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

COVID-19: Changing Trends and Its Impact on Future of Dentistry

The outbreak of coronavirus disease 2019 (COVID-19) rapidly escalated into a worldwide pandemic, creating a global health and economic crisis. It is a novel virus which is distinct from SARS-CoV and MERS-CoV, with Chinese horseshoe bats being the most probable origin. Transmission occurs primarily through droplet spread or contact routes. Due to the characteristics of dental settings, the risk of cross infection between dental health care personnel (DHCP) and patients can be very high. This article provides a brief overview of the structure of the virus, modes of transmission, and clinical features of COVID-19 disease. The aim of this article is to recommend infection control strategies and patient management protocols to provide optimum dental care and simultaneously prevent nosocomial infection in dental settings.

Impact of SARS-CoV2 (Covid-19) on dental practices: Economic analysis

Objectives

To combat SARS-CoV2 (Covid-19), policy makers worldwide have adopted different policy alternatives, often including mitigation/suppression policies. We assessed the economic impact of such policies on dental practices in Germany using a modelling approach.

Methods

A providers’ perspective within German healthcare was taken, with two provider scenarios (low/high volume practice, low/high proportion of non-statutory insurance revenue, low/high staff pool and costs; S1 and S2 scenarios) being modelled. Providers’ costs were estimated in different blocks (staff, material, laboratory, others). A telephone-based survey was conducted on 24th March to 2nd April 2020 on a random sample of 300 German dentists (response: n = 146) to determine the experienced dental services utilization changes in these service blocks. A Markov model was constructed, following 100 practices in each scenario for a total of 365 days. Different Covid-19 mitigation/suppression periods (90 days: base-case, 45, 135 days: sensitivity analyses) were modelled. Monte-Carlo micro-simulation was performed and uncertainty introduced via probabilistic and univariate sensitivity analyses.

Results

Mitigation/suppression reduced utilization of all services, the most severe for prevention (-80 % in mean), periodontics (-76 %) and prosthetics (-70 %). Within the base-case, mean revenue reductions were 18.7 %/15.7 % from the public insurance, 18.7/18.6 % from private insurers and 19 %/19 % for out-of-pocket expenses in S1/S2, respectively. If the mitigation/suppression was upheld for 135 days, overall revenue decreased by 31 %/30 % in S1/S2, respectively. In this case, 29 %/12 % S1/S2 would have a negative net profit over the course of one year.

Conclusions

Covid-19 and associated policies have profound economic effect on dental practices.

Clinical signifiance

Policy makers will want to consider our findings when designing governmental subsidy and safety nets with immediate and midterm economic relieve effects. Dentists may consider practice re-organization to reduce costs and maintain minimum profitability.

Covid-19 Pandemic: What Changes for Dentists and Oral Medicine Experts? A Narrative Review and Novel Approaches to Infection Containment

The authors performed a narrative review on Severe Acute Respiratory Syndrome- CoronaVirus-2 ( SARS-CoV-2) and all infectious agents with the primary endpoints to illustrate the most accepted models of safety protocols in dentistry and oral medicine, and to propose an easy view of the problem and a comparison (pre- vs post-COVID19) for the most common dental procedures. The outcome is forecast to help dentists to individuate for a given procedure the differences in terms of safety protocols to avoid infectious contagion (by SARS-CoV-2 and others dangerous agents). An investigation was performed on the online databases Pubmed and Scopus using a combination of free words and Medical Subject Headings (MESH) terms: "dentist" OR "oral health" AND "COVID-19" OR "SARS-CoV-2" OR "coronavirus-19". After a brief excursus on all infectious agents transmittable at the dental chair, the authors described all the personal protective equipment (PPE) actually on the market and their indications, and on the basis of the literature, they compared (before and after COVID-19 onset) the correct safety procedures for each dental practice studied, underlining the danger of underestimating, in general, dental cross-infections. The authors have highlighted the importance of knowing exactly the risk of infections in the dental practice, and to modulate correctly the use of PPE, in order to invest adequate financial resources and to avoid exposing both the dental team and patients to preventable risks.

Effect of the COVID-19 Pandemic on the Activity of Physicians Working in the Areas of Head and Neck Surgery and Otorhinolaryngology

Introduction  Coronavirus disease 2019 (COVID-19) is an acute infection caused by the new coronavirus (SARS-CoV-2) and it is highly transmissible, especially through respiratory droplets. To prepare the health system for the care of these patients also led to a restriction in the activity of several medical specialties. Physicians who work with patients affected by diseases of the head and neck region constitute one of the populations most vulnerable to COVID-19 and also most affected by the interruption of their professional activities.

Objective  The aim of the present study was to assess the impact of the COVID-19 pandemic on the practice of head and neck surgeons and otorhinolaryngologists in Brazil.

Methods  An anonymous online survey of voluntary participation was applied, containing 30 questions regarding demographic aspects, availability of personal protective equipment (PPE), and impact on the routine of head and neck surgeons and otorhinolaryngologists, as well as clinical oncologists and radiation oncologists who work with head and neck diseases.

Results  Seven hundred and twenty-nine answers were received in a period of 4 days, ∼ 40 days after the 1 ^st confirmed case in Brazil. With professionals working in public and private services, there was a high level of concerns with the disease and its consequences, limited availability of PPE and a significant decrease in the volume of specialized medical care.

Conclusion  The study demonstrated a direct impact of the COVID-19 pandemic on the clinical practice of specialties related to the treatment of patients with diseases of the head and neck region already in the beginning of the illness management in Brazil.

COVID-19 Disease in Children: What Dentists Should Know and Do to Prevent Viral Spread. The Italian Point of View

Coronavirus disease 2019 (COVID-19) has spread rapidly across the globe, becoming a major public health challenge not for China only, but also for countries around the world. Despite worldwide efforts to contain viral spread, the outbreak has not been stopped yet. Among healthcare personnel, dentists seem to be at elevated risk of exposure to COVID-19. This risk is even more serious in pediatric dentistry, since affected children, frequently, present an asymptomatic, mild or moderate clinical viral infection and, therefore, they may play a major role in community-based COVID-19 transmission. To date, despite no universal guidelines are available for dental procedures in pediatric dentistry during COVID-19 outbreak, routine dental practice should be postponed and only severe dental emergencies must be treated. In the case of a dental emergency, involving a pediatric patient, dentists should be aware of which recommended management protocol can be adopted during the practice to protect patient health, to safeguard their-self and to prevent viral transmission. The aim of this paper is to provide clinical recommendations, presenting a needed tool for dentists to allow a valid and safe how-to-do protocol. Pediatric dentists should keep a high level of awareness to help patients, minimize risk and prevent viral spread.

Perceived vulnerability to Coronavirus infection: impact on dental practice

SARS-CoV-2 is a new virus responsible for the outbreak of the respiratory disease COVID-19, which has spread to several countries around the world, causing considerable consternation and a fear of contagions in global healthcare settings. The objective of this study is to identify, among Madrid's adult population, the impact of COVID-19 on self-perceived vulnerability, infectiousness, aversion to germs, and other behaviors in the current situation regarding dental practice. This cross-sectional observational study involves 1,008 persons randomly surveyed on the streets of Madrid, Spain between March 1 and March 8, 2020. Their perceived vulnerability to disease was measured using the perceived vulnerability to disease scale. An additional questionnaire evaluated basic sociodemographic aspects, medical history, personal hygiene behavior, willingness to go to certain places and the perception of the risk of contagion when going to a dental practice. There are significant differences by sex on the germ aversion subscale (p < 0.05) and in the risk of waiting in the waiting room (p < 0.01), tooth extraction ((p < 0.05), endodontics (p < 0.05) and fillings ((p < 0.05). Women consider the risk to be higher than men do. The risk group (over 60 and with systemic disease) has significant differences on the subscales of infectivity (p < 0.01) and germ aversion (p < 0.01). Our study shows high levels of vulnerability regarding contracting COVID-19 and avoiding dental care as perceived by the population over 60 years old and with a systemic disease.

Epidemiological Aspects and Psychological Reactions to COVID-19 of Dental Practitioners in the Northern Italy Districts of Modena and Reggio Emilia

The outbreak and diffusion of the Severe Acute Respiratory Syndrome-Coronavirus-2 (Sars-CoV-2) and COronaVIrus Disease 19 (COVID-19) have caused an emergency status in the health system, including in the dentistry environment. Italy registered the third highest number of COVID-19 cases in the world and the second highest in Europe. An anonymous online survey composed of 40 questions has been sent to dentists practicing in the area of Modena and Reggio Emilia, one of the areas in Italy most affected by COVID-19. The survey was aimed at highlighting the practical and emotional consequences of COVID-19 emergence on daily clinical practice. Specifically, it assessed dentists' behavioral responses, emotions and concerns following the Sars-CoV-2 pandemic restrictive measures introduced by the Italian national administrative order of 10 March 2020 (DM-10M20), as well as the dentists' perception of infection likelihood for themselves and patients. Furthermore, the psychological impact of COVID-19 was assessed by means of the Generalized Anxiety Disorder-7 test (GAD-7), that measures the presence and severity of anxiety symptoms. Using local dental associations (ANDI-Associazione Nazionale Dentisti Italiani, CAO-Commissione Albo Odontoiatri) lists, the survey was sent by email to all dentists in the district of Modena and Reggio Emilia (874 practitioners) and was completed by 356 of them (40%). All dental practitioners closed or reduced their activity to urgent procedures, 38.2% prior to and 61.8% after the DM-10M20. All reported a routinely use of the most common protective personal equipment (PPE), but also admitted that the use of PPE had to be modified during COVID-19 pandemic. A high percentage of patients canceled their previous appointments after the DM-10M20. Almost 85% of the dentists reported being worried of contracting the infection during clinical activity. The results of the GAD-7 (General Anxiety Disorder-7) evaluation showed that 9% of respondents reported a severe anxiety. To conclude, the COVID-19 emergency is having a highly negative impact on the activity of dentists practicing in the area of Modena and Reggio Emilia. All respondents reported practice closure or strong activity reduction. The perception of this negative impact was accompanied by feelings of concern (70.2%), anxiety (46.4%) and fear (42.4%). The majority of them (89.6%) reported concerns about their professional future and the hope for economic measures to help dental practitioners.

Immunocompromised patients and coronavirus disease 2019: a review and recommendations for dental health care

In less than four months, an unprecedented pandemic changed the world scenario, closing institutions and commerce, paralyzing sports championships, blocking frontiers, and putting almost all populations in a house quarantine regimen. Immunocompromised patients are within the high-risk group to severe outcomes from COVID-19. However, there is no clear evidence of the association between impaired immune host status and complications from SARS-CoV-2 infection so far. The virus is transmitted by inhalation or direct contact with infected secretions, and therefore the dental office is a highly susceptible environment for such transmission. Here, we review the literature and discuss immunological COVID-19 related issues. We also make suggestions for immunocompromised patients' support in this new emerging context of clinical dental practice. Until comprehensive findings are published, individuals with impaired immunity should be considered as high-risk. Cross infection control procedures for the clinical care of immunocompromised patients should follow the same guidelines that are being proposed for immunocompetent ones. However, during the active outbreak, people under immunosuppressive conditions should not receive elective procedures, even if they do not have symptoms or exposure history to COVID-19, and in case of emergence, care must be done in a separate airborne room. In the pos-pandemic phase, the dental care general recommendations should be the same for all subjects. Changes in the current guidelines have been proposed to SARS-CoV-2 infection control in order to provide the best and safe dental practice. However, they still need to be validated by future studies.

COVID-19: how to decrease the risk of infection in dental practice?

A new pandemic classified by the World Health Organization and called COVID-19, is causing widespread respiratory infections and deaths in several countries on the five continents. Although it does not have a high lethality rate, this new virus can present rates of complications and hospitalizations in the intensive care unit in up to 20% of patients, especially the elderly and those with compromised health, which can cause a collapse in the health system national public health. Dentistry is one of the most vulnerable professions due to work in the oral cavity, one of the areas with the highest concentration of the virus, therefore having an important role in controlling the disease. The objective of this work is through a review of the current literature, to establish conducts that can reduce the contamination by COVID-19 between the population and the dental team during the service in the public and private health system.

Precautions and recommendations for orthodontic settings during the COVID-19 outbreak: A review

Introduction

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2). It emerged as a global pandemic in early 2020, affecting more than 200 countries and territories. The infection is highly contagious, with disease transmission reported from asymptomatic carriers, including children. It spreads through person-to-person contact via aerosol and droplets. The practice of social distancing—maintaining a distance of 1-2 m or 6 ft—between people has been recommended widely to slow or halt the spread. In orthodontics, this distance is difficult to maintain, which places orthodontists at a high risk of acquiring and transmitting the infection. The objective of this review is to report to orthodontists on the emergence, epidemiology, risks, and precautions during the disease crisis. This review should help increase awareness, reinforce infection control, and prevent cross-transmission within the orthodontic facility.

Methods

A comprehensive literature review of English and non-English articles was performed in March 2020 using COVID-19 Open Research Dataset (CORD-19 2020), PubMed, MEDLINE, Scopus, and Google Scholar to search for infection control and disease transmission in orthodontics.

Results

This review emphasizes minimizing aerosol production and reinforcing strict infection control measures. Compliance with the highest level of personal protection and restriction of treatment to emergency cases is recommended during the outbreak. Surface disinfection, adequate ventilation, and decontamination of instruments and supplies following the guidelines are required.

Conclusions

Reinforcing strict infection control measures and minimizing personal contact and aerosol production are keys to prevent contamination within orthodontic settings. Although no cases of COVID-19 cross-transmission within a dental facility have been reported, the risk exists, and the disease is still emerging. Further studies are required.

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Coronavirus disease 2019 is a highly contagious global pandemic.

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It could transmit by asymptomatic carriers via person-to-person contact, aerosol, and droplets.

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Strict infection control and aerosol containment are required in orthodontic settings.

Dentistry during the COVID-19 Epidemic: An Italian Workflow for the Management of Dental Practice

The COVID-19 outbreak has raised concerns about infection control all over the world. Among health workers, dentists are particularly exposed to the COVID-19 infection risk. The aim of this paper is to present a workflow to manage dental procedures already in use at the Dental Unit of the University Hospital of Messina. The proposed workflow accounts for the many aspects of dental practitioners’ risk in the COVID-19 era, and focuses on the assessment of patient risk level, a two-phase dental procedure management (remote and face-to-face), and the use of specific preventive measures. No cases of COVID-19 infection were detected among patients and staff of the dental unit in a two-month period of time while using this protocol. This workflow seems a promising and effective solution to manage dental procedures during the COVID-19 outbreak, and could be implemented in both public and private practices until the emergency is contained.

Saliva-Friend and Foe in the COVID-19 Outbreak

The coronavirus disease 2019 (COVID-19) outbreak, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global ongoing pandemic. Timely, accurate and non-invasive SARS-CoV-2 detection in both symptomatic and asymptomatic patients, as well as determination of their immune status, will facilitate effective large-scale pandemic control measures to prevent the spread of COVID-19. Saliva is a biofluid whose anatomical source and location is of particularly strategic relevance to COVID-19 transmission and monitoring. This review focuses on the role of saliva as both a foe (a common mode of viral transmission via salivary droplets and potentially aerosols) and a friend (as a non-invasive diagnostic tool for viral detection and immune status surveillance) in combating COVID-19.

Covid-19 Outbreak - Immediate and long-term impacts on the dental profession

The health professions and systems have been challenged evoking heightened reactions around the globe as response to Covid-19. While most heavily impacted, the role of the dental professionals in preventing the transmission and responding to its long-term impacts on dentistry is critically important. This report, while outlining the immediate impact that the Covid-19 outbreak currently has on dental healthcare professionals, it also looks at some heavier impacts that this outbreak might have on the profession of dentistry. As such this manuscript offers some suggestions and recommendations based on personal feeling.

Digital Undergraduate Education in Dentistry: A Systematic Review

The aim of this systematic review was to investigate current penetration and educational quality enhancements from digitalization in the dental curriculum. Using a modified PICO strategy, the literature was searched using PubMed supplemented with a manual search to identify English-language articles published between 1994 and 2020 that reported the use of digital techniques in dental education. A total of 211 articles were identified by electronic search, of which 55 articles were selected for inclusion and supplemented with 27 additional publications retrieved by manual search, resulting in 82 studies that were included in the review. Publications were categorized into five areas of digital dental education: Web-based knowledge transfer and e-learning, digital surface mapping, dental simulator motor skills (including intraoral optical scanning), digital radiography, and surveys related to the penetration and acceptance of digital education. This review demonstrates that digitalization offers great potential to revolutionize dental education to help prepare future dentists for their daily practice. More interactive and intuitive e-learning possibilities will arise to stimulate an enjoyable and meaningful educational experience with 24/7 facilities. Augmented and virtual reality technology will likely play a dominant role in the future of dental education.

Strength, Weakness, Opportunity, Threat (SWOT) Analysis of the Adaptations to Anatomical Education in the United Kingdom and Republic of Ireland in Response to the Covid-19 Pandemic

The Covid-19 pandemic has driven the fastest changes to higher education across the globe, necessitated by social distancing measures preventing face-to-face teaching. This has led to an almost immediate switch to distance learning by higher education institutions. Anatomy faces some unique challenges. Intrinsically, anatomy is a three-dimensional subject that requires a sound understanding of the relationships between structures, often achieved by the study of human cadaveric material, models, and virtual resources. This study sought to identify the approaches taken in the United Kingdom and Republic of Ireland to deliver anatomical education through online means. Data were collected from 14 different universities in the United Kingdom and Republic of Ireland and compared adopting a thematic analysis approach. Once themes were generated, they were collectively brought together using a strength, weakness, opportunity, threat (SWOT) analysis. Key themes included the opportunity to develop new online resources and the chance to engage in new academic collaborations. Academics frequently mentioned the challenge that time constrains could place on the quality and effectiveness of these resources; especially as in many cases the aim of these resources was to compensate for a lack of exposure to cadaveric exposure. Comparisons of the actions taken by multiple higher education institutions reveal the ways that academics have tried to balance this demand. Discussions will facilitate decisions being made by higher education institutions regarding adapting the curriculum and assessment methods in anatomy.

Knowledge, attitude and practice of dentists in Coronavirus disease 2019 pandemic in Turkey

PURPOSE

The aim was to assess the knowledge, attitudes and anxiety of the dentists in relation to COVID-19.

MATERIALS AND METHODS

This cross-sectional survey was conducted amongst 590 dentists employed in Turkey from March to April 2020. The electronic survey consisted of 22 questions related to demographic profile, knowledge, clinical practice and anxiety level of the participants towards dental management of COVID-19. The survey was sent to participants by email and mobile phone messages to be filled electronically.

RESULTS

Majority of respondents pointed to aerosol (98.5%), saliva (90.6%) and mucosal contact (71.4%) as the transmission routes of COVID-19. Amongst all clinical symptoms of the disease questioned, fever (99.8%), dry cough (99.1%), fatigue (90.0%) were associated with COVID-19 by vast majority of population. 96.4% of respondents agreed the usage of gloves as personal protective equipment and it was followed by face shield (88.1%), disposable gown (83.4%), protective goggles (73.9%). Increased usage of FFP2/N95 (33.9%) and FFP3/N99 (10.9%) respirators, contrary to reduction of surgical mask usage (50.7%), were observed in aerosolgenerating procedures comparing to dental procedures without producing aerosol and these differences were highly significant (p<0.001, p=0.004, p<0.001). The mean anxiety level of respondents was 3.35 ± 1.18 (ranging from 0 to 5).

CONCLUSION

These results demonstrated an adequate knowledge, especially in clinical symptoms of COVID-19 amongst dentists. However, the respirator usage rate in aerosol-generating procedures was not satisfactory which suggesting to necessity of dentists' education about pandemic.

Managing emerging challenges of Coronavirus disease 2019 (COVID-19) in dentistry

Dental centers have been referred to as a hub or reservoir for infection, where healthcare professionals and other staff, patients and the public together may potentially spread pathogenic microorganisms. This may occur via saliva, skin or indirectly through air, water, and contaminated surfaces or instruments. Everyone should therefore be considered as potential sources of infection. During a pandemic, limiting unnecessary care has been adopted as a clinical measure for some patient's, to reduce the risk of cross-infection in the short term. However, in order to enable continuation of necessary and qualified care, dental processes need to follow specific infection control strategies in order to prevent transmission of emerging pandemic risks following COVID-19. In this article, we develop a tool with practical recommendations to mitigate infection risks before, during and following pandemics to enable ongoing dental care provision in primary and secondary care based on national and global recommendations.

Modifications of emergency dental clinic protocols to combat COVID-19 transmission

During the COVID-19 pandemic, incidence rates for dental diseases will continue unabated. However, the intent to prevent the spread of this lethal respiratory disease will likely lead to reduced treatment access due to restrictions on population movements. These changes have the potential to increase dental-related emergency department visits and subsequently contribute to greater viral transmission. Moreover, dentists experience unique challenges with preventing transmission due to frequent aerosol-producing procedures. This paper presents reviews and protocols implemented by directors and residents at the Dental College of Georgia to manage a dental emergency clinic during the COVID-19 pandemic. The methods presented include committee-based prioritization of dental patients, a multilayered screening process, team rotations with social and temporal spacing, and modified treatment room protocols. These efforts aid in the reduction of viral transmission, conservation of personal protective equipment, and expand provider availability. These protocols transcend a university and hospital-based models and are applicable to private and corporate models.

Coronavirus disease (COVID-19): Characteristics in children and considerations for dentists providing their care

The emergence of the novel virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease (COVID-19) has led to a global pandemic and one of the most significant challenges to the healthcare profession. Dental practices are focal points for cross-infection, and care must be taken to minimise the risk of infection to, from, or between dental care professionals and patients. The COVID-19 epidemiological and clinical characteristics are still being collated but children's symptoms seem to be milder than those that adults experience. It is unknown whether certain groups, for example children with comorbidities, might be at a higher risk of more severe illness. Emerging data on disease spread in children, affected by COVID-19, have not been presented in detail. The purpose of this article was to report current data on the paediatric population affected with COVID-19 and highlight considerations for dentists providing care for children during this pandemic. All members of the dental team have a professional responsibility to keep themselves informed of current guidance and be vigilant in updating themselves as recommendations are changing so quickly.

The dilemma of COVID-19 in dental practice concerning the role of saliva in transmission: a brief review of current evidence

From December 12, 2019, a pandemic of acute respiratory syndrome, the novel human coronavirus disease (COVID-19), caused by a novel β-coronavirus (2019- nCoV) began to grow globally by person-to-person transmission. The production of airborne material during aerosol generating dental procedures would expose dental team and patients to remarkable risk of transmission concerning the faceto- face communication and splattered saliva, blood, and other body fluids. Dental professionals can be a substantial help in preventing the transmission of COVID-19. This study has reviewed relevant current evidences in literature that has addressed the role of saliva and the threats that may be inherent in transmission of the disease during dental procedures. The study also offers feasible proactive and preventive measures for dental practice during the outbreak to block possible person-toperson or indirect transmission in dental settings.

The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2) in Dentistry. Management of Biological Risk in Dental Practice

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a novel coronavirus first identified in Wuhan, China, and the etiological agent of Coronavirus Disease-2019 (COVID-19). This infection spreads mainly through direct contact with Flügge micro droplets or core droplets that remain suspended as aerosol. Moreover, it has been reported that infected subjects, both with and without clinical signs of COVID-19, can transmit the virus. Since the infection typically enters through mouth, nose, and eyes, dentistry is one of the medical practices at highest risk of infection due to the frequent production of aerosol and the constant presence of saliva. The World Health Organization (WHO) has suggested that only emergency/urgent procedures should be performed during the coronavirus outbreak. Considering the virus’ route of transmission, a specific protocol should be applied to reduce the risk of infection in addition to measures that prevent the spread of infection from a patient to another person or medical tools and equipment (cross-infection). This protocol should be implemented by modifying both patient management and clinical practice, introducing particular devices and organizational practices. This paper aims to discuss and suggest the most appropriate procedures in every aspect of dental practice to reduce infection risk.

Dental Care and Oral Health under the Clouds of COVID-19

KNOWLEDGE TRANSFER STATEMENT

This commentary provides a timely evidence-based overview on the impact of COVID-19 on dental care and oral health and identifies gaps in protection of patients and staff in dental settings. Oral symptoms are prominent before fever and cough occur. Dental professionals may play an important role in early identification and diagnosis of patients with COVID-19.

Fear and Practice Modifications among Dentists to Combat Novel Coronavirus Disease (COVID-19) Outbreak

An outbreak of novel coronavirus disease (COVID-19) in China has influenced every aspect of life. Healthcare professionals, especially dentists, are exposed to a higher risk of getting infected due to close contact with infected patients. The current study was conducted to assess anxiety and fear of getting infected among dentists while working during the current novel coronavirus diseases (COVID-19) outbreak. In addition, dentists' knowledge about various practice modifications to combat COVID-19 has been evaluated. A cross-sectional study was conducted using an online survey from 10th to 17th March 2020. The well-constructed questionnaire was designed and registered at online website (Kwiksurveys) and validated. A total of 669 participants from 30 different countries across the world responded. After scrutiny, completed questionnaires (n = 650) were included in the study. Statistical analysis was performed using SPSS version 25. Chi-Square and Spearman correlation tests were applied to control confounders and assess the relation of dentists' response with respect to gender and educational level. More than two-thirds of the general dental practitioners (78%) from 30 countries questioned were anxious and scared by the devastating effects of COVID-19. A large number of dentists (90%) were aware of recent changes in the treatment protocols. However, execution of amended treatment protocol was recorded as 61%. The majority of the dentists (76%) were working in the hospital setting out of which 74% were from private, and 20% were from government setups. Individually we received a large number of responses from Pakistan and Saudi Arabia, but collectively more than 50% of the responses were from other parts of the world. Despite having a high standard of knowledge and practice, dental practitioners around the globe are in a state of anxiety and fear while working in their respective fields due to the COVID-19 pandemic impact on humanity. A number of dental practices have either modified their services according to the recommended guidelines to emergency treatment only or closed down practices for an uncertain period.

COVID-19 Transmission in Dental Practice: Brief Review of Preventive Measures in Italy

The outbreak and diffusion of SARS-CoV-2, responsible for the coronavirus disease (COVID-19), has caused an emergency in the health system worldwide. After a first development in Wuhan, China, the virus spread in other countries, with Italy registering the second highest number of cases in Europe on the 7th of April 2020 (135,586 in total). The World Health Organization declared the pandemic diffusion of COVID-19, and restrictive measures to limit contagion have been taken in several countries. The virus has a predominantly respiratory transmission through aerosol and droplets. The importance of infection control is therefore crucial in limiting the effects of virus diffusion. We aim to discuss the risks related to dental practice and current recommendations for dental practitioners. A literature search was performed to retrieve articles on the management of COVID-19 diffusion in dental practice. The documented clinical experience, the measures of professional prevention, and the actual Italian situation were reported and described. Four articles were retrieved from the literature search. Among the eligible articles, 3 reported measures to contrast COVID-19 diffusion. The infection management protocols suggested were reviewed. Finally, recommendations based on the Italian experience in terms of patient triage, patients' entrance into the practice, dental treatment, and after-treatment management are reported and discussed. COVID-19 is a major emergency worldwide, which should not be underestimated. Due to the rapidly evolving situation, further assessment of the implications of COVID-19 outbreak in dental practice is needed.