COVID-19 transmission risk and protective protocols in dentistry: a systematic review

Dentists' Practices and Attitudes Toward Using Personal Protection Equipment and Associated Drawbacks and Cost Implications During the COVID-19 Pandemic

Objectives: During the COVID-19 pandemic, dentists have had to work under stressful conditions due to the nature of their work. Personal protection equipment (PPE) has become mandatory for work in the dentistry field. This study aimed to examine dentists' practices and attitudes regarding the use of PPE and the associated drawbacks and cost implications during the pandemic.

Methods: A questionnaire-based survey was used and was divided into five sections dedicated to collect demographic variables and to examine the dentists' practices, attitudes toward PPE, drawbacks, and cost of using PPE. Mann-Whitney U and Kruskal-Wallis tests were used to compare different sections of the questionnaire and linear regression was used to determine the predictors of the dentists' practices and attitudes toward PPE.

Results: The mean of practices regarding use of PPE was 5.41 ± 1.71 (median 6), attitude toward using PPE scored 2.26 ± 0.90 (median 2), while the means of drawbacks and cost recorded equal scores of 5.22 ± 1.24 (median 5) and 1.68 ± 0.74 (median 2), respectively. The recently graduated dentists, those with postgraduate degrees and those working in the private sector demonstrated higher levels of practices on PPE than their counterparts. Regression analysis revealed that practices of PPE can be predicted on the basis of qualifications and work place, whereas attitude toward PPE is significantly influenced by qualification only.

Conclusions: The study participants demonstrated satisfactory levels of practices and positive attitudes toward PPE. While complaints from using PPE and their cost were moderately affected.

"We will have to learn to live with it": Australian dentists' experiences during the COVID-19 pandemic

BACKGROUND

Australian dentists are among the frontline healthcare workers providing dental and oral health care during the COVID-19 pandemic, and therefore have been affected in multiple ways. In this study, we explore their experiences of practising and living in this pandemic.

METHODS

A qualitative study analysed responses of 333 Australian dentists' who participated in a survey with open-ended questions about the challenges and positive outcomes of practising during the COVID-19 pandemic. The questions were embedded in a national online survey of Australian dentists' knowledge, preparedness and experiences conducted between March and April 2021. Data were analysed using content analysis.

RESULTS

Australian dentists reported their challenging experiences to be four-fold, including 'public health orders and restrictions', 'Infection prevention and control measures (IPC), 'Personal concerns about COVID-19' and 'Detracting opinions about COVID-19'. Conversely, they reported positive outcomes in relation to their practice during COVID-19, including 'Awareness of and adherence to IPC practices', 'Teamwork and interpersonal dynamics', 'Decompressed workload', 'Perceived support' and 'unintended positive outcomes'.

CONCLUSION

The COVID-19 pandemic generated several challenges for Australian dentists, but it also engendered some positive outcomes. Understanding of these can help tailor the professional support plans to address the needs and priorities of Australian dentists during the current and future pandemics.

Microbial contamination of resin composites inside their dispensers: An increased risk of cross-infection?

OBJECTIVES

To evaluate the effects of microorganisms' contamination inside the dispensing syringes of different types of resin-based composites (RBCs).

METHODS

This study encompassed two sections. First, an anonymous electronic survey was submitted via Google forms to Italian dentists to acquire information about composite handling during clinical procedures. Then, a bench test was performed on nanohybrid RBCs differing in matrix chemistry and fillers [FiltekTM Supreme XTE (3MTM); Venus Pearl (Kulzer GmbH); Admira Fusion x-tra (Voco)] to evaluate the microbial viability on their surfaces with/out photocuring. Uncured RBCs were exposed to standardized inocula of Streptococcus Mutans, Candida Albicans, Lactobacillus Rhamnosus, or mixt plaque in an in vitro model reproducing clinical restorative procedures. Half of the RBC specimens were cured after exposure. Microbial viability was assessed using an MTT-based test. Statistical analysis included three-way ANOVA and Tukey's tests (p<0.05).

RESULTS

Among 300 dentists completing the survey, the majority declared to use the spatula to carry the RBCs from the syringe to the dental cavity (50% same spatula; 35% two spatulas). However, 80% of respondents had personal feelings that using one spatula could be a source of cross-contamination. In vitro results using one spatula showed microbial contamination of all RBCs after one hour of storage. The contamination levels depended on the used strain and RBC type (p<0.0001), but photocuring did not reduce contamination (p = 0.2992).

CONCLUSIONS

Microbial species' viability on uncured RBCs and after photocuring shows the existence of a considerable risk of cross-infection. Clinical procedures in Restorative Dentistry need to acknowledge and to reduce such risk during RBCs handling.

CLINICAL SIGNIFICANCE

Dentists must be aware of the possibility of cross-infection during restorative procedures, especially when the same spatula is repeatedly used for placing RBC in the cavity.

Infection Control Practices at the Dental Clinics in Jeddah, Saudi Arabia

Purpose

The aims of this study were to determine the rate of compliance of infection control and estimate the incidence of COVID-19 in dental clinics in Jeddah, Saudi Arabia.

Materials and Methods

This is an ecological correlational study of randomly sampled dental clinics in the city of Jeddah. The 32-question survey used in the study was constructed based on the infection control guidelines/protocols during the COVID-19 pandemic released by the ADA, CDC, and SMOH. A sample of clinics from a dental clinic list in Jeddah city, using a simple random technique.

Results

Fifty-three dental clinics consented to participate in our study, while ten refused. Most of the dental clinics checked their patients’ temperature (30.2%) and strictly required them to wear a surgical mask before entering the clinic (58.5%). Glove, gown, and face mask were the most common methods of infection control used during all dental procedures (98.1%, 96.2%, and 94.3%, respectively). Moreover, the incidence of COVID-19 was the highest among receptions/security (18.70%), followed by nurses (14.3%) and dentists (11.79%).

Conclusion

As the incidence of COVID-19 among dental staff will continue to increase in the future, it is highly recommended that infection control guidelines are followed in all dental clinics.

The impact of COVID-19 on access to dental care for people with disabilities: a global survey during the COVID-19 first wave lockdown

BACKGROUND

It is unclear what immediate impact the COVID-19 pandemic has had on delivery of oral healthcare to people with disabilities worldwide.

AIM

To report the international impact of COVID-19 lockdown on oral healthcare provision for people with disabilities before, during and after the first lockdown (March to July 2020).

MATERIAL AND METHODS

Cross-sectional online self-administered survey of dentists who treat people with disabilities completed 10th to 31st of July 2020. Responses allowed comparison from before, during and immediately after the first wave lockdowns of the COVID-19 pandemic. Data were analysed using McNemar's test to compare reported practice before to during lockdown, and before to after lockdown.

RESULTS

Four-hundred-thirty-six respondents from across global regions reported a significant reduction from before to during and from before to after lockdown regarding: the proportion of dentists treating people with all types of disability (p <0.001) and the number of patients with disabilities seen per week (p<0.0001). The proportion reporting no availability of any pharmacological supports rose from 22% pre-lockdown to 61% during lockdown (p < 0.001) and a persistent 44% after lockdown (p < 0.001). An increase in teledentistry was observed.

CONCLUSIONS

During the first COVID-19 lockdown, there was a significant negative impact on the delivery of dental care to people with disabilities. Oral healthcare access was significantly restricted for people with disabilities with access to sedation and general anaesthesia particularly affected. There is now an increased need to ensure that no-one is left behind in new and existing services as they emerge post-pandemic.

Quality of biosafety guidelines for dental clinical practice in world in early COVID-19 pandemic: A systematic review

OBJECTIVES

To conduct a systematic review of coronavirus disease 2019 (COVID-19)-related biosafety guidelines for dental clinical practice in the early stage of the pandemic, focusing on quality assessment.

METHODS

Electronic (via PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database, Brazilian Library in Dentistry, and Cochrane Library) and gray literature searches were performed for documents published up to May 12, 2020. Guidelines updated until April 17, 2021 were identified. Documents were included as guidelines if they (1) consisted of a set of statements, directions, or principles presenting current or future rules or policy; (2) were developed by government agencies, institutions, organizations, or expert panels; and (3) were related to the general conduct of healthcare activities rather a particular condition. Two researchers, using the Appraisal of Guidelines for Research & Evaluation II, independently extracted the recommendations and evaluated the quality of the guidelines.

RESULTS

Twenty-seven documents from 19 countries were included in the review. These documents presented 122 recommendations related to (1) professional biosafety; (2) patients’/companions’ safety; (3) the organization and biosafety of the physical dental facility environment; and (4) the work process in dental care. Overall, the scientific quality of the guidelines was considered low. Some recommendations presented in these guidelines would require further research to establish their effectiveness.

CONCLUSIONS

We found a wide variety of biosafety guidelines for dental practice regarding COVID-19 in the early months of the pandemic, but their quality was low. Biosafety recommendations should be frequently updated.

Clinical Experience, Knowledge, Attitudes and Practice of Turkish Pediatric Dentists during the COVID-19 Pandemic

Background and Objectives: “Coronavirus Disease 2019” (COVID-19) is a critical public health problem that has affected all fields, including dentistry. The dental management of children has become even more difficult during the COVID-19 pandemic. The purpose of this study was to evaluate the current knowledge, attitudes and practices of Turkish pediatric dentists who have been providing dental treatments to children during the COVID-19 pandemic. Materials and Methods: After receiving ethical approval, this cross-sectional study was conducted using the Google Forms online survey instrument. An online questionnaire link was sent to all the members of the Turkish Society of Paediatric Dentistry by e-mail and through social media. Statistical analyses were performed using descriptive statistics and Chi-square test; a p-value less than 0.05 was considered statistically significant. Results: A total of 200 pediatric dentists participated in this study and most of them (82%) only performed emergency dental treatments, whereas 18.5% performed both emergency and routine dental practices during the COVID-19 pandemic. The vast majority (72.5%) of pediatric dentists prescribed antibiotics and analgesics to their patients who were not cooperative with non-pharmacological behavior management techniques. The findings of the current study showed that the Turkish pediatric dentists had a good level of knowledge about COVID-19, satisfactorily conducted most of the infection control measures before and after the dental treatments, and attached importance to the use of PPEs; however, infection control measures during the dental treatments could be implemented better. Conclusions: Along with all precautions, the vaccination of healthcare workers and requesting a recent test result from patients showing a lack of COVID-19 disease before dental appointments could be used as effective infection control measures. Additionally, pediatric dentists should continue to follow local and universal guidelines, and education programmes should be frequently implemented in order to keep their COVID-19 management strategies up to date.

The incidence of COVID-19 among dentists practicing in the community in Canada: A prospective cohort study over a six-month period

Background

Oral health care settings carry a potentially high risk of causing cross-infection between dentists and patients and among dental staff members due to close contact and use of aerosol-generating procedures. The authors aimed to estimate COVID-19 incidence rates among Canadian dentists over a 6-month period.

Methods

The authors conducted a prospective cohort study of 644 licensed dentists across Canada from July 29, 2020, through February 12, 2021. An online questionnaire, adapted from the World Health Organization’s Unity Studies protocols for assessment of COVID-19 risk among health care workers, was used to collect data on self-reported severe acute respiratory syndrome coronavirus 2 infections every 4 weeks. A bayesian Poisson model was used to estimate the incidence rate and corresponding 95% credible intervals (CIs).

Results

Median age of participants was 47 years; most participants were women (56.4%) and general practitioners (90.8%). Median follow-up time was 188 days. Six participants reported COVID-19 infections during the study period, giving an incidence rate of 5.10 per 100,000 person-days (95% CI, 1.86 to 9.91 per 100,000 person-days). The incidence proportion was estimated to be 1,084 per 100,000 dentists (95% CI, 438 to 2,011 per 100,000 dentists) and 1,864 per 100,000 people (95% CI, 1,859 to 1,868 per 100,000 people) in the Canadian population during the same period.

Conclusions

The low infection rate observed among Canadian dentists from July 29, 2020, through February 12, 2021, should be reassuring to the dental and general community.

Practical Implications

Although the infection rates were low among Canadian dentists, it is important to continue to collect disease surveillance data.

The Impact of COVID-19 Vaccination on Anxiety Levels of Turkish Dental Professionals and Their Attitude in Clinical Care: A Cross-Sectional Study

Background: The current study aimed to assess the anxiety and fear levels and the attitude towards clinical care, such as the use of personal protective equipment and number of patients examined, before and after COVID-19 vaccination among Turkish dental professionals. Methods: A questionnaire including socio-demographical characteristics and clinical data regarding the number of patients, the use of personal protective equipment, vaccine confidence interval, positive or negative COVID-19 diagnosis, and fear and anxiety levels were examined. Results: A total of 475 dentists (196 men and 279 women) participated. Overall, the vaccination had a positive effect on the decrease of fear and anxiety levels of dental professionals. It was observed that the number of interventional procedures significantly increased after vaccination. Besides that, the amount of personal protective equipment used in patients, especially after the vaccination, has decreased. Conclusion: Despite the positive effects of vaccination on the anxiety levels of dental professionals, protective measurements should further be the main concern, regardless of the vaccination status of both the dental professional and the patient.

Acceptance of COVID-19 vaccination and its determinants among Lebanese dentists: a cross-sectional study

Background

Dentists are at high risk of exposure to occupational Coronavirus Disease 2019 (COVID-19). Since vaccination is crucial to control COVID-19 pandemic, we aimed to assess COVID-19 vaccination acceptance and its determinants among Lebanese practicing dentists.

Methods

A cross-sectional online study was conducted between February 15 and 22, 2021, among dentists practicing in Lebanon. Prevalence of COVID-19 vaccine acceptance was estimated. A multivariable modified Poisson regression model was used to explore determinants of COVID-19 vaccine acceptance.

Results

In total, 86% of participants were willing to receive or have already received a COVID-19 vaccine. Having received the influenza vaccine during the COVID-19 pandemic was linked to a 12% increase in the COVID-19 vaccination acceptance rate. In addition, participants having moderate and high COVID-19 vaccination knowledge levels were more likely to accept receiving the vaccine, and participants whose fear of COVID-19 level was high were more likely to accept receiving the vaccine compared to those having a low fear level. Contrarily, those who visit the medical doctor only when needed and once a year were less likely to accept COVID-19 vaccine compared to participants who routinely visit the medical doctor.

Conclusions

Our study showed a high level of acceptance of COVID-19 vaccination among Lebanese practicing dentists. And since knowledge about COVID-19 vaccination was associated with the vaccine acceptance, it should be improved and updated to further increase the acceptance rate. High acceptability of COVID-19 vaccination among dentists is expected to have a positive impact among the population in terms of increasing awareness and vaccine uptake.

Recommendations for Safe Dental Care: A Systematic Review of Clinical Practice Guidelines in the First Year of the COVID-19 Pandemic

In the context of a pandemic, the rapid development of clinical practice guidelines (CPGs) is critical to guide dental staff towards the safe provision of dental care; detailed knowledge of the recommendations will help to achieve the intended results. We carried out a systematic review of the recommendations in clinical practice guidelines (CPGs) on the provision of dental care issued during the first year of the COVID-19 pandemic. A systematic database search was performed in MEDLINE, EMBASE, LILACS, Epistemonikos, and Trip databases to identify documents with recommendations intended to minimize the risk of COVID-19 transmission during dental care. The selection process and data extraction were carried out by two researchers independently. The majority of CPGs recommended the use of rubber dam, high-volume evacuator, mouthwash prior to dental care, four-handed work, and mechanical barriers. The use of aerosol-generating equipment should be avoided whenever possible. In aerosol-generating procedures, the use of a N95 respirator (or similar) is recommended, in addition to a face protector, an impermeable disposable apron/gown, a cap, and gloves. The CPGs developed during the first year of the pandemic offer recommendations which guide dental staff in providing safe dental care, minimizing exposure to SARS-CoV-2 and reducing the risk of COVID-19 infection in the clinical environment. Such recommendations must, however, be updated as new evidence arises.

COVID-19 outbreak in North Macedonia: an overview of its impact on dentistry

Since the pandemic of the novel corona virus - SARS-CoV-2 - has been declared and strict social measures have been introduced in the middle of March, including curfew, the dentistry had to adjust and find ways to better adapt itself to the new situation. This article provides a brief overview of the situation with COVID-19 in our country since the beginning of the pandemic, gives a reminder of what COVID-19 is, and which its modes of transmission are, and considers the ways of protection in dental offices taking into account that dentistry is one of the riskiest activities given the patient-dentist proximity and the use of specific high-speed handpieces. This review also provides an overview of the dental preventive measures taken worldwide, including in the field of Pediatric Dentistry, as well as an overview of dental patients' management, and gives possible best ways to care for healthy, sick or patients suspected for COVID-19. Finally, an extensive presentation of the way of work at the University Dental Clinical Center and the Faculty of Dental Medicine in Skopje, North Macedonia, over the last year is given, including protocols for admission of patients.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2020 professional literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to this work to cover this broad topic. Specific subject areas addressed include prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders (TMDs); sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence day-to-day dental treatment decisions with a keen eye on future trends in the profession. With the tremendous volume of dentistry and related literature being published today, this review cannot possibly be comprehensive. The purpose is to update interested readers and provide important resource material for those interested in pursuing greater detail. It remains our intent to assist colleagues in navigating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the dental patients they encounter.

COVID-19 Impact on Access and Performing Dental Care in Bosnia and Herzegovina

Background:

The world was struck with a pandemic accompanied by maybe one of the most popular words out there right now, which is COVID-19. It has affected every aspect of life imaginable, especially in the medical sector particularly in our case dental care.

Objective:

This study goes on to analyse and assess the impact of COVID-19 on dental care in Bosnia and Herzegovina, varying from the staff, patients, supplies/equipment, and finances.

Methods:

An online survey and over-the-phone surveys were conducted, bringing in raw information to help with this study.

Results:

In total there were 10 different dental offices that information was obtained from. About 90% say that the pandemic has affected their patient flow, obviously due to some restrictions and regulations. And 60% say that the cost of PPE has increased since the pandemic started, while 40% said otherwise. Other data can be found in the rest of the study.

Conclusion:

Entering into the pandemic, dental practices quickly started to realize the seriousness of this situation, changing the way they do normal everyday work to accustom to this “new norm”. During such a problem, both sides have to participate to act upon accordingly to bring health and safety for everyone.

Frontline experiences and perceptions of Urgent Dental Care centre staff in England during the COVID-19 pandemic: a qualitative study

Introduction Following the World Health Organisation declaration of COVID-19 as a global pandemic, routine dental care in the UK ceased, and Urgent Dental Care centres (UDCs) were established to offer remote and face-to-face urgent dental treatment for those in need.Aim To explore perceptions and psychosocial experiences of frontline staff providing care at UDCs in England during COVID-19.Method A qualitative research study using a phenomenological approach. Semi-structured interviews were conducted remotely. Using line-by-line coding, data were analysed using a hybrid approach that incorporated both a deductive, theoretical process and an inductive, data-driven process.Results Participants included 29 dentists and nine dental nurses from UDCs across England. Twelve themes were identified and grouped into positive and negative experiences. Positive experiences were: role fulfilment and having a sense of purpose; team unity and collective coping strategies; and strategic teamwork and preparedness for effective organisation of care. Negative experiences included: feeling undervalued and frustrated due to fragmented guidance and communication; sense of unfairness generated by relational challenges; patient demand outstripping UDC capacity; complex decision-making; uncertainty over safety; suffocating PPE hindering effective communication; ineffective communication channels across healthcare sectors; lack of commitment to remote video consultations; and variable referral quality.Conclusions Participants reported experiencing a number of emotional challenges that appeared to be exacerbated by an unsupportive environment, often due to lack of leadership. However, positive experiences and coping strategies were also identified. Collective and sustained efforts at system level to improve the resilience and mental wellbeing of the current and future dental workforce and integration of dentistry into wider healthcare infrastructures are needed.

Local Dental Emergencies and Mitigation Strategies Adopted by Private Dental Practitioners of South India during COVID-19 Shelter in Place Warning - Multi-Centric Online Survey

Objective:

To evaluate the common dental emergencies reported to dental practitioners and to compare the mitigation strategies implemented during the Shelter-In-Place (SIP) warning with dental practitioners’ age and sex.

Methods:

We conducted a cross-sectional online survey among the dental practitioners of south India during the period of COVID-19 SIP warning. An initial pool of items was prepared to capture the mitigation strategies in managing local dental emergencies. A structured questionnaire was then prepared in English based on the inputs of four expert dentist panel. Age and sex of the practitioners were also recorded.

Results:

The mean age of the dental practitioners was 37.11(range: 23 - 63) years.Of 159 dental practitioners that responded to survey, 90 were male. Most dental practitioners responded that they were contacted through a phone call (n=140) and WhatsApp messaging (n=108). The common dental emergencies reported were tooth pain (100%), swelling (91.7%), a decayed tooth (81.3%), and gum pain (78.6%). A higher number of male than female dental practitioners had “scheduled the treatment immediately” (OR=3.45; P=0.002) after adjusting for age.

Conclusion:

The most common dental emergencies during COVID-19 SIP were tooth pain, swelling, decayed teeth, and gum pain. Males and older dental practitioners scheduled appointments immediately.

Dentist Related Factors Associated with Implementation of COVID-19 Protective Measures: A National Survey

Little is known about the extent to which dentists have implemented COVID-19 infection control guidelines and the factors influencing this process in daily practice. This national online survey assessed the implementation of enhanced infection control guidelines in daily practice, and explored dentist related factors influencing their application, more specifically dentist infection status and their perceived risk of cross-infection in the dental setting. The survey was validated, pretested and carried out in 2020. A total of 1436 dentists participated, of whom 9.1% presumably had COVID-19 infection experience. At least 75% of dentists complied with the core part of the recommended protective measures protocol. For each patient treated during the pandemic, an additional cost of 10–30 EUR (86.7%) and an extra time of 10–30 min (70.7%) was estimated. A stepwise binary logistic regression analysis revealed that dentists assumed to have experienced COVID-19 reported a higher self-perceived risk of virus acquisition (β = 2.090; p = 0.011), lower concern of getting infected (β = 0.576; p = 0.027), and lower confidence in being able to prevent disease transmission in the dental setting (β = 0.535; p = 0.022). Some parts of the protective measures were more difficult to apply than others; however, there was no indication of increased disease acquisition in the dental setting.

Delivery of Health Care by Spanish Dental Hygienists in Private and Public Dental Services during the COVID-19 De-Escalation Phase (June 2020): A Cross-Sectional Study

Background: The first wave of the COVID-19 pandemic in Spain posed a major challenge for Spanish dental professionals. The objective of this work is to describe the dental hygienists’ work status and employment patterns during the de-escalation phase in order to analyse the standards of knowledge, compliance with official recommendations, and dental activities both in the public health service and in the private sector. Material and Methods: A cross-sectional questionnaire was answered by Spanish dental hygienists via WhatsApp, Facebook, and Instagram. The questionnaire was piloted before it was distributed and carried out during June 2020. Results: Here, 517 dental hygienists were surveyed, of which 86.2% followed the official recommendations to avoid contagion and 63.8% agreed with the gradual return to work by limiting the use of aerosols. Private dental hygienists identified more with returning to work without restrictions (14.5%) versus those working for the public service (1.2%) (p < 0.005). Conclusions: Dental hygienists’ return to work has involved different strategies, aimed at controlling infection and guaranteeing the safety of patients and the rest of the dental team. The availability of personal protective equipment, the adaptation of clinical infrastructure, and patient care management have differed between professionals working in the private and public sectors.

The COVID-19 pandemic and its global effects on dental practice. An international survey

Objectives

A multicentre survey was designed to evaluate the impact of COVID-19 outbreak on dental practice worldwide, estimate the COVID-19 related symptoms/signs, work attitudes and behaviour and the routine use of protective measures and Personal Protective Equipment (PPE).

Methods

A global survey using a standardized questionnaire with research groups from 36 countries was designed. The questionnaire was developed and pretested during April 2020 and contained three domains: 1) Personal data; 2) COVID-19 positive rate and symptoms/signs presumably related to the coronavirus; 3) Working conditions and PPE adopted after the outbreak. Countries’ data were grouped by the Country Positive Rate (CPR) during the survey period and by Gross-National-Income per capita. An ordinal multinomial logistic regression model was carried out with COVID-19 self-reported rate referred by dental professionals as dependent variable to assess the association with questionnaire items.

Results

A total of 52,491 questionnaires were returned with a male/female ratio of 0.63. Out of the total respondents, 7,859 dental professionals (15%) reported symptoms/signs compatible with COVID-19. More than half of the sample (n = 27,818; 53%) stated to use FFP2/N95 masks, while 21,558 (41.07%) used eye protection. In the bivariate analysis, CPR and N95/FFP2 were significantly associated (OR = 1.80 _95%CI = 1.60/2.82 and OR = 5.20 _95%CI = 1.44/18.80, respectively), while Gross-National-Income was not statistically associated with CPR (OR = 1.09 _95%CI = 0.97/1.60). The same significant associations were observed in the multivariate analysis.

Conclusions

Oral health service provision has not been significantly affected by COVID-19, although access to routine dental care was reduced due to country-specific temporary lockdown periods. While the dental profession has been identified at high-risk, the reported rates of COVID-19 for dental professionals were not significantly different to those reported for the general population in each country. These findings may help to better plan oral health care for future pandemic events.

Effects of Natural Ventilation and Saliva Standard Ejectors during the COVID-19 Pandemic: A Quantitative Analysis of Aerosol Produced during Dental Procedures

The novel Coronavirus Disease 2019 (COVID-19) pandemic has renewed attention to aerosol-generating procedures (AGPs). Dental-care workers are at high risk of contamination by SARS-CoV-2. The aim of this study was to evaluate the efficacy of standard saliva ejectors and natural ventilation in reducing particulate matter (PM) concentration during different routine dental procedures in the pandemic period. The DustTrak monitor was used to measure PM1, PM2.5, PM10, and breathable (<4 microns) total dust during 14 procedures performed with and without the presence of natural ventilation in a dental unit. Moreover, measurements were performed near the practitioners or near the standard saliva ejectors during the different procedures. In the latter condition, reduced levels of PM10 were recorded (82.40 ± 9.65 μg/m³ vs. 50.52 ± 0.23 μg/m³). Moreover, higher levels of PM (53.95 ± 2.29 μg/m³ vs. 27.85 ± 0.14 μg/m³) were produced when the dental unit's windows were open. At the same time, the total level of PM were higher during scaling than during other procedures (data suggest not to adopt natural ventilation-both window and door opened-during dental procedures). It was also demonstrated that the use of standard saliva ejectors can considerably reduce the total released amount of PM10.

Evaluation of the effects of the COVID-19 pandemic on dentistry

Objectives

The aim of this study is to evaluate dentists' working conditions and the policies implemented for dentistry during the COVID‐19 pandemic. In addition, effects of working in private practice or governmental practice in terms of pandemic are also evaluated in the manuscript.

Methods

A questionnaire was prepared to elicit dentists' working conditions during the pandemic and analyze and evaluate the policies implemented for dentistry. The questionnaires were sent to the dentists registered in the Turkish Dental Association (TDA) via e‐mail, and collected between September 30, 2020, and October 20, 2020. Descriptive statistical methods, validity and reliability analysis, and regression analysis were applied for data analysis.

Results

Seven hundred thirty‐four dentists registered in the Turkish Dental Association took part in the study. 47% of respondents examined five or fewer patients per day during the pandemic. Dentists working in private practice examine more patients per day during the pandemic. 80.8% of the respondents experienced anxiety while examining patients during the pandemic. While the dentist's anxiety level increased with increasing the number of patients examined per day (β: 0.399), it decreased with increasing the dentist's age (β: −0.065). Respondents were not satisfied with the pandemic's management, with the decisions taken regarding dentistry, and with the supports provided to the dentists. 85.8% of the respondents were concerned about their professional future, which is higher among dentists who work in governmental practice (p < 0.05, ANOVA).

Conclusions

Increasing dentists' representation in the management of the pandemic and the future policy‐making process, taking steps for the future by creating planning processes will eliminate the uncertainties and dissatisfaction and ensure to be ready for new pandemics.

Dental care during COVID-19 pandemic: follow-up survey of experts' opinion

Objectives

The purpose of the present survey is to give an update of European experts' opinion on infection control and prevention in dentistry during second wave of pandemic. The secondary aim was to analyze how experts' opinion changed in the light of the new scientific evidence since the first wave.

Material & Methods

An anonymous online 14‐item questionnaire was sent to a total of 27 leading academic experts in Oral (and Maxillofacial) Surgery from different European countries, who had completed a previous survey in April‐May 2020. The questionnaire covered the topics of dental setting safety, personal protective equipment (PPE), and patient‐related measures to minimize transmission risk. Data collection took place in November‐February 2020/21.

Results

26 experts participated in the follow‐up survey. The overall transmission risk in dental settings was scored significantly lower compared to the initial survey (p < .05), though the risk associated with aerosol‐generating procedures (AGP) was still considered to be high. Maximum PPE was less frequently recommended for non‐AGP (p < .05), whereas the majority of experts still recommended FFP2/FFP3 masks (80.8%), face shields or goggles (88.5%), gowns (61.5%), and caps (57.7%) for AGP. Most of the experts also found mouth rinse relevant (73.1%) and reported to be using it prior to treatment (76.9%). No uniform opinion was found regarding the relevance of COVID‐19 testing of staff and patients.

Conclusion

With the continuation of dental care provision, transmission risk has been scored lower compared to the first wave of pandemic. However, high risk is still assumed for AGP, and maximum PPE remained advised for the respective treatments.

Non-pharmaceutical interventions during the COVID-19 pandemic: A review

Infectious diseases and human behavior are intertwined. On one side, our movements and interactions are the engines of transmission. On the other, the unfolding of viruses might induce changes to our daily activities. While intuitive, our understanding of such feedback loop is still limited. Before COVID-19 the literature on the subject was mainly theoretical and largely missed validation. The main issue was the lack of empirical data capturing behavioral change induced by diseases. Things have dramatically changed in 2020. Non-pharmaceutical interventions (NPIs) have been the key weapon against the SARS-CoV-2 virus and affected virtually any societal process. Travel bans, events cancellation, social distancing, curfews, and lockdowns have become unfortunately very familiar. The scale of the emergency, the ease of survey as well as crowdsourcing deployment guaranteed by the latest technology, several Data for Good programs developed by tech giants, major mobile phone providers, and other companies have allowed unprecedented access to data describing behavioral changes induced by the pandemic. Here, I review some of the vast literature written on the subject of NPIs during the COVID-19 pandemic. In doing so, I analyze 348 articles written by more than 2518 authors in the first 12 months of the emergency. While the large majority of the sample was obtained by querying PubMed, it includes also a hand-curated list. Considering the focus, and methodology I have classified the sample into seven main categories: epidemic models, surveys, comments/perspectives, papers aiming to quantify the effects of NPIs, reviews, articles using data proxies to measure NPIs, and publicly available datasets describing NPIs. I summarize the methodology, data used, findings of the articles in each category and provide an outlook highlighting future challenges as well as opportunities.

Proposal for Tier-Based Resumption of Dental Practice Determined by COVID-19 Rate, Testing and COVID-19 Vaccination: A Narrative Perspective

Since the emergence of the new coronavirus disease (COVID-19), profound alterations in general and specialist dental practice have been imposed to provide safe dental care. The guidelines introduced in response to the COVID-19 pandemic to mitigate healthcare disruption are inconsistent regarding the dental practice re-installation, particularly during a transitional time. Despite the successful mass vaccination campaigns rolled out in 2021, the presence of more than 80 genotypes of COVID-19, rapid neutralisation of antibodies within a short period of seropositivity, and the likelihood of recurrent infection raise some doubts on whether vaccination alone will provide long-term immunity against COVID-19 and its variants. Here, from this perspective, we aim to provide an initial proposal for dental services reinstallation, easily applicable in various care settings. We discuss the potential options for the transition of dental services, as well as challenges and opportunities to adapt to new circumstances after mass COVID-19 vaccination. The proposal of the universal three-tier system of dental services resumption, determined by regional COVID-19 rates, testing accessibility, and vaccination rollout has been presented. Following herd COVID-19 immunity enhancement, it would be prudent to confer various preventative measures until virus spread naturally diminishes or becomes less virulent. Based on modelling data, dental practices may not return to normal, routine operation even after global vaccination as there would still be a significant risk of outbreaks of infection. Variable, multi-level measures will still be required, depending on the local COVID-19 cases rate, to secure safe dental care provision, despite predicted success of vaccination agendas. This approach can be implemented by achievable, practical means as a part of risk assessment, altered work pattern, and re-arrange of dental surgery facilities. The adequate standard operating procedure, with the support of rapid point-of-care testing at workplace, would vastly intensify the uninterrupted recovery of the dental care sector.

Changing trends in the outpatient dental visits during the COVID - 19 pandemic in a tertiary care hospital

The coronavirus pandemic has caused a global public health crisis with an unprecedented shutdown of major establishments and non-emergency services. Disruptions across the country in dental hospitals led to challenges in addressing patient’s dental complaints. The present study aimed to analyse the difference in the pattern of the Outpatient dental visits during the pandemic period in comparison to that of the pre-pandemic period in a tertiary care hospital. This retrospective study was carried out by retrieving the patient data from the diagnostic register of the Department of Oral Medicine and Radiology for a period of one year. The data that was retrieved from 24th September 2019 to 23rd March 2020 was categorized under the pre-pandemic period and the data from 24th March 2020 to 24th September 2020 was grouped under the pandemic period. Patient data regarding the age, gender and clinical diagnosis was recorded and categorized under three main categories: “Emergency”, “urgent” and “elective”. 7550 patients during pre-pandemic period and 4035 patients during the pandemic period visited the dental hospital during the study period. Under the “emergency dental care” category, during the pre-pandemic period, majority of the cases reported of acute dental pain (71.0%) followed by cellulitis and space infection (20.1%) and maxillofacial trauma (8.7%). During the pandemic period, acute dental pain consisted of all emergency visits (n = 307). The proportion of emergency dental visits during the pandemic were significantly higher than the pre-pandemic period. Elective dental visits were significantly higher during pre-pandemic period in comparison to the pandemic period. (P < 0.001). There was a notable change in the outpatient trend of the dental visits during the COVID-19 pandemic in comparison to the pre-pandemic period. Emergency dental services were utilized at a higher rate during the pandemic period in comparison to the pre-pandemic counterpart.

Effective in vitro inactivation of SARS-CoV-2 by commercially available mouthwashes

Infectious SARS-CoV-2 can be recovered from the oral cavities and saliva of COVID-19 patients with potential implications for disease transmission. Reducing viral load in patient saliva using antiviral mouthwashes may therefore have a role as a control measure in limiting virus spread, particularly in dental settings. Here, the efficacy of SARS-CoV-2 inactivation by seven commercially available mouthwashes with a range of active ingredients were evaluated in vitro. We demonstrate ≥4.1 to ≥5.5 log10 reduction in SARS-CoV-2 titre following a 1 min treatment with commercially available mouthwashes containing 0.01-0.02 % stabilised hypochlorous acid or 0.58 % povidone iodine, and non-specialist mouthwashes with both alcohol-based and alcohol-free formulations designed for home use. In contrast, products containing 1.5 % hydrogen peroxide or 0.2 % chlorhexidine gluconate were ineffective against SARS-CoV-2 in these tests. This study contributes to the growing body of evidence surrounding virucidal efficacy of mouthwashes/oral rinses against SARS-CoV-2, and has important applications in reducing risk associated with aerosol generating procedures in dentistry and potentially for infection control more widely.

The Impact of the COVID-19 Pandemic on the Spectrum of Performed Dental Procedures

The COVID-19 pandemic has significantly altered existing health care operations, including dentistry. The fear of SARS-CoV-2 infection and the need for increased protection measures have led to a reduction in the number of appointments and the range of performed procedures. Our study aimed to assess the impact of the COVID-19 pandemic (the pre-vaccine period) on the spectrum of performed dental services, with particular emphasis on the change in the proportion of conservative and surgical procedures. The patient base in the University Center of Dentistry and Specialized Medicine (Poznan, Poland) from two periods—pre-pandemic (1 February 2019–31 January 2020) and pandemic (1 February 2020–31 January 2021)—was analyzed. The number of dental services was standardized against the sum of all procedures in a given month. During the COVID-19 pandemic, the number of conservative procedures such as commercial restorations or filled canals has significantly decreased, while the number of surgical procedures has increased. The pandemic has undoubtedly affected the spectrum of dental procedures performed, especially in its acute phase. It is very important to return to performing conservative procedures and educating students in the former range while respecting all safety standards.

Dentists' Working Conditions during the First COVID-19 Pandemic Lockdown: An Online Survey

The aim of this study was to investigate the operating conditions of dentists in Central Europe during the first coronavirus disease 2019 (COVID-19) lockdown. A survey including 24 questions was emailed to dentists in Austria, Germany, Switzerland and South Tyrol (Italy). Questions regarding dentists’ field of work, working hours, treatments performed, personal protective equipment and protocols, and economic consequences were asked. 1731 participants were included. 30.4% of participants worked mainly in Austria, 60.8% in Germany, 6% in Switzerland and 2.1% in South Tyrol. A country-specific analysis for the situation of South Tyrol was not possible due to the low participation; 53.7% of German, 45.5% of Austrian, and 11.7% of Swiss respondents reduced their working hours; 42.8% of Austrian, 41.5% of Swiss, and 17.3% of German participants closed their offices temporarily; 52.2% of respondents provided emergency service including pain management, restorations/temporaries, and denture repairs. A lack of access to FFP2/FFP3 (filtering facepiece) respirators was indicated by 59.4% Austrian, 38.0% German, and 11.7% Swiss dentists (p < 0.001). FFP2/FFP3 respirators were, when available, most frequently used in Austria (86.9%), followed by Switzerland (61.2%) and Germany (56.7%) (p < 0.001). Financial consequences could not be conclusively quantified by 58.6% of the participants. Most respondents in all partaking countries made use of governmental support. A lack of blueprints/guidelines resulted in heterogeneous working conditions. In consideration of a potentially high risk of infection in the dental setting, non-emergency dental treatments were largely suspended in all participating countries.

The Impact of the First Wave of the COVID-19 Pandemic on Providing Special Care Dentistry: A Survey for Dentists

This study aimed to investigate the impact of COVID-19 on the experiences of special care dentistry providers worldwide. An online survey was administered from 10 to 31 July 2020. Age, sex, years of professional activity, COVID-19 status, geographical area of origin and length of lockdown period were recorded for all participating dentists. The relationships between these variables and the changes in clinical activity, the treated patients' COVID-19 status and the implementation of protective measures in the dental clinic were analyzed. A total of 436 (70.6% women) dentists from 59 countries responded to the survey. Clinical activity was reduced or stopped for 79.1% of respondents. The most common change was to limit treatment to urgent care only (53.7%). Treatment under general anesthesia or deep sedation was discontinued (51.0%) or reduced (35.8%) for the majority of respondents. Male dentists were more likely to maintain their clinical activity than female dentists (p < 0.001), and respondents from North America were more likely to do so than participants from other geographical regions (p < 0.001). Dentists from Latin America and the Caribbean were more likely to report treatment of confirmed cases of COVID-19 than those from Europe (p < 0.001). The implementation of protective measures in the dental office was determined by the survey participant's sex, intensity of clinical activity and geographical area of origin. To conclude, the provision of special care dentistry was considerably reduced in response to the pandemic. Service maintenance was mainly related to the geographical area in which the surveyed dentists worked, further exacerbating pre-existing inequalities.

Characteristics and Detection Rate of SARS-CoV-2 in Alternative Sites and Specimens Pertaining to Dental Practice: An Evidence Summary

Knowledge about the detection potential and detection rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in various body fluids and sites is important for dentists since they, directly or indirectly, deal with many of these fluids/sites in their daily practices. In this study, we attempt to review the latest evidence and meta-analysis studies regarding the detection rate of SARS-CoV-2 in different body specimens and sites as well as the characteristics of these sample. The presence/detection of SARS-CoV-2 viral biomolecules (nucleic acid, antigens, antibody) in different clinical specimens depends greatly on the specimen type and timing of collection. These specimens/sites include nasopharynx, oropharynx, nose, saliva, sputum, bronchoalveolar lavage, stool, urine, ocular fluid, serum, plasma and whole blood. The relative detection rate of SARS-CoV-2 viral biomolecules in each of these specimens/sites is reviewed in detail within the text. The infectious potential of these specimens depends mainly on the time of specimen collection and the presence of live replicating viral particles.

Impact of COVID-19 pandemic on oral health procedures provided by the Brazilian public health system: COVID-19 and oral health in Brazil

Objective

The objective of this study was to assess the number of dental procedures performed in the Brazilian Public Health System (SUS) during the first wave of COVID-19 in Brazil (1^st semester of 2020) and compare it with the same period of 2019.

Methods

A retrospective study was conducted based on the SUS Dataset (DATASUS). Descriptive analysis of the number of dental procedures and socio-demographic regions was presented and the number of dental procedures during the first semester of 2020 was compared to 2019, using Wilcoxon Signed Rank Test (α = 0.05). The number of COVID-19 confirmed cases and deaths were also retrieved from DATASUS.

Results

Dental procedures decreased from 47 million in the first semester of 2019 to 15 million in 2020, representing an overall decrease of about 66%. Statistically significant differences were observed for the numbers of procedures regarding preventive actions related to oral health (-84.53%; p < 0.001), primary care (-60.69%; p < 0.001), endodontic specialized care (-52.50%; p < 0.001), and periodontal and oral surgery specialized care (-54.57%; p < 0.001).

Conclusion

The COVID-19 pandemic also reduced by half the number of oral health procedures provided by the SUS in almost all Brazilian states regardless of whether these states had a large number of confirmed cases or deaths. Future policies are recommended in order to reduce the negative impact of the suspension of dental services on the oral health of the population.

Impact of COVID-19 pandemic on brazilian dentists in 2020: an epidemiologic study

Abstract Introduction The COVID-19 pandemic has led to an interruption in work activities in various sectors, generating an economic crisis and a high rate of unemployment worldwide. Objective To assess the behavior and perceptions of Brazilian dentists about the COVID-19 pandemic and to verify its impact on the routine of dental care. Material and method The electronic questionnaire was disseminated through social networks from July to November/2020. The representativeness for the study sample was calculated, generating a sample calculation of 385 dentists. Result In total, 318 dentists (82.6%) from all regions of Brazil answered the questionnaire, being 112 men (35.2%) and 206 women (64.8%). Most of the interviewees, that is, 249 dentists (78.3%) reported working in private offices or clinics. Of the interviewees, 26 (8.8%) tested positive for COVID-19 and another 10 (3.1%) had symptoms of the disease, but did not take the test. No interviewees reported having been hospitalized due to the disease. During the period of application of the questionnaire, 235 respondents were attending routine and emergency patients (73.9%). Only 174 (54.7%) reported feeling safe with the use of personal protective equipment. Most interviewees declared that they did not have a financial reserve for the interruption of work activities (54.7%). Conclusion The COVID-19 pandemic has had a major impact on dentistry, and better financial planning, in addition to constant reinforcement of biosafety care, which is essential for professionals in the healthcare area, can help to protect them and maintain their professional practice in times of pandemic and uncertainty.

Evaluating the Influence of COVID-19 Among Dental Practitioners After Lockdown

Clinical activities at dental premises after the COVID-19 lockdown period or post-COVID-19 are likely to be a challenge for all practicing dentists. To assess the impact of the COVID-19 pandemic on dentists and change in dental practice following lockdown, a total of 1150 participants were approached through online survey forms registered on www.surveys.google. A link containing details of the questionnaire and a consent form was sent to dentists through emails and social media forums. The questionnaire included 3 domains comprising of seventeen questions. The first section focused on demographics. The second section inquired about the change in dental practice, that is, clinical hours, use of PPE, type of treatment, and patient flow. The third section investigated the impact of COVID-19 on dentistry. Means, standard deviation, and percentages were calculated using descriptive statistics. Chi-square was used to find an association between different variables. The response rate was 87%. Demographic factors revealed participants aged from 20.45 to 40.55 years. The data showed around 89.6% (896) of dentists have altered their clinical working hours post lockdown and, approximately, 59.7% (597) of dentists provided only emergency treatments. 88.1% (881) of the dentists wore PPE during dental procedures. Overall, a huge negative impact of the COVID-19 pandemic was observed among practicing dentists in terms of the dental supply chain, cost, and availability of dental equipment, treatment cost, and bill payments.COVID-19 pandemic compromised dental care. Though dentists were taking precautionary measures and have changed their practice according to the guidelines provided by the ADA and World Health Organization, they were still experiencing monetary loss due to decrease patient influx post lockdown.

Mothers' Knowledge, Attitudes, and Fears About Dental Visits During the COVID-19 Pandemic: A Cross-sectional Study

OBJECTIVES

This study aimed to assess mothers' knowledge of coronavirus disease 2019 and to evaluate their attitudes and fears about dental visits during the pandemic.

MATERIALS AND METHODS

A structured questionnaire, developed in English and Arabic, adapted from previous questionnaires was remotely applied to a sample of 833 mothers of children aged 17 years and younger, from different socioeconomic backgrounds. Eligible participants were encouraged to invite others. The questionnaire collected information on knowledge about COVID-19, dental visit patterns, willingness of mothers to take their children to the dentist, and factors affecting it during the pandemic. Frequencies and percentages of categorical variables were presented, and predictors of willingness to visit a dentist during the pandemic were examined by logistic regression.

RESULTS

Mothers who perceived the dental clinic to be of less or similar danger to public places were more willing to take their children to the dentist during the pandemic than were those who perceived it to be more dangerous (odds ratio [OR] = 2.9, 95% confidence interval [CI]: 1.2-7.0; OR = 2.3, 95% CI: 1.1-4.8, respectively). Mothers who were willing to go to the dentist during the pandemic were more likely to take their children to the dentist compared with mothers who were not willing to go themselves, OR = 16.9 (6.0-47.1). The most commonly reported barrier to visiting the dental clinic was fear of contracting the virus from someone there (80%). Most parents did not take their child to the dentist during the pandemic (83%), and 24% of those who had an appointment did not allow their children to attend.

CONCLUSION

Mothers were unlikely to take their children to the dentist except for an emergency and perceived the dental clinic as a risky place for contracting the virus. More reassuring information about infection control measures at dental clinics should be delivered to this population.

Cross-Sectional Analysis of the Complaints and Emergency Department Attendances During COVID-19 Pandemic

In December of 2019, an emergence of a new type of pneumonia resulted in a pandemic. To prevent the spread of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), governments worldwide introduced a multitude of restrictions and preventative measures, including national lockdowns. Previous studies reported the clinical characteristics and epidemiology of the disease. The purpose of this article is to provide an analysis of changes in the number and nature of the accidents and emergency department attendances during the early phase of COVID-19 lockdown in the United Kingdom.