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

Fear control and danger control amid COVID-19 dental crisis: Application of the Extended Parallel Process Model

OBJECTIVES

There is high risk of contamination with COVID-19 virus during routine dental procedures and infection control is crucial. The aim of this study was to determine the factors associated with Covid-19 preventive behaviors among oral health care providers using an extended parallel process model (EPPM).

METHODS

In a cross-sectional study, short text message invite surveys were sent to 870 oral health care providers in west part of Iran. Data were collected through validated self-report EPPM questionnaires. Descriptive statistics, Chi-square and Fishers exact tests were used for data analysis.

RESULTS

In total, 300 completed questionnaires were received and the mean age of respondents was 29.89 ± 11.17 years (range: 20-75 years). Among the study population, 284 (94.67%) perceived the threat of infection highly. Washing hands frequently with water and soap and use of hand sanitizer was reported by 93.33%, of participants. Age (P = 0.010), sex (P = 0.002) and occupation field (P = 0.010) were significantly associated with danger control responses. Data identified that those oral health care providers that were on the danger control response adopted preventive behaviors more strictly than those on fear control response.

CONCLUSION

The results of this study showed how degrees of perceived threat and perceived efficacy influenced oral health providers' willingness to perform recommended health behaviors. These findings can assist public health agencies in developing educational programs specifically designed for promoting preventive behaviors among oral health providers in pandemic situations.

Guidance for dental treatment of patients with disabilities during COVID-19 pandemic

People with disabilities are challenged managing their oral hygiene and more often burdened with oral diseases. They often require immediate dental treatment for severe pain and greater precautions are needed to cope with COVID-19. The potential for COVID-19 infection can be relatively high in patients with disabilities due to concomitant systemic diseases, unique individual circumstances, relationship with caregivers and the living conditions of long-term care facilities, which make them vulnerable to the virus. For behavior management, dental treatment is often provided under general anesthesia with meticulous preoperative evaluation and the use of high-quality viral filters. In response to COVID-19, additional considerations should be taken for dental procedures on patients with special needs. These recommendations for dental treatment of the disabled are based on 6 months of authors COVID-19 pandemic experience.

A Dental Response to the COVID-19 Pandemic-Safer Aerosol-Free Emergent (SAFER) Dentistry

Dental services are significantly impacted by the COVID-19 pandemic. Almost all dental procedures carry a high infection risk for providers and patients due to the spread of aerosols. As a consequence, public health agencies and professional associations have issued guidelines for enhanced infection control and personal protection equipment and have also limited care to urgent or emergency services. However, there is no dental service concept for pandemic disaster preparedness or response that might be applied. Moreover, pathways to dental care provision in a post-pandemic future with persisting risks are needed. We propose Safer Aerosol-Free Emergent Dentistry (SAFER Dentistry) as one approach to dental services during and emerging from the pandemic. The concept's starting point is the identification of the most common patient needs. The next step is to replace common treatments addressing the most frequent needs with alternative interventions involving a lower infection risk because they do not generate aerosols. SAFER Dentistry is innovative, avoids risk, and responds to the requirements of a pandemic and post-pandemic emergency where the risk of airborne disease transmission remains high. SAFER Dentistry thereby ensures continuity of dental services while protecting providers and patients from infectious pathogens. Moreover, SAFER Dentistry allows dental service providers to remain operational and generate income even under pandemic conditions. Potential implementation and policy options for SAFER Dentistry include universal availability without co-payments by patients and a uniform bundled payment scheme for providers to simplify budgeting, reimbursement, and administration during a pandemic. Adaptations and adjustments of the concept are possible and encouraged as long as the principle of avoiding aerosol-generating procedures is maintained.

Dental Health Services Response to COVID-19 in Norway

We aimed to investigate the management of urgent dental care, the perception of risk and workplace preparedness among dental staff in Norway during the COVID-19 pandemic. An electronic questionnaire regarding the strictest confinement period in Norway (13 March-17 April 2020) was distributed to dental staff. Among the 1237 respondents, 727 (59%) treated patients, of whom 170 (14%) worked in clinics designated to treat patients suspected or confirmed to have COVID-19. Out of them 88% (143) received training and 64% (103) simulation in additional infection prevention procedures, while 27 (24%) respondents reported deviation. In total, 1051 (85%) respondents perceived that dental staff had a high risk of being infected, 1039 (84%) that their workplace handled the current situation well, 767 (62%) that their workplace had adequate infection control equipment and 507 (41%) agreed that their workplace is well equipped to handle an escalation. Before an appointment, 1182 (96%) respondents always/often inquired per phone information if a patient experienced symptoms of COVID-19, and 1104 (89%) asked about a history of travel to affected areas. Twice as many patients on average per week were treated by phone than in a clinic. A lower proportion of dental staff in high incidence counties applied additional infection prevention measures compared to low and medium incidence counties. To conclude, urgent dental health care was managed relatively well in Norway. Additional training of the dental staff in adequate infection prevention and step-by-step procedures may be needed. These results may be used to improve the dental health service's response to future outbreaks.

The Impact of COVID-19 Related Lockdown on Dental Practice in Central Italy-Outcomes of A Survey

The COVID-19 pandemic has affected lives and professions worldwide. We aimed to determine the behavior of dentists during the lockdown in Central Italy through an online survey. We demonstrated that the most frequent of urgencies, not otherwise manageable through telemedicine, was dental pulp inflammation. Although a statistically significant increase in the use of some of the personal protective equipment (PPE) from pre to during lockdown was shown, dentists were afraid of being infected during the dental procedures. Moreover, we showed that digital dentistry, telemedicine, use of the rubber dam, distancing of the appointments and further structural changes at the dental office are necessary to reduce the contagion among dentists and patients. No significant differences were shown between gender.

COVID-19 Related Experience, Knowledge, Attitude, and Behaviors Among 2,669 Orthodontists, Orthodontic Residents, and Nurses in China: A Cross-Sectional Survey

Objectives: To assess the current COVID-19 related experiences, knowledge, attitudes, and behaviors among orthodontists, orthodontic residents, and orthodontic nurses in China, and to identify factors associated with their self-perceived and actual level of knowledge, as well as their willingness to treat/care for COVID-19 patients.

Materials and Methods: A cross-sectional online survey was conducted in China using a 37-item questionnaire developed based on previous research. A professional online survey tool (www.wjx.cn) and a social media platform (WeChat) were used to display and distribute the questionnaire. Data were collected during April 11 to 13, 2020, when most regions of China had resumed dental practice except for high-risk regions such as Wuhan. Then the data were analyzed with multivariable generalized estimating equations.

Results: A total of 2,669 valid questionnaires were collected. Orthodontic services were suspended for nearly all respondents (97.8%) during the epidemic, and 68.0% had resumed work by the time they completed the questionnaire. The majority of respondents (80.2%) were confident that they understood COVID-19 related knowledge, but most of them only correctly answered less than half of the questions testing their actual level of knowledge. About two-thirds (64.1%) were willing to treat/care for patients with confirmed or suspected COVID-19. The completion of relevant training programs was significantly associated with more confidence in knowledge mastery (P < 0.001) and a higher actual level of knowledge (P < 0.001), but did not increase their willingness to treat/care for patients with COVID-19 (P = 0.235).

Conclusions: Before work resumption, COVID-19-related training programs are essential for the improvement of knowledge, confidence, and preparedness of orthodontic professionals. Sufficient and proper protection should also be provided to ensure safety and reduce the psychological burden on them.

Clinical Relevance: The findings can provide evidence for policy-making related to the resumption of elective dental services.

Perceived impact of the COVID-19 pandemic on orthodontic practice by orthodontists and orthodontic residents in Nigeria

Background

The Coronavirus Disease 2019 (COVID-19) pandemic has had far-reaching effects on orthodontic care delivery worldwide. This study aimed to assess the impacts of the pandemic on orthodontists and orthodontic residents in Nigeria.

Methods

This cross-sectional study was conducted among consenting orthodontists and orthodontic residents. The respondents were contacted through the WhatsApp group of the Nigerian Association of Orthodontists to fill the self-administered online questionnaires (Google forms). The questionnaire had two sections: A, Sociodemographics; B, Perceived impact of the COVID-19 pandemic. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics were used to compute mean and standard deviation and chi-square for association. Level of significance was set at P < 0.05.

Results

This study population comprised 98 people; however, only 73 participants responded, which represented a response rate of 74.5%. Approximately 60% (44) of the respondents thought that the COVID-19 pandemic would lead to a reduction in the number of orthodontic patients in the future, whereas almost all the respondents reported that it would affect their future practice of orthodontics. Most of the respondents (63.0%) reported that the pandemic had recorded a moderate to severe negative economic impact on them. Significant gender differences were recorded, in the social life of respondents, in addition to economic and psychosocial effects.

Conclusions

Almost all respondents reported that they would change their future practice of orthodontics, particularly with respect to placing a greater emphasis on infection control. Most of the respondents reported perceived economic, psychosocial, and social impacts due to the pandemic.

Impact on Dental Economics and Dental Healthcare Utilization in COVID-19: An Exploratory Study

Aim:

The current exploratory research establishes a correlation between the general unemployment rate due to COVID-19 and its effect on dental healthcare service utilization, workforce, and education attainments.

Materials and methods:

The conceptual model utilized in the study is the circular flow diagram explaining economy organization. The study is an exploratory research review. PRISMA guidelines are followed for the review of articles. The literature data for the current review study is obtained from Web of Science, Statista, Grey Literature like, the Federal Bank St. Louis, American Dental Association (ADA), Health Policy Institute, to justify the economic impact in the dental industry sector. The search terms employed to search for literature from the Web of Science database are “Dental” and “COVID-19.” Only research articles published in the past one year in English language are included as the final sample of literature review. Statista, Federal Bank, and ADA are utilized to take into consideration evolving economic impact data due to COVID-19.

Results:

Much less of research has been performed on the impact of COVID-19 on dental economics, and this study is one of the insights of projections about COVID-19 impact in the dental healthcare sector. The projected hardships of the economy during and post pandemic demand for timely measures in place. The dental regulating bodies must undertake those protocols to save the dental healthcare industry.

Conclusions:

Unlike other healthcare sectors, the impact of COVID-19 will disproportionately affect the dental healthcare sector for several reasons. Given dental healthcare services aid in generating nation’s revenue like any other sector, it demands urgent actions from regulating authorities.

Corona virus disease bring a new challenge for the dentistry: A review

An outbreak of coronavirus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (SARS-CoV-2) began in the city of Wuhan in China and has widely spread worldwide. While human strains of coronavirus (CoV) are associated with about 15% of cases of the common cold, the SARS-CoV-2 may present with varying degrees of severity, from flu-like symptoms to death. It is currently believed that this deadly CoV strain originated from wild animals at the Huanan market in Wuhan, a city in Hubei province. Bats, snakes, and pangolins have been cited as potential carriers based on the sequence homology of CoV isolated from these animals and the viral nucleic acids of the virus isolated from SARS-CoV-2 infected patients. Common clinical signs of the infection comprises of respiratory symptoms in the form of fever, cough, shortness of breath, and breathing difficulties. In more severe cases, infection results in pneumonia, severe acute respiratory syndrome, kidney failure, and even death. Standard recommendations advocated to prevent spread of infection consist of frequent hand washing, covering mouth and nose when coughing and sneezing. This article, based on our experience and relevant guidelines and research, introduces essential knowledge about CoV in dental settings and provides recommended management protocols for dental practitioners affected areas.

Proceedings of the OMS COVID-19 Response Conference

The coronavirus disease 2019 (COVID-19) pandemic has affected the world in unprecedented ways. It is clear that this pandemic, unlike any public health challenge in recent memory, has the potential to fundamentally alter the delivery of many healthcare services, including the practice of oral and maxillofacial surgery. In response to this global health crisis, the Oral and Maxillofacial Surgery (OMS) COVID-19 Response Conference was held virtually on April 9, 2020, organized by oral and maxillofacial surgeons (OMSs) and administrators from multiple institutions to provide a forum for OMSs to discuss how COVID-19 has affected the specialty. As evidence-based information on COVID-19 continues to emerge, the present report serves as a method to disseminate the current opinions and management strategies from a variety of experts in OMS.

Reopening dentistry after COVID-19: Complete suppression of aerosolization in dental procedures by viscoelastic Medusa Gorgo

The aerosol transmissibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has impacted the delivery of health care and essentially stopped the provision of medical and dental therapies. Dentistry uses rotary, ultrasonic, and laser-based instruments that produce water-based aerosols in the daily, routine treatment of patients. Abundant aerosols are generated, which reach health care workers and other patients. Viruses, including SARS-CoV-2 virus and related coronavirus disease (COVID-19) pandemic, continued expansion throughout the USA and the world. The virus is spread by both droplet (visible drops) and aerosol (practically invisible drops) transmission. The generation of aerosols in dentistry-an unavoidable part of most dental treatments-creates a high-risk situation. The US Centers for Disease Control and The Occupational Safety and Health Administration consider dental procedures to be of "highest risk" in the potential spreading of SARS-CoV-2 and other respiratory viruses. There are several ways to reduce or eliminate the virus: (i) cease or postpone dentistry (public and personal health risk), (ii) screen patients immediately prior to dental treatment (by appropriate testing, if any), (iii) block/remove the virus containing aerosol by engineering controls together with stringent personal protective equipment use. The present work takes a novel, fourth approach. By altering the physical response of water to the rotary or ultrasonic forces that are used in dentistry, the generation of aerosol particles and the distance any aerosol may spread beyond the point of generation can be markedly suppressed or completely eliminated in comparison to water for both the ultrasonic scaler and dental handpiece.

Navigating telemedicine for facial trauma during the COVID-19 pandemic

Importance

The COVID-19 pandemic is changing how health care providers practice. As some telemedicine and telecommunication support tools have been incorporated into the otolaryngology practice in response to safety and access demands, it is essential to review how these tools and services can help facilitate facial trauma evaluation during a time when clinical resources are limited.

Objective

To review applications of telemedicine for the evaluation of facial trauma to better direct utilization of these methods and technologies during times of limited access to clinical resources such as the COVID-19 pandemic.

Methods

A systematic review was conducted using PubMed, Embase, and Web of Science.

Results

After screening 158 titles and abstracts, we identified 16 eligible studies involving facial trauma evaluation using telemedicine. Telemedicine opportunities for facial trauma evaluation have the potential to be developed in the areas of multidisciplinary remote consultations, facial trauma triage, patient engagement, and postoperative follow-up.

Conclusion

The COVID-19 pandemic is posing obstacles for both providers and patients in the delivery of health care at a time of limited clinical resources. Telemedicine may provide a potential useful tool in the evaluation and triage of facial injuries and patient engagement.

The patient-doctor relationship: new insights in light of the current Ministerial recommendations regarding Phase 2 of the COVID-19 pandemic

Following the publication of the Italian Ministerial recommendations relating to dentistry in Phase 2 of the COVID-19 pandemic (focusing on operational protocols for all dental staff), we believe that the patient/dentist relationship should increasingly take into account the heightened fears and anxious thoughts of patients. This particularly regards patients who are about to undergo dental work. Moreover, dentists should also pay close attention to recent events, which have determined the new recommendations regarding SARS-COV-2 biocontainment. Furthermore, the authors of this paper consider it appropriate to make suggestions and develop interventionist techniques regarding the interface with the patient starting from the initial consultation. The latter is invariably determinant in establishing clear communication of the Ministerial recommendations in encouraging a relaxed atmosphere with the patient. This interface is also a decisive factor in promoting patient empowerment, including specifying the time period envisaged for treatment in the new COVID-19 era in as calm a manner as possible. Such an approach will have a positive impact on the dentistry team.

A detailed report on the measures taken in the Department of Conservative Dentistry and Periodontology in Munich at the beginning of the COVID-19 outbreak

OBJECTIVES

The corona disease (COVID-19) is developing into one of the greatest challenges for healthcare professionals around the world. In this article, we report the detailed actions taken in the Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany, during the early phase of the COVID-19 pandemic.

MATERIAL AND METHODS

After a joint on-site inspection of the dental clinic with the Department of Clinical Microbiology and Hospital Hygiene, existing clinical and hygiene protocols were adapted for COVID-19 patients.

RESULTS

A comprehensive summary of the preparation of the facilities as well as pre- treatment, treatment and posttreatment protocols are described and arising problems are being discussed.

CONCLUSIONS

The importance of rigorous hygiene and treatment protocols as well as a sufficient supply of PPE for dental offices and hospitals is highlighted. The measures reported may be subject to change due to the dynamics of the pandemic.

CLINICAL RELEVANCE

The modes of transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (e.g., droplets, aerosols, and fomites) can pose a risk for dental healthcare professionals and patients alike. The presented measures may guide dental faculties and dental practices during the early stage of the COVID-19 crisis.

Analysis of Dentistry YouTube Videos Related To COVID-19

Abstract This study aimed to analyze the videos available on YouTube related to dentistry and the novel coronavirus (COVID-19), as there is no such analysis in the existing literature. The terms “dental” and “COVID-19” were searched on YouTube on May 9, 2020. The top 116 English-language videos with at least 300 views were analyzed by two observers. Data was saved for each video, including target audience, source, country of origin, content, number of views, time watched, average views, duration, like/dislike ratio, and usefulness. Total video information and quality index (VIQI) scores were calculated, consisting of flow, information, accuracy, quality, and precision indices. Non-parametric tests were used for analysis. The analyzed videos were viewed 375,000 times and totaled 20 h of content. Most videos were uploaded by dentists (45.7%), originated from the United States (79.3%), and contained information targeted towards patients (48.3%). Nearly half of the videos (47.4%) were moderately useful. For the usefulness of the videos, statistically significant differences were found for all indices as well as total VIQI scores. A comparison of the indices according to the relevance of the videos showed statistically significant differences in the videos’ information and precision indices and total VIQI scores. The results of this study showed that dentistry YouTube videos related to COVID-19 had high view numbers; however, the videos were generally moderate in quality and usefulness.

Physician deaths from corona virus (COVID-19) disease

Background

The COVID-19 pandemic has caused much morbidity and mortality to patients but also health care providers.

Aims

We tabulated the cases of physician deaths from COVID-19 associated with front-line work in hopes of mitigating future events.

Methods

On 15 April 2020, a Google internet search was performed using the keywords ‘doctor’, ‘physician’, ‘death’, ‘COVID’ and ‘coronavirus’ in English and Farsi, and Chinese using the Baidu search engine. The age, sex and medical speciality of physicians who died from COVID-19 in the line of duty were recorded. Individuals greater than 90 years of age were excluded.

Results

We found 278 physicians who died with COVID-19 infection, but complete details were missing for 108 individuals. The average age of the physicians was 63.7 years with a median age of 66 years, and 90% were male (235/261). General practitioners and emergency room doctors (108/254), respirologists (5/254), internal medicine specialists (13/254) and anaesthesiologists (6/254) comprised 52% of those dying. Two per cent of the deceased were epidemiologists (5/254), 2% were infectious disease specialists (4/254), 6% were dentists (16/254), 4% were ENT (9/254) and 3% were ophthalmologists (8/254). The countries with the most reported physician deaths were Italy (121/278; 44%), Iran (43/278; 15%), Philippines (21/278; 8%), Indonesia (17/278; 6%), China (16/278; 6%), Spain (12/278; 4%), USA (12/278; 4%) and UK (11/278;4%).

Conclusions

Physicians from all specialities may die from COVID. Lack of personal protective equipment was cited as a common cause of death. Consideration should be made to exclude older physicians from front-line work.

Evaluation of knowledge, attitudes, and clinical education of dental students about COVID-19 pandemic

BACKGROUND

The novel coronavirus disease (COVID-19) is a new viral respiratory illness, first identified in Wuhan province, China. Dental professionals and dental students are at an increased risk for these viruses from dental patients, as dental practice involves face-to-face communication with the patients and frequent exposure to saliva, blood, and other body fluids. Dental education can play an important role in the training of dental students, adequate knowledge and adopting attitudes regarding infection control measures. The aim of this study was to evaluate knowledge, attitudes, and clinical education of dental students about COVID-19 pandemic.

METHODS

A total of 355 pre-clinical and clinical dental students (242 and 113, respectively, comprising 190 females and 165 males) at Fırat University Dentistry Faculty, in Elazığ, Turkey answered an online questionnaire about the biosafety procedures for and their attitudes to and knowledge of COVID-19. The study was conducted in March 2020, Turkey. The data gained were analyzed using descriptive statistical methods and chi-square test.

RESULTS

Both the clinical and preclinical students were found to be afraid of infecting themselves and their environment with COVID-19, and the difference between them was statistically significant. Three quarters (74.9%) of the participants responded yes to the question of whether they thought that experiences related to COVID-19 affected them psychologically, with the differences between gender and clinical status were statistically significant. Responses to the question of which clinical rotation worried them more were 29.9% endodontics, 25.1% oral and maxillofacial surgery, 16.3% prosthesis, 15.2% periodontology, 6.8% restorative dentistry, 3.9% oral diagnosis and radiology, 1.7% pedodontics, and 1.1% orthodontics, with a significant difference between the preclinical and clinical students. Regarding the measures applied by the clinical students in their clinical rotation, the responses were 100% gloves and 100% mask (with 11.5% FFP3/N95 mask), 73.6% face protective shield and 37.1% safety glasses, and 49% bonnet and 16.8% disposable box, with 90.2% frequent hand washing, and 86.7% frequent hand antiseptic usage.

CONCLUSIONS

While students gave good responses regarding the standard measures they take to protect against transmission of COVID-19, their knowledge and attitudes about the extra measures they can take should be improved. For students to be least affected by fears associated with the disease, dental faculties should be ready to provide psychological services to those in need.

Biosafety Measures at the Dental Office After the Appearance of COVID-19: A Systematic Review

The purpose of this research was to determine biosecurity measures at the dental office after the appearance of coronavirus disease 2019 (COVID-19). A search was conducted in the main databases of the scientific literature using the words “COVID-19, coronavirus, SARS-Cov2, biosecurity, disinfection and dentistry.” We analyzed biosecurity and disinfection standards at the dental office and dental health personnel to date, and their adaptation to the needs and way of working of each. As a result, according to the information collected the following procedure was identified: a telephone appointment must be made and a questionnaire should be given before dental care; at arrival to the appointment, the temperature of the patient should be taken and proper cleaning and disinfection of the waiting room should be maintained. Panoramic radiography and CBCT are the auxiliary methods of choice. Absolute isolation and atraumatic restorative therapy techniques are a good alternative to decrease fluid exposure. The removal of protective clothing and accessories must follow a specific order and washing hands before and after is essential. In conclusion, the efficient biosecurity for dentists and patients in all dental care processes before, during, and immediately after the appointment reduces the risk of COVID-19 infection and allows healthy dental care environments.

Perceived Job Insecurity and Depressive Symptoms among Italian Dentists: The Moderating Role of Fear of COVID-19

Containment measures adopted to reduce the spread of coronavirus disease 2019 (COVID-19) have produced a general perception of job insecurity. Dentists have been highly affected by such measures, as they represent an easy source of contagion. As perceived job insecurity is associated with psychological distress and Italian dentists have been highly affected by the COVID-19 outbreak in terms of potential financial loss and the risk of being infected, this study aimed at assessing whether the fear of COVID-19 moderated the effect of perceived job insecurity on depressive symptoms. This cross-sectional online study has included 735 Italian dentists recruited during the lockdown and ranging in age from 27 to 70 years old (495 men and 240 women). A quantile regression model with an inference based on the median and with an interaction term between the fear of COVID-19 and perceived job insecurity has been used to estimate the hypothesized associations. The results indicated that both perceived job insecurity and fear of COVID-19 were positively associated with depressive symptoms, and that the effect of perceived job insecurity on depressive symptoms was weaker among those with a low fear of COVID-19. The findings may inform public health policies for dentists in relation to reducing the risk of developing negative mental health outcomes.

The efficacy and safety of Lianhua Qingwen (LHQW) for coronavirus disease 2019 (COVID-19): A protocol for systematic review and meta analysis

BACKGROUND

Since the outbreak of Novel Coronavirus Pneumonia (NCP), it has swept the world with rapid development. Up to now, there is no effective drug to treat it. Lianhua Qingwen has been used in the treatment of COVID-19 in China, but there is no systematic review about it. This study will systematically evaluate its efficacy and safety in the treatment of COVID-19.

METHODS

We will search electronic database of PubMed, EMBASE, Cochrane library, Web of Science (WOS), China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chinese Scientific and Journal Database (VIP) and Wan Fang database (Wanfang) for the literature of RCTs of Lianhua Qingwen capsule for coronavirus disease 2019 (COVID-19). We will also search the Chinese Clinical Trial Registry (ChiCTR) and ClinicalTrials.gov (www.ClinicalTrials.gov) for ongoing trials with unpublished data, and the Conference abstracts will be searched manually. We will use the Cochrane Handbook for Systematic Reviews of Interventions to assess the risk of bias. The protocol will be conducted according to the approach and Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P).

RESULTS

The study results will provide evidence of the efficacy and safety of Lianhua Qingwen (LHQW) for coronavirus disease 2019 (COVID-19).

CONCLUSION

The result of the study will be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42020180877.

Change of Outpatient Oral Surgery during the COVID-19 Pandemic: Experience of an Italian Center

COVID-19, which appeared to originate in China in December 2019, has spread worldwide in a pandemic way. The aim of this work is to present a protocol to standardize the outpatient oral surgery activities through remote triage, diagnostic tests, protections, and precautions that allow to provide care while minimizing risk for both patients and surgeons. This article summarizes the clinical and surgical experience of the Oral Surgery Unit of the “Mater Domini” Hospital (Magna Graecia University of Catanzaro, Italy) during the COVID-19 pandemic. The application of a scrupulous triage protocol, the use of remote consultations to limit patients' access to the clinic, and the correct use of PPE prevented transmission of the virus between patients and staff members.

Copper-Alloy Surfaces and Cleaning Regimens against the Spread of SARS-CoV-2 in Dentistry and Orthopedics. From Fomites to Anti-Infective Nanocoatings

The latest diffusion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the coronavirus disease (COVID-19), has involved the whole world population. Even if huge efforts to control the pandemic have been done, the viral spread is still continuing. COVID-19 is reported as a zoonosis jumped from bats and pangolins to humans. After infection in humans, SARS-CoV-2 is found in the nasopharyngeal and salivary secretions. The virus has also been detected in the blood plasma of infected patients. The viral spread occurs through droplets exhaled from the nose and mouth of the infected people when they breath or talk, or through droplets propelled as a dense cloud by chough or sneeze. The virus can also be delivered as an aerosol from blood plasma, through surgical procedures. Following these ways, the virus can disperse in the air, then reaching and settling on the exposed surfaces. How long the virus will survive on a surface depends on the material the surface is made from. Infection via high-touch surfaces should be prevented. Copper alloy coatings, combined with efficient hygienic/disinfectant procedures and careful surgical practice, could be helpful to health protection in dental practice and can also be adopted in orthopedic traumatology.

COVID-19 in Dental Practice: Transmission Risk, Infection Control Challenge, and Clinical Implications

Objective:

The COVID-19 pandemic has become a worldwide, significant public health challenge. Dental care providers are at high risk due to the nature of their profession, which necessitates close proximity to the patient's oropharyngeal region and the use of droplet and aerosol-generating procedures.

Methods:

A review of the evolving literature on the COVID-19 pandemic was conducted. Published articles addressing SARS-CoV2 transmission modes and risks, and infection control procedures required in the dental office to protect dental patients and health care providers were assessed. Also, clinical guidelines on the management of dental patients during the pandemic were reviewed.

Results:

The established modes of transmission of SARS-CoV2 appear to be through respiratory droplets and through close contact with either symptomatic or asymptomatic patients. In addition to standard precautions of infection control widely followed in dental practices, extra precautionary measures are needed to control the spread of this highly infectious disease. Dental treatment during the pandemic is limited to emergent and urgent cases after a meticulous patient risk assessment and dental needs are triaged to minimize the risk of COVID-19 transmission and avoid cross-contamination.

Conclusion:

Dentists should be aware of the recently updated knowledge about COVID-19 modes of transmission and the recommended infection control measures in dental settings. Effective management protocols to regulate droplet and aerosol contamination in the dental clinic should be implemented to deliver dental care in a safe environment.

Utilizing Aligners to Solve the COVID-19-Affected Orthodontic Practice Conundrum!

Dentists all around the world are facing a dilemma on whether to resume their practice or not and the ones who have made the effort to resume work, feel they are at high risk of getting infected by the coronavirus. A majority of dental treatments require the use of high-speed handpieces as well as ultrasonic scalers which can make it even more dangerous for the treating dentists and assistants as these release aerosols which could aid in virus transmission. High-quality personal protective equipment is hard to procure and, if so, is very expensive adding to the cost of running clinics during this period. One of the main issues plaguing dentists practicing orthodontics is the inability to see their patients regularly during this period, which can cause a lot of unwanted tooth movements. This is where aligners can be of big help as the entire treatment planning process can be done virtually and the treatment can be monitored without the need of the patient having to visit the clinic physically.

Assessment of the Economic and Health-Care Impact of COVID-19 (SARS-CoV-2) on Public and Private Dental Surgeries in Spain: A Pilot Study

Objectives: The COVID-19 (SARS-CoV-2) pandemic is an ongoing public health challenge, also for the dentistry community. The main objective of this paper was to determine the economic and health-care impact of COVID-19 on dentists in the Autonomous Region of Galicia (Spain). Methods: This was a descriptive observational study in which the data was collected by means of a self-administered survey (from 1 April 2020 to 30 April 2020). Results: A total of 400 dentists from Galicia responded to the survey. Only 12.3% of the participants could obtain personal protective equipment (PPE) including FFP2 masks. Of the male respondents, 33.1% suffered losses >€15,000 compared to 19.4% of female respondents (OR = 3.121, p < 0.001). Economic losses seem to have contributed to the applications for economic help as 29.5% of the respondents who applied for this measure recorded losses in excess of €15,000 (p = 0.03). Patients complained more about the fact that only emergency care was available during the State of Alarm, in dental surgeries that do not work with insurance companies or franchises. Only 4 professionals tested positive, 50% of whom worked exclusively in private practice and the other 50% who practised in both private and public surgeries. Dentists who practise in the public sector saw more urgent patients per week than those practising in private surgeries (p = 0.013). Conclusions: The COVID-19 pandemic has had economic repercussions in dentistry as only urgent treatment was available during the State of Alarm. These repercussions seem to be higher in male participants, as the majority of the participants have revealed higher economic losses than females. The level of assistance has also been affected, reducing the number of treated patients, although this quantity has been different in private and public surgeries. By presenting these findings we look to highlight the role that dentists play in society in treating dental emergencies in our surgeries, and this must be recognised and addressed by the relevant authorities, who must provide PPEs as a priority to this group as well as providing special economic aid in accordance with the losses incurred by the sector.

Publications on COVID-19 in High Impact Factor Journals: A Bibliometric Analysis

The COVID-19 pandemic caused by the SARS-CoV-2 virus has sickened more than six million people worldwide. This context has led to an abundance of publications quickly since the beginning of the outbreak. In a few months, thousands of scientific papers have appeared. This article aims to provide a bibliometric analysis of the publications on COVID-19 in five high-impact journals indexed to the Web of Science Core Collection's Science Citation Index Expanded (SCI-EXPANDED) including The Lancet, New England Journal of Medicine, Science, Nature, and JAMA-Journal of the American Medical Association. We found 169 documents associated with the search criteria. The findings indicate that China, the United States, and the United Kingdom are the most represented countries in these publications, The Lancet is the journal with the highest number of contributions with 66% of documents, and the University of Hong Kong leads the ranking of institutions. Future bibliometric and scientometric studies on COVID-19 should provide updated information to analyse other relevant indicators in this field.

COVID-19: a new turning point for dental practice

Recent new zoonotic respiratory viruses have infected humans and led to severe acute respiratory syndrome: severe acute respiratory syndrome coronavirus (SARS-CoV), influenza A H5N1, influenza A H1N1 and Middle East respiratory syndrome coronavirus (MERS-CoV). The first SARS-CoV outbreak took place in 2003, in Guangdong, China. A decade later, another pathogenic coronavirus, MERS-CoV caused an endemic in Middle Eastern countries. The latest pandemic coronavirus infectious disease (COVID-19) has been related to the newly isolated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For the first time since the acquired immunodeficiency syndrome (AIDS) in the 1980s. Dentistry is facing a new turning point. This critical review aims to discuss the impact of COVID-19 infection on oral health care. In dental practice COVID-19 patients are the main source of infection and symptomatic patients are more contagious. Dentists can be first line of diagnosis of the disease, as they work in close contact with patients and are at the risk of being affected by COVID-19 and all respiratory infections. Several guidelines for dental practice environments have been published by dental associations and regulatory boards. It is already evident that biological, psychological and social effects of the COVID-19 pandemic have present and future impacts on dental practice. Dental schools, regulatory boards, scientific associations, government authorities, and public and private health care services must join efforts to design enduring answers for severe and long-standing viral challenges.

COVID-19 pandemic: Students' perspectives on dental geriatric care and education

Objectives

With the emergence of the COVID‐19 pandemic in Canada and the curtailment of clinical and face‐to‐face university instruction in British Columbia on March 16, 2020, the opportunity arose to explore how third‐ and fourth‐year undergraduate dental students critically considered the impact of the pandemic on education and the practice of dental geriatrics.

Methods

All third‐ and fourth‐year undergraduate dental students within a dental geriatric module were asked to provide a written guided reflection on the question: “In your opinion, what factors make outbreaks (or pandemics) like COVID‐19 relevant to the practice of dental geriatrics?” Reflections were gathered from March 12 to May 8, 2020. Thematic analysis was conducted to identify and interpret patterns of meaning within the reflections by means of an interactive coding process.

Results

A total of 115 reflections, between 291 and 710 words each, were received from 56 third‐year (62.5% male) and 59 fourth‐year (42.6% male) students. Five main themes emerged: experiencing uncertainties, frailty as a moderator, constraints in accessing care, preparedness protocol, and redefining care. The frequency in which the same codes, categories, and themes were assigned varied from 16 to 140 times.

Conclusions

Students’ reflections highlighted the effects of the pandemic, not only on their education but also on frail older adults themselves and the profession of dentistry in general. Further studies are warranted to explore how this curtailment might impact educators’ approaches to geriatric education, as well as the way graduating students will set up their practices and approach geriatric care in the future.

Biosafety for Dental Patients During Dentistry Care After COVID-19: A Review of the Literature

The world is currently changing due to coronavirus disease 2019 (COVID-19), and the field of dentistry is no stranger to this. The care of patients in the dental office involves very strict biosafety protocols, and patients must be aware of the protection barriers implemented to allow satisfactory, safe dental care. The purpose of this study was to synthesize and analyze the management of the current biosafety standards for dental patients since the arrival of the COVID-19 pandemic. A bibliographic search of the main sources of information including MEDLINE (by means of PubMed), Scopus, Science Direct, SCIELO, and Google Scholar was carried out. Articles published without language restriction, systematic reviews, literature reviews, and observational studies were included. We identified the biosafety measures that must be taken before, during, and after dental practice following the arrival of COVID-19. The main measures include telephone triage, temperature taking on arrival at the office, the organization of the waiting room, washing hands before entering the office, knowing the auxiliary radiographic exams of choice and what type of treatment can be performed, albeit with restrictions. In conclusion, dental patients must comply with all the biosafety measures established by international protection standards and implemented by dentists before, during, and after dental practice to reduce the possibility of COVID-19 infection.

Subjective Overload and Psychological Distress among Dentists during COVID-19

Psychological distress during the COVID-19 pandemic is not solely limited to SARS-CoV-2 infection. It may also be related to social, cultural, and environmental factors, which may act as additional stressors. The aim of the current study was to explore the association between psychological distress and subjective overload among dentists in different countries, and whether it is associated with COVID-19-related factors. A cross-sectional survey was conducted among 1302 dentists from China, India, Israel, Italy, and the UK, who filled out demographics data, COVID-19-related factor questions, subjective overload, and psychological distress scales. Our findings showed that the positive association between subjective overload and psychological distress was different among countries, suggesting higher rate of intensity in Italy compared to China, India, and Israel (the UK was near significance with China and Israel). The interaction variable of the subjective overload × psychological distress was significantly associated with a particular country, with those individuals reporting fear of contracting COVID-19 from patients, fear of their families contracting COVID-19, and receiving enough professional knowledge regarding COVID-19. Given the above, dentists were found to have elevated levels of subjective overload and psychological distress, which differed among the countries, presumably due to certain background issues such as social, cultural, and environmental factors.

Mental distress in orthodontic patients during the coronavirus disease 2019 pandemic

Introduction

The ongoing coronavirus disease 2019 (COVID-19) outbreak impacts the mental health of patients, health workers, and the public. The level of impact on the mental health of orthodontic patients in treatment is unknown. The objective of the study was to evaluate the mental health of orthodontic patients in China during the early stage of the pandemic.

Methods

An online survey was conducted on a convenience sample of anonymous participants. The questionnaire, in Chinese (Mandarin), comprised 5 sections. Sections 1-3 included demographic, epidemical, and orthodontic status of the patients. Section 4 assessed mental health-related to orthodontics. Section 5 was the Kessler-10 Mental Distress Scale. A total of 48 orthodontists were invited to distribute the questionnaires to their patients. Descriptive statistics, principal component analysis, K-means cluster analysis, and bivariate logistics regression analysis were performed with significance set at P <0.05.

Results

Questionnaires were collected from 558 patients (104 males, 354 females; mean age 24.78 ± 6.33 years). The prevalence of mental distress was 38% (174/458). Higher odds ratios were associated with female participants, missed appointments, and Hubei residence. The type of orthodontic appliance was associated with the anxiety of prolonged treatment duration. The manner of communication with patients regarding the postponement of appointments was associated with patients' concerns of prolonged treatment duration. The frequency of contact from dentists was associated with patients' independence.

Conclusions

Over one-third of orthodontic patients experienced mental distress during the pandemic. Multiple factors affected the level of anxiety of orthodontic patients, such as the type of orthodontic appliance, time since last dental visit, manner of communication with the orthodontist, and the localities of the pandemic progression.

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Thirty-eight percent of patients had orthodontic-related mental distress during the pandemic.

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Orthodontic patients in the epicenter revealed higher odds of mental distress.

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Orthodontists who contact patients personally might relieve their anxiety.

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Patients with invisible appliances felt less anxiety about the duration of treatment.

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The results could guide orthodontists from other countries with similar situations.

Coronavirus disease 2019 (COVID-19): Experiences and protocols from the Department of Prosthodontics at the Wuhan University

STATEMENT OF PROBLEM

The novel Coronavirus Disease 2019 (COVID-19) is a global pandemic, and many countries and regions are still currently in the midst of the outbreak. This pandemic has caused prosthodontics units to suspend their clinical and educational operations in academia.

PURPOSE

The purpose of this article was to review the experiences from the Department of Prosthodontics, Wuhan University School and Hospital of Stomatology (DP-WHUSHS), during the COVID-19 outbreak and the protocols DP-WHUSHS used to resume clinical activities after the outbreak.

MATERIAL AND METHODS

The descriptive approach was used in this article to provide a chronological narrative of the experiences and protocols from the DP-WHUSHS during the COVID-19 outbreak and after the outbreak.

RESULTS

During the COVID-19 outbreak period, clinical care was provided for patients with dental emergencies by using enhanced grade 2 or grade 3 personal protective equipment (PPE). Teledentistry was used to provide care for patients with nonemergency needs. Online webinars and lectures were conducted for the predoctoral students, residents, and dentists to minimize the interruption in their education and engage the dental community amid the pandemic. Various factors were considered before clinical activities resumed after the outbreak subsided. Additional resources were allocated for facility preparation and management and employee training. New infection control and clinical operation protocols were developed to minimize the health-care-associated infection of airborne transmission diseases. The psychological health and mental wellness of the employees were emphasized. Distance or online education is still under rapid development to provide students and dentists opportunities to advance their knowledge amid the pandemic.

CONCLUSIONS

Within the limitation of this descriptive review, the following conclusions were drawn. Patient welfare and emergency needs should be considered amid the pandemic. Enhanced grade 2 or grade 3 PPE should be used during the outbreak. Multifactorial considerations for work resumption after the outbreak included facility preparation and management, training for employees, and clinical operation management. In-person psychological consultation and online mental wellness programs were available to employees to improve their mental wellness. Distance or online education was under rapid development to minimize the interruption in education for the students and to engage the dental community amid a pandemic.

COVID-19 Pandemic and Dental Practice

SARS-CoV-2, a virus causing severe acute respiratory syndrome, has inundated the whole world, generating global health concerns. There is a wildfire-like effect, despite the extensive range of efforts exercised by the affected countries to restrain the expanse of this pandemic, owing to its community spread pattern. Dental specialists in the upcoming days will likely come across patients with presumed or confirmed COVID-19 and will have to ensure stringent infection prevention and control to prevent its nosocomial spread. This paper strives to provide a brief overview of the etiology, incubation, symptoms, and transmission paradigms of this novel infection and how to minimize the spread in a dental healthcare setting. This review presents evidence-based patient management practice and protocols from the available literature to help formulate a contingency plan with recommendations, for the dental practices prior to patients' visit, during in-office dental treatment, and post-treatment, during the pandemic and after.

COVID-19: establishing an oral surgery-led urgent dental care hub

COVID-19 has changed the face of dentistry in the UK and around the world. The potential for aerosol generation, the presence of the virus within saliva and the fact that dental professionals work with the oral-pharyngeal environment determines that dental treatment poses a risk of viral transmission. At the start of the pandemic, the cessation of routine dental care across the country necessitated the rapid establishment of an emergency dental service at King's College Hospital. This paper describes its evolution to date and the challenges encountered along the way.

Provision of dental services at a single institution in the UK's epicentre during the COVID-19 pandemic

Coronavirus disease 2019 (COVID-19) has had a significant impact on dentistry in the UK due to the perceived risks associated with infection control. These concerns have led to a complete paralysis of routine dental care with provisions for emergency dental care only, which have been scarce. Considering the latter, this article presents a service evaluation of a hospital-based acute dental care service, which was rapidly adapted and enhanced to continue managing dental emergencies during the COVID-19 pandemic. The analysis is based upon the dental diagnoses, management and geography of travel of over 1,500 attending patients in a five-week period during the rise and peak of COVID-19 in the UK. In addition, we assess our dental workforce's COVID-19 sickness reporting for those providing urgent dental care within this enhanced service. The article aims to provide additional and valuable frontline clinical information, experience and outcomes, including our categorisation of personal protective equipment used for varying face-to-face dental management during COVID-19.

Saliva: a diagnostic option and a transmission route for 2019-nCoV

Data sources This review included 13 clinical studies (observational or clinical trial) which reported results of studies of the 2019 novel coronavirus (2019-nCoV). The other 62 referenced papers were of different types (eg, reviews, WHO protocols, letter to editor etc).Study selection The study selected trials, reviews, and in-vitro research assessing the critical aspects of saliva as an easily accessible and early-stage diagnostic source, and also an entry route for 2019-nCoV. Most of the clinical studies were descriptive case series of patients who had contracted 2019-nCoV in China. These were mainly studies designed to compare saliva samples with throat swabs, with regard to the presence of 2019-nCoV RNA. Another aspect of the included studies was the susceptibility of oral tissues to 2019-nCoV due to the expression of angiotensin-converting enzyme II (ACE2) as a receptor for the 2019-nCoV. Some review studies and clinical infection control protocols were also included to discuss the transmission patterns of 2019-nCoV from the oral cavity. Studies were not restricted to English language and they were not all full-text papers.Data extraction and synthesis A narrative synthesis of the results was conducted using distinct headings and subheadings, defined by the authors based on relevancy to the consensus about the importance of saliva with reference to 2019-nCoV.Results There was an inherent heterogeneity among the included clinical studies concerning their designs, sampling techniques, and the results about the diagnostic value of saliva. The percentage of coronavirus disease of 2019 (COVID-19) patients with positive 2019-nCoV RNA varied from 12.9% to 91.67% among these studies. Regarding the possibility of direct virus invasion into the oral tissues, the results suggested that ACE2+ cells in salivary glands could possibly be the target cells of 2019-nCoV and theoretically could generate infectious saliva in a sustained way. Furin was suggested as another protein which makes the tongue more vulnerable to 2019-nCoV, especially in conditions inducing its upregulation (for example, squamous cell carcinoma). According to the comparisons between 2019-nCoV and SARS-CoV, saliva could be considered of diagnostic value via the early detection of viral RNA for both of the viruses. Whilst the viral peak was shown to be at onset of symptoms for 2019-nCoV, it can linger up to the tenth day after the appearance of symptoms for SARS-CoV. Finally, this paper warns about airborne transmission, particularly for close contacts.Conclusions Saliva can be proposed as an easily accessible diagnostic source although further clinical studies are required. Given the presence of viral RNA in saliva in the early stages of COVID-19, the recommendations to wear masks to prevent the rapid transmission of infectious droplets into the air, and keep a safe distance from other people are clearly based in evidence.

Safety guidelines for nonsurgical facial procedures during COVID-19 outbreak

Background

The novel coronavirus (COVID‐19) pandemic is expected to last for an extended time, making strict safety precautions for office procedures unavoidable. The lockdown is going to be lifted in many areas, and strict guidelines detailing the infection control measures for aesthetic clinics are going to be of particular importance.

Methods

A virtual meeting was conducted with the members (n = 12) of the European Academy of Facial Plastic Surgery Focus Group to outline the safety protocol for the nonsurgical facial aesthetic procedures for aesthetic practices in order to protect the clinic staff and the patients from SARS‐CoV‐2 infection. The data analysis was undertaken by thematic and iterative approach.

Results

Consensus guidelines for nonsurgical facial aesthetic procedures based on current knowledge are provided for three levels: precautions before visiting the clinic, precautions during the clinic visit, and precautions after the clinic visit.

Conclusions

Sound infection control measures are mandatory for nonsurgical aesthetic practices all around the world. These may vary from country to country, but this logical approach can be customized according to the respective country laws and guidelines.

Is the ultrasonic scalpel recommended in head and neck surgery during the COVID-19 pandemic? State-of-the-art review

BACKGROUND

Guidelines for ultrasonic devices use are imperative because infectious aerosols arising from airway procedures were a key etiologic factor in prior coronavirus outbreaks. This manuscript aims to summarize the available recommendations and the most relevant concepts about the use of ultrasonic scalpel during the SARS-CoV-2 pandemic.

METHODS

Literature review of manuscripts with patients, animal models, or in vitro studies where the ultrasonic scalpel was used and the plume produced was analyzed in a quantitative and/ or qualitative way.

DISCUSSION

Activated devices with tissue produce a biphasic bioaerosol composed (size 68.3-994 nm) of tissue particles, blood, intact and no viable cells, and carcinogenic or irritant hydrocarbons (benzene, ethylbenzene, styrene, toluene, heptene, and methylpropene).

CONCLUSION

It is imperative to use an active smoke evacuator, to avoid ultrasonic scalpel use in COVID-19 positive patients and in upper airway surgery, as well as to follow the protection recommendations of the guidelines for management this type of patients.

A Survey on Perceived COVID-19 Risk in Dentistry and the Possible Use of Rapid Tests

AIM

The present study was conducted to assess the perceived risk of COVID-19 transmission in dental professionals (DPs), that include dentists and dental auxiliary staffs, and whether rapid tests should be a recommended tool to constrain the transmission of the COVID-19, and who should be bearing their cost (governments, dentists, or patients) through an online survey.

MATERIALS AND METHODS

A sample size of n = 700 was recruited in the study. The study included DPs from all over the world. A randomized selection of samples was done through dental groups present on social networks. An online survey was conducted in April 2020, using the Google Form software to provide questions and collect and elaborate answers. Data were analyzed using the statistical software STATA and presented in terms of percentages.

RESULTS

About 78% of the study participants perceived a very high risk of COVID-19 contamination in dental settings. Nearly 80% of the study participants were willing to be subjected to rapid tests and the same could be performed on patients visiting their dental clinics, which could prevent the spread of the disease. About 55% of the participants had reported that additional costs for the rapid tests should be borne by the governments.

CONCLUSION

The results of the present survey report that DPs do not feel safe and perceive a high risk of COVID-19 contagion and prevention of the disease could be done by performing rapid tests on dentists, dental staff, and patients visiting the dental clinics irrespective of age and gender of the participants.

SIGNIFICANCE

Since all the dentists and allied staff have perceived increased risk for COVID-19 transmission, it is important that preventive measures are implemented through rapid test kits at the earliest.

Evolution of COVID-19 Guidelines for University of Washington Oral and Maxillofacial Surgery Patient Care

The emergence of coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 (SC2) virus, in late December 2019 has placed an overwhelming strain on healthcare institutions nationwide. The modern healthcare system has never managed a pandemic of this magnitude, the ramifications of which will undoubtedly lead to lasting changes in policy and protocol development for viral testing guidelines, personal protective equipment (PPE), surgical scheduling, and residency education and training. The State of Washington had the first reported case and death related to COVID-19 in the United States. Oral and maxillofacial surgeons have a unique risk of exposure to SC2 and developing COVID-19 because of our proximity of working in and around the oropharynx and nasopharynx. The present report has summarized the evolution of COVID-19 guidelines in 4 key areas: 1) preoperative SC2 testing; 2) PPE stewardship; 3) surgical scheduling guidelines; and 4) resident education and training for oral and maxillofacial surgery at the University of Washington, Seattle, Washington.

Clinical orthodontic management during the COVID-19 pandemic

OBJECTIVES

To provide a comprehensive summary of the implications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) on orthodontic treatment, contingency management, and provision of emergency orthodontic treatment, using currently available data and literature.

MATERIALS AND METHODS

Orthodontically relevant sources of information were searched using electronic databases including PubMed and Google Scholar and current reports from major health bodies such as Centers for Disease Control and Prevention, World Health Organization, National Institutes of Health, and major national orthodontic associations.

RESULTS

Where available, peer-reviewed and more recent publications were given priority. Due to the rapidly evolving nature of COVID-19 and limitations in quality of evidence, a narrative synthesis was undertaken. Relevant to orthodontics, human-to human transmission of SARS-CoV-2 occurs predominantly through the respiratory tract via droplets, secretions (cough, sneeze), and or direct contact, where the virus enters the mucous membrane of the mouth, nose, and eyes. The virus can remain stable for days on plastic and stainless steel. Most infected persons experience a mild form of disease, but those with advanced age or underlying comorbidities may suffer severe respiratory and multiorgan complications.

CONCLUSIONS

During the spread of the COVID-19 pandemic, elective orthodontic treatment should be suspended and resumed only when permitted by federal, provincial, and local health regulatory authorities. Emergency orthodontic treatment can be provided by following a contingency plan founded on effective communication and triage. Treatment advice should be delivered remotely first when possible, and where necessary, in-person treatment can be performed in a well-prepared operatory following the necessary precautions and infection prevention and control (IPAC) protocol.

Potential SARS-COV preclinical (in vivo) compounds targeting COVID-19 main protease: a meta-analysis and molecular docking studies

BACKGROUND

Due to the migratory flow of infected people with severe acute respiratory syndrome virus (SARS COV-2), the number of confirmed cases of coronavirus disease 2019 (COVID-19) is accelerating globally; preclinical evidence of antiviral agents that can combat this pandemic is still elusive. We identified published articles on SARS-COV efficacy experiments in which some selected compounds were used to test the reduction of the virus load in mice.

METHODS

A systematic search of articles was conducted in PubMed, Web of Science, and Scopus. We then developed a combined model based on a systematic review, meta-analyses, and molecular docking studies to evaluate the effect size of preclinical studies of compounds that have been tested against SARS-COV. Because substantial heterogeneity was expected, random effect model meta-analyses were carried out to estimate the overall pooled disease's prevalence. All meta-analyses were performed with Stata version 15.0. Subgroup analyses on therapies were conducted as well. Molecular docking studies of the inhibitors in the active pocket of COVID-19 protease were also performed.

RESULTS

From all screened articles, six studies were appropriate for ultimate meta-analysis and systematic review. The residual amount of heterogeneity was high (τ2 =0.02; heterogeneity I2 =85.5 % with heterogeneity chi-square =103.57, a degree of freedom =15, and p <0.001). The overall random pooled prevalence of infected mice treated with the selected compounds was 78.1 % [95 % Confidence Interval (CI): 14.7-17.0 %]. Prophylactic has a significantly higher pooled prevalence than therapeutic, with 21.8 % (95 % CI: 16.4 % to 28.8 %). Our results indicated that most of the SARS-COV inhibitors analyzed were less effective in reducing the lung virus titer of SARS-COV infection in animal models. The findings from molecular docking studies also identified COVID-19 inhibitors that are good for optimization and drug development to fight against COVID-19 infection.

CONCLUSIONS

Findings from the review showed that studies on the preclinical compounds targeting SARS-COV and COVID-19 are limited. Furthermore, molecular docking studies and meta-analysis results substantiated three compounds, i.e., EIDD-2801, GS-5734, and amodiaquine. HIPPOKRATIA 2020, 24(3): 99-106.