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

Deciphering the role of Saliva in COVID 19: A global cross-sectional study on the knowledge, awareness and perception among dentists

OBJECTIVES

The global pandemic outbreak of the coronavirus has instilled the quest amongst researchers on the expedited need for the early detection of viral load. Saliva is a complex oral biological fluid which not only causes the disease transmission but can be an effective alternative sample for detection of SARS-CoV2. This provides an ideal opportunity for dentists to be the frontline healthcare professionals who can collect the salivary samples; however the awareness of this amongst dentists is uncertain. Hence the aim of this survey was to evaluate the knowledge, perception and awareness of the role of saliva in detecting the SARS-CoV2 among dentists worldwide.

METHODS

The online questionnaire comprising of 19 questions was shared to 1100 dentists worldwide and a total of 720 responses was collected. The data was tabulated, statistically analysed using the non- parametric Kruskal-Wallis test (p < 0.05). Based on the principal component analysis, 4 components (knowledge about virus transmission, perception about SARS-CoV2 virus, awareness on the sample collection and knowledge about prevention of the virus) were obtained which was compared with the 3 independent variables (years of clinical experience, occupation and region).

RESULTS

A statistically significant difference was observed in the awareness quotient amongst the dentists with 0-5 years and greater than 20 years of clinical experience. In terms of the occupation, a significant difference was noted when comparing the postgraduate students to practitioners knowledge about the virus transmission. A highly significant difference was seen on comparing academicians and postgraduate students and also between academicians and practitioners. No significant difference was evidenced amongst the different regions, however the mean score was in the range of 3-3.44.

CONCLUSION

This survey highlights the deficiency in the knowledge, perception and awareness among dentists worldwide.

Evaluation of Knowledge, Awareness, Preparedness, and Measures among Dental Technicians Attending COVID-19 in Jordan

Introduction:

During the pandemic of COVID-19, Jordan imposed strict measures and abandoned selected medical procedures. Due to the high risk of cross-infection among dental team members, dental clinics and laboratories were subjected to definite regulations before being allowed back to work.

Aims:

This survey aims to assess the knowledge, awareness and preparedness of dental technicians in Jordan regarding COVID-19. Also, to investigate prevention measures for dental technicians working during the COVID-19 pandemic.

Methods:

A cross-sectional self-administered online survey was distributed electronically as a Google formviasocial media platforms. The study population consisted of registered dental technicians working in public and private laboratories in Jordan. The questionnaire consisted of a series of questions; demographic characteristics; knowledge and awareness about COVID-19, and the preparedness and measures to practice dental laboratory procedures during the pandemic.

Results:

This study included a total of 90 dental technicians (31 females and 59 males); their ages ranged from 22-60 years old. Almost all the participants (90%) were found knowledgeable about COVID-19. Governmental organizations, and visual and social media were the main sources of information. The majority of participants (>85%) encouraged drifting to digital dental technology protocols during COVID-19 pandemic. More than 65% of the participants reported COVID-19 very dangerous and considered themselves in a high risk of COVID-19 transmission.

Conclusion:

Most dental technicians have sufficient knowledge about COVID-19. However, most of them are not prepared to deal with impressions, restorations, and dentures of infected/suspected cases. Educational and training programs regarding COVID-19 among dental technicians are significantly needed.

E-learning as a strategy in dentistry in the context of COVID-19: a path to follow?

The current study aims to assess the effectiveness of e-learning in compliance with the new biosafety recommendations in dentistry in the context of COVID-19 applied to the clinical staff of a dental school in Brazil. A quasi-experimental epidemiological study was carried out by means of a structured, pre-tested online questionnaire, applied before and after an educational intervention, using an e-learning format. After data collection, statistical tests were performed. A total of 549 members of the clinical staff participated in the study in the two collection phases, with a return rate of 26.9%. After the e-learning stage, a reduction was found in the reported use of disposable gloves, protective goggles, and surgical masks. The course had no impact on the staff's knowledge concerning the proper sequence for donning PPE and showed 100% effectiveness regarding proper PPE doffing sequence. Knowledge about avoiding procedures that generate aerosols in the clinical setting was improved. Despite the low rate of return, it can be concluded that online intervention alone was ineffective in significantly improving learning about the new clinical biosafety guidelines. Therefore, the use of hybrid teaching and repetitive training is highly recommended.

Preprocedural Viral Load Effects of Oral Antiseptics on SARS-CoV-2 in Patients with COVID-19: A Systematic Review

(1) There are limited clinical trials to support the effectiveness of mouth rinses when used as a preprocedural rinse against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This systematic review aims to evaluate the efficacy of antiseptic mouth rinses as a preprocedural rinse in reducing SARS-CoV-2 oral viral load in-vivo. (2) Methods: A literature search was conducted through November 2022 for the following databases: PubMed, Web of Science, Cochrane Library, and Google Scholar. The evaluated outcomes were quantitative changes in viral load and the statistical significance of that change after using antiseptic mouth rinses. (3) Results: 14 randomized controlled trials (RCT) were selected for risk of bias assessment and data extraction. (4) Conclusion: Within the limits of this systematic review, preprocedural mouth rinses may significantly reduce SARS-CoV-2 in the mouth, thus, reducing the viral particles available for airborne dispersion. Preprocedural mouth rinses may be an effective strategy for reducing airborne SARS-CoV-2 dispersion in the environment. Their use may be a preventive strategy to reduce the spread of COVID-19 in selected medical and healthcare facilities, including dental clinics. Potential preprocedural mouth rinses are identified for use as an integral part of safe practice for healthcare protocols. This systematic review was registered with the National Institute for Health Research, international prospective register of systematic reviews (PROSPERO): CRD42022315177.

Orthodontic care in orthodontic patients during the COVID-2019 pandemic: emergency, emergency response and orthodontic treatment preference

BACKGROUND

The objective of this study was to investigate the characteristics of emergencies and the requirement for emergency treatment after the suspension of orthodontic appointments. The attitude towards orthodontic treatment preference was evaluated as well, including receiving orthodontic treatment and the preference for orthodontic appliances.

SUBJECTS AND METHODS

An electronic questionnaire was distributed to the patients, including 4 sections: Section 1 - demographic and basic information; Section 2 - the characteristics of emergencies and emergency treatment requirements; Section 3 - the NRS-11 for pain and Manchester Orofacial Pain Disability Scale used to evaluate the intensity of orofacial pain and disability; and Section 4 - attitudes towards receiving orthodontic treatment and appliance preference. Descriptive statistics, Pearson's chi-square test, Wilcoxon's rank-sum test and stepwise generalized linear model (GLM) were performed with significance set at P < 0.05.

RESULT

Most participants' (91.61%) follow-up appointments were suspended. The emergency rate and emergency treatment requirements were not different between the fixed appliance (FA) and clear aligner (CA) groups. Patients who reported emergencies (P < 0.01) in the FA group (P < 0.05) and some emergencies in the FA (P < 0.05) suffered worse pain and disability. More FA participants preferred alternative appliances (P < 0.05) due to pain and disability (P < 0.05).

CONCLUSION

FA patients' emergencies caused worse pain and disability when orthodontic appointments were suspended. Pain and disability were not the causes of emergency treatment requirements. The CA group seemed to show a tendency towards orthodontic appliance preference, which was an ideal modality to weather the epidemic, combined with telemedicine.

Changes in the teaching of prosthodontics adopted in the last academic course of the degree in Dentistry in Spain during the first period of the COVID-19 pandemic

OBJECTIVES

To investigate the impact of the COVID-19 pandemic in the teaching of prosthodontics, on the 5^th course of the Bachelor's degree in Dentistry in Spain.

METHODS

In June 2021, a two-section survey was submitted to the coordinators of prosthodontics of the 23 Spanish faculties of Dentistry. The first section was focused on the theoretical lessons, seminars, and clinical discussion sessions. The second part relied on the clinical teaching and the implemented preventive measures.

RESULTS

The response rate was 100%. By the end of the 2020-21 course, both the theoretical and practical teaching were replaced by online activities, returning to face-to face in 2021-22. While most participants preferred in-person seminars and clinical discussion sessions, concerning the theory, comparable percentages of professors chose either face-to-face or blended learning (BL). The students' satisfaction with BL is high, but they seem more attentive in-person. At the beginning of the pandemic, the most common emergency in prosthodontics was debonding. Overall, a low concern about cross-infection was noticed. The barrier measures were the mainly adopted for prevention.

CONCLUSIONS

Although the BL is appreciated in prosthodontics for theoretical lessons, face-to-face teaching appears to be the best option for seminars and clinical case discussions. The students are satisfied with BL.

CLINICAL SIGNIFICANCE

In the face of the COVID-19 pandemic, the Spanish faculties of Dentistry responded quickly to continuing offering quality education through an accelerated digitization process that has created a new paradigm. Detailed analyses of these changes may help establish plans to respond systematically to unforeseen emergencies.

Probiotics and their postbiotics for the control of opportunistic fungal pathogens: A review

During past twenty years the opportunistic fungal infections have been emerging, causing morbidity and mortality. The fungi belonging to Aspergillus, Mucor, Rhizopus, Candida, Fusarium, Penicillium, Dermatophytes and others cause severe opportunistic fungal infections. Among these Aspergillus and Candida spp cause majority of the diseases. The continuum of fungal infections will prolong to progress in the surroundings of the growing inhabitants of immunocompromised individuals. Presently many chemical-based drugs were used as prophylactic and therapeutic agents. Prolonged usage of antibiotics may lead to some severe effect on the human health. Also, one of the major threats is that the fungal pathogens are becoming the drug resistant. There are many physical, chemical, and mechanical methods to prevent the contamination or to control the disease. Owing to the limitations that are observed in such methods, biological methods are gaining more interest because of the use of natural products which have comparatively less side effects and environment friendly. In recent years, research on the possible use of natural products such as probiotics for clinical use is gaining importance. Probiotics, one of the well studied biological products, are safe upon consumption and are explored to treat various fungal infections. The antifungal potency of major groups of probiotic cultures such as Lactobacillus spp, Leuconostoc spp, Saccharomyces etc. and their metabolic byproducts which act as postbiotics like organic acids, short chain fatty acids, bacteriocin like metabolites, Hydrogen peroxide, cyclic dipeptides etc. to inhibit these opportunistic fungal pathogens have been discussed here.

Pre-dental treatment screening in Indonesia during the COVID-19 pandemic: a questionnaire survey of dental practitioners

BACKGROUND

Dental practitioners have a high risk of contracting COVID-19 during the treatment of patients because of exposure to airborne droplets. However, the application of pre-procedure treatment screening in dental practices in Indonesia varied during the pandemic. The purpose of this study was to investigate the use of updated pre-procedure dental treatment protocols and procedures among dental practitioners in Indonesia.

METHODS

This study consisted of dentists registered as members of the Indonesian Dental Association who attended the Indonesian Dental Association webinar series in 2021. All the participants completed a questionnaire survey. The participants, who were from various regions in Indonesia, were granted password-protected access to a URL hosting the questionnaire. The questionnaire collected demographic information and contained questions on adherence to updated protocols and patient screening procedures, to which the respondents answered "Yes" or "No". For the analysis, the participants were divided into three groups based on the type of facility where they were employed: public (government) hospitals, private hospitals, or university hospitals (dental schools). A chi-square test was used to investigate the association between professional background and the implementation of updated protocols, including pre-procedure dental treatment screening. A value of P < 0.05 was considered statistically significant.

RESULTS

The age range of the participants was 20 - 60 years. The participants worked in facilities in 32 provinces in Indonesia. In total, there were 5,323 participants (males: n = 829; females: n = 4,494). In terms of professional backgrounds, 2,171, 2,867, and 285 participants were employed in government hospitals, private hospitals, and dental faculties, respectively. Among 5,232 participants who implemented updated COVID-19 prevention protocols, 5,053 (98%) participants performed pre-surgery procedures Among 151 participants who did not implement updated COVID-19 prevention protocols, 133 (88%) individuals carried out pre-rinse procedures.

CONCLUSIONS

Almost all the dental practitioners employed in government hospitals, private hospitals, and dental faculties in Indonesia performed pre-surgery patient screening procedures. There was an agreement between the dental professionals in all three settings on the need for COVID-19 pre-treatment screening procedures in dental practices during the COVID-19 pandemic.

Applications and effectiveness of teledentistry in orthodontic practice during the COVID-19 restrictions

BACKGROUND

The aim of this study was to identify the areas of application for teledentistry and analyze its effectiveness in orthodontic practice during the COVID-19 pandemic.

METHODS

A total of 233 patients (159 women, 74 men) receiving orthodontic treatment were included. During the COVID-19 restriction period, patients were given teledentistry appointments. During these video conferences, remote orthodontic checkups were performed by one orthodontist, who asked the patients for photos or videos. The applications carried out during the interviews were recorded, classified, and analyzed. In addition, clinical emergency patients were identified. After the teledentistry consultations, two different questionnaires were presented to the patients, depending on their attendance at teledentistry appointments, and the results were statistically evaluated.

RESULTS

In all, 21.25% of the patients were identified as having clinical emergencies, including injury because of damage from brackets and wires; 10% of them reported bracket breakage; 17.5% were encouraged to use intermaxillary elastics; and 3.75% were in pain. However, 50% of them were found to be unproblematic. A total of 91% of the participants in the survey reported that online checkups were sufficient to understand and resolve their symptoms. However, 28% wanted to communicate with orthodontists by video call or with photos instead of meeting face to face (65.5%) when unexpected problems arose during the COVID-19 pandemic.

CONCLUSIONS

Teledentistry can be an effective method for motivating patients who are undergoing orthodontic treatments that require cooperation. It is also an effective way of understanding the patients' symptoms and reducing the risk of cross-infection by identifying patients who will require face-to-face emergency treatment during pandemics.

Perspectives of Indian dental residents on novel online practical examination during COVID-19: A cross-sectional study

PURPOSE

This cross-sectional study aimed to assess the graduating dental residents' perspectives on the online clinical examination format.

METHODS

The questionnaire used to assess the perspectives was developed via a focus group discussion and was validated for face and content validity, readability testing, and pilot testing for the online version. This self-administered, online questionnaire integrated 15 Likert-scale-based multiple choice questions and one open-ended question. It was distributed to the residents across 16 dental schools after the clinical examination was completed. The perspectives regarding examination preparation, the ability to transition to online mode, and the performance in the examination were assessed. Descriptive statistical analysis (counts and percentages) was performed.

RESULTS

A total of 256 subjects participated in the study by returning the online survey. In the preparation phase, 70.7% (n = 181) residents reported anxiety and 56.1% (n = 144) reported stress. During the examinations, only 13.6% (n = 35) of the participants reported difficulty with internet speed. The majority, 64.6% (n = 165) of the participants reported that the absence of an external examiner face-to-face reduced anxiety. The compiled answers to the open-ended question revealed that residents expressed inconvenience in digitizing the academic logbooks and clinical work. The poor quality of sound and images affected the display of skills.

CONCLUSIONS

The study revealed a moderate level of acceptance for the novel online practical examination method. The residents reported stress before and during the examination due to the sudden transition to an online examination. The online practical examination with modifications might be a viable alternative to the in-person clinical examination.

Preprocedural mouthwashes for infection control in dentistry-an update

OBJECTIVES

Aerosols and splatter are routinely generated in dental practice and can be contaminated by potentially harmful bacteria or viruses such as SARS-CoV-2. Therefore, preprocedural mouthwashes containing antiseptic agents have been proposed as a potential measure for infection control in dental practice. This review article aims to summarize the clinical (and, if insufficient, preclinical) evidence on preprocedural mouthwashes containing antiseptic agents and to draw conclusions for dental practitioners.

METHODS

Literature on preprocedural mouthwashes for reduction of bacterial or viral load in dental aerosols was searched and summarized.

RESULTS

Preprocedural mouthwashes, particularly those containing chlorhexidine digluconate (CHX), cetylpyridinium chloride (CPC), or essential oils (EO), can significantly reduce the bacterial load in dental aerosols. With respect to viruses such as HSV-1, there are too little clinical data to draw any clear recommendations. On the other hand, clinical data is consolidating that CPC-containing mouthwashes can temporarily reduce the intraoral viral load and infectivity in SARS-CoV-2 positive individuals. Nevertheless, potential risks and side effects due to regular antiseptic use such as ecological effects or adaptation of bacteria need to be considered.

CONCLUSIONS

The use of preprocedural mouthwashes containing antiseptics can be recommended according to currently available data, but further studies are needed, particularly on the effects on other viruses besides SARS-CoV-2. When selecting a specific antiseptic, the biggest data basis currently exists for CHX, CPC, EO, or combinations thereof.

CLINICAL RELEVANCE

Preprocedural mouthwashes containing antiseptics can serve as part of a bundle of measures for protection of dental personnel despite some remaining ambiguities and in view of potential risks and side effects.

Factors of Compliance of Dental Patients in Primary Health Care Services during the Pandemic

The compliance of dentists with good hygiene practices during the COVID-19 pandemic was essential to minimize the transmission of SARS-CoV-2 strains, and the pandemic has significantly interrupted the provision of oral health care to many individuals. We aimed to examine, in a cross-sectional study, factors affecting dental patients' compliance in primary dental health settings during the pandemic period. The present study was conducted on 300 dental patients visiting four private dental offices in the city of Larissa in Central Greece during the period October-December 2021. The patients in the study sample were of an average age of 45.79 years with a standard deviation of 15.54 years, and 58% of the sample were females. A significant proportion of the participants, 22%, reported that they would be influenced if they knew that the dentist had been ill with COVID-19 despite being fully recovered. A total of 88% of the participants reported that they would feel safe if they knew their dentist was vaccinated against COVID-19. Regarding the information received by dentists, 88% of the participants agreed that the dentist's role is important in dealing with the COVID-19 pandemic, and 89% of them agreed that the information they received from the dentist about the COVID-19 pandemic was sufficient. One-third of the total sample reported that COVID-19 negatively impacted keeping dental appointments, and 43% of the sample kept scheduled appointments. A total of 98% reported that the dentist followed all health protocols against COVID-19 and that their office was equipped to follow health protocols. In the present study, we observe that dentists had adequate knowledge of, attitudes towards, and practices of infection control protocols against COVID-19 during the second wave, according to patients' perceptions.

Reduction of SARS-CoV-2 salivary viral load with pre-procedural mouth rinses: a randomised, controlled, clinical trial

Introduction The purpose of this study was to test the short-term efficacy of four commercial mouthwashes versus water in reducing SARS-CoV-2 viral load in the oral cavity over clinically relevant time points.Methods In total, 32 subjects that were proven SARS-CoV-2-positive via polymerase chain reaction (PCR)-based diagnostic test were recruited and randomised into five parallel arms. Cycle threshold (Ct) values were compared in saliva samples between the groups, as well as within the groups at baseline (pre-rinse), zero hours, one hour and two hours post-rinse, using SARS-CoV-2 reverse transcription-PCR analysis.Results We observed a significant increase in Ct values in saliva samples collected immediately after rinsing with all the four mouthwashes - 0.12% chlorhexidine gluconate, 1.5% hydrogen peroxide, 1% povidone iodine, or Listerine - compared to water. A sustained increase in Ct values for up to two hours was only observed in the Listerine and chlorohexidine gluconate groups. We were not able to sufficiently power this clinical trial, so the results remain notional but encouraging and supportive of findings in other emerging mouthwash studies on COVID-19, warranting additional investigations.Conclusions Our evidence suggests that in a clinical setting, prophylactic rinses with Listerine or chlorhexidine gluconate can potentially reduce SARS-CoV-2 viral load in the oral cavity for up to two hours. While limited in statistical power due to the difficulty in obtaining this data, we advocate for pre-procedural mouthwashing, like handwashing, as an economical and safe additional precaution to help mitigate the transmission of SARS-CoV-2 from a potentially infected patient to providers.

COVID-19 self-isolation patterns in UK dental care professionals from February to April 2020

Aim Dentistry is routinely associated with aerosol generating procedures. It has been suggested that aerosol generating procedures may place the dental professionals at increased risk of infection from respiratory pathogens. In the absence of widespread testing of the dental workforce to ascertain the incidence of COVID-19, a web-based self-reporting survey captured self-isolation patterns in dental professionals.Method A web-based closed questionnaire via the Survey Monkey platform captured reported COVID-19 self-isolation patterns in the dental team.Results A total of 3,309 responses were collected: 2,888 (87.3%) responses contained valid data and 26.8% of respondents reported self-isolating. Of these, 31.2% did so because they were suffering from COVID-like symptoms, 21.3% did so in order to protect a vulnerable member of their household, 25.7% did because a member of their household was suffering from COVID-like symptoms, and 21.8% self-isolated to protect themselves.Conclusion Despite the inherent limitations of self-reporting surveys, a web-based self-reporting questionnaire rapidly captured self-isolating patterns in DCPs. The initial findings from this survey would suggest that between February and April 2020, dental professionals did not experience disproportionately higher levels of COVID-like symptoms than the general population.

Impact of DHCWs' Safety Perception on Vaccine Acceptance and Adoption of Risk Mitigation Strategies

OBJECTIVES

To estimate the association between safety perception on vaccine acceptance and adoptions of risk mitigation strategies among dental health care workers (DHCWs).

METHODS

A survey was emailed to DHCWs in the New Jersey area from December 2020 to January 2021. Perceived safety from regular SARS-CoV-2 testing of self, coworkers, and patients and its association with vaccine hesitancy and risk mitigation were ascertained. Risk Mitigation Strategy (RiMS) scores were computed from groupings of office measures: 1) physical distancing (reduced occupancy, traffic flow, donning of masks, minimal room crowding), 2) personal protective equipment (fitted for N95; donning N95 masks; use of face shields; coverings for head, body, and feet), and 3) environmental disinfection (suction, air filtration, ultraviolet, surface wiping).

RESULTS

SARS-CoV-2 testing of dental professionals, coworkers, and patients were perceived to provide safety at 49%, 55%, and 68%, respectively. While dentists were least likely to feel safe with regular self-testing for SARS-CoV-2 (P < 0.001) as compared with hygienists and assistants, they were more willing than hygienists (P = 0.004; odds ratio, 1.79 [95% CI, 1.21 to 2.66]) and assistants (P < 0.001; odds ratio, 3.32 [95% CI, 1.93 to 5.71]) to receive the vaccine. RiMS scores ranged from 0 to 19 for 467 participants (mean [SD], 10.9 [2.9]). RiMS scores did not significantly differ among groups of DHCWs; however, mean RiMS scores were higher among those who received or planned to receive the COVID-19 vaccine than those with who did not (P = 0.004). DHCWs who felt safer with regular testing had greater RiMS scores than those who did not (11.0 vs. 10.3, P = 0.01).

CONCLUSIONS

Understanding DHCWs' perception of risk and safety is crucial, as it likely influences attitudes toward testing and implementation of office risk mitigation policies. Clinical studies that correlate risk perception and RiMS with SARS-CoV-2 testing are needed to demonstrate the effectiveness of RiMS in dental care settings.

KNOWLEDGE TRANSFER STATEMENT

Educators, clinicians, and policy makers can use the results of this study when improving attitudes toward testing and implementation of risk mitigation policies within dental offices, for current and future pandemics.

Fluorescent Marker as a Tool to Improve Strategies to Control Contaminated Surfaces and Decrease Danger of Cross-Contamination in Dental Clinics, during and beyond the COVID-19 Pandemic

The COVID-19 pandemic posed an increased threat to dental personnel and patients. Close encounters with patients' breath and saliva and the use of intraoral rotating instruments which disperse microscopic airborne particles both increase the possibility of environmental infection. In this study, fluorescent marker (FM) was used to assess and enhance surface cleanliness in the dental clinics and public areas of a major dental school. Initially, 574 surfaces in various areas of a dental school were marked with FM for 3 consecutive months to monitor the surface cleanliness. The initial evaluation results were visually presented to both students and para-dental and cleaning personnel during a designated educational session, and were used to stress the importance of preventing cross-contamination. Following educational intervention, 662 surfaces were re-examined for an additional 3 months, using the same method. A significant improvement in the surfaces' cleanliness (ANOVA, F₍₁₎ = 10.89, p < 0.005) was observed post-intervention. The results were more prominent in students' clinics, which were the students' cleaning responsibility. The results show that fluorescent markers can serve as an educational tool to improve strategies to control contaminated surfaces in large clinics, such as dental schools. Their use can substantially decrease the hazard of cross-contamination during the pandemic and beyond.

Efficacy of a Mouthwash Containing CHX and CPC in SARS-CoV-2-Positive Patients: A Randomized Controlled Clinical Trial

Soon after the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, preprocedural mouthwashes were recommended for temporarily reducing intraoral viral load and infectivity of individuals potentially infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in order to protect medical personnel. Particularly, the antiseptic cetylpyridinium chloride (CPC) has shown virucidal effects against SARS-CoV-2 in vitro. Therefore, the aim of this randomized controlled clinical trial was to investigate the efficacy of a commercially available mouthwash containing CPC and chlorhexidine digluconate (CHX) at 0.05% each in SARS-CoV-2-positive patients as compared to a placebo mouthwash. Sixty-one patients who tested positive for SARS-CoV-2 with onset of symptoms within the last 72 h were included in this study. Oropharyngeal specimens were taken at baseline, whereupon patients had to gargle mouth and throat with 20 mL test or placebo (0.9% NaCl) mouthwash for 60 s. After 30 min, further oropharyngeal specimens were collected. Viral load was analyzed by quantitative reverse transcriptase polymerase chain reaction, and infectivity of oropharyngeal specimens was analyzed by virus rescue in cell culture and quantified via determination of tissue culture infectious doses 50% (TCID₅₀). Data were analyzed nonparametrically (α = 0.05). Viral load slightly but significantly decreased upon gargling in the test group (P = 0.0435) but not in the placebo group. Viral infectivity as measured by TCID₅₀ also significantly decreased in the test group (P = 0.0313), whereas there was no significant effect but a trend in the placebo group. Furthermore, it was found that the specimens from patients with a vaccine booster exhibited significantly lower infectivity at baseline as compared to those without vaccine booster (P = 0.0231). This study indicates that a preprocedural mouthwash containing CPC and CHX could slightly but significantly reduce the viral load and infectivity in SARS-CoV-2-positive patients. Further studies are needed to corroborate these results and investigate whether the observed reductions in viral load and infectivity could translate into clinically useful effects in reducing COVID-19 transmission (German Clinical Trials Register DRKS00027812).

Tracing ΦX174 bacteriophage spreading during aerosol-generating procedures in a dental clinic

OBJECTIVE

The aim of this study was to test the plausibility of using the ΦX174 bacteriophage as a tracer of viral aerosols spreading in a dental aerosol-generating procedure (AGP) model.

METHODS

ΦX174 bacteriophage (~ 10⁸ plaque-forming units (PFU)/mL) was added into instrument irrigation reservoirs and aerosolized during class-IV cavity preparations followed by composite fillings on natural upper-anterior teeth (n = 3) in a phantom head. Droplets/aerosols were sampled through a passive approach that consisted of Escherichia coli strain C600 cultures immersed in a LB top agar layer in Petri dishes (PDs) in a double-layer technique. In addition, an active approach consisted of E coli C600 on PDs sets mounted in a six-stage cascade Andersen impactor (AI) (simulating human inhalation). The AI was located at 30 cm from the mannequin during AGP and afterwards at 1.5 m. After collection PDs were incubated overnight (18 h at 37 °C) and bacterial lysis was quantified.

RESULTS

The passive approach disclosed PFUs mainly concentrated over the dental practitioner, on the mannequin's chest and shoulder and up to 90 cm apart, facing the opposite side of the AGP's source (around the spittoon). The maximum aerosol spreading distance was 1.5 m in front of the mannequin's mouth. The active approach disclosed collection of PFUs corresponding to stages (and aerodynamic diameters) 5 (1.1-2.1 µm) and 6 (0.65-1.1 µm), mimicking access to the lower respiratory airways.

CONCLUSION

The ΦX174 bacteriophage can be used as a traceable viral surrogate in simulated studies contributing to understand dental bioaerosol's behavior, its spreading, and its potential threat for upper and lower respiratory tract.

CLINICAL RELEVANCE

The probability to find infectious virus during AGPs is high. This suggests the need to continue characterizing the spreading viral agents in different clinical settings through combination of passive and active approaches. In addition, subsequent identification and implementation of virus-related mitigation strategies is relevant to avoid occupational virus infections.

Impact of the Suspension of Dental Service on Oral Health-related Quality of Life in Orthodontic Patients During the COVID-19 Pandemic

PURPOSE

To assess the levels of oral health-related quality of life (OHRQoL) in orthodontic patients both during the suspension of dental services caused by COVID-19 and after a year of dental service reinstatement, and to evaluate the associated factors for OHRQoL in those patients during the suspension period.

MATERIALS AND METHODS

A cross-sectional online study was conducted both during the suspension of dental service due to COVID-19 (T1) and after a year of dental service reinstatement (T2). The questionnaire - consisting of personal information, subjective complaints, OHIP-14 and oral health conditions - was completed by the participants at T1 and T2. Data were evaluated by the Χ2 test, the Wilcoxon rank-sum test, and multivariate logistic regression analysis.

RESULTS

324 participants were ultimately included in the study sample. The participants reported higher OHIP-14 total scores at T1 than T2 (p < 0.001). Statistically significant differences were detected in the domains psychological discomfort, psychological disability, social disability and handicap (p < 0.001). The multivariate logistic regression analysis showed that wearing fixed appliances, being over 18 years old, having delayed orthodontic treatment and poor oral hygiene habits were statistically significantly associated with higher OHIP-14 total scores at T1 (p < 0.05).

CONCLUSION

The OHRQoL in orthodontic patients was negatively impacted by the suspension of dental services during COVID-19, which was reflected in all the psychosocial domains. Types of appliances, ages, delays in follow-up visits and oral hygiene habits seemed to be the factors associated with OHRQoL in orthodontic patients during the suspension.

Effect of SARS CoV-2 Infection on Periodontal Tissue: A Systematic Review

Background:

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) infection in human respiratory cells. The first spread of this disease first occurred in Wuhan, China, in December 2019, and on March 11, 2020, the World Health Organization declared the spread of the infection as a global pandemic. People who are infected experience mild to moderate clinical symptoms which are characterized by an increase in T cell, CD8, and IgM/IgG levels. The occurrence of severe clinical symptoms reflects an excessive and uncontrolled increase in the secretion of pro-inflammatory cytokines, which impacts the systemic condition and periodontal tissues of affected patients.

Objective:

The aim of this study is to describe the impact of SARS CoV-2 infection on periodontal tissues.

Methods:

In this study, we searched the NCBI, PubMed, Google Scholar, and Research Gate databases. The keywords used were “coronavirus disease” or “COVID-19” or “SARS-CoV-2” with “oral manifestations” and “periodontal,” and we screened the articles using the PRISMA flow diagram.

Results:

Patients with COVID-19 present with a variety of systemic symptoms, as well as manifestations in the periodontal tissues, especially in the gingival area.

Conclusion:

SARS CoV-2 infection can impact periodontal tissues in the form of necrotizing ulcerative gingivitis, aphthous stomatitis, gingival hyperpigmentation, edema and erythema, lichen planus, and aphthous-like ulcers.

Spatiotemporal distribution and control measure evaluation of droplets and aerosol clouds in dental procedures

We evaluated the distributions of dental splatters and the corresponding control measure effects with high-speed videography and laser diffraction. Most of the dental splatters were small droplets (<50 μm). High-volume evacuation combined with a suction air purifier could clear away most of the droplets and aerosols.

Dental students' knowledge about protective guidelines for clinical practice during the COVID-19 pandemic

Objective

The coronavirus disease 2019 (COVID-19) originated in China, in December 2019, spread worldwide promptly and turned into an outbreak which caused an international public health concern. The novel coronavirus which is also called SARS-CoV-2 transmits predominantly by respiratory droplets and the spread pattern of this infection throughout the community became a big challenge encountering the dental profession. Recently several guidelines have been developed for dental clinicians to protect both patients and practitioners, agents this infection. The aim of this study was to estimate the knowledge of dental students about the content of protective guidelines for clinical practice during the COVID-19 pandemic.

Methods

An online questionnaire was developed by a team of specialists which were the faculty member of Tehran University of Medical sciences according to the content of the protective guidelines of ADA for dental practice during the COVID-19 pandemic. The questionnaire was validated and its reliability was confirmed by retesting 10 samples after 2 weeks with a cronbach alpha of 0.9. The online questionnaire was sent to 4 dental schools in the city of Tehran and was fill out by 170 dental students.

Results

The mean knowledge score for all 170 participants was 16.23 out of 32 (50.72%) with the maximum score of 24 (75.0%) and the minimum score of 1 (3.1%). There was a significant relationship between the gender of participants and their knowledge score (p = 0.032) in the way that male students had significantly higher score than females. Students with more advanced educational level achieved higher knowledge scores. (p = 0.038) However, there were no significant correlation between other variables and the students' knowledge score. (p > 0.05).

Conclusion

Dental students had acceptable knowledge about the general protocols against corona virus in terms of hand hygiene, wearing face masks, surface sanitization and diagnostic symptoms of a patient susceptible to be infected by corona virus. However, mostly they were not aware of the details of the guideline's items which makes it crucial to add related content in the dental students' educational curriculum.

Perception of Remote Learning by Fixed Prosthodontic Students at a Romanian Faculty of Dentistry

The COVID-19 pandemic has forced the transfer of traditional on-site educational activities to the online environment. This study aimed to evaluate the perception and acceptance of remote learning among fixed prosthodontic students attending the Faculty of Dental Medicine of "Grigore T. Popa" University of Medicine and Pharmacy in Iasi, Romania, and to analyze the feedback regarding their experience with the new online methods, the perceived quality thereof and suggestions for improvement. An observational cross-sectional, online study based on 22 questions was conducted with 259 students. The general opinion of online education was good or very good (40.15%); regarding its efficiency, 28.57% found it efficient while 34.36% found it inefficient or very inefficient; regarding the pleasure of learning online, 45.95% of students enjoyed online learning, while 36.64% did not enjoy it. The problem that was most cited by respondents was that of keeping all students motivated and involved (65.6%). Sixty-two percent of the respondents believe that online dental education should not exist, or just to a small extent, a result justified by the practical nature of the profession. The general opinion was that health risks should be managed and mitigated by using a hybrid system that would allow students to do on-site clinical training with direct contact with patients.

Impacts of the COVID-19 pandemic on the routine of Brazilian oral radiologists

OBJECTIVE

To analyze the challenges and impacts of COVID-19 on the routine of Brazilian oral radiologists regarding changes in biosafety protocols, number of patients and staff, the flow of acquisition, and availability of images.

METHODS

Structured digital questionnaires with questions related to the impacts of the COVID-19 pandemic on Oral Radiology were applied and analyzed. Descriptive statistical analysis was used to describe the items included in the survey, and means and standard deviations were calculated to describe continuous variables and frequency percentages to describe categorical data.

RESULTS

A high number of Brazilian oral radiologists continued to work in the pandemic period, with little or no change in their working hours. Digital flow and teleradiology are in most of their workplaces and the changes imposed by the pandemic will be incorporated and permanent, according to most of the participants in this study.

CONCLUSIONS

The COVID-19 pandemic brought important impacts on radiology clinics, with changes in the flow of patients, in the service and in the type of exam performed. In addition, adaptation to biosafety standards became necessary, with a significant increase in spending on personal protective equipment.

Characterization of dental dust particles and their pathogenicity to respiratory system: a narrative review

OBJECTIVES

Dental professionals are exposed to large amounts of dust particles during routine treatment and denture processing. This article provides a narrative review to investigate the most prevalent dust-related respiratory diseases among dental professionals and to discuss the effects of dental dust on human respiratory health.

MATERIALS AND METHODS

A literature search was performed in PubMed/Medline, Web of Science, and Embase for articles published between 1990 and 2022. Any articles on the occupational respiratory health effects of dental dust were included.

RESULTS

The characterization and toxicity evaluation of dental dust show a correlation between dust exposure and respiratory system injury, and the possible pathogenic mechanism of dust is to cause lung injury and abnormal repair processes. The combination use of personal protective equipment and particle removal devices can effectively reduce the adverse health effects of dust exposure.

CONCLUSIONS

Dental dust should be considered an additional occupational hazard in dental practice. However, clinical data and scientific evidence on this topic are still scarce. Further research is required to quantify dust in the dental work environment and clarify its pathogenicity and potential toxicological pathways. Nonetheless, the prevention of dust exposure should become a consensus among dental practitioners.

CLINICAL RELEVANCE

This review provides dental practitioners with a comprehensive understanding and preventive advice on respiratory health problems associated with dust exposure.

Psychological factors and oral health during initial outbreak of COVID-19 in China: A cross-sectional study

OBJECTIVES

To investigate associations between oral health and psychological factors (i.e., depression, anxiety, and resilience) in a group of Chinese individuals who had sought an intervention online during the COVID-19 pandemic.

METHODS

For this cross-sectional study, online questionnaires were created using online survey software from set items of instruments commonly used to assess depression, anxiety, and resilience combined with an oral health survey. The study was conducted from March 13 to 16, 2020.

RESULTS

568 participants (188 men and 380 women) with a mean ± SD age of 41.7 ± 10.2 years were included in the analyses. In total, 152 (27%) participants were from Beijing, 149 (26%) from Wuhan, 110 (19%) from Shenyang, and 157 (28%) from other Chinese cities. Halitosis and bleeding gums were the most common reasons for individuals to seek an intervention. Compared with other cities, participants from Wuhan showed higher anxiety and depression and worse previous oral health. Resilience mediated the relationship between depression and oral health, but not between anxiety and oral health.

CONCLUSION

We hope that the data from this study will inform clinical practitioners and demonstrate that mental health awareness and resilience training are important strategies that may mitigate the negative impact of lockdown and isolation on oral health.

[Risks, contamination and prevention against COVID-19 in dental work: a review]

INTRODUCTION

In April 2020 The COVID-19 pandemic caused more than one million infections and 54 600 deaths to date around the world. The spread of SARS-CoV-2 is rapid, and its transmission is through droplets of saliva, hence its importance in dentistry.

OBJECTIVE

Identify the main risks, transmission routes and prevention measures against COVID-19.

METHODS

A review of the scientific literature of the last two years on the subject was carried out in the PubMed, ScienceDirect, Google Scholar and Research Gate databases. The descriptors used were: "coronavirus", "COVID-19", "dental", "dentistry", "oral", "stomatology", and "aerosol". 350 articles were found, but 50 were selected for their topicality, relationship, and focus. The transmission of the COVID-19 is carried out mainly through saliva drops, aerosols and fomites. The virus can subsist for a time on the environment and surfaces. Dentists are health workers who are at risk of contagion because several of their procedures release aerosols. The biosecurity in the exercise of this profession must be strict and extreme, also the cleaning and disinfection of the environment and contact surfaces.

CONCLUSIONS

In the dental profession the potential risk of contamination among operators, assistants and patients is high. Knowing the causative agent and the disease allows you to reduce the possibility of contagion. The dentist must consider patients as suspects to COVID-19 and apply biosecurity at all levels.

Chemomechanical Caries Removal Methods: A Literature Review

Aim

To provide dental practitioners and researchers with a comprehensive review of the historical development, chemical composition, mechanisms of action, advantages, and drawbacks of different chemomechanical caries removal (CMCR) agents.

Methods

An electronic search was performed for all articles published on CMCR agents in various databases, including the Web of Science, PubMed, Cochrane, Scopus, and Google Scholar bibliographic databases, from January 1, 1975, to July 31, 2022.

Results

Records were identified using the following search terms: Brix3000, Carie-Care, Caridex, Carisolv, chemomechanical caries removal, conventional surgical method, and Papacárie. A total of 171 articles were screened based on the titles and abstracts, of which 126 were deemed eligible for inclusion after duplicates were removed. Following a manual search of the reference list, eight articles were added. Articles were then excluded for other reasons, such as being written before 1975, being written in a language other than English, and the non-availability of the full text. Overall, 120 articles were included in the analysis (literature reviews [n = 27], systematic reviews [n = 8], research articles [n = 82], case reports [n = 3]).

Conclusion

CMCR is a potential method of caries control in the future as an alternative to the conventional surgical approach in standard dentistry applications. It is more widely accepted, less painful, and has comparable efficacy to the conventional surgical method.

Clinical significance

A continuous trend among manufacturers has been observed since 1975 to reduce the drawbacks of CMCR agents. Moreover, evidence-based minimally invasive techniques, including CMCR agents that require minimal or no aerosol-generating procedures, are preferred while measures to control the spread of coronavirus disease are in force.

[COVID-19 Pandemic: Psychosocial impact among healthcare professionals in Tunisia]

OBJECTIVE

To determine the psycho-affective impact of the Covid-19 pandemic on the mental health of health professionals in Tunisia and to estimate the associated factors.

METHODS

This is a multicenter, cross-sectional, descriptive and analytical study of health professionals carried out from May 2, 2020 to June 30, 2020 in Tunisia. Healthcare professionals included doctors, nurses, dentists and pharmacists. The participants answered a pre-established questionnaire using an electronic "Google Form". This questionnaire gathered demographic data and medical history. It included two psychometric scales, the GAD-7 (General Anxiety Disorder-7) and the PHQ-9 (Patient Health Questionnaire-9) to assess the prevalence and intensity of anxiety symptoms and depressive symptoms respectively.

RESULTS

The study included 203 healthcare professionals. The professionals had a mean age of 30.74±6.33years, 69.5 % were women, and the majority were doctors (77.8 %). Among professionals, 9.4 % were nurses, 7.4 % were dentists, and 5.4 % were pharmacists. A third of the participants 34.3 % worked in departments with Covid-19 patienfor having moderate to severe anxiety symptoms.

CONCLUSION

In order to ensure better patient care, early detection of psychiatric disorders and the implementation of specific strategies to ensure better mental health among healthcare professionals are priorities not only during the current pandemic but also in the event of a future similar pandemic.

Preparedness of recent dental graduates and final-year undergraduate dental students for practice amidst the COVID-19 pandemic

INTRODUCTION

Dental education involves performing clinical procedures on patients under expert supervision. The COVID-19 pandemic has disrupted routine face-to-face teaching-learning-assessment dynamics world over. This study assessed the self-perceived preparedness of dental undergraduate students for practice, whose clinical training was interrupted by the COVID-19 pandemic from dental schools across Malaysia.

MATERIALS AND METHODS

This cross-sectional web-based questionnaire survey was done among new dental graduates of the academic year 2019-2020 and the final year undergraduate students (academic year 2020-2021) from dental schools in Malaysia, using the Dental Undergraduates Preparedness Assessment Scale (DU-PAS), from 6th to 26th April 2021. The questionnaire addressed clinical skill competence, and cognitive and behavioral attributes. The number of respondents needed to achieve a confidence level of 95% with margin of error of 5% was 306.

RESULTS

A total of 453 (243 final year students and 210 new graduates) responded from dental schools nationwide, with a response rate of 30.6%. The overall mean score for preparedness for dental practice was 76.3±14.7, for clinical skills 39.7±7.3, and behavioral and cognitive attributes 36.5±9.1. New graduates had significantly higher mean preparedness score (78.6±14.4) as compared to students in their final year (74.2±14.7). Performing endodontic treatment on multi-rooted teeth had the lowest perceived competency (29.8%), followed by assessing treatment needs of patients requiring orthodontics (37.1%), prescribing drugs (46.6%) and providing crowns using principles of tooth preservation (48.1%).

CONCLUSIONS

Satisfactory scores were obtained for most attributes. The final-year cohort was significantly less prepared for dental practice compared to the newly graduated cohort.

Modified Negative Pressure Enclosure During Tracheostomy in Patients With COVID-19

COVID-19 also known as severe acute respiratory syndrome coronavirus 2 is the result of a highly transmissible coronavirus which can result in severe infection of the respiratory tract. The global pandemic which began in early 2020 has created a number of challenges for the medical community to contain the rate of transmission, especially to health care workers. A minority of the infected population will progress toward severe respiratory distress ultimately requiring mechanical ventilator assistance. Although preliminary data suggest a poor prognosis for those requiring ventilation support, there is a subgroup who will eventually be weaned off. As the pandemic evolves, this cohort of infected, chronically intubated and ventilated individuals will become more prevalent and may require tracheostomy to aid in recovery. Unfortunately, tracheostomy is an aerosol-generating procedure which poses high risks to all members within the operating room, as described by previous authors. There is an urgent need to explore and develop methods to maximize the safety of tracheostomy and other aerosol-generating procedures in order to reduce intraoperative transmission. In the present article, we present a modified technique for negative pressure enclosure in patients with COVID-19 who underwent tracheostomy.

Information technology and artificial intelligence support in management experiences of the pediatric designated hospital during the COVID-19 epidemic in 2022 in Shanghai

Objective

To describe the information technology and artificial intelligence support in management experiences of the pediatric designated hospital in the wave of COVID-19 in Shanghai.

Methods

We retrospectively concluded the management experiences at the largest pediatric designated hospital from March 1st to May 11th in 2022 in Shanghai. We summarized the application of Internet hospital, face recognition technology in outpatient department, critical illness warning system and remote consultation system in the ward and the structed electronic medical record in the inpatient system. We illustrated the role of the information system through the number and prognosis of patients treated.

Results

The COVID-19 designated hospitals were built particularly for critical patients requiring high-level medical care, responded quickly and scientifically to prevent and control the epidemic situation. From March 1st to May 11th, 2022, we received and treated 768 children confirmed by positive RT-PCR and treated at our center. In our management, we use Internet Information on the Internet Hospital, face recognition technology in outpatient department, critical illness warning system and remote consultation system in the ward, structed electronic medical record in the inpatient system. No deaths or nosocomial infections occurred. The number of offline outpatient visits dropped, from March to May 2022, 146,106, 48,379, 57,686 respectively. But the outpatient volume on the internet hospital increased significantly (3,347 in March 2022 vs. 372 in March 2021; 4,465 in April 2022 vs. 409 in April 2021; 4,677 in May 2022 vs. 538 in May 2021).

Conclusions

Information technology and artificial intelligence has provided significant supports in the management. The system might optimize the admission screening process, increases the communication inside and outside the ward, achieves early detection and diagnosis, timely isolates patients, and timely treatment of various types of children.

Antimicrobial effect and the mechanical and surface properties of a self-disinfecting and a chlorhexidine-incorporated Type IV dental stone

STATEMENT OF PROBLEM

Stone casts are subject to contamination, but whether disinfectants incorporated into the stone are effective is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the antimicrobial activity and the mechanical and surface properties of self-disinfecting gypsum (SDG) and gypsum mixed with 2% chlorhexidine (GCHX).

MATERIAL AND METHODS

Antimicrobial action was evaluated using the diffusion-disk technique on Streptococcus aureus and Candida albicans 1 hour and 24 hours after pouring the gypsum. The groups were SDG, GCHX, a positive control (PC) of gypsum mixed with distilled water, and a negative control (NC) of filter paper disk soaked with 2% chlorhexidine; n=8. Inhibition halos were measured using the ImageJ software program and statistically analyzed using the repeated measures mixed ANOVA with time×group interaction. Compressive strength (CS) in MPa and surface roughness (SR) in μm (parameters: Ra - roughness average; and Sa - 3-dimensional (3D) arithmetic mean of the surface profile) tests were performed to characterize the specimens (evaluated groups: SDG, GCHX, and PC; n=10). CS data were analyzed by a 2-way ANOVA with time×group interaction, and SR data by a 1-way ANOVA (α=.05).

RESULTS

For S aureus, there were differences between GCHX and SDG at 1 hour and 24 hours (P<.05), but no significant differences were found for C albicans (P>.05). GCHX was better than PC, except for C albicans, and showed a reduction in CS when compared with PC and SDG (P<.05) at all time intervals. The SR of GCHX increased (Ra:1.76, Sa:2.08) when compared with PC (Ra:0.89, Sa:1.12) and SDG (Ra:1.03, Sa:1.35) (Ra: P<.004 and Sa: P<.001).

CONCLUSIONS

The antimicrobial activity of GCHX against S aureus was better than that of SDG, but neither had an effect against C albicans. As for CS and SR, GCHX presented a decrease in properties when compared with PC and SDG but was within the American Dental Association #25 specification values.

Usefulness of Telemedicine for Disabled Children Receiving Feeding Therapy

We performed a retrospective cohort study using medical records of 374 pediatric patients who visited a university dental clinic specializing in dysphagia rehabilitation in Japan between 2019 and 2020 to clarify the usefulness of telemedicine among disabled children receiving feeding therapy. The primary outcome was the feeding developmental stage confirmed at the final evaluation. Propensity score matching was performed between individuals in two treatment groups (in-person and telemedicine) before the final analysis using patients' age, sex, primary disease, gross motor function, and feeding developmental stage as covariates. A total of 36 patients were enrolled in each of the in-person and telemedicine groups. The initial evaluation for the propensity score matched population using the χ² test showed no significant difference between the two groups in any parameter. The feeding developmental stage evaluated at the final evaluation using the Wilcoxon signed-rank test significantly improved compared with the stage at the initial evaluation in both groups (in-parson group, p = 0.007; telemedicine group, p = 0.013). The difference in level achieved at the final evaluation revealed that the most common level was "unchanged," followed by "improvement by one level" in both groups, indicating that there was no significant difference in the efficacy of feeding therapy between the two groups (p = 0.314). Our results show that telemedicine can achieve the same therapeutic outcomes as in-person therapy to improve feeding function in children with disabilities when receiving feeding therapy.

Effect of the COVID-19 pandemic on depression, perceived stress and hypochondria of frontline dental staff (FDS): A cohort study

BACKGROUND

The coronavirus 2019 (COVID-19) pandemic had several mental effects on medical staff.

OBJECTIVE

This study intended to evaluate deviations in Frontline Dental Staff (FDS) depression, perceived stress and hypochondria during the COVID-19 outbreak, and to assess whether the existence of potential risk-factors influenced these symptoms over time.

METHODS

This prospective cohort study surveyed FDS three periods from February 1, 2021 to April 8, 2022. FDSs' mental health was assessed through Beck Depression Inventory, Cohen Perceived Stress and the Evans Self-Illness Questionnaires; multivariate linear regression were used to identify potential factors associated with changes on each outcome (depression, perceived stress and hypochondria) over time. All analyses were performed in STATA ver.14.

RESULTS

In a total of 635 FDS, about 69%, 83%, and 71% reported relative depression, 77%, 87%, and 64% reported moderate to high stress level, and 60%, 76% and 74% reported moderate hypochondriac from first, second, and third survives, respectively. The mean and standard deviation of the variables increased dramatically at second survive (July 17 to October 21, 2021) and decreased again at third survive significantly. Being female, working in public sector, and low socioeconomic level were main predictors of higher levels of depression (p < 0.001) and perceived stress (p < 0.001). Perceived stress was a strong predictor of high-level depression (t  =  7.79, p < 0.001).

CONCLUSION

FDSs' depression, stress and hypochondria were high and positively associated with being female, working in public-sector, and low socioeconomic level. To increase the effectiveness and decrease work burnout, psychological support should be provided.

Impact of the COVID-19 lockdown on the oral health status of paediatric dental patients in Greece

BACKGROUND

Limited evidence regarding the post-COVID-19 dental status of paediatric patients is available, with most studies assessing only children's oral health habits.

AIM

To evaluate the effect of the COVID-19 lockdown on the oral health of paediatric dental patients in Greece.

DESIGN

This was a retrospective cohort study that included a questionnaire on children's oral health behavior and a clinical examination assessing dental caries and dental treatment needs using the International Caries Detection and Assessment System criteria, dmft/DMFT, and Treatment Need Index. The Wilcoxon signed-rank test was used for a statistical comparison between questionnaire and clinical data before, during, and after the lockdown.

RESULTS

A total of 102 children with a median age of 9 years were recruited from the current cohort of patients that had their last dental examination 6 months prior to the lockdown. Results from the questionnaire showed decreased brushing frequency with increased eating frequency and sugar consumption during the lockdown period (p < .001). Moreover, 16.5% had to visit the dentist for urgent care during the lockdown, 13.6% experienced dental pain, and 51.5% did not experience any dental emergencies. Clinical examination, after the lockdown, recorded significantly increased mean dmft/DMFT scores by 0.63 units in the primary dentition (p = .01) and 0.52 units in the permanent teeth (p = .002). Significantly higher treatment needs, with more carious lesions requiring extensive treatment after the lockdown, were recorded (p < .001).

CONCLUSION

The COVID-19 lockdown negatively affected children's oral health behavior: caries prevalence increased and more complex dental treatments were required.

Organizational Preventative Strategies Undertaken by Dental Clinics in Fiji during COVID-19 Pandemic: A Qualitative Study

Aim:

This research aims to determine the organizational preventative strategies implemented by dental clinics in Fiji during the COVID-19 pandemic.

Methods:

This qualitative study was conducted amongst Dental Officers (Dos) and Dental Managers (DMs) who were working at government dental clinics, private dental clinics, and the School of Dentistry and Oral Health clinic (SDOH), in the Central Division, Fiji. A semi-structured open-ended questionnaire was used for data collection through in-depth interviewsviazoom. A manual thematic analysis of the data was conducted.

Results:

Thirty Dos and 17 DMs participated in this study. 16 themes emerged from data analysis: Major Strategies implemented, Staff perception about strategies in place, Triaging and Screening, Hand hygiene, Waiting room changes, Operational Capacity, Universal precautions, Personal Protective Equipment (PPEs), Disinfection and decontamination protocols, Ventilation, Sterilization, Pre-procedural mouth rinse, Waste management, Vaccination status, Bubbles and Adaptation of Protocols. The Dos were generally satisfied with the strategies implemented by the DMs. The DMs along with other Dos had used various guidance documents to devise tailor-made ones suited for dental clinics in Fiji.

Conclusion:

Various strategies were adopted from several guidelines and tailor-made Standard Operating Procedures (SOPs) for each workplaces were developed by the various DMs. The majority of Dos were in favor of and satisfied with the protocols in place. Future research can be conducted in other divisions and include other health care professionals as well apart from just Dos and DMs.

State of the Oral Implantology Practice in Spain during the COVID-19 Pandemic: A Cross-Sectional Survey

At the beginning of the COVID-19 pandemic, strict measures of confinement and social distancing were taken. Dentists were considered essential personnel and their activity was restricted to emergency treatment. The present observational study aims to determine the situation of oral implantology practice in Spain during the initial period of the COVID-19 pandemic. This is a cross-sectional observational study based on the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. An electronic survey consisting of three blocks of questions was sent to all members of the Spanish Society of Implants. The data were analyzed using descriptive analysis. A total of 237 participants (14.3%) responded to the questionnaire. The majority of participants (60.8%) only attended emergencies during the first 9 months of the pandemic. Despite this, 77.2% reported having performed dental implant surgeries and 75.5% indicated that they performed non-essential treatments. The activity was fully recovered by 64.1% of the surveyed dentists. The majority of dentists (90.7%) considered that sufficient/adequate preventive measures were carried out at their workplace, which possibly contributed to the fact that 49.3% were not afraid of becoming infected. This concern was significantly and directly proportionally associated with the age of the surveyed dentists. The oral implant practice was affected to a greater extent during the first 9 months of the pandemic, especially in urban areas, with a greater impact on the workload of professionals with less specialised training in oral implantology.

Knowledge mapping of COVID-19 and dentistry: A bibliometric analysis

Background

COVID-19 has a significant impact on dental medicine. The present study aims to overview dental-related research on COVID-19 by visual mapping method.

Methods

We analyzed the publications in the "Dentistry Oral Surgery Medicine" category in the Web of Science core collection. On June 10, 2022, we conducted an advanced search using the items TS = ("Novel coronavirus 2019" or "COVID 19" or "Coronavirus disease 2019" or "2019-nCOV" or "SARS-CoV-2" or "coronavirus-2") and WC = ("Dentistry Oral Surgery medicine") to screen publications in the dental field that focus on COVID-19 or SARS-CoV-2. The contributions of authors, journals, institutions, and countries were described using Microsoft Excel 2010 and VOSviewer. The keywords co-occurring analysis and references analysis were visualized using VOSviewer and CiteSpace.

Results

A total of 1,732 papers were identified between 2020 and 2022. The United States, the United Kingdom, and Brazil were three major contributors to this field. Univ São Paulo (Brazil) ranked first with 55 publications in this field. Martelli Junior, Hercilio from Universidade Jose do Rosario Vellano (Brazil) was the most prolific author with 19 publications. Oral Diseases and British Dental Journal were the two most productive journals. The central topics were dental practice and infection control, oral manifestation related to COVID-19, dental education and online learning, teledentistry, and mental health problems.

Conclusion

The growth rate of publications regarding dental research on COVID-19 has risen sharply. Research topics shifted from "Dental practice and infection control, oral manifestation related to COVID-19" in 2020 to "Dental education and online learning, teledentistry, mental health problems," which are three important research topics for the future.

Changes in Medication Prescribing Due to COVID-19 in Dental Practice in Croatia-National Study

The 2019 coronavirus pandemic (COVID-19) has affected clinical practice and, consequently, drug prescribing in dental practice. We investigated how the pandemic affected the prescribing behavior of dentists in Croatia. Data on prescribing practices for this study were provided by the Croatian Health Insurance Institute. The analysis included the number of prescriptions, costs, and the number of packages prescribed. The World Health Organization's defined daily dose per 1000 inhabitants (DID) per day was used as an objective utilization comparison. During the first pandemic year, prescribing practice changed the most. Wide-spectrum antibiotics, analgesics, and antiseptics showed the highest trend in change. A statistically significant change in prescribing practices during the pandemic period was noted for amoxicillin with clavulanic acid, ibuprofen, and ketoprofen which showed an increase in trend, while cephalexin and diclofenac showed a statistically significant decrease. The highest increase in trend was recorded for azithromycin, at +39.3%. The COVID-19 pandemic has been associated with a marked increase in medication utilization, especially in the first year of the pandemic. The increase in wide-spectrum antibiotic classes needs to be addressed and regulated so that patients accept that antibiotics are not a substitute for dental treatment and dentists always start treatment with narrow-spectrum antibiotics regardless of specific times, as is the case with the pandemic.

An Outlook on Dental Practices to Avoid the Oral Transmission of COVID-19

The oral microbiome plays an important role in the maintenance of immune homeostasis, whereas its association with SARS-CoV-2 infection remains under investigation. Since the oral path is one of the transmission routes for COVID-19, we attempt to show the relationship between the oral microbiome, COVID-19 infection, and oral hygiene. We highlight the importance of oral hygiene to control the infection, especially for ICU cases with COVID-19. Moreover, we present the current strategies adapted by in-person dental clinics to overcome the spread of COVID-19. New emerging policies and protocols suggested during the pandemic and their future implementation to minimize virus transmission are also summarized in this review.

Factors Associated with Epidemiological, Preventive and Health Care Knowledge of Dentists from North of the Peruvian Capital about COVID-19: A Cross-Sectional Study under a Predictive Model

Aim: In dental practice there is a high risk of contact with fluids that may contain SARS-CoV-2. Salivary secretions in the form of droplets are the main route of infection. The present study aimed to evaluate factors associated with epidemiological, preventive and health care knowledge of dentists from the north of the Peruvian capital about COVID-19. Materials and Methods: This analytical, observational, cross-sectional and prospective study evaluated 142 dental professionals from the Directorate of Integrated Health Networks (DIRIS) in the north of the Peruvian capital during June to August 2022. A validated questionnaire of 20 closed multiple-choice questions was used to measure the level of epidemiological, preventive and health care knowledge about COVID-19. A logit model was used to evaluate the influence of the following variables: age, sex, marital status, children, origin, university of origin, academic degree, work modality, work status and number of training courses. In addition, a predictive model was constructed with the causal variables considering a significance level of p < 0.05. Results: Epidemiological, preventive and health care knowledge about COVID-19 was fair in 17.6%, 34.5% and 57.7%, respectively. Likewise, all the variables analyzed were influential factors. It was observed that being single (OR = 0.05, CI: 0.01−0.26), having studied at a private university (OR = 0.09, CI: 0.023−0.38) and having received four to six trainings on COVID-19 related topics (OR = 0.02, CI: 0.002−0.238) were protective factors against fair knowledge. Conclusions: More than half of the dentists surveyed had fair knowledge about COVID-19. The factors that favored a good level of overall knowledge were: being single, having studied at a private university and having received 4 to 6 training courses on COVID-19-related topics. It is advisable that the competent authorities continue to educate dental professionals with training programs about infection control practices in accordance with the health care work they perform in their specialty. It will also be of utmost importance for the professional to be updated with reliable information accredited by the Centers for Disease Control and Prevention as well as the WHO.

Factors affecting the infection control behaviours of Korean dental hygienists in response to the coronavirus disease 2019 pandemic

OBJECTIVES

This study aimed to identify the factors affecting the prevention of cross-infection with coronavirus disease-19 (COVID-19) among Korean dental hygienists.

METHODS

The level of knowledge about COVID-19 (KNW_CO ), level of awareness of infection control (AWR_IC ), degree of performance for infection control (PRF_IC ), and organizational factors for infection control (OFW_IC ) of clinical dental hygienists in Korea to prevent COVID-19 transmission were investigated. A self-written online questionnaire was administered to dental hygienists currently working in dental clinics or hospitals, and the survey results of 263 participants were analysed. Pearson's correlation coefficients were calculated for relationships between the KNW_CO , AWR_IC , PRF_IC , and OFW_IC . Multiple linear regression analysis was performed to identify the factors affecting the PRF_IC . Statistical significance was set at p < 0.05.

RESULTS

Knowledge about COVID-19, AWR_IC , PRF_IC , and OFW_IC were significantly correlated with each other. OFW_IC (β = 0.491, p < 0.001), followed by AWR_IC (β = 0.428, p < 0.001) and KNW_CO (β = 0.095, p = 0.013), had the greatest impact on PRF_IC with regard to the prevention of COVID-19 transmission.

CONCLUSIONS

Organizational factors for infection control and AWR_IC should be strengthened to improve PRF_IC and prevent COVID-19 transmission during dental care.

Effectiveness of Selected Air Cleaning Devices During Dental Procedures

INTRODUCTION

The recent COVID-19 pandemic has underscored the necessity of protecting health care providers (HCPs) against the transmission of infectious agents during dental procedures. To this end, the effectiveness of several air cleaning devices (ACDs) in reducing HCPs exposure to aerosols generated during dental procedures was estimated, separately or in combination with each other. These ACDs were a chairside unit capturing aerosols at the source of generation, and four ambient ACDs: a portable ambient ACD; a negative pressure module; a custom made, fan-operated and wall-mounted air filter (WMAF); and a smaller and passive version of the latter. The last three ACDs were intended for mobile dental clinics (MDCs) only.

MATERIALS AND METHODS

This assessment was performed in two different environments: in a dental clinic operatory and in a MDC. Two dental personnel, acting in the roles of dentist and dental assistant, performed on simulated patient aerosol-generating and non-aerosol-generating procedures. For each 5-minute scenario, the cumulative exposure to airborne particulate matter 10 µm in size or smaller (PM10) was determined by calculating the sum of all 1 second readings obtained with personal and ambient air monitors. The effectiveness of the ACDs in capturing PM10 was estimated based on the capability of the ACDs to keep PM10 level at or below the initial background level.

RESULTS

In all conditions assessed in the dental clinic operatory, when both the chairside and portable ambient ACDs were functioning, an estimated effectiveness of 100% in capturing PM10 was achieved. In the MDC, in all conditions where the chairside ACD was used without the negative pressure module, an estimated effectiveness of 100% was also achieved. The simultaneous operation of the negative pressure module in the MDC, which led to a room negative pressure of -0.25 inch wc, reduced the chairside ACD's effectiveness in capturing aerosols. Conversely, the use of the WMAF in the MDC in combination with the chairside ACD further reduced exposure to PM10 below the initial background level. Nonetheless, in all conditions assessed in both settings (dental clinic operatory and MDC), larger visible aerosols were produced, often landing on the surrounding environment. A fair portion of these aerosols landed on the inside of the chairside ACD flange.

CONCLUSIONS

This assessment suggests that the use of the tested chairside ACD, by capturing aerosols at the source of generation, had the greatest impact on reducing exposure of dental personnel to PM10 produced during dental procedures. This study also indicates that such exposure is further reduced with the addition of an ambient ACD. However, creating a negative pressure room as high as -0.25 inch wc can lead to air turbulence reducing the effectiveness of ACDs in capturing aerosols at the source. Furthermore, the presence of uncaptured droplets and spatter on the surrounding environment supports the need to complement the use of engineering controls with proper administrative controls and personal protective equipment, as recommended by governmental agencies and the scientific community for preventing the transmission of infection in health care settings.

Theory-Guided Remote Cooperative Learning-Based Preventive Dental Education as Part of the School Curriculum

BACKGROUND

Oral health is fundamental to overall well-being. As teens are at high risk for tooth decay, we require a unique approach to motivate them to maintain oral health.

METHODS

Sixty-four adolescents (10-13 years) were recruited from 2 schools. Oral health education was based on cooperative learning guided by the social determination theory (SDT) principles. Students' oral health knowledge and oral self-care skills were assessed at baseline (before education), 3 weeks, and 6 months after the education.

RESULTS

Complete data were available for 51 students (follow-up rate 79.7%). There were significant (p < 0.001) changes in the mean (SD) toothbrushing score from 10.1 (±6.3) (baseline) to 26.5 (±6.0) (follow-up 1) and to 28.1 (±5.3) (follow-up 2). The mean (SD) tooth brushing time significantly (p < 0.001) increased from the baseline of 84.0 (±43.5) to the first follow-up to 107.0 (±39.8) and to 102.3 (±33.1) at the second follow-up. The mean (SD) diet knowledge scores significantly (p < 0.001) increased from 8.2 (±2.1) at the baseline to 10.2 (±2.7) at the first follow-up and remained the same at the second follow-up.

CONCLUSION

Social determination theory-guided cooperative learning was efficient in improving student oral health-related knowledge and oral self-care skills, and this improvement was maintained for 6 months after the discontinued education.

Dental floss ties for rubber dam isolation: A proposed classification and a new technique

Rubber dam application has become an essential part of restorative dentistry. In late 2019, dentistry faced a new challenge with the COVID-19 pandemic and therefore, the implementation of extra isolation methods became crucial. This article introduces a classification of dental floss ties used with a rubber dam, including the "simple" ties that are subdivided into traditional ties, single-loop self-ligating ties and double-loop self-ligating ties, and a new state-of-the-art design. The "compound tie" design incorporates a combination of one or more subdivisions of the simple ties. This new design may provide better isolation and more consistent gingival tissue retraction. Furthermore, due to the advanced technique applied, the tie will offer improved stability and prevent the sheet from sliding over the dental floss tie from all surfaces.

Dentists' lived experience of providing dental care during the COVID-19 pandemic: A qualitative study in Mashhad, Iran

Background

This study aimed to explore the lived experiences of dentists practicing in Mashhad, Iran, during the COVID-19 pandemic and identify possible influencing factors for providing dental health in this era.

Methods

Sixteen dentists took part in this qualitative phenomenological study. Semi-structured face-to-face interviews were performed and evaluated using a qualitative content analysis approach. The MAXQDA program (2020) was used to code and classify the data. Purposive sampling, audio recording, member checking, and peer review were employed to verify transferability, reliability, and validity. The interview transcripts were transcribed, and sentences and remarks relevant to the study's goal were retrieved and classified.

Results

Six hundred twenty-eight codes were extracted after several readings of the texts. Five core themes and fourteen sub-themes were determined after deleting repeated themes and axial coding. The main five themes included: "Coping with the COVID-19 pandemic", "Alternations in providing dental care," "Infection control," "COVID-19-related news and information sources", and "Positive and negative aspects of COVID-19 in dental care ".

Conclusions

During the COVID-19 pandemic, dentists noted various challenges in delivering routine dental treatment, including a lack of resources, reliable and straightforward guidelines for dentists, and governmental policies for dental facility restrictions. Dentists concluded that financial, educational, and financial support from the government would significantly enhance the delivery of community dental care services. With the right strategies and lessons learned, dentists may be better prepared for future challenges in global health care.

Mouth rinses efficacy on salivary SARS-CoV-2 viral load: A randomized clinical trial

Considering the global trend to confine the COVID-19 pandemic by applying various preventive health measures, preprocedural mouth rinsing has been proposed to mitigate the transmission risk of SARS-CoV-2 in dental clinics. The study aimed to investigate the effect of different mouth rinses on salivary viral load in COVID-19 patients. This study was a single-center, randomized, double-blind, six-parallel-group, placebo-controlled clinical trial that investigated the effect of four mouth rinses (1% povidone-iodine, 1.5% hydrogen peroxide, 0.075% cetylpyridinium chloride, and 80 ppm hypochlorous acid) on salivary SARS-CoV-2 viral load relative to the distilled water and no-rinse control groups. The viral load was measured by quantitative reverse transcription PCR (RT-qPCR) at baseline and 5, 30, and 60 min post rinsing. The viral load pattern within each mouth rinse group showed a reduction overtime; however, this reduction was only statistically significant in the hydrogen peroxide group. Further, a significant reduction in the viral load was observed between povidone-iodine, hydrogen peroxide, and cetylpyridinium chloride compared to the no-rinse group at 60 min, indicating their late antiviral potential. Interestingly, a similar statistically significant reduction was also observed in the distilled water control group compared to the no-rinse group at 60 min, proposing mechanical washing of the viral particles through the rinsing procedure. Therefore, results suggest using preprocedural mouth rinses, particularly hydrogen peroxide, as a risk-mitigation step before dental procedures, along with strict adherence to other infection control measures.

Public Trust in Dentists among Arabic Populations

Objective

To investigate public trust in dentists, fear of dentists, factors related to trust, and the impact of the COVID-19 pandemic on the trust in dentists.

Materials and Methods

We used an Arabic online anonymous survey to collect data from a random population of 838 adults to investigate public trust in dentists, the factors they perceive to affect trust, their perception of key factors in the dentist-patient relationship, fear of dentists, and the impact of the COVID-19 pandemic on the level of their trust in the dentists.

Results

Eight hundred thirty-eight subjects with a mean age of 28.5 responded to the survey (595 (71%) females, 235 (28%) males, and 8 (1%) did not specify their gender). More than half trust their dentist. The COVID-19 pandemic did not decrease trust in dentists according to 62.2%. There were significant gender differences in reporting fear of dentists (p < 0.001) and in the perception of factors affecting trust (p=0.028). Honesty was chosen by 583 (69.6%), competence by 549 (65.5), and dentist's reputation by 443 (52.9%).

Conclusions

The findings of this study show that the majority of the public trust dentists, more females reported fear of dentists, and the majority perceived honesty, competence, and reputation as key factors affecting trust in the dentist-patient relationship. The majority reported that the COVID-19 pandemic did not have a negative impact on their trust in dentists.

Orthodontic emergencies and mental health of patients undergoing orthodontic treatment during COVID-19 pandemic: A questionnaire study

Objectives

To evaluate the impact of COVID-19 pandemic on orthodontic treatment and mental health of patients undergoing orthodontic treatment and to compare their mental health with the age-matched control group.

Materials and methods

484 orthodontic patients (245 males and 239 females) and 200 age-matched control subjects were divided into two age groups. Group 1 had 14-18 years of adolescents (N = 274) and 100 control participants (Group 2) and Group 3 comprised of 19 years above adults (N = 210) and 100 control participants (Group 4). Group 1 and 3 patients filled the 4 sections of the questionnaire related to orthodontic emergencies (Sections 1-3) and mental distress (Kessler Psychological Distress Scale-Section 4), while groups 2 and 4 were asked to fill only Section-4. The comparison of mental distress on high/low Kessler scores was made using the Chi-Square test/Fisher's exact test. The factors which came out to be significant were put to bivariate logistic regression analysis.

Results

The percentage of patients with high Kessler scores among Group 1 and Group 3 were 9.9% and 17.2% respectively, and their differences with age-matched control groups were non-significant. The mean differences of Kessler score were significantly higher for Group 3 compared to group 1. The higher Kessler score was associated with age, higher education, a feeling of concern for non-availability of appointments, increased treatment duration, its effect on the quality of treatment, and sabotaging of definitive future plans.

Conclusions

The orthodontic treatment and emergencies may not be a significant factor contributing to increased stress among patients during the lockdown.