Register of Controlled Trials, Scopus, Web of Science, LILACS and ClinicalTrials.Gov was conducted using key terms and MeSH (Medical Subject Headings) words relating to the review questions. Methodological quality including sensitivity was assessed using a schema developed to measure quality aspects of studies using a traffic light system to allow inter- and intra-study overview and comparison. A narrative synthesis was conducted for assessment of the included studies and for the synthesis of results.

RESULTS

Eleven studies on oral surgery (including extractions) were included in the review. They explored microbiological (bacterial and fungal) and blood (visible and/or imperceptible) contamination at the person level (patients, operators and assistants) and/or at a wider environmental level, using settle plates, chemiluminescence reagents or air samplers; all within 1 m of the surgical site. Studies were of generally low to medium quality and highlighted an overall risk of contaminated aerosol, droplet and splatter generation during oral surgery procedures, most notably during removal of impacted teeth using rotatory handpieces. Risk of contamination and spread was increased by factors, including proximity to the operatory site, longer duration of treatment, higher procedural complexity, non-use of an extraoral evacuator and areas involving more frequent contact during treatment.

CONCLUSION

A risk of contamination (microbiological, visible and imperceptible blood) to patients, dental team members and the clinical environment is present during oral surgery procedures, including routine extractions. However, the extent of contamination has not been explored fully in relation to time and distance. Variability across studies with regards to the analysis methods used and outcome measures makes it difficult to draw robust conclusions. Further studies with improved methodologies, including higher test sensitivity and consideration of viruses, are required to validate these findings.

Analysis of the Infection Status of Healthcare Workers in Wuhan During the COVID-19 Outbreak: A Cross-sectional Study

BACKGROUND

Healthcare workers (HCWs) at the frontline are facing a substantial risk of infection during the coronavirus disease 2019 (COVID-19) outbreak.

METHODS

We acquired information and data on general information on and infection and death status of HCWs in Wuhan during the COVID-19 outbreak and completed statistical analyses.

RESULTS

We obtained the data on 2457 infected cases among HCWs in Wuhan, China. More than half of the infected individuals were nurses (52.06%), whereas 33.62% of infected cases were doctors and 14.33% of cases were medical staff. In particular, the case infection rate of nurses (2.22%) was remarkably higher than that of doctors (1.92%). Most infected cases among HCWs were female (72.28%). A majority of the infected HCWs (89.26%) came from general hospitals, followed by specialized hospitals (5.70%) and community hospitals (5.05%). The case infection rate of HCWs (2.10%) was dramatically higher than that of non-HCWs (0.43%). The case fatality rate of HCWs (0.69%) was significantly lower than that of non-HCWs (5.30%).

CONCLUSIONS

The infection risk of HCWs is clearly higher than that of non-HCWs. HCWs play an essential role in fighting the pandemic. The analysis of the infection status of HCWs is essential to attract enough attention from the public, provide effective suggestions for government agencies, and improve protective measures for HCWs.

Development of research on COVID-19 by the World Scientific Community in the first half of 2020

The World Scientific Community has carried out several studies on the novel coronavirus, responsible for the current COVID-19 pandemic. This study aimed to verify the development level and research evolution on COVID-19, summarizing experts' main trends in the first half of 2020. The most cited articles focused on understanding the disease, addressing aspects of its transmission, viral activity period, symptoms, health complications, risk factors, and the estimate of new cases. These papers also focused on the treatment/prevention and management of COVID-19. Several drugs and alternative treatments have been investigated, such as the convalescent plasma transfusion and stem cell transplantation, while an efficient vaccine is developed. Prevention and control measures, such as social isolation and immediate case identification, were also investigated. Therefore, the main COVID-19 trends were identified and classified in disease, treatment/prevention, and pandemic management, contributing to scientific understanding and future studies.

Information technology in emergency management of COVID-19 outbreak

Emergency management of the emerging infectious disease outbreak is critical for public health threats. Currently, control of the COVID-19 outbreak is an international concern and has become a crucial challenge in many countries. This article reviews significant information technologyIT) applications in emergency management of COVID-19 by considering the prevention/mitigation, preparedness, response, and recovery phases of the crisis. This review was conducted using MEDLINE PubMed), Embase, IEEE, and Google Scholar. Expert opinions were collected to show existence gaps, useful technologies for each phase of emergency management, and future direction. Results indicated that various IT-based systems such as surveillance systems, artificial intelligence, computational methods, Internet of things, remote sensing sensor, online service, and GIS geographic information system) could have different outbreak management applications, especially in response phases. Information technology was applied in several aspects, such as increasing the accuracy of diagnosis, early detection, ensuring healthcare providers' safety, decreasing workload, saving time and cost, and drug discovery. We categorized these applications into four core topics, including diagnosis and prediction, treatment, protection, and management goals, which were confirmed by five experts. Without applying IT, the control and management of the crisis could be difficult on a large scale. For reducing and improving the hazard effect of disaster situations, the role of IT is inevitable. In addition to the response phase, communities should be considered to use IT capabilities in prevention, preparedness, and recovery phases. It is expected that IT will have an influential role in the recovery phase of COVID-19. Providing IT infrastructure and financial support by the governments should be more considered in facilitating IT capabilities.