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

Dentists' knowledge, attitudes, and professional behavior toward the COVID-19 pandemic: A multisite survey of dentists' perspectives

Background

COVID-19 continues to affect the dental community worldwide. The authors conducted a cross-sectional electronic study using a multisite survey to examine dentists’ knowledge, attitudes, and professional behavior toward COVID-19 and the affect on their livelihood.

Methods

A questionnaire was circulated via e-mail and social media platforms to dentists in North America, Europe, Eastern Mediterranean, and Western Pacific regions. It covered demographic characteristics and questions about the COVID-19 outbreak related to dentists’ levels of comfort for preventive and safety measures, provision of treatment, affect on work, and financial implications. Responses were tabulated and analyzed by means of χ² or Fisher exact test. Mann-Whitney and Kruskal-Wallis tests were used to compare means. P < .05 was considered significant.

Results

A total of 1,251 dentists responded. General dentists represented 63.9% of the respondents and 62.5% worked in private practice. The global score for level of comfort with the preventive measures and provisions of treatment during the COVID-19 pandemic was low (14 of 30), and differences between regions were significant (P < .01); dentists working in private practice and general dental practitioners were less comfortable (P < .01).

Conclusions and Practical Implications

The respondents reported a lack of preparedness to confront a highly infectious respiratory disease. A new level of protective armamentarium in the dental operatory and updated operational guidance and policies are required, necessitating educators and regulators to ensure the delivery of knowledge and skills to oral health care providers. Dentists need to address the sustainability of their practices and have a robust business plan.

Behavior change due to COVID-19 among dental academics-The theory of planned behavior: Stresses, worries, training, and pandemic severity

OBJECTIVE

COVID-19 pandemic led to major life changes. We assessed the psychological impact of COVID-19 on dental academics globally and on changes in their behaviors.

METHODS

We invited dental academics to complete a cross-sectional, online survey from March to May 2020. The survey was based on the Theory of Planned Behavior (TPB). The survey collected data on participants' stress levels (using the Impact of Event Scale), attitude (fears, and worries because of COVID-19 extracted by Principal Component Analysis (PCA), perceived control (resulting from training on public health emergencies), norms (country-level COVID-19 fatality rate), and personal and professional backgrounds. We used multilevel regression models to assess the association between the study outcome variables (frequent handwashing and avoidance of crowded places) and explanatory variables (stress, attitude, perceived control and norms).

RESULTS

1862 academics from 28 countries participated in the survey (response rate = 11.3%). Of those, 53.4% were female, 32.9% were <46 years old and 9.9% had severe stress. PCA extracted three main factors: fear of infection, worries because of professional responsibilities, and worries because of restricted mobility. These factors had significant dose-dependent association with stress and were significantly associated with more frequent handwashing by dental academics (B = 0.56, 0.33, and 0.34) and avoiding crowded places (B = 0.55, 0.30, and 0.28). Low country fatality rates were significantly associated with more handwashing (B = -2.82) and avoiding crowded places (B = -6.61). Training on public health emergencies was not significantly associated with behavior change (B = -0.01 and -0.11).

CONCLUSIONS

COVID-19 had a considerable psychological impact on dental academics. There was a direct, dose-dependent association between change in behaviors and worries but no association between these changes and training on public health emergencies. More change in behaviors was associated with lower country COVID-19 fatality rates. Fears and stresses were associated with greater adoption of preventive measures against the pandemic.

COVID-19: Perspectives for the management of dental care and education

The rapid and abrupt transmission pattern of the SARS-CoV-2 unleashed the current COVID-19 pandemic, as recognized by the World Health Organization in March 2020. Considering the high risk of transmission of the virus in dental environments and the specificities in clinical practice, COVID-19 posed immediate challenges for dental care and education. Due to the need to establish infection prevention and control guidance in dental health settings to enable a safe clinical practice, this review aims to list the challenges and perspectives in managing dental care in services and schools. This review employed materials collected from PubMed and the main guidelines and studies on the novel coronavirus to provide an overview of the clinical procedures and decisions made by health care personnel in dental offices and dental schools. We expect the COVID-19 scenario to promote significant changes in clinical practice and dental education; dentists should seek specific and particular regulations for dental practice established by their state or country. Biosafety checklists are strongly recommended for appointments at dental services and face-to-face activities in dental schools.

Managing the Oral Health of Cancer Patients During the COVID-19 Pandemic: Perspective of a Dental Clinic in a Cancer Center

The practice of dentistry has been dramatically altered by the coronavirus disease 2019 (COVID-19) pandemic. Given the close person-to-person contact involved in delivering dental care and treatment procedures that produce aerosols, dental healthcare professionals including dentists, dental assistants and dental hygienists are at high risk of exposure. As a dental clinic in a comprehensive cancer center, we have continued to safely provide medically necessary and urgent/emergent dental care to ensure that patients can adhere to their planned cancer treatment. This was accomplished through timely adaptation of clinical workflows and implementation of practice modification measures in compliance with state, national and federal guidelines to ensure that risk of transmission remained low and the health of both immunocompromised cancer patients and clinical staff remained protected. In this narrative review, we share our experience and measures that were implemented in our clinic to ensure that the oral health needs of cancer patients were met in a timely manner and in a safe environment. Given that the pandemic is still on-going, the impact of our modified oral healthcare delivery model in cancer patients warrants continued monitoring and assessment.

Characteristics of US Adults Delaying Dental Care Due to the COVID-19 Pandemic

Background:

Coronavirus disease 2019 (COVID-19) has disrupted the delivery of health care services, including dental care. The objective of this study was to quantify and describe US adults who delayed dental care due to the COVID-19 pandemic.

Methods:

We analyzed cross-sectional responses collected from a nationally representative and long-running panel survey of US adults conducted in late May and early June 2020 (response rate = 70%). The survey included questions about dental care delayed due to the COVID-19 pandemic, purpose of the delayed dental visits, timing of future dental visits, and demographic information. Pearson’s chi-square tests were used to determine if rates of delayed dental care varied by subgroup. A multivariable regression model, adjusted for age, race, Hispanic ethnicity, census division, and rurality, was estimated to predict the odds of reporting delayed dental care.

Results:

Nearly half of respondents (46.7%) reported delaying going to the dentist or receiving dental care due to the COVID-19 pandemic. Among adults who reported delaying dental care due to the pandemic, 74.7% reported delaying a checkup, 12.4% reported delaying care to address something that was bothering them, and 10.5% reported delaying care to get planned treatment. About 44.4% of adults reported that they planned to visit the dentist within the next 3 mo. In the multivariable regression model, only living in an urban (vs. rural) area was associated with significantly higher odds of delayed dental care due to the pandemic (odds ratio: 1.5; 95% confidence interval: 1.1, 2.1).

Conclusions:

Nearly half of US adults reported delaying dental care due to the COVID-19 pandemic during the spring of 2020. Our results offer insight into the experiences of patients seeking dental care this spring and the economic challenges faced by dental providers due to the pandemic.

Knowledge Transfer Statement:

This article describes US adults who delayed dental care due to the COVID-19 pandemic. Results can be used by clinicians and policymakers to understand delayed care during the pandemic.

Immunological aspects of COVID-19: What do we know?

The newly emerged coronavirus (severe acute respiratory syndrome coronavirus 2 SARS-CoV-2) and the disease that it causes coronavirus disease 2019 (COVID-19) have changed the world we know. Yet, the origin and evolution of SARS-CoV-2 remain mostly vague. Many virulence factors and immune mechanisms contribute to the deteriorating effects on the organism during SARS-CoV-2 infection. Both humoral and cellular immune responses are involved in the pathophysiology of the disease, where the principal and effective immune response towards viral infection is the cell-mediated immunity. The clinical picture of COVID-19, which includes immune memory and reinfection, remains unclear and unpredictable. However, many hopes are put in developing an effective vaccine against the virus, and different therapeutic options have been implemented to find effective, even though not specific, treatment to the disease. We can assume that the interaction between the SARS-CoV-2 virus and the individual's immune system determines the onset and development of the disease significantly.

Epidemiological Investigation of OHCWs with COVID-19

During the coronavirus disease 2019 (COVID-19) pandemic, there is an important risk of infection in health care workers, including oral health care workers (OHCWs), due to the characteristics of dental practice. In this retrospective study, data pertaining to the 31 OHCWs diagnosed with COVID-19 in Wuhan, Hubei Province, were retrieved and analyzed. Questionnaires were administered to the subjects over the Internet and telephone. Clinical and epidemiological characteristics and information on the use of personal protective equipment (PPE) were collected. There were 22 females and 9 males, with a median age of 39 y. Although the severity of most cases of COVID-19 (93.5%) was mild or moderate, 1 case was severe, and another case was critical, resulting in death. Fever was the main first symptom of COVID-19, followed by fatigue and myalgia. Most of the OHCWs routinely used PPE such as medical masks, gloves, caps, and work clothes while performing clinical work. N95 or KN95 masks were rarely available because of the scarcity of PPE during the outbreak. Nineteen OHCWs reported a contact history, among whom 7 worked in a fever clinic, 5 reported contact with dental patients suspected of having COVID-19, and 7 reported contact with family members with COVID-19–related symptoms at least 1 d earlier. Our findings indicated that there were few clusters of COVID-19 in dental settings. Since the outbreak, the Hospital of Stomatology, Wuhan University, has provided emergency dental treatment, and none of their staff were infected while providing dental service, which indicates that comprehensive measures such as the use of advanced PPE and environmental disinfection can prevent cross-infection in dental practice. The analysis of the procedures followed during the emergency treatments indicated that OHCWs preferred to recommend conservative treatment to patients, suggesting that attention should be paid to the psychological impact of COVID-19 on dental practitioners.

Italian Response to Coronavirus Pandemic in Dental Care Access: The DeCADE Study

The aim of the study was to evaluate the impact of the coronavirus pandemic on the willingness, anxiety and concerns of Italian people on undergoing dental appointments. An anonymous survey was posted online on social media on 11 May 2020 and was completed by 1003 respondents in one week. Multiple correspondence analysis and multiple logistic regression were used to evaluate the association between socio-demographic characteristics, dental care access, contagion fear of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), trust in dentists regarding sanitization procedures and perception of the impact of the risk of contagion on dental care. Subjects with a high level of education, attending public dental offices and that are used to go to dental offices for urgent care would not feel comfortable in undergoing a dental appointment and would prefer to postpone or cancel dental visits, waiting for a decrease in the number of the contagions. Moreover, the risk of canceling or postponing the appointment at the dentist was 1.59 times greater in those who claimed to be strongly influenced by SARS-CoV-2. Fear of coronavirus disease (COVID-19), new cases decrease and the not urgent nature of dental visits influenced more than the lowered income household on upcoming or resuming dental appointments. In the next months, despite the forecasted economic crisis caused by coronavirus pandemic, fear and anxiety generated by the spread of the virus will impact more than the lowered familiar income with regards to access to dental care.

Nigerian undergraduate dental students' knowledge, perception, and attitude to COVID-19 and infection control practices

Purpose/objectives

The current coronavirus disease 19 (COVID‐19) pandemic has affected most countries. Infection, Prevention, and Control training is important in mitigating the spread of COVID‐19. The closure of universities by the Nigerian government has hampered academic activities of dental students. Our objectives were to assess the knowledge, perception, and attitude of undergraduate dental students in Nigeria to the COVID‐19 pandemic and infection control practices.

Methods

This was a cross‐sectional study of undergraduate clinical dental students from the dental schools in Nigeria. Self‐administered questionnaires were distributed to participants using an online data collection platform. Correct responses to the 45‐item questionnaire on COVID‐19 knowledge were scored to determine their knowledge level. A Likert scale of 1‐5 was used to assess the 13‐item perception and attitude questions. The level of significance was set at P values ≤ 0.05.

Results

A total of 102 undergraduate clinical dental students participated in the study. Males represented 54.9%, and mean age was 25.3 ± 2.4 years. Fifty percent of the students had adequate knowledge of COVID‐19. Final‐year students (58.1%) demonstrated more adequate knowledge of COVID‐19 than penultimate‐year students (28.6%, P = 0.008). Most (95.1%) respondents had positive attitudes towards infection control practices against COVID‐19.

Conclusion

Although the clinical dental students had a positive attitude to infection control practices against COVID‐19, the overall knowledge of COVID‐19 was barely adequate. Guidelines on COVID‐19 from reputable health authorities should be reviewed by dental school authorities and disseminated to the students to suit their clinical practice.

Dental care management during the COVID-19 outbreak

Aim

The level of preparedness of the healthcare system plays an important role in management of coronavirus disease 2019 (COVID‐19). This study attempted to devise a comprehensive protocol regarding dental care during the COVID‐19 outbreak.

Methods and result

Embase, PubMed, and Google Scholar were searched until March 2020 for relevant papers. Sixteen English papers were enrolled to answer questions about procedures that are allowed to perform during the COVID‐19 outbreak, patients who are in priority to receive dental care services, the conditions and necessities for patient admission, waiting room and operatory room, and personal protective equipment (PPE) that is necessary for dental clinicians and the office staff.

Conclusion

Dental treatment should be limited to patients with urgent or emergency situation. By screening questionnaires for COVID‐19, patients are divided into three groups of (a) apparently healthy, (b) suspected for COVID‐19, and (c) confirmed for COVID‐19. Separate waiting and operating rooms should be assigned to each group of patients to minimize the risk of disease transmission. All groups should be treated with the same protective measures with regard to PPE for the dental clinicians and staff.

Deep MLP-CNN Model Using Mixed-Data to Distinguish between COVID-19 and Non-COVID-19 Patients

The limitations and high false-negative rates (30%) of COVID-19 test kits have been a prominent challenge during the 2020 coronavirus pandemic. Manufacturing those kits and performing the tests require extensive resources and time. Recent studies show that radiological images like chest X-rays can offer a more efficient solution and faster initial screening of COVID-19 patients. In this study, we develop a COVID-19 diagnosis model using Multilayer Perceptron and Convolutional Neural Network (MLP-CNN) for mixed-data (numerical/categorical and image data). The model predicts and differentiates between COVID-19 and non-COVID-19 patients, such that early diagnosis of the virus can be initiated, leading to timely isolation and treatments to stop further spread of the disease. We also explore the benefits of using numerical/categorical data in association with chest X-ray images for screening COVID-19 patients considering both balanced and imbalanced datasets. Three different optimization algorithms are used and tested:adaptive learning rate optimization algorithm (Adam), stochastic gradient descent (Sgd), and root mean square propagation (Rmsprop). Preliminary computational results show that, on a balanced dataset, a model trained with Adam can distinguish between COVID-19 and non-COVID-19 patients with a higher accuracy of 96.3%. On the imbalanced dataset, the model trained with Rmsprop outperformed all other models by achieving an accuracy of 95.38%. Additionally, our proposed model outperformed selected existing deep learning models (considering only chest X-ray or CT scan images) by producing an overall average accuracy of 94.6% ± 3.42%.

Knowledge and preventive practice to COVID-19 among household heads in Enugu metropolis, South-East Nigeria

Introduction

the coronavirus disease COVID-19 pandemic has affected the way we live. The use of non-pharmaceutical interventions (NPI) has been reported to be effective in controlling similar respiratory diseases outbreak in the past and is being used as one of the mainstays of control of the pandemic. We therefore assessed the knowledge and practice of preventive measures against COVID-19 among adults in Enugu metropolis during the outbreak in the State.

Methods

we conducted a descriptive cross-sectional study among 320 adults who were recruited through a multistage sampling technique. We used semi-structured interviewer-administered questionnaire to collect information on the knowledge and preventive practices against COVID-19. The data were analyzed using the IBM-SPSS version 25.

Results

the mean age of the participants was 41.6±12.5 years. There were 168 (52.5%) male, 69.7% had attained tertiary education and 57.8% were self-employed. Overall, 256 (80.0%) of the respondents had good knowledge about COVID-19. Only 133 (41.6%) had good practice of preventive measures among respondents. The more commonly practiced NPIs among the respondents were use of alcohol hand sanitizer (86.6%), physical distancing (85.6%), washing of hands with soap and water (81.6%) and disinfecting frequently touched surfaces (80.9%). The NPIs the respondents practiced poorly were use of face mask (33.8%) and avoidance of crowded areas (47.2%). Having good knowledge (aOR: 3.2; 95% CI: 1.65 - 6.05) and attaining secondary education or less (aOR: 2; 95%CI: 10-3.13) were the only predictors of good practice of preventive measures.

Conclusion

the highly educated segment of the population needs to be targeted with appropriate messages to improve their adoption of the right preventive measures against COVID-19.

A Call for Action to Safely Deliver Oral Health Care during and Post COVID-19 Pandemic

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak started just a couple of months ago and it grew rapidly causing several deaths and morbidities. The mechanism behind the transmission of the virus is still not completely understood despite a multitude of new specific manuscripts being published daily. This article highlights the oral cavity as a possible viral transmission route into the body via the Angiotensin converting enzyme 2 receptor. It also provides guidelines for routine protective measures in the dental office while delivering oral health care.

A perspective on dental activity during COVID-19: The Italian survey

OBJECTIVES

During the months of March and April 2020, Italy saw an exponential outbreak of COVID-19 epidemic. Dental practitioners were particularly limited in their routine activity, and the sole performance of urgent treatments was strongly encouraged during the peak of the epidemic. A survey among dental professionals was performed between 6th and 13th of April, in order to evaluate the status of dental practice during COVID-19 in Italy.

MATERIALS AND METHODS

An online anonymous questionnaire was administered to retrieve data on the dental procedures performed, the preventive measures adopted, and the predictions on the future changes in dentistry following the pandemic.

RESULTS

The survey was completed by 3,254 respondents and, according to the results obtained, dental activity was reduced by the 95% and limited to urgent treatments. The majority of the surveyed dentists employed additional personal protective equipment compared to normal routine, although in a non-negligible number of cases difficulty in retrieving the necessary equipment was reported.

CONCLUSIONS

The survey provided a snapshot of dental activity during the SARS-CoV-2 outbreak. Overall, following the peak of the epidemic, it is probable that dental activities will undergo some relevant changes prior to fully restart.

Self-reported dental student stressors and experiences during the COVID-19 pandemic

OBJECTIVE

To compare the influence of coronavirus disease 2019 (COVID-19) pandemic on the student reported outcomes among dental students reading/studying different courses offered in the only dental school in Malta.

MATERIALS AND METHODS

An anonymous questionnaire consisting of 13 closed-ended and open-ended questions was sent to all students (n = 97) at the Faculty of Dental Surgery at the University of Malta. Emergent themes from open-ended questions were identified and tallied. Since data were classified as categorical ranks, nonparametric tests were used to compare variables among the different courses, years of study, preclinical/clinical students, and gender categories.

RESULTS

Dental technology students were significantly less stressed about contracting COVID-19 (P = 0.005) and regarding lack of preparation due to inability to physically go to the library (P = 0.019). Female students reported significantly more anxiety for the following factors: "feeling anxious all the time" (P = 0.033), "worried about contracting COVID-19'" (P = 0.012), "worried that a family member may contract COVID-19'" (P = 0.048), "more anxious about exams this year because of the challenges we are facing" (P = 0.029), and "concern about losing manual dexterity skills" (P = 0.038). Qualitative data gathered show considerable stress reported by students regarding changes in examination processes and formats and lack of timely communication.

CONCLUSION

Students were greatly affected by the COVID-19 pandemic and this caused fear of losing their manual dexterity skills, anxiety related to its consequences on their long-term plans, and anxiety related to the examinations. Dental schools in turn should adapt rapidly and customize changes that are specific to the individual student cohort and their stage of training.

Assessing Fear and Anxiety of Corona Virus Among Dental Practitioners

OBJECTIVE

Originating in China in December 2019, coronavirus disease 2019 (COVID-19) rapidly spread to more than 216 countries in the world by May 2020. Because dentists are at a higher risk of contracting the disease, the present study assessed the fear and anxiety among dental practitioners of becoming infected with COVID-19.

METHODS

An online cross-sectional questionnaire survey comprising of 9 questions was conducted among dental practitioners of Telangana. Age, gender, qualification, type of practice, years of practice, and place of residence were the demographic variables recorded. The response to each question was recorded in a YES or NO format, and mean fear score was calculated to categorize answers into low and high levels of fear. Comparison of mean fear score was done using t-test for 2 variables and analysis of variance for 3 or more than 3 variables. Multiple logistic regression analysis of the levels of fear with demographic variables was done. P < 0.05 was considered statistically significant.

RESULTS

The mean fear and anxiety score of this study population reported was high 6.57 ± 2.07, with 58.31% of the population presenting with a low level of fear and anxiety. Only qualification (P = 0.045) and gender (P = 0.035) revealed a significant difference in fear to Q7and Q8, respectively. Irrespective of the age, gender, qualification, type of practice, and years in practice, the levels of fear reported in the present study were very similar. Respondents between 41 and 60 y of age (6.70 ± 2.01 y) and those with individual practices (6.70 ± 2.06 y) exhibited high fear scores.

CONCLUSIONS

The present study demonstrates cross-sectional data of fear and anxiety among dental practitioners during the COVID-19 outbreak. Heightened levels of fear observed in this study call for a nationwide analysis of fear among dentists and deliberate management strategies for the same.

Rubber Dam Isolation and High-Volume Suction Reduce Ultrafine Dental Aerosol Particles: An Experiment in a Simulated Patient

The ongoing Coronavirus Disease 2019 (COVID-19) pandemic has triggered the paralysis of dental services ascribed to the potential spread of severe acute respiratory syndrome (SARS)-CoV-2. Aerosol-generating procedures (AGPs) are common in dentistry, which in turn increase the risk of infection of the dental personnel due to the salivary presence of SARS-CoV-2 in COVID-19 patients. The use of rubber dam isolation (RDI) and high-volume evacuators (HVE) during AGPs is recommended to control dental aerosols, but the evidence about their effectiveness is scarce. This first study aimed to compare, in a simulated patient, the effectiveness of the following strategies: standard suction (SS), RDI and RDI + HVE. Using the laser diffraction technique, the effect of each condition on the volume distribution, average size and concentration of coarse (PM10), fine (PM2.5) and ultrafine (PM0.1) particles were evaluated. During the teeth drilling, the highest volume fraction of dental aerosol particles with SS was below 1 μm of aerodynamic diameter. Additionally, the RDI + HVE significantly reduced both the ultrafine dental aerosol particles and the concentration of total particulate matter. AGPs represent a potential risk for airborne infections in dentistry. Taken together, these preliminary results suggest that isolation and high-volume suction are effective to reduce ultrafine dental aerosol particles.

COVID-19 and dental clinical practice: Students and clinical staff perceptions of health risks and educational impact

PURPOSE/OBJECTIVES

Due to the nature of the profession, dental healthcare workers are exposed to infectious diseases such as coronavirus disease 2019 (COVID-19), and the severity of the pandemic presents challenges to dental education institutions worldwide. This study investigated dental students and clinical staff perceptions of health risks and impacts on clinical competence of working in teaching clinics during the COVID-19 outbreak.

METHODS

A 39-item survey composed of closed and open questions was sent to students and clinical staff of a prominent Australasian dental school. Questions focused on students and clinical staff perceived impact of COVID-19 on their health, clinical safety and dental education.

RESULTS

The majority of staff and students perceived their health to be at risk and this increased their stress and impacted clinical performance, particularly for students. The production of aerosols and violation of cross-infection protocols by some students were the main perceived contributors to COVID-19 cross-infection in teaching clinics. Both students and staff considered the closure of teaching clinics would cause extreme impacts on students' clinical competence; however, online case-based discussions and tutorials were suggested as potential alternative teaching methods that could be adopted during that period.

CONCLUSION(S)

The challenges of the COVID-19 pandemic also bring opportunities for dental education development; mainly in terms of infection prevention and control improvement, preparedness to respond to future contagious diseases, and exploring the benefits of online learning in dentistry.

Non-Antagonistic Contradictoriness of the Progress of Advanced Digitized Production with SARS-CoV-2 Virus Transmission in the Area of Dental Engineering

The general goals of advanced digitized production in the Industry 4.0 stage of the industrial revolution were presented along with the extended holistic model of Industry 4.0, introduced by the authors, indicating the importance of material design and the selection of appropriate manufacturing technology. The effect of the global lockdown caused by the SARS-CoV-2 virus transmission pandemic was a drastic decrease in production, resulting in a significant decrease in the gross domestic product GDP in all countries, and gigantic problems in health care, including dentistry. Dentists belong to the highest risk group because the doctor works in the patient’s respiratory tract. This paper presents a breakthrough authors solution, implemented by the active SPEC strategy, and aims to eliminate clinical aerosol at the source by negative pressure aspirating bioaerosol at the patient’s mouth line. The comparative benchmarking analysis and its results show that only the proprietary solution with a set of devices eliminates the threat at the source, while the remaining known methods do not meet the expectations. The details of this solution are described. Photopolymer materials and additive Digital Light Printing (DLP) technology were used.

Plastic surgery practices amidst global COVID-19 pandemic: Indian consensus

INTRODUCTION

The COVID-19 pandemic having spread globally has profound implications on medical and surgical care, which is given by the health care providers. At this time, though there are guidelines and recommendations for medical management of these patients, there is a lack of guidance on how a plastic surgeon should approach the COVID-19 suspect or infected patient who presents either in an elective or emergency setting. We aim to provide a consensus guideline based on the current recommendations of the Indian Council of Medical Research (ICMR) and the pooled experience of the major centers performing plastic and reconstructive surgery in India.

METHODS

The current guidelines and recommendations on the COVID-19 pandemic were studied from both government and nongovernment sources including ICMR. The problems in the specialty of plastic surgery were categorized into four groups and for each group, separate and individual guidelines have been formulated.

GUIDELINES

Consensus guidelines have been formulated for the specialty of Plastic and Reconstructive surgery. The patients requiring plastic surgery service have been categorized into four groups of acute, subacute, chronic, and late category. Acute cases are the ones who require intervention within 24-48 h. Subacute cases are the ones who require intervention in the next 3-10 days, while the chronic are the ones who need plastic surgery preferably within a month. The late category are the ones who need surgery within the next six months. This has been done based on the urgency and priority of surgical intervention titrated against the risks of operating and inadvertently acquiring the exposure of COVID-19-positive patients.

CONCLUSION

Currently, in the wake of COVID-19 pandemic, there are no clear guidelines specific to the vast majority of patients who come for a plastic surgery intervention. This puts the patients at risk due to the impending plastic surgery problem while at the same time it poses a risk of exposure to COVID-19 for the surgical team. Consensus guidelines are presented, to steer the plastic surgeon in his work, in the wake of COVID-19 crisis. The guidelines are based on firm scientific evidence from the reputed research and regulatory bodies and have been made in consonance with plastic surgery experts around the country, so that these practices best suit the needs of the patients, while being mindful of resource limitations and infection risks. The approach of "delayed conservative treatment" works best in the present case scenario.

Self-reported dental treatment needs during the COVID-19 outbreak in Brazil: an infodemiological study

The aim of the present infodemiological study was to evaluate whether the COVID-19 outbreak has influenced the volume of content related to the dental treatment needs of Brazilian Twitter users to summarize the trends, and to identify the perceptions of the treatment needed. We collected tweets related to dental care needs of individuals exposed to the COVID-19 outbreak scenario between March 23 to May 4, 2020 and of those not exposed to the COVID-19 pandemic (unexposed group) on the same reported days of 2019 using the terms "dentista (dentist), dente (tooth), siso (third molar), and aparelho (orthodontic appliance)." Descriptive analysis was performed to provide summary statistics of the frequencies of tweets related to different dental treatment needs and also the differences in volume content between the years 2019 and 2020. Moreover, the data were analyzed by qualitative analysis using an inductive approach. A total of 1,763 tweets from 2020 and 1,339 tweets from 2019 were screened. Those tweets posted by non-Brazilian users, duplicates, and those unrelated to dental treatment needs were removed and, therefore 1,197 tweets from 2020 and 719 tweets from 2019 were selected. Content volume related to dental treatment needs greatly increased during the COVID-19 outbreak. Findings from the word cloud and content analysis suggest that dental pain, related or not to the third molar, and problems with orthodontic appliances were the topics most commonly related to dental treatment needs discussed during the COVID-19 outbreak, mainly conveying anxiety and distress. The volume of tweets related to dental treatment needs posted by Brazilian users increased during the COVID-19 outbreak and self-reported pain and urgencies were the most popular topics.

Current Clinical Dental Practice Guidelines and the Financial Impact of COVID-19 on Dental Care Providers

The novel coronavirus disease 2019 (COVID-19) has been acknowledged as a pandemic by the World Health Organization (WHO). The aim of this study was to review guidelines issued by different health regulatory bodies amid the COVID-19 outbreak and financial constraints faced by dentists globally. Relevant papers and news articles were identified in Google Scholar and PubMed. The search was made using the keywords “COVID-19,” “COVID-19 and dentistry,” and “the financial impact of COVID-19 on dentistry.” Studies and news articles published in languages other than English were excluded and a final selection of 53 relevant studies, guideline documents, and news articles were made. The outbreak of COVID-19 has affected all businesses including general dental practices, which are suffering huge financial losses as they have been advised to provide only emergency dental care. These recommendations should be appreciated as a positive step but they have caused serious financial implications for dental practices. It can be concluded that current dental practice globally is limited to the provision of emergency treatments only. This step is appreciative, but has resulted in huge financial losses sustained by dental care providers (DCPs) worldwide. The governments and health regulatory bodies of developed countries are trying to help dental practices to evolve from this troublesome situation, but there is no visible policy from the underdeveloped world that could help the DCPs to save their practices from closing down due to the financial constraints.

Dental Care during COVID-19 Outbreak: A Web-Based Survey

OBJECTIVE

 This survey aimed to assess the effects of coronavirus disease 2019 (COVID-19) on elective and urgency/emergency dental care and dentists concerned.

MATERIALS AND METHODS

 A web-based survey was performed using Google forms questionnaire sent to dentists in Brazil. Questions included: personal information, type of dental care provided during quarantine, if emergencies increased, the dental office biosafety routine, among others. The levels of concern about the impact of quarantine on dental care and patient oral health conditions and the economic impact on dental practices were evaluated using a 0- to 10-point scale. Statistical analysis included descriptive, percentages, one-way ANOVA, Tukey, and chi-square tests.

RESULTS

 During quarantine, 64.6% of the dentists attended only urgency/emergency treatments, while 26.1% maintained routine appointments, and 9.3% closed the dental offices. A higher percentage of dentists from the least affected states continued routine dental treatment; dentists were younger and presented a significantly lower level of concern about dental treatments and oral health conditions of their patients. An increase in urgency/emergency procedures was reported by 44.1% of the dentists, mostly due to the unavailability of routine/elective dental care and increased patient anxiety and stress. The main causes of urgency/emergency appointments were toothache, dental trauma, and broken restorations, besides the breakage of orthodontic appliances and temporomandibular disorders. Dentists reported a high level of concern about the economic impact caused by quarantine.

CONCLUSIONS

 The pandemic/quarantine has negatively affected the clinical routine. Personal protection/hygiene care must be adopted and reinforced by dental professionals/staff to make dental procedures safer.

A prospective clinical pilot study on the effects of a hydrogen peroxide mouthrinse on the intraoral viral load of SARS-CoV-2

Objectives

SARS-CoV-2 is mainly transmitted by inhalation of droplets and aerosols. This puts healthcare professionals from specialties with close patient contact at high risk of nosocomial infections with SARS-CoV-2. In this context, preprocedural mouthrinses with hydrogen peroxide have been recommended before conducting intraoral procedures. Therefore, the aim of this study was to investigate the effects of a 1% hydrogen peroxide mouthrinse on reducing the intraoral SARS-CoV-2 load.

Methods

Twelve out of 98 initially screened hospitalized SARS-CoV-2-positive patients were included in this study. Intraoral viral load was determined by RT-PCR at baseline, whereupon patients had to gargle mouth and throat with 20 mL of 1% hydrogen peroxide for 30 s. After 30 min, a second examination of intraoral viral load was performed by RT-PCR. Furthermore, virus culture was performed for specimens exhibiting viral load of at least 10³ RNA copies/mL at baseline.

Results

Ten out of the 12 initially included SARS-CoV-2-positive patients completed the study. The hydrogen peroxide mouthrinse led to no significant reduction of intraoral viral load. Replicating virus could only be determined from one baseline specimen.

Conclusion

A 1% hydrogen peroxide mouthrinse does not reduce the intraoral viral load in SARS-CoV-2-positive subjects. However, virus culture did not yield any indication on the effects of the mouthrinse on the infectivity of the detected RNA copies.

Clinical relevance

The recommendation of a preprocedural mouthrinse with hydrogen peroxide before intraoral procedures is questionable and thus should not be supported any longer, but strict infection prevention regimens are of paramount importance.

Trial registration

German Clinical Trials Register (ref. DRKS00022484)

Dental Risks and Precautions during COVID-19 Pandemic: A Systematic Review

OBJECTIVE

To provide dentists and dental team with insights concerning risk and precautions during COVID-19 outbreak crisis as it would help in decision making among dental community.

MATERIALS AND METHODS

A comprehensive review of all English and non-English articles was carried out using the available CORD-19 dataset with MEDLINE via PubMed, Cochrane library, Google Scholar and ScienceDirect databases. The study included all articles that matched the search terms.

RESULTS

A total of 353 were retrieved, of which 13 articles were reviewed comprehensively. Studies included in this systematic review emphasized on reinforcing strict infection control measures and minimizing human-to-human contact during COVID-19 outbreak. All surfaces in operatory room including waiting area need adequate ventilation and disinfection. Dental patients need to be screened using COVID-19 targeted questions as well as measuring their body temperature. Restricting dental treatments to only emergency cases and rescheduling all routine visits is advised with careful attention to minimize aerosol generation and following highest level of personal protection when treating COVID-19 confirmed cases. Dental offices need to establish a standard protocol of case reporting and referral to other well-prepared facilities. Lastly, online platforms are beneficial tools in providing psychological support to distressed dentists, dental team and dental patients and educating public during COVID-19 crisis.

CONCLUSION

Dental team need to follow strict infection control measures and minimize aerosol generation during COVID-19 outbreak. It is the responsibility of dental care workers to keep themselves informed and ensure safety and control transmission within dental facilities. Further research is required.

Minimizing the aerosol-generating procedures in orthodontics in the era of a pandemic: Current evidence on the reduction of hazardous effects for the treatment team and patients

The purpose of this critical review is to list the sources of aerosol production during orthodontic standard procedure, analyze the constituent components of aerosol and their dependency on modes of grinding, the presence of water and type of bur, and suggest a method to minimize the quantity and detrimental characteristics of the particles comprising the solid matter of aerosol. Minimization of water-spray syringe utilization for rinsing is suggested on bonding related procedures, while temporal conditions as represented by seasonal epidemics should be considered for the decision of intervention scheme provided as a preprocedural mouth rinse, in an attempt to reduce the load of aerosolized pathogens. In normal conditions, chlorhexidine 0.2%, preferably under elevated temperature state should be prioritized for reducing bacterial counts. In the presence of oxidation vulnerable viruses within the community, substitute strategies might be represented by the use of povidone iodine 0.2%-1%, or hydrogen peroxide 1%. After debonding, extensive material grinding, as well as aligner related attachment clean-up, should involve the use of carbide tungsten burs under water cooling conditions for cutting efficiency enhancement, duration restriction of the procedure, as well as reduction of aerosolized nanoparticles. In this respect, selection strategies of malocclusions eligible for aligner treatment should be reconsidered and future perspectives may entail careful and more restricted utilization of attachment grips. For more limited clean-up procedures, such as grinding of minimal amounts of adhesive remnants, or individualized bracket debonding in the course of treatment, hand-instruments for remnant removal might well represent an effective strategy. Efforts to minimize the use of rotary instrumentation in orthodontic settings might also lead the way for future solutions. Measures of self-protection for the treatment team should never be neglected. Dressing gowns and facemasks with filter protection layers, appropriate ventilation and fresh air flow within the operating room comprise significant links to the overall picture of practice management. Risk management considerations should be constant, but also updated as new material applications come into play, while being grounded on the best available evidence.

Psychological Impact of the COVID-19 Pandemic on Dental Interns in Riyadh, Saudi Arabia: A Cross-sectional Survey

BACKGROUND

Dental profession is labeled as a high-risk profession, due to which dental care professionals are under tremendous pressure during the outbreak of COVID-19 pandemic. The aim of this study was to assess the psychological impact of the COVID-19 pandemic on dental interns in Riyadh, Saudi Arabia.

MATERIALS AND METHODS

A cross-sectional study was conducted among dental interns from different universities in Riyadh, Saudi Arabia. The data were collected using a validated Depression, Anxiety and Stress Scale-21 Items (DASS-21) questionnaire. Descriptive statistics were presented using frequencies (n) and percentages (%). Chi-square and Fisher exact tests were used to assess the association between sociodemographic data (age, gender, nationality, marital status, and history of physical and mental illness) and levels of depression, anxiety, and stress. A p < 0.05 was considered as statistically significant.

RESULTS

A total of 160 dental interns were invited to participate in this survey; out of which 110 participants responded yielding a response rate of 78%. The mean age of the study participants was 25.1 years. About 65% of the participants were female. Only 14.5% of the subjects reported having a past history of physical or mental illness. Depression, anxiety, and stress were identified in 11.9%, 7.3%, and 0.9% of the dental interns, respectively. Demographic characteristics did not appear to influence depression, anxiety, or stress levels (p > 0.05).

CONCLUSION

The outbreak of COVID-19 pandemic has affected the mental health of dental interns. The presence of depression, anxiety, and stress among dental interns highlights the need for special intervention and support programs to promote mental health and well-being among dental interns.

HOW TO CITE THIS ARTICLE

Khanagar SB, Alfadley A. Psychological Impact of the COVID-19 Pandemic on Dental Interns in Riyadh, Saudi Arabia: A Cross-sectional Survey. Int J Clin Pediatr Dent 2020;13(5):508-512.

Systematic review of international guidelines for tracheostomy in COVID-19 patients

At this moment, the world lives under the SARS-CoV-2 outbreak pandemic. As Otolaryngologists - Head & Neck Surgeons, we need to perform and participate in examinations and procedures within the head and neck region and airway that carry a particularly high risk of exposure and infection because of aerosol and droplet contamination. One of those surgical procedures in demand at this moment is tracheostomy due the increasing ICU admissions. This review of international guidelines for tracheostomy in COVID-19 infected patients, aims to summarize in a systematic way the available recommendations: indications, timing, technique and safety measures for tracheostomy, from all over the world.

Impact of 3D printed medical equipment on the management of the Covid19 pandemic

Very high mortality rates of coronavirus pandemic (COVID-19) are observed around the world due to lack of medical equipment. The increased need for medical devices and personal protective equipment (PPE) has kept several healthcare professionals at risk. Fortunately, 3D printing technology allows to overcome the lack of medical supplies. This study highlights the impact of 3D printing on the combat against COVID19, and its importance in the medical product supply chain. Indeed, the existing medical equipment fabricated by 3D printing technology and its role in the management of Covid19 pandemic is presented. Moreover, the last works are examined to know whether the models of the medical equipment are free of use and whether useful informations are presented (eg, available design data and setup guidelines).

Control of SARS-CoV-2 transmission in orthodontic practice

The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has attracted worldwide concerns because of its high person-to-person infectivity and lethality, and it was labeled as a pandemic as the rapid increase in the number of confirmed patients in most areas around the world became evident. The SARS-CoV-2 is mainly transmitted through respiratory droplets and close contact. There is also evidence of transmission through aerosols and digestive tracts. Because orthodontic treatment involves a large population who need routine return-visits, it was significantly affected and suspended because of the COVID-19 pandemic and the shutdown of the dental clinics and hospitals. Although the spread of COVID-19 has been effectively controlled in China, and many areas have gradually resumed work and classes, orthodontic participants are still under high risks of SARS-CoV-2 infection. This is due to the fact that the asymptomatic carriers of SARS-CoV-2 or patients in the incubation period may cause the cross-infection between orthodontic practitioners and patients. The close proximity between the practitioners and the patients, and the generation of droplets and aerosols that contain saliva and blood during treatment further increase the risks of transmission. In this article, we summarized the preventive strategies for control of SARS-CoV-2 transmission to protect both staff and patients during the orthodontic practice.

COVID-19 Risk Factors Among Health Workers: A Rapid Review

Coronavirus disease 2019 (Covid-19) poses an important occupational health risk to health workers (HWs) that has attracted global scrutiny. To date, several thousand HWs globally have been reported as infected with the severe acute respiratory syndrome coronavirus 2 virus that causes the disease. It is therefore a public health priority for policymakers to understand risk factors for this vulnerable group to avert occupational transmission. A rapid review was carried out on 20 April 2020 on Covid-19 risk factors among HWs in PubMed, Google Scholar, and EBSCOHost Web (Academic Search Complete, CINAHL Complete, MEDLINE with Full Text, CINAHL with Full Text, APA PsycInfo, Health Source-Consumer Edition, Health Source: Nursing/Academic Edition) and WHO Global Database. We also searched for preprints on the medRxiv database. We searched for reports, reviews, and primary observational studies (case control, case cross-over, cross-sectional, and cohort). The review included studies conducted among HWs with Covid-19 that reported risk factors irrespective of their sample size. Eleven studies met the inclusion criteria. Lack of personal protective equipment, exposure to infected patients, work overload, poor infection control, and preexisting medical conditions were identified as risk factors for Covid-19 among HWs. In the context of Covid-19, HWs face an unprecedented occupational risk of morbidity and mortality. There is need for rapid development of sustainable measures that protect HWs from the pandemic.

Innovative diagnostic approach and investigation trends in COVID19-A systematic review

A highly contagious viral infection emerged in Wuhan city; China had increased mortality with uncertain pathogenesis spreads throughout the world to become a pandemic. It is reported to be caused by a member of β coronaviruses and named it as COVID-19 by the World Health Organization (WHO). The disease is caused by a mutant strain of coronavirus SARS-COV-2 that affects the respiratory tract causing mild to severe respiratory tract illness. The clinical manifestation ranges from mild, moderate, severe and very severe signs and symptoms result in death due to severe hypoxia or multi-organ dysfunction. Also, the affected persons were capable of infecting others through various modes of transmission through respiratory droplets (aerosol spread). A definite investigation protocol has followed to diagnose COVID 19 disease but mainly confirmed with reverse transcription polymerase chain reaction. Computerized tomography scan plays a significant role in the diagnosis and prognosis of affected individuals. The major problem with COVID-19 is due to its novelty and lack of vaccination or treatment. This review focuses on the mutation, pathogenesis, various diagnostic tests adopted and autopsy findings in patients affected with COVID-19.

Impact of delayed orthodontic care during COVID-19 pandemic: Emergency, disability, and pain

BACKGROUND

The aim of this study was to evaluate the impact of clinical closure and delayed orthodontic care delivery in terms of types of emergencies, pain intensity, and disability experienced by orthodontic patients during the COVID-19 pandemic.

METHODS

This was a descriptive cross-sectional study using an electronic survey that was distributed to orthodontic patients who were not seen in clinic for 2 to 3 months due to clinic closure. The survey included demographics, types of orthodontic emergencies, Numerical Rating Scale, and Manchester Orofacial Pain Disability Scale.

RESULTS

There were a total of 150 respondents with mean age of 20 years; 57.33% were female patients. The most common reported orthodontic emergencies were poking wire 30%, debonded brackets 27.3%, bad odor 24%, sharp ligature tie 20%, inflammation and bleeding 9.3%, ulcer 8.7%, and problematic palatal device 8%. Pain was significantly associated with poking wire (P < 0.001), sharp ligature tie (P < 0.01), ulcer (P < 0.05), and problematic palatal device (P < 0.01). Poking wire, sharp ligature tie, and problematic palatal device were found to be significant predictors of pain intensity. Median pain intensity was 3, similar to the median disability score. There was a significant association between pain intensity and disability score (P < 0.01). With each unit increase in pain intensity, the disability score increased by 1.18.

CONCLUSIONS

Delay in receiving orthodontic care could result in an orthodontic emergency, yet pain and disability resulting from these events are minimal. The decision to resume clinical service should be evaluated considering risks and benefits in case of the pandemic. Further studies are required.

John MA. Time for a Paradigm Shift in Head and Neck Cancer Management During the COVID-19 Pandemic

OBJECTIVE

The coronavirus disease 2019 (COVID-19) pandemic has caused physicians and surgeons to consider restructuring traditional cancer management paradigms. We aim to review the current evidence regarding the diagnosis and management of head and neck cancer, with an emphasis on the role of the multidisciplinary team (MDT) during a pandemic.

DATA SOURCES

COVID-19 resources from PubMed, Google Scholar, the American Academy of Otolaryngology-Head and Neck Surgery, and the American Head and Neck Society were examined.

REVIEW METHODS

Studies and guidelines related to the multidisciplinary management of head and neck cancer in the COVID-19 setting were reviewed. A total of 54 studies were included. Given the continuously evolving body of literature, the sources cited include the latest statements from medical and dental societies.

RESULTS

The unpredictable fluctuation of hospital resources and the risk of the nosocomial spread of SARS-CoV-2 have direct effects on head and neck cancer management. Using an MDT approach to help define "essential surgery" for immediately life- or function-threatening disease processes in the context of available hospital resources will help to maximize outcomes. Early enrollment in an MDT is often critical for considering nonsurgical options to protect patients and health care workers. The role of the MDT continues after cancer treatment, if delivered, and the MDT plays an essential role in surveillance and survivorship programs in these challenging times.

CONCLUSION

Head and neck cancer management during the COVID-19 pandemic poses a unique challenge for all specialists involved. Early MDT involvement is important to maximize patient outcomes and satisfaction in the context of public and community safety.

Assessment of dentists' awareness and knowledge levels on the Novel Coronavirus (COVID-19)

Coronavirus disease-2019 (COVID-19) is the most recent infectious disease that is spreading rapidly throughout the world. This study aimed to evaluate the knowledge and awareness levels of dentists on COVID-19. This survey study, consisting of 37 questions, was sent to dentists via an online link in the first two weeks of April 2020. The questionnaire consisted of questions related to the knowledge level of dentists on COVID-19 during the pandemic period. The knowledge level of dentists was assessed with a 24-point scoring, consisting of correct answers. A Chi-square test was used to compare qualitative data (p < 0.05). A total of 267 dentists participated in this study, of which 51.7% were aged under 30 years, and 67% were women. The participants' knowledge level means score was 19.03 ± 3.15. According to these results, 231 were determined (86.5%) as high knowledgeable. Positive associations between increased knowledge level and factors such as being a woman, working in a university hospital, and being informed outside the institution were determined. The knowledge level of the dentists working in Istanbul about the COVID-19 pandemic is quite high.

Dental Facilities During the New Corona Outbreak: A SWOT Analysis

Recently, there have been many global outbreaks of diseases. The latest is the coronavirus disease of 2019 (COVID-19) pandemic. The virus has spread worldwide and is transmitted mainly through droplets or by touching contaminated surfaces. Globally, healthcare systems are challenged due to a lack of workplace safety and professional obligations in addition to the rapid spread of the virus. Dental facilities are at greater risk due to the nature of dental care. The aim of this review study was to provide a situational analysis within dental facilities during the new COVID-19 outbreak. Published papers concerning dental facilities and COVID-19 were retrieved from PubMed, search engines, and organizational websites. All data were reviewed, arranged into themes, and then categorized either as strengths or weaknesses with respect to addressing the COVID-19 pandemic in dental facilities, and accordingly, threats and possible opportunities to the handling of the pandemic were identified. Preparedness of dental facilities during the current pandemic is a weakness that needs to be addressed promptly. Shortage of dental care providers, cyber security, economic losses, and ethical challenges are possible threats due to the current outbreak. Coordination and prompt communication among all healthcare providers during such outbreaks is a strength that needs to be supported. This strengths, weaknesses, opportunities, and threats (SWOT) analysis can be a useful tool for guiding decision-making as it is crucial during the current pandemic to work on weaknesses, avoid threats, and utilize all future opportunities.

Evaluation of Knowledge and Preparedness Among Indian Dentists During the Current COVID-19 Pandemic: A Cross-Sectional Study

PURPOSE

The current scenario of the COVID-19 pandemic has forced dentists to prepare themselves by updating their knowledge and receive training to face the present and after effects of COVID-19. The present survey was thus conducted to assess the knowledge, risk perception, attitude, and preparedness of the dentists in India about COVID-19.

MATERIALS AND METHODS

A cross-sectional online survey was carried out among registered dentists in India. A self-administered, anonymous, questionnaire comprising of 25 close-ended questions was circulated to gather the relevant information. A total of 765 dentists submitted a response, out of which 646 complete responses were included in the statistical analysis. Pearson's Chi-square test was used for inter-group statistical comparison.

RESULTS

The majority (80.8%) of the dentists had a fair knowledge about the characteristics of COVID-19. Nearly 60.7% and 49.7% of the dentists had taken infection control training and special training for COVID-19, respectively. Nearly 50% of the dentists had the perception that COVID-19 is very dangerous. Only 41.8% of the dentists were willing to provide emergency services to patients. Most of the dentists had an opinion that there is a need to enhance personal protective measures. During the survey, it was found that varied technological advances are offered to dentists to ensure good clinical practice. They also concurred that there was a need to standardize the tools and measures available to carry out dental practices.

CONCLUSION

In the present study, Indian dentists have presented satisfactory knowledge with adequate preparedness as the majority of them had a fair level of knowledge with significantly higher knowledge among female respondents and those with post-graduation studies. Dentists should make judicious utilization of all the precautionary measures to safely practice dentistry. As we are going through an evolutionary phase where new advances are expected to evolve, dentists will definitely emerge successfully out from the crisis of the COVID-19 pandemic.

Novel Metal Auxiliary (Device) to Prevent Cross-contamination of Elastomeric Modules

Emerging and prevalent infectious pose a significant threat to all stakeholders in the orthodontic office, namely, treating orthodontists, clinical assistants, and the patients. Due diligence must be applied to prevent further transmission of disease and infections. The elastomeric modules are one of the most frequent components of the fixed appliance. This clinical aid puts forth a novel clinical tip to prevent cross-contamination of and from elastomeric modules.

Evaluation of preventive procedures followed by the medical staff against covid-19 in the Syrian Arab Republic: A cross-sectional study

Objectives:

This study was oriented to investigate the current situation of Syrian medical staff working in different fields and their response regarding the preventive procedures.

Material and Methods:

Questionnaire was designed according to the World Health Organization guidelines and recommendations, addressing the preventive measures, which must be followed by healthcare workers to protect themselves and their community against COVID-19. The participation in the study was average as 1339 participants from medical staff (596 males and 743 females) have filled the questionnaire.

Results:

The results displayed high percentages of commitment in general regarding preventive measures followed (health rules, personal protective equipment, and disinfection) for all healthcare workers. The proportions of responses were varied depending on job nature. In addition, the highest range of percentage of self-evaluation was 50–75% for all medical staff.

Conclusion:

Based on the filled information, the study showed relatively good commitment to the preventive procedures by healthcare workers to control COVID-19 and prevents its spread in the community.

Dental services during the COVID-19 pandemic: A tertiary care hospital experience

The Aga Khan University is the largest tertiary care hospital in the biggest metropolis of Pakistan, in this paper six weeks of experience during the COVID‐19 pandemic is shared, we will discuss the measures that were taken to mitigate the spread of COVID‐19 amongst dental health care providers (DHCPS) and provide a neoteric workflow for the provision of safe dental care as dental services move towards normalcy. Furthermore topic such as fit testing, contact tracing, employee health and training are discussed and experience of such measures is shared. It is hoped that till the time new evidence based data is generated these communications may help spread awareness to help setup clinical protocols for other tertiary care settings.

Pandemic preparedness of dentists against coronavirus disease: A Saudi Arabian experience

Background

Dental offices are among the highest risk for transmission of the COVID-19, having the potential to transmit the virus via routine dental procedures. This cross-sectional study assessed the preparedness and perception of infection control measures against the COVID-19 pandemic by dentists in Saudi Arabia.

Materials and methods

This online survey addressed the impact and perception of the COVID-19 pandemic on dental practice in Saudi Arabia. The questionnaire comprised 26 closed-ended questions. Descriptive statistics included frequency distributions with percentages. In addition, the significance between the different demographic variables and questions about dentists’ perception of the COVID-19 pandemic was tested using the Chi-square test.

Results

COVID-19 management in dental clinics varied in terms of adherence to the Ministry of Health (MOH) guidelines. Dental clinics’ screening questionnaire for patients showed good adherence (67%), while the lowest agreement was detected with the question on the existence of an airborne infection in the isolation room (15%). Almost two-thirds of the respondents agreed that the dental reception area adopted the proper COVID-19 preventive measures. Greatest accord was observed in their answers on questions about dentists’ perception of the COVID-19 pandemic, ranging from 64%–89%. In addition, there were statistically significant differences in questions about the perception of dentists towards the COVID-19 pandemic by different demographic variables such as age and years of work experience (p < 0.05).

Conclusion

The response of most dentists regarding the preparedness and perception of infection control measures against the COVID-19 pandemic was positive. Dental clinics need to adhere more to the MOH recommendations in preparedness of their facilities or by educating their dentists and staff.

Protective device to reduce aerosol dispersion in dental clinics during the COVID-19 pandemic

AIM

To describe the use of a new protective device to reduce aerosol dispersion in dental clinics during the COVID-19 pandemic.

METHODOLOGY

The device consists of a rigid translucent acrylic structure (methyl polymethacrylate), adjusted to the dental chair, involving the patient's head, neck and chest. There is also a piping system to generate negative pressure, for aspiration and filtering of the air inside the device chamber. The operator works through small holes in the acrylic structure, to reduce contact with the microparticles arising from aerosols during dental procedures. Simulated dental procedures using a fluorescent dye in the water of the dental equipment were carried out, with and without the use of the device. The presence of the dye was analysed at various locations, such as on personal protective equipment (PPE), the dental chair and on the clinic floor.

RESULTS

In the simulated dental procedure without the device, the dye was obvious on surgical gloves, aprons (waist, chest, legs, fists) and face shields, as well as on the dental chair (backrest, light reflector) and clinic floor. In the simulated dental procedure using the device, the dye was observed only on surgical gloves, apron (fists), inside the pipe system and internal walls of the acrylic chamber. There was a certain limitation of movement and visualization by the dentist whilst using the device.

CONCLUSIONS

The present device is a low-cost complementary resource for use in conjunction with standard PPE, to reduce the transmission of SARS-CoV-2 in the dental setting. Further clinical trials should be carried out to test the efficacy of this device to reduce aerosol dispersion and the consequent vector of contamination, as well as the ergonomic impacts related to its use.

Resumption of Endodontic Practices in COVID-19 Hardest-Hit Area of China: A Web-based Survey

INTRODUCTION

The purpose of this study was to investigate the resumption of endodontic practices in Hubei Province, China 1 month after the end of the lockdown.

METHODS

A Web-based survey was sent to 1069 active endodontic specialists and general dentists who provided endodontic care in Hubei Province from May 7 to May 9, 2020. The survey consisted of 18 questions on demographics, the current situation of endodontic practice for the participants, and concerns regarding contracting or spreading the virus in newly opened endodontic practices.

RESULTS

A total of 322 participants completed the survey. Most respondents (62%) were from Wuhan. Almost 83% of the respondents have resumed their endodontic practice partially or fully. Most respondents in practice (99%) would take measures to screen patients before treatment including paid screening measures. More than 93% of the respondents reported having taken special measures for routine endodontic treatment at this stage, with the most common measure taken being wearing an N95 mask. The rubber dam was recognized as efficient in preventing infection by most respondents. Many respondents were concerned about contracting coronavirus disease 2019 (COVID-19) as a result of routine endodontic practice at this stage, and respondents with more than 11 years of endodontic experience were significantly less concerned about infection compared with those with fewer than 5 years of experience (P < .05).

CONCLUSIONS

There is a fear of contracting/spreading COVID-19 among endodontic clinicians, the fear is negatively associated with years of practice, and most clinicians believe that rubber dam isolation can protect them and their patients from COVID-19.

Considerations for Pregnant Dental and Health Care Workers amid COVID-19

INTRODUCTION

Coronavirus disease 2019 (COVID-19) is a highly contagious disease that quickly reached pandemic levels. Over 5 million COVID-19 cases and approximately 330,000 deaths have been recorded worldwide. Transmission is primarily spread through direct, indirect (through contaminated objects or surfaces), or close contact with infected people via respiratory droplets, the mouth, and/or nose secretions. Health care professionals (HCPs), including dental HCPs, are recognized to be at considerably high risk for infection due to the close proximity to patients and aerosol-generating procedures. During pregnancy, HCPs may be at even higher risk since pregnancy substantially increases the susceptibility to infectious diseases.

OBJECTIVES

Here, we present the posed risks and potential effects of COVID-19 on maternal and fetal health. Current prevention and management strategies for COVID-19 on pregnant dental and HCPs are also discussed.

RESULTS

Significant progress is being made in understanding the pathogenesis and clinical consequences of COVID-19. Pregnant women are affected more adversely with viral illnesses, although evidence of vertical transmission of COVID-19 is controversial. Based on the presence of atypical symptoms, the significant numbers of asymptomatic individuals who are COVID-19 positive, and the high susceptibility to viral diseases observed in pregnant women, recommendations have been put forth to limit the exposure of COVID-19-positive or even suspected cases to pregnant HCPs, and these are likely to evolve as new information becomes available.

CONCLUSION

Pregnant HCPs require extra caution: not only are they considered a high-risk population, but their work at the frontline in a pandemic may expose them to additional risks. Complete awareness of the effects of COVID-19 on maternal and fetal/infant health, as well as prevention and management guidelines for pregnant HCPs, will allow for a safer work environment. Health care institutional policies aimed at protecting pregnant HCPs should consider avoiding their assignment as first responders, especially if equally trained staff are available.

KNOWLEDGE TRANSFER STATEMENT

Dental and health care professionals can use the information in this review to improve their awareness of COVID-19 risks, signs, and symptoms and the associated effects on the health of pregnant health care professionals and their unborn/newborn children.