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

Characteristics of Endodontic Emergencies during Coronavirus Disease 2019 Outbreak in Wuhan

Introduction

In late 2019, an outbreak of a new coronavirus named severe acute respiratory syndrome coronavirus 2 was detected in Wuhan, China. A great percentage of patients with this disease developed symptoms of dry cough, malaise, and a high fever. During this time, several patients requiring assessment and treatment of endodontic emergencies were directed to the School and Hospital of Stomatology at Wuhan University, Wuhan, China. We examined the characteristics of these patients.

Methods

A total of 96 patients with a mean age of 42.24 ± 18.32 years visited the general and emergency department of the School and Hospital of Stomatology at Wuhan University because of endodontic emergencies during the peak period of February 22 to March 2, 2020. Patient information was collected and organized by date of visit, sex, age, and systemic disease history. Body temperature was measured and acquired for each patient, a coronavirus disease 2019 (COVID-19) epidemiologic investigation questionnaire was given to each patient, an endodontic diagnosis was determined for the offending tooth, and a verbal numerical rating scale (VNRS) was used to record pain levels.

Results

Of the total patient visits during this period, 50.26% of visits were for endodontic treatment. No patients had a fever (>37.2°C). One patient with a confirmed COVID-19 history was admitted after recovery. Three admitted patients had been exposed to confirmed or suspected COVID-19 patients. Twelve admitted patients (12.5%) with a mean age of 62.42 ± 13.77 years had a history of systemic diseases. The most common age group for endodontic emergencies was 45–64 years (30.21%), and patients of this group showed a significantly higher mean VNRS score compared with that of the 6- to 19-year age group and the 20- to 34-year age group (P < .05). The majority of endodontic emergency diagnoses were diseases of symptomatic irreversible pulpitis (53.10%). Patients who were diagnosed with symptomatic irreversible pulpitis, symptomatic apical periodontitis, and acute apical abscess showed a significantly higher mean VNRS score than that of other groups (P < .05).

Conclusions

Endodontic emergencies, with symptomatic irreversible pulpitis being the most common, consist of a much higher proportion of dental emergencies in a COVID-19 high-risk area than normally. Vital pulp therapy can advantageously reduce treatment time, resulting in a reduced risk of infection for vital pulp cases. Rubber dams, personal protective equipment, and patient screening are of great importance during the COVID-19 outbreak in protecting clinicians.

Dentists' Awareness, Perception, and Attitude Regarding COVID-19 and Infection Control: Cross-Sectional Study Among Jordanian Dentists

BACKGROUND

Despite the availability of prevention guidelines and recommendations on infection control, many dental practices lack the minimum requirements for infection control.

OBJECTIVE

This study aimed to assess the level of awareness, perception, and attitude regarding the coronavirus disease (COVID-19) and infection control among Jordanian dentists.

METHODS

The study population consisted of dentists who worked in private clinics, hospitals, and health centers in Jordan. An online questionnaire was sent to a sample of Jordanian dentists in March 2020. The questionnaire was comprised of a series of questions about dentists' demographic characteristics; their awareness of the incubation period, the symptoms of the disease, mode of transmission of COVID-19 and infection control measures for preventing COVID-19; and their attitude toward treating patients with COVID-19.

RESULTS

This study included a total of 368 dentists aged 22-73 years (mean 32.9 years, SD 10.6 years). A total of 112 (30.4%) dentists had completed a master or residency program in dentistry, 195 (53.0%) had received training in infection control in dentistry, and 28 (7.6%) had attended training or lectures regarding COVID-19. A total of 133 (36.1%) dentists reported that the incubation period is 1-14 days. The majority of dentists were aware of COVID-19 symptoms and ways of identifying patients at risk of having COVID-19, were able to correctly report known modes of transmission, and were aware of measures for preventing COVID-19 transmission in dental clinics. A total of 275 (74.7%) believed that it was necessary to ask patients to sit far from each other, wear masks while in the waiting room, and wash hands before getting in the dental chair to decrease disease transmission.

CONCLUSIONS

Jordanian dentists were aware of COVID-19 symptoms, mode of transmission, and infection controls and measures in dental clinics. However, dentists had limited comprehension of the extra precautionary measures that protect the dental staff and other patients from COVID-19. National and international guidelines should be sent by the regional and national dental associations to all registered dentists during a crisis, including the COVID-19 pandemic, to make sure that dentists are well informed and aware of best practices and recommended disease management approaches.

Approaches to the management of patients in oral and maxillofacial surgery during COVID-19 pandemic

Oral and maxillofacial surgery is correlated with a high risk of SARS-CoV-2 transmission. Therefore, the aim of the review is to collect and discuss aspects of the management of patients in oral and maxillofacial surgery during the COVID-19 pandemic.

In order to save resources and to avoid unnecessary exposure to infected patients, there is the need to schedule interventions depending on their priority. During the peak of the pandemic, no elective surgery should be performed. Even urgent procedures might be postponed if there is a view to recovery of a COVID-19 patient within a few days. Emergency procedures do not allow any delay.

Specialties with overlap in therapies should have well defined arrangements among each other concerning the treatment spectra in order to avoid redundancy and loss of resources.

Inpatient and outpatient units have to be organized in such a way that the risk of cross-infection among patients is reduced to a minimum. Especially, testing of patients for SARS-CoV-2 is important to detect the infected patients at an early stage. When surgery is performed on COVID-19 patients, adequate personal protective equipment is crucial. There must be negative pressure in the operating room, and aerosol formation must be reduced to a minimum.

In order to address the COVID-19 challenge adequately, significant changes in the infrastructure of outpatient units, inpatient units, and operating rooms are needed. In addition, the demands concerning personal protective equipment increase significantly. The major aim is to protect patients as well as the medical staff from unnecessary infection, and to keep the healthcare system running effectively. Therefore, every effort should be taken to make the necessary investments.

Custom-made 3D-printed face masks in case of pandemic crisis situations with a lack of commercially available FFP2/3 masks

In the case of pandemic crisis situations, a crucial lack of protective material such as protective face masks for healthcare professionals can occur. A proof of concept (PoC) and prototype are presented, demonstrating a reusable custom-made three-dimensionally (3D) printed face mask based on materials and techniques (3D imaging and 3D printing) with global availability. The individualized 3D protective face mask consists of two 3D-printed reusable polyamide composite components (a face mask and a filter membrane support) and two disposable components (a head fixation band and a filter membrane). Computer-aided design (CAD) was used to produce the reusable components of the 3D face mask based on individual facial scans, which were acquired using a new-generation smartphone with two cameras and a face scanning application. 3D modelling can easily be done by CAD designers worldwide with free download software. The disposable non-woven melt-blown filter membrane is globally available from industrial manufacturers producing FFP2/3 protective masks for painting, construction, agriculture, and the textile industry. Easily available Velcro fasteners were used as a disposable head fixation band. A cleaning and disinfection protocol is proposed. Leakage and virological testing of the reusable components of the 3D face mask, following one or several disinfection cycles, has not yet been performed and is essential prior to its use in real-life situations. This PoC should allow the reader to consider making and/or virologically testing the described custom-made 3D-printed face masks worldwide. The surface tessellation language (STL) format of the original virtual templates of the two reusable components described in this paper can be downloaded free of charge using the hyperlink (Supplementary Material online).

Surgical Practice in the Shadow of COVID-19 Outbreak

BACKGROUND

COVID-19 epidemic rapidly spread all around the world with over 1500 thousand infected cases and 95000 deaths. This rapid pandemic may overwhelm health care capacity and shortage of resources is a major concern. Literature provided guidelines on management of COVID-19 patients but healthcare service to the normal population should be continued meanwhile. Health system should act immediately and wisely to support essential surgical care while fighting against COVID-19.

METHODS

We conducted a comprehensive search in the major data bases since 2020, using the combination of MeSH words of "COVID-19 " and "surgery" and finally 34 full texts entered to data extraction phase to define a plan for surgical practice during COVID-19 pandemic.

RESULTS

Healthcare workers are at the higher risk of contamination by COVID-19 especially in early stage of outbreak when they were not aware of the different aspects of COVID-19 pandemic. All healthcare staff must be trained to properly use PPE. All patients have to be screened at the hospital triage. All elective surgical interventions must be postponed. Operation room is considered as a place with high risk of cross infection so the highest level of protection should be maintained. Anesthesia, endoscopy and oral surgery are considered as aerosol producing procedures with very high risk of contamination. There is not any evidence to support the risk of infection trough blood products. Postoperative respiratory problems are more common among COVID-19 patients that may increases the estimated risk of morbidity and mortality.

CONCLUSION

COVID-19 pandemic is a dynamic challenge for health system to save the healthcare staff and equipment resources by timely decisions. Healthcare workers are at the higher risk of contamination by COVID-19 especially in early phase of epidemic when the protection is sub-optimal.

Human Saliva: Non-Invasive Fluid for Detecting Novel Coronavirus (2019-nCoV)

The breakthrough of novel coronavirus (2019-nCoV) in Wuhan, a city of China, has damaged the status of health and quality of life. In the sequel of this epidemic or contagious disease, the patient experiences fever, chest paint, chills, a rapid heartbeat, breathing difficulties, pneumonia, and kidney failure. It has been suggested that this disease can spread through human-to-human transmission or by super spreading. By the help of the non-invasive fluid "saliva", it is easy to detect the virus. This can help with the comfort of the patient as well as healthcare personnel. Under this perspective, we discuss the epidemic situation of 2019-nCOV and its relationship with human saliva.

COVID-19 Outbreak: An Overview on Dentistry

Coronavirus disease 2019, also called COVID-19, is the latest infectious disease to rapidly develop worldwide [...].

Knowledge and Perception of COVID-19 among Pedodontists in India: A Quick Online Cross-sectional Study

INTRODUCTION

The coronavirus disease 2019 (COVID-19) epidemic began in Wuhan, China, in December 2019 on January 1, 2020. For dental practices and hospitals in countries/regions that are (potentially) affected with COVID-19, strict and effective infection control protocols are urgently needed.

AIM AND OBJECTIVE

To investigate knowledge and perception of COVID-19 among pedodontists in India.

POPULATION AND METHODS

A quick online cross-sectional study was conducted among 335 pedodontists in India. The questionnaire was sent to 410 pedodontists in India, out of those 335 responded. The study objective and questionnaire were sent to pedodontists via "Google Forms". The collected data were sent for appropriate statistics.

RESULTS

Of the total participants, 82% of pedodontists think that children are silent carriers of COVID-19. Sixty-two percent of pedodontists say that it is very difficult to treat pediatric dental patients by use of a personal protective equipment (PPE) kit. Sixty-four percent of pedodontists will overcome this financial crisis by increasing working time and 36% of them by increasing the cost of treatment.

CONCLUSION

The role of pedodontists in preventing the transmission of COVID-19 is critically important. Pedodontists' role in the prevention of COVID-19 is crucial.

HOW TO CITE THIS ARTICLE

Sajjanar A, Rojekar N, Gahlod N, et al. Knowledge and Perception of COVID-19 among Pedodontists in India: A Quick Online Cross-sectional Study. Int J Clin Pediatr Dent 2020;13(S-1):S98-S101.

Occupational hazard for Dental staff exposed to the SARS-CoV-2 virus during Dental procedures

Introduction: The dental profession is a high-risk profession, considering the aspect of a possible 100% infection from patients who are carriers of bacterial, viral and fungal diseases during dental interventions. Aim: To perform the analysis of all data that explain the possibility of a SARS-CoV-2 virus infection in dental practice. Material and Methods: The literature data on the presence of SARS-CoV-2 virus, and its characteristics and behavior in the external environment and in living tissues was analyzed. Databases from the Medline, Cochrane Library, Science-Direct, EMBASE, and Google scholar libraries were used, as well as other sources of literature information about this virus. Results: SARS-CoV-2 is an RNA virus, which has a submicron size and the ability to survive in various environments. The retention of SARS-CoV-2 virus in air / aerosol lasts an average of 3 hours, while the half-life of this virus is 5 to 6 hours on stainless steel and 6 to 8 hours on plastic. Infected patients with SARS-CoV-2 virus develop COVID-19 disease, which manifests itself through presymptomatic, symptomatic and post-symptomatic periods of the disease. Conclusion: The SARS-CoV-2 virus can be found in aerosols generated by dental equipment, which uses compressed air for its work. Protection of dentists and staff from infection with the virus is possible by wearing an N95 respiratory mask with protection levels 2 and 3, which has a filtration efficiency, i.e. retention of submicron particles with an efficiency of ≥ 98%. Waterproof goggles with a protective visor or a special industrially designed facial visor in the form of a full face mask, which has its own motor for the supply of filtered air to the mask, and which prevents the contamination of the mucous membranes of the eyes, nose and mouth from liquid or solid aerosol in the air, need to be used. Other disposable protective equipment also must be waterproof. Korona virus izaziva prehladu kod ljudi, koja ima uobičajne simptome prehlade gornjih respiratornih puteva; zahvata nosnu šupljinu,a ponekad se širi i na ždrelo, larinks i sinuse 5,6,7 . Sa druge strane, SARS-CoV-2 virus, koji je izazivač masovne/globalne virusne infekcije, ima sličnosti sa druga dva korona virusa -beta korona virusom (SARS-CoV-1) i virusom srednjeistočnog respiratonog sindroma (MERS-CoV).

Potential Role of Oral Rinses Targeting the Viral Lipid Envelope in SARS-CoV-2 Infection

Emerging studies increasingly demonstrate the importance of the throat and salivary glands as sites of virus replication and transmission in early COVID-19 disease. SARS-CoV-2 is an enveloped virus, characterized by an outer lipid membrane derived from the host cell from which it buds. While it is highly sensitive to agents that disrupt lipid biomembranes, there has been no discussion about the potential role of oral rinsing in preventing transmission. Here, we review known mechanisms of viral lipid membrane disruption by widely available dental mouthwash components that include ethanol, chlorhexidine, cetylpyridinium chloride, hydrogen peroxide, and povidone-iodine. We also assess existing formulations for their potential ability to disrupt the SARS-CoV-2 lipid envelope, based on their concentrations of these agents, and conclude that several deserve clinical evaluation. We highlight that already published research on other enveloped viruses, including coronaviruses, directly supports the idea that oral rinsing should be considered as a potential way to reduce transmission of SARS-CoV-2. Research to test this could include evaluating existing or specifically tailored new formulations in well-designed viral inactivation assays, then in clinical trials. Population-based interventions could be undertaken with available mouthwashes, with active monitoring of outcome to determine efficacy. This is an under-researched area of major clinical need.

Make-over in the sustainable working platform during COVID-19 pandemic

Civilizations have witnessed a long list of diseases that have made a devastating impact on humankind's working in almost all aspects of life. At the start, COVID-19 bought the world to a standstill. Today lakhs have lost their lives, many are still struggling on the death bed, and large numbers have lost their jobs. The world's conventional education system seems to come to a halt with the physical closure of all schools and institutions. Understanding the losses that occurred due to several diseases, the present world has to prepare a backup strategy to reduce the economic and human losses. The paper aims to identify the measures required for minimizing the losses caused by COVID-19 to human evolution. Further, this study proposes a working mechanism for several affected sectors during the disease. The paper also discusses the current challenges from the COVID-19 pandemic crisis and possible make-over in the working platform. With the help of this sustainable working platform, the affected sectors from COVID-19 can be helped. Further, we can reset specific sectors and sustainably reshape the world.

Dentistry during and after COVID-19 Pandemic: Pediatric Considerations

This article is a rumination on the outbreak of the dreaded coronavirus disease-2019 (COVID-19) pandemic which has engulfed both the developed and the developing countries, thereby causing widespread global public health concerns and threats to human lives. Although countries have made varied efforts, the pestilence is escalating due to the high infectivity. It is highly likely that dental professionals in upcoming days will come across COVID-19 patients and SARS-CoV-2 carriers, and hence must ensure a tactful handling of such patients to prevent its nosocomial spread. Despite the avalanche of information that has exploded in relation to this rapidly spreading disease, there is a lack of consolidated information to guide dentists regarding clinical management including precautions to take materials to use and postprocedure care, during and after the COVID-19 pandemic. Available sources of information have been analyzed, while relying on peer-reviewed reports followed by information available from the most respected authoritative sources, such as WHO, Centers for Disease Control and Prevention (CDC), and ADA. This review aims to provide a comprehensive summary from the available literature on COVID-19, its insinuation in dentistry, recommendations that have been published, and the actual in-practice implications, so a plan can be formulated and adapted to the circumstances of each dental practice during the pandemic and the times to follow.

Dental Practice Infection Control Measurements: Coronavirus Disease (COVID-19) Outbreaks

A new coronavirus disease called COVID-19 has been considered to be a public health emergency of international apprehension by the WHO. This new disease includes multiple symptoms such as fever, cough, sore throat, and rhinorrhea. The disease is mild in most people; however, in some patients, it may develop to pneumonia, acute respiratory distress syndrome (ARDS), and multiple dysfunctions in the organs which may lead to death. There are two routes of transmission for this virus, the first route is the direct transmission, through cough or droplet inhalation, while the second route is through contact, for example, contact with oral and nasal mucous membranes; consequently, extensive and intensive measures should be taken to decrease the transmission of COVID-19 from person to person. Due to the nature of dental work and its procedures, the dental professionals are in a high risk of transmission. Hence, in this article, we wanted to highlight the clinical features, trajectories of spread, and infection control considerations to prevent and control the spread of this fatal disease.