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

Adapting new strategies in dental care to help geriatric and special needs patients during COVID-19 pandemic

Purpose

This paper aims to discuss and urge further deliberation on possible strategies to help geriatric and special needs patients to receive dental care during the pandemic.

Design/methodology/approach

This paper contains literature review of published research articles related to past epidemics, COVID-19 and older persons.

Findings

Accurate prediction of adverse outcomes, detection of unidentified problems, improved estimation of residual life expectancy and appropriate use of geriatric interventions is required to understand the necessity of the treatment and effect of possible COVID-19 contraction during the treatment.

Research limitations/implications

The authors reviewed the only published literature and collated the lessons learnt from past epidemics, as the natural history of the COVID-19 is not known.

Practical implications

Future dentists must be trained in crisis management to deal with pandemics more effectively. The dental fraternity should be equipped to provide some sort of “psychological counseling and reassurance” prior to dental care to vulnerable individuals with comorbidities and special needs.

Originality/value

There are very few published articles focused on unique dental care plans for geriatric and special needs patients.

COVID-19 Associated Stress Among Dental Students

Background:

The COVID-19 pandemic has exposed the global population to a high risk of infection that constitutes a major stress factor, especially for vulnerable groups such as dental students.

Objective:

To assess levels of COVID-19 related stress and anxiety, changes in hygienic and social habits, as well as subjective worries regarding the dental profession among dental students.

Methods:

A self-structured questionnaire was sent to students at the College of Dentistry, Umm Al-Qura University. It included demographic data, questions about the level of change in personal hygiene and social habits, students’ perception about the sufficiency of information received during the outbreak and its source, subjective worries regarding the dental profession, and the Generalized Anxiety Disorder 7-item (GAD-7) scale. Two hundred fifty-eight responses were received.

Results:

Moderate and severe anxiety were reported in 17% and 4% of students, respectively, with non-significant associations between anxiety and gender or level of study. A high percentage of students (46.5% to 62.4%) reported great change in most hygienic and social habits with a highly significant association between change in buying more sanitizers and anxiety levels. Forty-six percent agreed that their job performance was not at its best, and 31% reported a possible intention to change profession, with the latter reported more by male students (63.8%).

Conclusion:

A considerable percentage of dental students in our college are anxious and changed their hygienic and social habits due to COVID-19. This anxiety reflects worries about the dental profession in one-third of participants that necessitate counselling services and psychological support.

[Odontología en entorno COVID-19. Adaptación de las Unidades de Salud Bucodental en los centros de salud de la Comunidad de Madrid.]

The COVID-19 respiratory manifestations go from mild symptoms similar to those of a common cold to severe pneumonia with respiratory distress syndrome, septic shock and multiorgan failure. The disease is caused by the SARS-CoV-2 virus, whose transmission mechanism most relevant to dentistry is through respiratory droplets and possibly also aerosols, as well as direct contact with mucous membranes of the nose, mouth or eye via contaminated hands or objects. The professionals of the dental health units have a high risk exposure since they work at short distances (less than 1 m from the head of the patient) in the oral cavity, where a maximal expression of possible cell receptors for the virus has been reported. Also, most procedures in the dental cabinet imply aerosol generation. Cross-infection is possible during dental care, not only with diagnosed COVID-19-positive patients but also with patients who remain undetected due to asymptomatic or presymptomatic disease. For all these reasons, dental care in the primary health setting has had to change in order to adapt to the pandemic. The changes affect both the appointment scheduling and the care itself and imply the establishment of general and specific barrier protections as well as measures related to ventilation, cleaning, disinfection and sterilization, reinforced with additional infection prevention and control measures. This article summarizes the available scientific evidence about this adaptation.

COVID-19: Impacts on oral healthcare delivery in dependent older adults

OBJECTIVES

To evaluate the impacts of restrictions to the provision of dental services for dependent older patients due to the COVID-19 pandemic.

METHODS

Data were gathered on the number of dependent older patients treated, emergency treatment provided and the revenues generated by a specialised clinic for geriatric dentistry during the current pandemic period and compared with the recorded clinical activity from the preceding year. Hypothetical projections were generated for the remainder of the current year based on the assumption that restrictions due to COVID-19 would remain.

RESULTS

A significant decrease in the total number of dependent older patients treated was recorded during the periods of January-March 2020 (P = .026) and April-May 2020 (P = .001) when compared to 2019. According to projections, by December 2020 the clinic will be providing 81.14% less clinical activity compared to 2019 (P < .0001), including a complete cessation of domiciliary services. Despite decreases in expenditure, revenues generated by the clinic have decreased significantly due to reduced clinical activity during January-March 2020 (P = .268) and April-May 2020 (P = .010) compared to 2019, and would decline further by 899.61% by December 2020.

CONCLUSIONS

The restrictions implemented to prevent the spread of COVID-19 have resulted in a significant reduction in oral healthcare provision for dependent older adults. Within this clinic, dedicated to dependent older adults, clinical activity is projected to reduce by 81% by the end of 2020 with associated reductions in revenue generation. Given the importance of oral healthcare delivery for this patient group, this may have significant and lasting impacts.

Estimating COVID-19 prevalence and infection control practices among US dentists

BACKGROUND

Understanding the risks associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission during oral health care delivery and assessing mitigation strategies for dental offices are critical to improving patient safety and access to oral health care.

METHODS

The authors invited licensed US dentists practicing primarily in private practice or public health to participate in a web-based survey in June 2020. Dentists from every US state (n = 2,195) answered questions about COVID-19-associated symptoms, SARS-CoV-2 infection, mental and physical health conditions, and infection control procedures used in their primary dental practices.

RESULTS

Most of the dentists (82.2%) were asymptomatic for 1 month before administration of the survey; 16.6% reported being tested for SARS-CoV-2; and 3.7%, 2.7%, and 0% tested positive via respiratory, blood, and salivary samples, respectively. Among those not tested, 0.3% received a probable COVID-19 diagnosis from a physician. In all, 20 of the 2,195 respondents had been infected with SARS-CoV-2; weighted according to age and location to approximate all US dentists, 0.9% (95% confidence interval, 0.5 to 1.5) had confirmed or probable COVID-19. Dentists reported symptoms of depression (8.6%) and anxiety (19.5%). Enhanced infection control procedures were implemented in 99.7% of dentists' primary practices, most commonly disinfection, COVID-19 screening, social distancing, and wearing face masks. Most practicing dentists (72.8%) used personal protective equipment according to interim guidance from the Centers for Disease Control and Prevention.

CONCLUSIONS

COVID-19 prevalence and testing positivity rates were low among practicing US dentists. This indicates that the current infection control recommendations may be sufficient to prevent infection in dental settings.

PRACTICAL IMPLICATIONS

Dentists have enhanced their infection control practices in response to COVID-19 and may benefit from greater availability of personal protective equipment. ClinicalTrials.gov: NCT04423770.

On the Nature of Fear and Anxiety Triggered by COVID-19

Emergencies that occur during natural disasters, such as avalanches, earthquakes, and floods, tend to be sudden, unexpected, and ephemeral and recruit defensive responses, similar to the ones recruited when faced with dangerous animals. Defensive behaviors are triggered by activity in survival circuits that detects imminent threats and fear is the conscious emotion of that follows immediately. But this particular threat (COVID-19) is useable and mysterious, triggering anxieties much more than fear. We conducted a literature search on May 1, 2020 in Google Scholar, PsychInfo, and PubMed with search terms related to COVID-19 fears and found 28 relevant articles. We categorized the papers into six groups based on the content and implications: fear of the unknown, social isolation, hypochondriasis, disgust, information-driven fears, and compliance. Considering the nature of fear and anxiety, combined with the characteristics of the present COVID-19 situation, we contemplate that physicians and other health care workers of several specialties, as well as police officers, fire-fighters, and rescue personnel, and first responders might be more able to deal with COVID-19 if they have (a) some tolerance of the unknown, (b) low illness anxiety disorder, (c) tolerance to social isolation; (d) low levels of disgust sensitivity; (e) be granted financial support, (f) have priority if needed medical assistance (g) use caution relatively to the COVID-19 media coverage and (h) be trained to have high levels of efficacy. Possibilities for preventive and therapeutic interventions that can help both health care personnel and the general population are also discussed.

A Review on COVID-19 Mediated Impacts and Risk Mitigation Strategies for Dental Health Professionals

In the light of coronavirus disease 2019 (COVID-19), dentistry is facing unprecedented challenges. The closure of clinics has impacted dental health professionals (DHPs) not only financially but also psychologically. In this review, these consequences are discussed in detail to highlight the challenges that DHPs are facing thus far, in both developing and developed nations. Compromised mental health among DHPs is an important area that requires attention during this difficult period. Although, in previous pandemics, dentists have not worked on the frontline, the article discusses how their wide range of skillsets can be leveraged if another wave of COVID-19 pandemic appears. Finally, guidelines to reopen clinics and patient management have been discussed in detail that could serve as a quick reference guide for DHPs.

Coronavirus diseases 2019: Current biological situation and potential therapeutic perspective

Coronavirus Disease 2019 (COVID-19) caused by a Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) was first reported in Wuhan, China at the end of December 2019. SARS-CoV-2 is a highly pathogenic zoonotic virus and closely related to the Severe Acute Respiratory Coronavirus (SARS-CoV) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV). The COVID-19 was declared as a global pandemic due to its high infectiousness, and worldwide morbidities and mortalities. The Chinese scientists at the start of the outbreak reported genome sequences, which made the characterization of glycoproteins and other structural proteins possible. Moreover, researchers across the world have widely focused on understanding basic biology, developing vaccines, and therapeutic drugs against the COVID-19. However, until now, no promising treatment options, as well as vaccines, are available. In this review, we have described SARS-CoV-2's genome, transmission, and pathogenicity. We also discussed novel potential therapeutic agents that can help to treat the COVID-19 patients.

Knowledge of dental academics about the COVID-19 pandemic: a multi-country online survey

BACKGROUND

COVID-19 is a global pandemic affecting all aspects of life in all countries. We assessed COVID-19 knowledge and associated factors among dental academics in 26 countries.

METHODS

We invited dental academics to participate in a cross-sectional, multi-country, online survey from March to April 2020. The survey collected data on knowledge of COVID-19 regarding the mode of transmission, symptoms, diagnosis, treatment, protection, and dental treatment precautions as well as participants' background variables. Multilevel linear models were used to assess the association between dental academics' knowledge of COVID-19 and individual level (personal and professional) and country-level (number of COVID-19 cases/ million population) factors accounting for random variation among countries.

RESULTS

Two thousand forty-five academics participated in the survey (response rate 14.3%, with 54.7% female and 67% younger than 46 years of age). The mean (SD) knowledge percent score was 73.2 (11.2) %, and the score of knowledge of symptoms was significantly lower than the score of knowledge of diagnostic methods (53.1 and 85.4%, P <  0.0001). Knowledge score was significantly higher among those living with a partner/spouse than among those living alone (regression coefficient (B) = 0.48); higher among those with PhD degrees than among those with Bachelor of Dental Science degrees (B = 0.48); higher among those seeing 21 to 30 patients daily than among those seeing no patients (B = 0.65); and higher among those from countries with a higher number of COVID-19 cases/million population (B = 0.0007).

CONCLUSIONS

Dental academics had poorer knowledge of COVID-19 symptoms than of COVID-19 diagnostic methods. Living arrangements, academic degrees, patient load, and magnitude of the epidemic in the country were associated with COVD-19 knowledge among dental academics. Training of dental academics on COVID-19 can be designed using these findings to recruit those with the greatest need.

COVID-19 is a challenge for dental education-A commentary

The COVID-19, which appeared to originate in China in December 2019, has spread worldwide pandemically. In this commentary, authors described this new challenge for dental education using the recent literature and experience gained in the Italian University of Catanzaro.

COVID-19 Guidelines to Protect Healthcare Workers at Hospitals and Dental Professionals at Dental Office

BACKGROUND

Coronavirus disease 2019 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2. This study aimed to address the preventive procedures to protect healthcare workers at hospital to avoid COVID-19, and infection control procedures to protect dental professionals in dental office.

METHODS

We conducted a search of published articles from PubMed, google scholar databases using key words such as COVID-19, healthcare worker, infection control, and dental practice. Relevant articles were identified and reviewed. Most published papers were clinical reports and case studies. We have selected some of the current published papers written in English in 2020.

RESULTS

Infection control procedures to protect health workers at hospitals, and dental professionals at dental office were summurised and presented. Infection control procedures for healthcare workers at hospitals include Personal protective equipment, Korea filter (KF)94 respirator, goggles, face protector, disposable waterproof long-arm gown, and gloves, and others. Extra-protection procedures should be taken with old and vulnerable healthcare workers. Dental professionals should evaluate patients in advance before starting dental treatment. Aerosols generating procedures should be avoided and personal protective equipment should be used. Dental treatment should be restricted to emergency cases only.

CONCLUSION

Old medical staff should be in safer distance to avoid infection, but young physicians and nurses should work at frontline as their immunity is better than their colleagues at old age. Screening patients and measurement of the body temperature are essential measures before dental treatment.

The impact of COVID-19 on dental education in North America-Where do we go next?

During the COVID-19 pandemic, the dental education community faced unprecedented challenges. In this commentary, we share the perspectives of faculty clinicians, residents and students in academic dental institutions in the United States and Canada. We discuss COVID-19's impact on various aspects of academic dentistry including patient care, education, research and raise key concerns regarding the future of dental education post-pandemic.

Role of graphene in biosensor and protective textile against viruses

Coronavirus disease (COVID-19) is a recently discovered infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Graphene is an emerging material due to its extraordinary performance in the field of electronics and antimicrobial textiles. Special attention devoted to graphene oxide-based materials due to its surface to volume ratio is very high which make it easy to attach biomolecules by simple adsorption or by crosslinking between reactive groups and the graphene surface. In response to the COVID-19 pandemic, we have summarized the recent developments of graphene and its derivatives with possible virus detection and textile applications. Moreover, graphene strain sensors can be executed on high-performance textiles and high-throughput drug efficacy screening.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Effects of COVID-19 in South African health system and society: An explanatory study

BACKGROUND AND AIMS

The underestimation of the severity of COVID-19 by the South African government resulted in delayed action against the pandemic. Ever since WHO declared COVID-19 a pandemic preventive action was comprehensively upgraded worldwide. This prompted South African authorities to implement physical distancing, self-isolation, closure of non-essential services, schools, travelling restrictions and recursive national lockdowns to mitigate the impact of COVID-19. This explanatory study sought to review the effects of COVID-19 in the South African health system and society.

METHODS

The study applied literature research of COVID-19 reports, policies from the National Department of Health, WHO, Africa CDC, and articles from Google Scholar, Science Direct, Web of Science, Scopus and PubMed.

RESULTS

The South African health system is affected by the lack of PPEs, increased mortality rates, mental health problems, substance abuse, resurgent of NCDs. The closure of international borders, global demand meltdown, supply disruptions, dramatic scaling down of human and industrial activities during lockdown cause socio-economic problems. The prolonged effects of lockdown on psychosocial support services resulted in the outbursts of uncertainties, acute panic, fear, depression, obsessive behaviours, social unrests, stigmatization, anxiety, increased gender-based violence cases and discrimination in the distribution of relief food aid.

CONCLUSION

To slow down the spread of COVID-19, massive testing must be adopted, contact tracing, isolation, and home quarantine guidelines for asymptomatic cases which promote behavioural change and reviewing of policy on food relief.

Coronavirus Disease 2019 (COVID-19) and Neurosurgery Residency Action Plan: An Institutional Experience from the United States

BACKGROUND

The current pandemic crisis, caused by a novel human coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), has forced a dramatic change in our society. A key portion of the medical work force on the frontline is composed of resident physicians. Thus, it becomes imperative to create an adequate and effective action plan to restructure this valuable human resource amid the SARS-CoV2 pandemic. We sought to describe a comprehensive approach taken by a Neurosurgery Department in quaternary care academic institution in the United States of America amid the SARS-CoV2 pandemic focused in resident training and support.

OBJECTIVE

To describe a comprehensive approach taken by a Neurosurgery Department in quaternary care academic institution in the United States of America amid the SARS-CoV2 pandemic focused on resident training and support.

RESULTS

A restructuring of the Neurosurgery Department at our academic institution was performed focused on decreasing their risk of infection/exposure and transmission to others, while minimizing negative consequences in the training experience. An online academic platform was built for resident education, guidance, and support, as well as continue channel for pandemic update by the department leadership.

CONCLUSIONS

The SARS-CoV2 pandemic constitutes a global health emergency full of uncertainty. Treatment, scope, duration, and economic burden forced a major restructuring of our medical practice. In this regard, academic institutions must direct efforts to diminish further negative impact in the training and education of the upcoming generation of physicians, including those currently in medical school. Perhaps the only silver lining in this terrible disruption will be greater appreciation of the role of current health care providers and educators, whose contributions to our society are often neglected or unrecognized.

Psychological impact of the coronavirus disease 2019 (COVID-19) pandemic on dental students: A nationwide study

OBJECTIVES

Public mental health concerns have been raised during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to assess the psychological impact of the pandemic on dental students in Saudi Arabia.

METHODS

A cross-sectional analytical study was conducted among dental students from different universities in Saudi Arabia selected using 2-stage cluster sampling. The psychological impact was assessed using the validated Arabic version of the Depression, Anxiety and Stress Scale-21 Item questionnaire. The data were analyzed using SPSS software. The Mann-Whitney U and Kruskal-Wallis tests were used as appropriate. A chi-squared test was used to compare the proportions between the sociodemographic data and logistic regression analysis to identify variables associated with the student's responses.

RESULTS

The internal consistency of the scale was excellent (0.954). A total of 697 dental students participated voluntarily in the study; their mean age was 21.76 ± 1.859 years, and 54.7% were female. The majority (96.1%) were single, and 69.4% lived in a household of > 5 persons. Significant differences in mental health outcomes were evident for gender, university, and survey time. Elevated levels of depression, anxiety, and stress were recorded among 60.64%, 37.02%, and 34.92%, respectively, of the students. Females, students who lived alone, and junior students were more likely to experience psychological problems during the COVID-19 pandemic.

CONCLUSIONS

The presence of elevated levels of depression, anxiety and stress among dental students highlights the need for psychological empowerment strategies involving institutional counseling services.

Dental care during COVID-19 pandemic: Survey of experts' opinion

Objectives

The current COVID‐19 outbreak in conjunction with the need to provide safe dental treatments and the limited knowledge on the efficacy of protective measures has posed dentists into a challenging situation. Therefore, the present article aimed at collecting experiences and recommendations of frontline clinical experts on critical aspects of dental treatment provision during pandemic.

Material & Methods

From a total of 32 European countries, one leading academic expert in Oral and Maxillofacial Surgery or Oral Surgery per country was asked to participate in an anonymous online 10‐item survey on COVID‐19 covering the topics of safety of dental settings, personal protective equipment (PPE), and patient‐related measures to reduce transmission risk. Data collection took place from April 12th to May 22nd, 2020.

Results

A total of 27 experts from different European countries completed the survey. The transmission risk of SARS‐CoV‐2 in dental settings for aerosol‐generating procedures was considered high by all experts except two. For aerosol‐free and aerosol‐generating procedures, more than 80% of the experts recommended face protection and caps for every single treatment. For aerosol‐generating procedures, additional measures (FFP2/FFP3 masks and gowns) were suggested by the vast majority of the experts. To reduce transmission risk, all experts recommended limiting aerosol‐generating procedures and reducing the number of patients in waiting areas as well as hand hygiene for the patients.

Conclusion

The limitation of aerosol‐generating procedures along with the usage of adequate personal protection equipment was considered to be crucial to protect dental healthcare providers and patients, thus reducing the transmission risk of COVID‐19.

Head and neck cancer therapy-related oral manifestation management in the COVID-19 pandemic: a critical review

With the onset of the new coronavirus disease (COVID-19) pandemic, the dental treatment of patients at risk of infection has become quite challenging. In view of this, patients with head and neck cancer may present with oral complications due to anticancer therapy, making dental assistance necessary. Thus, the objective of the study was to review the literature and critically discuss important concerns about the treatment of patients with head and neck cancer during the COVID-19 pandemic. Because dental professionals are in close contact with the main viral transmission routes, this study presents recommendations for management and protection during clinical dental care. The main characteristics and transmission routes of COVID-19 are also discussed. Dental professionals should control pain and the side effects of antineoplastic treatment and use preventive measures for infection control. During this pandemic, patients with head and neck cancer should not undergo elective procedures, even if they do not have symptoms or a history of COVID-19; therefore, in asymptomatic or painless cases, only preventive actions are recommended. In symptomatic or painful cases, precautions for safe interventional treatments must be implemented by following the hygiene measures recommended by health agencies and using personal protective equipment. During health crises, new protocols emerge for cancer treatment, and professionals must act with greater attention toward biosafety and updated knowledge. It is important to offer adequate individualized treatment based on the recommendations of preventative and interventional treatments so that patients can face this difficult period with optimized quality of life.

Environmental Disinfection of a Dental Clinic during the Covid-19 Pandemic: A Narrative Insight

BACKGROUND

The control of biological hazard risk in health care and dental clinic environments represents a critical point in relation to the Covid-19 infection outbreak and international public health emergency. The purpose of the present review was to evaluate the scientific literature on the no-touch disinfection procedures in dental clinics aiming to limit transmission via airborne particles or fomites using no-touch procedures for environmental decontamination of dental clinics.

METHODS

An electronic database literature search was performed to retrieve research papers about Covid-19 and no-touch disinfection topics including full-length articles, editorials, commentaries, and outbreak studies. A total of 86 papers were retrieved by the electronic research.

RESULTS

No clinical article about the decontamination of a dental clinic during the Covid-19 pandemic was detected. About the topic of hospital decontamination, we found different no-touch disinfection procedures used in hospital against highly resistant organisms, but no data were found in the search for such procedures with respect to SARS-CoV-2: (1) aerosolized hydrogen peroxide, (2) H2O2 vapor, (3) ultraviolet C light, (4) pulsed xenon, and (5) gaseous ozone. One paper was retrieved concerning SARS-CoV-2; 32 documents focused on SARS and MERS. The cleaning and disinfection protocol of health care and dental clinic environment surfaces are essential elements of infection prevention programs, especially during the SARS-CoV-2 pandemic.

CONCLUSION

The decontamination technique that best suits the needs of the dental clinic is peroxide and hypochlorous which can be sprayed via a device at high turbine speed with the ability of producing small aerosol particles, recommendable also for their low cost.

Preventive Measures for COVID-19 in Dental Treatments

Objective:

The 2019 coronavirus disease (COVID-19) has spread to most countries around the world, infecting millions of people and resulting in the pandemic. This presents great challenges for dental professionals. It is necessary to explore preventive measures for COVID-19 in dental treatments.

Methods:

In this paper, we outline several measures designed to prevent COVID-19 in dental treatments, such as 3-level pre-examination triage and 2-body temperature tests, 3-level protection for medical personnel, gargling before oral treatment, implementing the 4-hand operation, suctioning saliva during oral treatment, using a rubber dam, and strict enforcement of hand hygiene. These measures include recommendations for medical staff and give practical advice for managing treatment.

Results:

The epidemic has been brought under control, and routine oral examination and treatments have gradually been resumed from March 9, 2020, in Hunan Province, China. From January 24 to March 8, 2020, a total of 4272 patients received oral therapy during the COVID-19 epidemic in our hospital. We followed these guidelines during the COVID-19 epidemic, and none of the clinical dental staff, other workers, or patients were infected with COVID-19.

Conclusions:

These preventive measures for COVID-19 in dental treatments can be used as a reference for oral clinics and stomatological hospitals.

Clinical Trials Developed in Brazil on Covid-19: What Is Being Researched?

Background: The coronavirus disease 2019 pandemic (COVID-19) has brought great public health challenges into our lives. To date, there has been no specific therapeutic protocol for this disease, which requires a study with high-quality evidence. Objectives: To analyze clinical trials on COVID-19 in Brazil. Methods: Documentary research was conducted on the clinical trial registration platform. For the search strategy, the “COVID-19” keyword was established in the “condition or disease” section and “Brazil” in the “country” section. No limit on the search period was considered. Data were analyzed and presented using descriptive statistics. Results: Of the 81 registered clinical trials, 48 met the eligibility criteria. The sample size ranged from 10 to 3,000 individuals. Most studies recruited individuals aged 18 - 64 years (48.5%) and > 65 years (48.5%). Regarding the study design, randomized (91.6%), parallel (89.5%), quadruple-blind (39.6%), and therapeutic (97.9%) types were more frequent. Most studies used standard two-arm trial (70.8%), used drugs (79.2%), placebo (58.3%), and were sponsored by pharmaceutical/biotechnology companies and universities with 33.3% and 29.2%, respectively. Conclusions: Clinical trials under development in Brazil on COVID-19 are mostly carried out with adult and elderly participants, and regarding the study design, have a predominance of randomized allocation, parallel model, quadruple-blind masking with a therapeutic purpose. Most studies use antithrombotic agents or combinations of antithrombotic agents.

COVID-19 and Infection Control in Dental Clinics; Assessment of Public Knowledge, Attitudes and Practices in Several Regions of Saudi Arabia

Background:

The recent outbreak of the Corona Virus Disease (COVID-19) has affected millions of lives in different countries including the Kingdom of Saudi Arabia. Due to the characteristics of dental practice settings, there is a high risk of infection transmission between patients and dentists.

Objectives:

The aim of this study was to assess the level of public knowledge, attitude and practice regarding COVID-19 and infection control when visiting a dentist.

Methods:

In April 2020, a web-based cross-sectional survey was distributed randomly among the public through social media platforms. A validated anonymous questionnaire was used to assess knowledge about COVID-19 and participants’ attitudes toward extra measures to prevent the spread of infection.

Results:

Among the completed questionnaires (N=521), the mean age of the participants was 36.24 years, 68.3% were women, 87.5% held a university degree, and 81% were from the Makkah region. Most of the participants (99%) obtained a good knowledge score regarding COVID-19. Women were more likely than men to have more knowledge (p<0.05). Nearly all of the participants (99.6%) demonstrated good attitudes towards precautionary measures in dental clinics.

Spearman’s rho test showed a statistically significant correlation between age and attitude score, suggesting that attitude score increased with age (p<0.05). Overall, 73.3% reported that they would maintain good hygiene practices when visiting a dentist during this pandemic.

Conclusion:

Most Saudi residents with a high education level are knowledgeable about COVID-19, hold promising attitudes, and have appropriate practices towards precautionary measures needed while visiting a dental clinic during the virus outbreak.

Patient Perceptions about Professional Dental Services during the COVID-19 Pandemic

Background:

Dental professionals are at high risk of being infected by and transmitting COVID-19 to patients. Patients’ perceived risk for infection and attitudes about receiving dental care during the pandemic are important to understand as patients consider returning to routine dental care as the pandemic progresses.

Objective:

The purpose of this study was to explore dental patients’ perceptions of susceptibility to contracting COVID-19, their related attitudes and beliefs regarding dental care visits, and their considerations for returning to routine care during and after the pandemic.

Method:

Data for this cross-sectional study came from an electronic survey of 464 US adults. Survey variables include demographics, dental hygiene behaviors, perceived susceptibility to COVID-19, attitudes and beliefs regarding risk for attending dental appointments, and the necessary conditions and events for them to feel comfortable returning to regular dental appointments.

Results:

Over half of study participants had a 4-y degree, an annual income of at least $50,000, and good oral hygiene practices of frequent brushing and routine dental visits. Older age and agreement with positive attitudinal statements and beliefs about professional dental care were positively related to perceived susceptibility for contracting COVID-19 in a dental setting. Perceptions of susceptibility, a higher valuation of dentistry, and agreement that COVID-19 is a serious infection were each positively related to attitudinal statements and beliefs reflecting caution in attending dental visits. Last, assurance from public health officials confirming the safety to return for routine dental care was the largest reported factor necessary for a return to routine dental visits.

Conclusion:

This study provides early data about patient perceptions of susceptibility and attitudes toward COVID-19 in a professional dental setting and necessary conditions for returning to regular visits. This information can help formulate messaging related to returning to professional dental care, specifically targeting fears among the most susceptible populations.

Knowledge Transfer Statement:

Government and public health agencies can play an important role in alleviating concerns and instilling confidence that dental settings are safe. With this information from the public, dental professionals and public health agencies can work together to share messaging that will consistently inform the public regarding the safety of returning to professional dental care as it relates to the reopening of states and cities.

A Retrospective Analysis of the Coagulation Dysfunction in COVID-19 Patients

To discuss the coagulation dysfunction in COVID-19 patients and to find new biomarkers to separate severe COVID-19 patients from mild ones. We use a retrospective analysis of 88 COVID-19 patients, and compare the coagulation function between severe and mild groups. We found the prothrombin time (PT), thrombin time (TT), D-dimer were significantly higher in the severe group (P < 0.05), and the highest area under the curve (AUC) is 0.91 for D-dimer, while the AUC of PT and TT were 0.80 and 0.61 respectively. We identified that D-dimer has a better value in predicting patients who are likely to develop into severe cases, with the sensitivity and specificity were 84.4% and 88.8%, respectively. D-dimer may be a good biomarker to separate the severe COVID-19 patients from the mild ones.

In silico Investigation on the Inhibiting Role of Nicotine/Caffeine by Blocking the S Protein of SARS-CoV-2 Versus ACE2 Receptor

In this paper, we studied the in silico interaction of angiotensin-converting enzyme 2 (ACE2) human receptor with two bioactive compounds, i.e., nicotine and caffeine, via molecular dynamic (MD) simulations. The simulations reveal the efficient blocking of ACE2 by caffeine and nicotine in the exposure to the spike (S) protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We have selected the two most important active sites of ACE2-S protein, i.e., 6LZG and 6VW1, which are critically responsible in the interaction of S protein to the receptor and thus, we investigated their interaction with nicotine and caffeine through MD simulations. Caffeine and nicotine are interesting structures for interactions because of their similar structure to the candidate antiviral drugs. Our results reveal that caffeine or nicotine in a specific molar ratio to 6LZG shows a very strong interaction and indicate that caffeine is more efficient in the interaction with 6LZG and further blocking of this site against S protein binding. Further, we investigated the interaction of ACE2 receptor- S protein with nicotine or caffeine when mixed with candidate or approved antiviral drugs for SARS-CoV-2 therapy. Our MD simulations suggest that the combination of caffeine with ribavirin shows a stronger interaction with 6VW1, while in case of favipiravir+nicotine, 6LZG shows potent efficacy of these interaction, proposing the potent efficacy of these combinations for blocking ACE2 receptor against SARS-CoV-2.

Understanding value in oral health: the oral health value-based care symposium

OBJECTIVE

There are both opportunities and challenges with the implementation of oral health value-based care (OHVBC). To tackle concerns and advance conversation, a symposium was convened with subject matter experts to develop a gap analysis and capture insights into professional readiness for value-based care design.

METHODS

The symposium was convened as a private event for 46 participants over the course of one and a half days in December 2019. Thematic analyses utilized the OHVBC Readiness Framework (DentaQuest Partnership, 2019) to further codify conversations as part of the gap-analysis process. Poll Everywhere, a text messaging application that allows participants to answer questions in real time, was also employed to solicit responses.

RESULTS

Attendees of the symposium felt that OHVBC would have a large portion of market share within the next 10 years. A qualitative assessment of multiple table discussions determined that the participants developed more consensus around themes for the current state and the future-desired state than the action-planning needed to close the gap between the two. This may relate to individual ideology, and the siloed environment is still prevalent in the oral health realm. In a postsymposium survey, respondent attendees did not perceive that COVID-19 would delay or negatively impact the adoption of OHVBC and may result in accelerating its utilization.

CONCLUSION

The oral health community is experiencing multiple drivers to adopt more OHVBC within business and care models. However, there is still a lack of uniformity on how to execute this delivery model.

Dental Practice during COVID-19 in Nepal: A Descriptive Cross-sectional Study

Introduction:

Currently, coronavirus disease (COVID-19) has become pandemic and spread globally. In Nepal, the number of COVID-19 is increasing day-by-day. This research was done to find out the impact of COVID-19 on dentists, patients, and dental practice in Nepal.

Methods:

This study is a cross-sectional study conducted using an online survey from May 10 to17, 2020. A questionnaire was designed and uploaded in Freeonlinesurveys.com. Following ethical approval, the questionnaire was distributed among 500 dentists, and 406 dentists participated in the study. The survey link was dispersed to the Nepali dentists through social media and e-mail, and the results of the responses were received online. The questionnaire consisted of a total of 34 closed-ended questions containing three parts; demographic details, knowledge of dentists on COVID-19, and the impact of COVID-19 on dentists, patients, and dental treatments.

Results:

It showed that majority of the participants were females 243 (60%) of the age group 25-29 years with the clinic as the workplace. Patients receive dental treatments only from 40 (10%) of the dentist. A high number of dentists: 284 (70%) were severely affected by the financial burden and were not receiving a salary during this lockdown. About 349(86%) of the dentist think they should do regular dental treatments, but only 101 (25%) think the dentist should do only dental emergency treatments for COVID-19 infected cases.

Conclusions:

Dentists, patients, and dental practice are severely affected by the COVID-19. The majority of the dentists have faced financial burdens. The dental treatments should be done with high standards of care and infection control following proper recommendations.

Recommendations, Practices and Infrastructural Model for the Dental Radiology Set-up in Clinical and Academic Institutions in the COVID-19 Era

The pandemic of Coronavirus disease (COVID-19) has emerged as a global catastrophe that is plaguing mankind. In the past eight months since the world discovered about COVID-19, we learned a lot about server acute respiratory syndrome coronavirus 2 (SARS CoV-2) and perhaps there is much more to discover and understand about the virus. With the current understanding of the disease, we assume it will remain in an active state of transmission and progression among the community for a long time. Thus, it is advisable to adopt the disease's prevention protocol in our daily and work routine. During this pandemic patient requiring dental treatment cannot be neglected and the role of dental imaging is crucial in delivering treatment. Hence, this article attempts to provide an evidence-based compilation about the mode of transmission and clinical features of COVID-19. It also throws light on the potential source of disease transmission in the dental radiology setting. In addition, it suggests preventive measures to curb the infection and infrastructural model of the clinical setting that will assist in achieving control over the disease transmission. This article intends to project a strategy about protocols, infrastructure, and daily activities in a dental radiology office that institutions can adopt with modifications according to their local scenario.

Impact of novel coronavirus disease (COVID-19) on Egyptian dentists' fear and dental practice (a cross-sectional survey)

Objectives

This study aimed to evaluate the fear of infection among Egyptian dentists practicing during the current coronavirus disease 2019 (COVID-19) pandemic and to explore the dentist’s knowledge about guidelines to fight the virus and to assess various modifications in dental practice.

Methods

An online survey was submitted to dental professionals. Data were collected through a validated questionnaire consisting of 23 closed-ended questions. The gathered data were statistically analyzed.

Results

An overall 216 dentists completed the survey. A total of 200 (92.6%) dental professionals were afraid of becoming infected with COVID-19 while 196 (90.7%) became anxious to treat patients showing suspicious symptoms. The majority of the participants were aware of the mode of transmission of COVID-19 and a lot of them were updated with the current Disease Control and Prevention (CDC) or World Health Organization (WHO) guidelines for cross-infection control.

Conclusions

COVID-19 pandemic has a significant impact on dental professionals.

Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious diseases

BACKGROUND

Many dental procedures produce aerosols (droplets, droplet nuclei and splatter) that harbour various pathogenic micro-organisms and may pose a risk for the spread of infections between dentist and patient. The COVID-19 pandemic has led to greater concern about this risk.

OBJECTIVES

To assess the effectiveness of methods used during dental treatment procedures to minimize aerosol production and reduce or neutralize contamination in aerosols.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases on 17 September 2020: Cochrane Oral Health's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (in the Cochrane Library, 2020, Issue 8), MEDLINE Ovid (from 1946); Embase Ovid (from 1980); the WHO COVID-19 Global literature on coronavirus disease; the US National Institutes of Health Trials Registry (ClinicalTrials.gov); and the Cochrane COVID-19 Study Register. We placed no restrictions on the language or date of publication.

SELECTION CRITERIA

We included randomized controlled trials (RCTs) and controlled clinical trials (CCTs) on aerosol-generating procedures (AGPs) performed by dental healthcare providers that evaluated methods to reduce contaminated aerosols in dental clinics (excluding preprocedural mouthrinses). The primary outcomes were incidence of infection in dental staff or patients, and reduction in volume and level of contaminated aerosols in the operative environment. The secondary outcomes were cost, accessibility and feasibility.

DATA COLLECTION AND ANALYSIS

Two review authors screened search results, extracted data from the included studies, assessed the risk of bias in the studies, and judged the certainty of the available evidence. We used mean differences (MDs) and 95% confidence intervals (CIs) as the effect estimate for continuous outcomes, and random-effects meta-analysis to combine data. We assessed heterogeneity.

MAIN RESULTS

We included 16 studies with 425 participants aged 5 to 69 years. Eight studies had high risk of bias; eight had unclear risk of bias. No studies measured infection. All studies measured bacterial contamination using the surrogate outcome of colony-forming units (CFU). Two studies measured contamination per volume of air sampled at different distances from the patient's mouth, and 14 studies sampled particles on agar plates at specific distances from the patient's mouth. The results presented below should be interpreted with caution as the evidence is very low certainty due to heterogeneity, risk of bias, small sample sizes and wide confidence intervals. Moreover, we do not know the 'minimal clinically important difference' in CFU. High-volume evacuator Use of a high-volume evacuator (HVE) may reduce bacterial contamination in aerosols less than one foot (~ 30 cm) from a patient's mouth (MD -47.41, 95% CI -92.76 to -2.06; 3 RCTs, 122 participants (two studies had split-mouth design); very high heterogeneity I² = 95%), but not at longer distances (MD -1.00, -2.56 to 0.56; 1 RCT, 80 participants). One split-mouth RCT (six participants) found that HVE may not be more effective than conventional dental suction (saliva ejector or low-volume evacuator) at 40 cm (MD CFU -2.30, 95% CI -5.32 to 0.72) or 150 cm (MD -2.20, 95% CI -14.01 to 9.61). Dental isolation combination system One RCT (50 participants) found that there may be no difference in CFU between a combination system (Isolite) and a saliva ejector (low-volume evacuator) during AGPs (MD -0.31, 95% CI -0.82 to 0.20) or after AGPs (MD -0.35, -0.99 to 0.29). However, an 'n of 1' design study showed that the combination system may reduce CFU compared with rubber dam plus HVE (MD -125.20, 95% CI -174.02 to -76.38) or HVE (MD -109.30, 95% CI -153.01 to -65.59). Rubber dam One split-mouth RCT (10 participants) receiving dental treatment, found that there may be a reduction in CFU with rubber dam at one-metre (MD -16.20, 95% CI -19.36 to -13.04) and two-metre distance (MD -11.70, 95% CI -15.82 to -7.58). One RCT of 47 dental students found use of rubber dam may make no difference in CFU at the forehead (MD 0.98, 95% CI -0.73 to 2.70) and occipital region of the operator (MD 0.77, 95% CI -0.46 to 2.00). One split-mouth RCT (21 participants) found that rubber dam plus HVE may reduce CFU more than cotton roll plus HVE on the patient's chest (MD -251.00, 95% CI -267.95 to -234.05) and dental unit light (MD -12.70, 95% CI -12.85 to -12.55). Air cleaning systems One split-mouth CCT (two participants) used a local stand-alone air cleaning system (ACS), which may reduce aerosol contamination during cavity preparation (MD -66.70 CFU, 95% CI -120.15 to -13.25 per cubic metre) or ultrasonic scaling (MD -32.40, 95% CI - 51.55 to -13.25). Another CCT (50 participants) found that laminar flow in the dental clinic combined with a HEPA filter may reduce contamination approximately 76 cm from the floor (MD -483.56 CFU, 95% CI -550.02 to -417.10 per cubic feet per minute per patient) and 20 cm to 30 cm from the patient's mouth (MD -319.14 CFU, 95% CI - 385.60 to -252.68). Disinfectants ‒ antimicrobial coolants Two RCTs evaluated use of antimicrobial coolants during ultrasonic scaling. Compared with distilled water, coolant containing chlorhexidine (CHX), cinnamon extract coolant or povidone iodine may reduce CFU: CHX (MD -124.00, 95% CI -135.78 to -112.22; 20 participants), povidone iodine (MD -656.45, 95% CI -672.74 to -640.16; 40 participants), cinnamon (MD -644.55, 95% CI -668.70 to -620.40; 40 participants). CHX coolant may reduce CFU more than povidone iodine (MD -59.30, 95% CI -64.16 to -54.44; 20 participants), but not more than cinnamon extract (MD -11.90, 95% CI -35.88 to 12.08; 40 participants).

AUTHORS' CONCLUSIONS

We found no studies that evaluated disease transmission via aerosols in a dental setting; and no evidence about viral contamination in aerosols. All of the included studies measured bacterial contamination using colony-forming units. There appeared to be some benefit from the interventions evaluated but the available evidence is very low certainty so we are unable to draw reliable conclusions. We did not find any studies on methods such as ventilation, ionization, ozonisation, UV light and fogging. Studies are needed that measure contamination in aerosols, size distribution of aerosols and infection transmission risk for respiratory diseases such as COVID-19 in dental patients and staff.

Students' and lecturers' perspective on the implementation of online learning in dental education due to SARS-CoV-2 (COVID-19): a cross-sectional study

BACKGROUND

On account of physical distancing measures, universities worldwide are strongly affected by SARS-CoV-2 (COVID-19). Thus, the dental school of Justus-Liebig-University Giessen (Germany) transferred the established "face-to-face" learning to online learning in the spring term 2020. The aim of this study was to assess the students' and lecturers' perspectives on the implementation of online learning due to COVID-19, using a questionnaire survey.

METHODS

After the online period, all students and lecturers were asked to fill out an online questionnaire containing evaluative statements regarding handling, didactic benefit, motivation, and overall assessment. Furthermore, the questionnaire for lecturers contained additional aspects regarding knowledge gain in terms of providing online learning. Besides that, students and lecturers were asked for the amount of online learning in the future curriculum (independent of COVID-19). Data were subjected to regression analysis and T-test (p < .05).

RESULTS

36.8% of students preferred "face-to-face" learning instead of sole online learning. An increase of know how concerning online teaching was observable for lecturers. Both, students and lecturers, want to keep up with online courses in the future curriculum. However, in terms of the optimal amount of online learning a significant difference between students' and lecturers' perspective was observed. While students suggested 53.2% (24.9) (mean (standard deviation)) lecturers only stated 38.6% (21.5).

CONCLUSIONS

Within the limitation of this study, students' and lecturers' showed a predominantly positive perspective on the implementation of online learning, providing the chance to use online learning even beyond COVID-19 in the future curriculum.

COVID-19 Perceptional Disparity Among Dental Healthcare Personnel at King Faisal University: Applying Health Belief Model

Objectives  In Saudi Arabia, more than 100, 000 cases of COVID-19 have been reported, and more than 4,000 in Al Hofuf to date. Dental healthcare personnel are at a higher risk of COVID-19 due to their exposure to saliva, blood, and aerosol/droplet during their daily practice. Their perceptions of COVID-19 drive their behaviors.

Materials and Methods  A cross-sectional online survey to assess COVID-19 related perceptions and possible disparities between them.

Statistical analysis  Data were analyzed using the Statistical Package for the Social Science, version 23 (IBM SPSS). Descriptive analyses were performed using frequencies and percentages for categorical variables, mean and (± SD) for numerical variables. Bivariate analyses were assessed using t -test and one-way ANOVA, with a 95% confidence interval (CI).

Results  With a response of 75% (150), results showed that there were perceptional disparities: students and technical staff perceived more barriers to preventive measures compared to faculties with a mean difference of (−0.145 SD ± 0.580, p = 0.802, CI −1.29 / 1.00 and −2.433, SD ± 0.94, p = 0.010), respectively. This was also shown in threat perception with a mean difference of (2.525, SE ± 0.917, CI 0.71/4.34, p = 0. 0.007). Students perceived more threat than clerks did with a mean difference of (1.281, SE ± 0.569, CI − 0.16 / 2.41, p = 0.026), while clerks perceived less threat than the technical staff with a mean difference of (−2.790, SE ± 0.860, CI −4.49 /−1.09, p = 0.001).

Conclusions  There was a clear disparity in the perceptions among the different categories of participants. More emphasis on the training and preparedness of the dental healthcare personnel is required.

COVID-19 transmission risk and protective protocols in dentistry: a systematic review

BACKGROUND

Among several potential transmission sources in the spreading of the COVID-19, dental services have received a high volume of attention. Several reports, papers, guidelines, and suggestions have been released on how this infection could be transmitted through dental services and what should be done. This study aimed to review the guidelines in order to develop a practical feasibility protocol for the re-opening of dental clinics and the reorientation of dental services.

METHODS

This study systematically reviewed the published literature and the guidelines of international health care institutions on dentistry and COVID-19. We searched Pubmed, Web of Science, and SCOPUS electronic databases using MESH terms. The recommendations identified were tested with a convenience sample of experienced practitioners, and a practical step-by-step protocol is presented in this paper.

RESULTS

To the date this paper was drafted, 38 articles were found, of which 9 satisfied our inclusion criteria. As all the nine studies were proposed in a general consensus, any elective non-emergency dental care for patients with suspected or known COVID-19 should be postponed for at least 2 weeks during the COVID-19 pandemic. Only urgent treatment of dental diseases can be performed during the COVID-19 outbreak taking into consideration pharmacological management as the first line and contagion-reduced minimally invasive emergency treatment as the secondary and final management.

CONCLUSIONS

While the currently available evidence has not demonstrated a clear and direct relationship between dental treatment or surgery and the possibility of the transmission of COVID-19, there is clearly the potential for transmission. Therefore, following the protective protocols in the COVID-19 crisis is of utmost importance in a dental setting.

Expectations Regarding Dental Practice: A Cross-Sectional Survey of European Dental Students

Obtaining information on expectations among dental students regarding their career planning was the main purpose of this observational online survey. The questionnaire was designed with 18 items in five different languages: English, French, German, Italian and Spanish. Data were collected on nationality, age, sex, country of residence, university attended, semester, expected year of graduation and expectations about future career. More than 3000 participants (n = 3851, 2863 females 74.34% and 988 males 25.66% with a sex ratio of 0.35) participated in the survey. Almost one-third (31.29%) of the participants plan to start their own practice at least three years after vocational training, a quarter (25.76%) after three, and only 12.59% after one year. A positive influence of the family in the decision to start a practice was observed in 50.07% of the sample with a statistically significant difference regarding sex (p < 0.01). Almost one-third of the participants did not wish to work in an institution run by private equity or insurance companies, while 21.79% would work in that environment (p < 0.01). European dental students desire mainly to become self-employed and start their own practice. New professional practices also offer them options for their future career that they have not yet decided on or thought about.

Reducing the Risk of COVID-19 Transmission in Dental Offices: A Review

The COVID-19 epidemic has become a major public health challenge around the world. According to the World Health Organization (WHO), as of August 2020 there are more than 833,556 dead and over 24,587,513 people infected around the world. This pandemic has adversely affected many professions around the globe, including dentistry. COVID-19, caused by the Corona virus family, is transmitted mainly by direct contact with an infected person or through the spread of aerosol and droplets. Dentistry by nature is considered to be one of the most vulnerable professions with regards to the high risk of transmission between the dentist, dental team, and patients; therefore, a protocol for infection control and the prevention and spreading of the COVID-19 virus in dental settings is urgently needed. This article reviews essential knowledge about this virus and its transmission and recommends preventive methods based on existing scientific research and recommendations to prevent the spread of this virus in dental offices and clinics.

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

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

Learner behaviors in synchronous online prosthodontic education during the 2020 COVID-19 pandemic

Statement of problem

Synchronous online prosthodontic courses became a popular learning mode during the 2020 COVID-19 pandemic crisis. Nonetheless, the extent of learner participation and completion of these courses remains unknown.

Purpose

The purpose of this study was to assess learner behaviors in synchronous online prosthodontic continuing education lectures in China during the 2020 COVID-19 pandemic.

Material and methods

All live online prosthodontic courses held by an online dental school in China from February to May 2020 were retrieved. The no-cost lectures could be accessed anonymously and viewed repeatedly on the day of broadcast. Learning behavior data (teacher speaking time, audience total, timing of first visit to the online classroom, viewing time, and completion rate) were obtained. Learning progress was calculated by dividing viewing time by teacher speaking time. When a learner progressed through 95% of a lecture, the lecture was considered completed.

Results

A total of 41 781 learners participated in 18 online prosthodontic courses, which had a mean duration of 77.2 ±15.8 minutes. For each lecture, 2321 ±1454 participants attended, with 510 ±404 participants completing each session. There were 13 098 participants (31.35%) who viewed the lectures for less than 1 minute. Approximately half of the participants viewed the lectures for less than 10 minutes, with their learning progress failing to pass 10%. The average completion rate was 21.97%, with variation in completion rate dependent on when a learner first visited the online classroom. Significant differences were found among the lecture completion rates and the timing of the first visit to the online classroom (P<.001).

Conclusions

Synchronous online prosthodontic education courses in China had a high number of participants but low learning progress and completion rates during the 2020 COVID-19 pandemic.

COVID-19-Orthodontic Care During and After the Pandemic: A Narrative Review

OBJECTIVES

To provide comprehensive information regarding the implications of the coronavirus disease 2019 (COVID-19), mode of transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), and its effects on orthodontic care during the pandemic and post-pandemic outbreak of the disease, based on currently available literature and information.

MATERIALS AND METHODS

A comprehensive research for studies that focused on the COVID-19 pandemic and orthodontic care up to August 18, 2020, with no language restriction. The databases included PubMed, MEDLINE, Scopus, Google Scholar, and COVID-19 Open Research Dataset (CORD-19) 2020. The research was focused on presenting symptoms, disease transmission, infection control, orthodontic care, and financial implications affecting the delivery of orthodontic treatment. The research also included reports from major health policy regulatory bodies such as World Health Organization, Centers for Disease Control and Prevention, European Centre for Disease Control and Prevention, and major international dental and orthodontic societies and associations. The peer-reviewed publications and guidelines from the health regulatory authorities were given priority.

RESULTS

The latest information on the SARS-CoV-2 virus effects and orthodontic implications were arranged sequentially. The SARS-CoV-2 virus mode of transmission and its prevention were emphasized to keep the orthodontic and dental operatory safe for continuing practice.

CONCLUSION

The COVID-19 outbreak has changed the way orthodontics is practiced. Strict infection control, near-zero aerosol production, and minimal touch dentistry are the keys to prevent contamination of orthodontic operatory. During the pandemic, only emergency orthodontic procedures could be extended to the orthodontic patient while adhering to all the regulatory guidelines. Fortunately, to date, there is no reported case of cross-transmission of the SARS-CoV-2 virus at the dental setup.

Managing dental caries against the backdrop of COVID-19: approaches to reduce aerosol generation

The COVID-19 pandemic resulted in severe limitation and closure of dental practices in many countries. Outside of the acute (peak) phases of the disease, dentistry has begun to be practised again. However, there is emerging evidence that SARS-CoV-2 can be transmitted via airborne routes, carrying implications for dental procedures that produce aerosol. At the time of writing, additional precautions are required when a procedure considered to generate aerosol is undertaken.This paper aims to present evidence-based treatments that remove or reduce the generation of aerosols during the management of carious lesions. It maps aerosol generating procedures (AGPs), where possible, to alternative non-AGPs or low AGPs. This risk reduction approach overcomes the less favourable outcomes associated with temporary solutions or extraction-only approaches. Even if this risk reduction approach for aerosol generation becomes unnecessary in the future, these procedures are not only suitable but desirable for use as part of general dental care post-COVID-19.

Awareness of COVID 19 pandemic among dental practioners of Telangana state, India: A cross sectional survey

BACKGROUND

Coronavirus diseases (COVID-19) is a public health emergency of international concern. The dental professionals are considered to be at high risk, as most of the treatments may lead to the spread of infection due to direct proximity with saliva, blood and aerosols generation.

AIM

The aim of the current study was to evaluate the awareness, regarding COVID19 pandemic among dental practioners in state of Telangana.

MATERIALS AND METHODOLOGY

A self-administered, structured, pilot-tested close-ended 20 point questionnaire,was distributed among the dental practioners in Telangana state. A total of 385 participants completed the questionnaire. Data obtained was analyzed using SPSS 22.0 (SPSS Inc., Chicago, IL, USA) for data analysis.

RESULTS

Among 385 participants a total of 115 (29.9%) exhibited high level of knowledge while 167 (43.4%) demonstrated moderate knowledge and 103 (26.8%) demonstrated low level of knowledge. Mean knowledge score was 12.46 ± 2.47, minimum and maximum scores were 5 and 15 respectively among the dental practioners (DPs).

CONCLUSION

All the respondents seem to have adequate knowledge regarding COVID19 and adoption of control measures to prevent the spread of COVID19. However, some deficiencies were noted. The, dentists, must be well informed of the recommended practices.Initiatives for attending webinars, continuing dental education programs on COVID19, have to be undertaken to keep them selves updated and be prepared with extra precautionary measures to be taken.

Dental radiographic procedures during COVID-19 outbreak and normalization period: recommendations on infection control

Dental professionals have always been meticulous about infection control due to high risk of cross-contamination during dental procedures. Nevertheless, there is an urgent need to review and revise our current practice of infection control and develop more strict protocols that will prevent nosocomial spread of infection during COVID-19 outbreak and future pandemics. The risk of contamination is high during dental radiography if proper disinfection techniques are not applied. This document provides advice and guidance for infection control when practicing dental radiography during COVID-19 pandemic.

Risk for dental healthcare professionals during the COVID-19 global pandemic: An evidence-based assessment

OBJECTIVES

Heightened anxiety among dental healthcare professionals (DHPs) during the COVID-19 pandemic stems from uncertainties about the effectiveness of personal protective equipment (PPE) against dental aerosols and risk levels of asymptomatic patients. Our objective was to assess the risks for DHPs providing dental care during the pandemic based on available scientific evidence.

METHODS

We reviewed the best available evidence and estimated the annualized risk (p=das(1-1-p0p1(1-e)yn) for a DHP during the COVID-19 pandemic based on the following basic parameters: p0, the prevalence of asymptomatic patients in the local population; p1, the probability that a DHP gets infected by an asymptomatic patient; e, the effectiveness of the PPE; s, the probability of becoming symptomatic after getting infected from asymptomatic patient; da, the probability of dying from the disease in age group a; n, number of patients seen per day; and y, number of days worked per year.

RESULTS

With the assumption that DHPs work fulltime and wear a N95 mask, the annualized probability for a DHP to acquire COVID-19 infection in a dental office, become symptomatic, and die from the infection is estimated at 1:13,000 (0.008 %) in a medium sized city in the US at the peak of the pandemic. The risk estimate is highly age-dependent. Risk to DHPs under the age of 70 is negligible when prevalence of asymptomatic cases is low in the local community.

CONCLUSIONS

Risk of COVID-19 transmission in dental office is very low based on available evidence on effectiveness of PPE and prevalence of asymptomatic patients. Face shields and pre-procedure oral rinses may further reduce the risks.

CLINICAL SIGNIFICANCE

DHPs should follow guidelines on pre-appointment protocols and on PPE use during dental treatments to keep the risk low.

An updated min-review on environmental route of the SARS-CoV-2 transmission

The risk of newly emerging diseases is constantly present in a world where changes occur significantly in climatic, commercial, and ecological conditions, in addition to the development of biomedical investigations in new situations. An epidemic respiratory disease instigated by a new coronavirus was initially identified in and has resulted in the current global dissemination. This viral strain and its related disease has been termed "SARS-CoV-2" and "coronavirus disease 2019" (abbreviated "COVID-19" or "2019-nCoV"), respectively, which is transmitted simply between individuals. The World Health Organization (WHO) announced the COVID-19 outburst as a pandemic on March 11, which necessitates a cooperative endeavour globally for mitigating the spread of COVID-19. The absence of previous, and minimum present-day information, particularly concerning the path of contagion have precluded the control of this disease. The present article, therefore, describes the SARS-CoV-2 paths of contagion such as drinking water, solid waste, sewer water, ambient air, and the rest of emerging likely paths.

The Role of the Dental Surgeon in Controlling the Dissemination of COVID-19: A Literature Review

As early as December 2019 in the province of Hubei, China, contamination of patients with pneumonia of an unknown etiology occurred. These patients presented with symptoms such as coughing, sore throat, malaise, diarrhea, high fever, and dyspnea. This emerging disease was named COVID-19 due to being part of the group of coronaviruses (CoVs) belonging to the subfamily Orthocoronavirinae, in the Coronaviridae family and in the Nidovirales order. COVID-19 is most commonly transmitted through speech, coughing, sneezing, and salivary sputum. Because dental professionals work closely with the oral cavity, it is imperative that infection prevention controls are strictly adhered to. It is important that the dental profession treats patients while also limiting the possible contamination through the production of aerosol in the dental environment. Furthermore, the dental professional also has a key role in raising awareness and guidance amongst the population concerning COVID-19 related biosafety measures. This literature review aims to inform dental professionals about the COVID-19 pandemic and to present the implications of the virus to the dentist. Dental professionals are considered to be at high risk for contracting SARS-CoV-2.

Proposal for a provisional protocol for the care and identification of dental transmission routes of COVID-19 in Latin America: A Literature review

BACKGROUND

The new coronavirus called COVID-19 originated in the city of Wuhan, China and has currently spread to different continents, leading the World Health Organization (WHO) to declare a "pandemic". Therefore, the aim of this review was to present a new proposal for a care protocol in Peruvian Dentistry: Provisional review of the diagnosis, treatment, epidemiological characteristics, routes of transmission and recommendations of COVID-19.

MATERIAL AND METHODS

A search of digital scientific literature was made in the databases: Science Direct, Pubmed and Google Scholar. The Boolean operators AND, OR and NOT: "Covid-19" "Dental" "Routes of transmission. They were included Scientific articles published in English between December 2019 - March 2020.

RESULTS

Different studies were found mainly of epidemiological, observational and experimental design. On March 6, 2020, the President of the Republic of Peru confirmed and declared in Peru the beginning of the first case of coronavirus. According to reports from the Ministry of Health (MINSA) as of July 30, there are: PCR (+) 108, 299; Rapid test (+) 292, 384 positive cases and 18, 816 deceased with a lethality of 4.7%.

CONCLUSIONS

Within the limitations of this literature review, the presence of the virus is inevitable in dental practice. The dentist must understand the evolution of this microorganism like all vulnerable professionals in the health sciences. Key words:COVID-19, dentistry, Peru, protocol, routes of transmission.

The practice of oral and maxillofacial radiology during COVID-19 outbreak

The current coronavirus disease 2019 (COVID-19) outbreak has brought substantial challenges to the world health system, including the practice of dental and maxillofacial radiology (DMFR). DMFR will carry on an imperative role in healthcare during this crisis. This rapid communication has collected and evaluated all the best current evidence and published guidelines as well as professional recommendations to help maxillofacial radiologists and dental practitioners for safer radiological and imaging examinations on healthy, suspected, or confirmed COVID-19 patients during outbreak. Some strategies have been depicted including procedural indications, infection control, and correct employment of personal protection equipment along with evoking the proper practice environment during and after the COVID-19 outbreak.