COVID-19 Management in Clinical Dental Care. Part I: Epidemiology, Public Health Implications, and Risk Assessment

Dental radiographic changes in individuals with COVID-19: a controlled retrospective study

OBJECTIVE

The aim of this study is to compare the pre-COVID-19 and post-COVID-19 dental radiological findings of individuals with positive rRT-PCR test results and with healthy controls using the apical periodontitis grade scale (APGS), radiographic-based periodontal bone loss (R-PBL), and radiographic DMFT indices, and to investigate the relatively long-term dental effects of COVID-19.

METHODS

This study included people who had two panoramic radiographs taken between 2018 and 2022. There are 52 patients with positive rRT-PCR tests in the study group. The control group included 50 individuals. Study and control groups were compared using the apical periodontitis grade scale (APGS), radiographic-based periodontal bone loss (R-PBL), and radiographic DMFT indices.

RESULTS

Although results showed a significant difference in percentage R-PBL value and R-PBL types in the study group, there was no significant difference in percentage R-PBL value and R-PBL types in the control group. Also, both groups showed a significant difference in the DMFT index.

CONCLUSIONS

According to the results of this study, it can be said that COVID-19 increases the incidence of periodontitis, and it can be interpreted that the pandemic may adversely affect the general oral health of all people.

Personal protective equipment during COVID-19: A natural history of dental and dental hygiene regulatory guidance in Canada

BACKGROUND

Due to the evolving nature of COVID-19, there is evidence that COVID-19-specific infection prevention and control guideline (IPCG) documents formulated for oral health care settings are also changing rapidly. To better inform future policies, a comprehensive review of all IPCG documents across different phases of restrictions for oral health care practitioners is required.

TYPES OF STUDIES REVIEWED

A search was performed for documents shared from March 2020 through January 2022 on websites of oral health regulatory authorities in Canada's 10 provinces and 3 territories. The authors performed a narrative review of the identified IPCG documents for dentists (n = 78) and dental hygienists (n = 57).

RESULTS

Overall findings from more than 100 IPCG documents distributed during a period of 23 months revealed that the frequency of these updates differed among jurisdictions and between the 2 oral health care practitioners (ie, dentists and dental hygienists) within the same jurisdiction. The most notable observation was the different face-covering recommendations for dentists and dental hygienists within the same jurisdiction during the same timeframe. A common document was sometimes observed for dentists and dental hygienists, however, most jurisdictions had separate IPCG documents.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The different approaches could have been justified on the basis of prevalence of COVID-19 and availability of personal protective equipment; however, there was a risk of creating confusion about IPCG best practices. The findings of this review will support decision makers when planning future development and dissemination of regulations for all oral health care practitioners.

The COVID-19 Pandemic and Dental Professionals' Infection Risk Perception: An International Survey

A global survey among dentists was used to identify the various impacts of the COVID-19 pandemic on this professional group. Special attention was given to perception and assessment of infection risk. From May to August 2020, the questionnaire was delivered in 36 countries by respective research groups and was completed by 52,491 dental professionals. The survey was designed as a cross-sectional survey based on a previously standardized questionnaire. This study focuses on the part of the questionnaire that deals with the perception of the infection risk of COVID-19 by dentists and their patients. A logistic regression model was used, which consisted of four Likert items as response options and the additional self-reported routine or emergency treatment as the dependent variable. Analysis by continent found that European and Asian dentists were particularly likely to be infected at work (OR = 1.45 95%CI = 1.02/1.84 and OR = 2.68, 95%CI = 1.45/3.22, respectively), while it was likely that Australian dentists did not feel particularly at risk due to low infection rates. Three quarters of Americans treated only emergencies during this survey period, while Europeans (64.71%) and Asians (66.67%) provided mostly routine care. This could affect the Europeans' confidence that they would not be able to protect themselves from infections in the long-term. The COVID-19 pandemic and its impact on dental professionals' infection risk perception is determined by the geographical origin of dentists. This study shows that, especially in high-incidence countries, infection risk perception was higher when dentists tried to provide routine dental procedures to their patients. Dental professionals can offer themselves and their patients good protection by maintaining high standards of hygiene. However, their concerns should be taken seriously and the dental professionals' group that is of great importance for oral health care and prevention, should not be neglected in the future, even in the event of emerging pandemics.

Designing an optimization model for the vaccine supply chain during the COVID-19 pandemic

The COVID-19 pandemic has affected people's lives worldwide. Among various strategies being applied to addressing such a global crisis, public vaccination has been arguably the most appropriate approach to control a pandemic. However, vaccine supply chain and management have become a new challenge for governments. In this study, a solution for the vaccine supply chain is presented to address the hurdles in the public vaccination program according to the concerns of the government and the organizations involved. For this purpose, a robust bi-level optimization model is proposed. At the upper level, the risk of mortality due to the untimely supply of the vaccine and the risk of inequality in the distribution of the vaccine is considered. All costs related to the vaccine supply chain are considered at the lower level, including the vaccine supply, allocation of candidate centers for vaccine injection, cost of maintenance and injection, transportation cost, and penalty cost due to the vaccine shortage. In addition, the uncertainty of demand for vaccines is considered with multiple scenarios of different demand levels. Numerical experiments are conducted based on the vaccine supply chain in Kermanshah, Iran, and the results show that the proposed model significantly reduces the risk of mortality and inequality in the distribution of vaccines as well as the total cost, which leads to managerial insights for better coordination of the vaccination network during the COVID-19 pandemic.

Potential links between COVID-19 and periodontitis: a bioinformatic analysis based on GEO datasets

Background

2019 Coronavirus disease (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The COVID-19 pandemic has already had a serious influence on human existence, causing a huge public health concern for countries all around the world. Because SARS-CoV-2 infection can be spread by contact with the oral cavity, the link between oral illness and COVID-19 is gaining traction. Through bioinformatics approaches, we explored the possible molecular mechanisms linking the COVID-19 and periodontitis to provide the basis and direction for future research.

Methods

Transcriptomic data from blood samples of patients with COVID-19 and periodontitis was downloaded from the Gene Expression Omnibus database. The shared differentially expressed genes were identified. The analysis of Gene Ontology, Kyoto Encyclopedia of Genesand Genomes pathway, and protein–protein interaction network was conducted for the shared differentially expressed genes. Top 5 hub genes were selected through Maximal Clique Centrality algorithm. Then mRNA-miRNA network of the hub genes was established based on miRDB database, miRTarbase database and Targetscan database. The Least absolute shrinkage and selection operator regression analysis was used to discover possible biomarkers, which were then investigated in relation to immune-related genes.

Results

Fifty-six shared genes were identified through differential expression analysis in COVID-19 and periodontitis. The function of these genes was enriched in regulation of hormone secretion, regulation of secretion by cell. Myozenin 2 was identified through Least absolute shrinkage and selection operator regression Analysis, which was down-regulated in both COVID-19 and periodontitis. There was a positive correlation between Myozenin 2 and the biomarker of activated B cell, memory B cell, effector memory CD4 T cell, Type 17 helper cell, T follicular helper cell and Type 2 helper cell.

Conclusion

By bioinformatics analysis, Myozenin 2 is predicted to correlate to the pathogenesis and immune infiltrating of COVID-19 and periodontitis. However, more clinical and experimental researches are needed to validate the function of Myozenin 2.

COVID-19 Risk Management in Dental Offices: A Review Article

BACKGROUND: As all the dental staff, including nurses and practitioners, are exposed to various routes of contamination due to the novel COVID-19 virus, which is still unknown to the scientific world, developing strategies to reduce the risk of transmission and decontaminate surfaces in a dental office would be of high importance. Although there is still insufficient data on managing this virus in dental offices, several studies have suggested protocols for improving care. AIM: This study aimed to review present investigations and reach a conclusion on what we know and need to know to combat this virus. MATERIALS AND METHODS: In this review, Scopus, PubMed, and MEDLINE databases were searched using the keywords “COVID-19,” “SARS-CoV-2,” “Medical Disinfectants,” “Personal Protective Equipment’s,” and “Surface Decontamination.” Articles were reviewed, and finally, relevant articles published during 2000–2022 were included in the final paper. RESULTS: The present research concluded that using a combination of the face shield and N95 masks protected the eyes, nose, and mouth. To have more efficient protection, water-resistant long-sleeved gowns and gloves were highly suggested. To overcome aerosols, high-performance air filters and ultraviolet were found quite effective. Allowing the patient to use antiseptic mouthwash before starting the treatment could reduce oral microorganisms and the following airborne contamination. CONCLUSION: This review has gathered all available data regarding dentistry and COVID-19 in order to conclude what has been achieved yet in the prevention of this virus through dental offices; however, more investigations are needed to have a definitive protocol against the virus.

The Impact of COVID-19 on Dental Treatment in Kuwait—A Retrospective Analysis from the Nation’s Largest Hospital

Background: The COVID-19 pandemic has changed the way dentistry has been practiced the world over. This study sought to assess the impact of the COVID-19 pandemic on the patterns of attendance for dental treatment in a large hospital in Kuwait through comparisons with data from the year prior to the pandemic. Methods: A total of 176,690 appointment records from 34,250 patients presenting to the AlJahra specialist hospital in Kuwait for dental treatment from April 2019 to March 2021 were analyzed. The types of procedures and the departments in which they presented were analyzed, and the patterns of attendance before and during the pandemic were compared. Results: While there was a significant reduction in the number of orthodontic, endodontic, and periodontal procedures, there were no impacts on oral surgery, restorative procedures, or pediatric dentistry. Conclusions: There has been a return in the number of patients obtaining dental treatment; however, there has been a definite shift in the use of certain dental procedures.

Covid-19 and SARS-CoV-2 infection in periodontology: A narrative review

The present review examined the available evidence on possible involvement of gingival tissues in SARS‐CoV‐2 infection. Gingival tissue possess SARS‐CoV‐2 entry and transmission factors, among them ACE2 (angiotensin‐converting enzyme 2) and TMPRSS2 (transmembrane protease serine 2), which are the principal mediators of the virus cell invasion. Clinical observations reveal SARS‐CoV‐2 RNA in periodontal tissues and crevicular fluid, suggesting that the periodontium may act as an entry point for the virus and/or as a dissemination site. The preliminary observations prove infection potential of gingival crevicular fluid and shed epithelial cells from the periodontium. There are also findings on potential associations between periodontitis and Covid‐19 (coronavirus disease 2019). PubMed and Scopus databases were used to search for suitable keywords such as: SARS‐CoV‐2, Covid‐19, oral virus infection, gingival crevicular fluid, oral mucosa, periodontium, gingiva, ACE2, TMPRSS2, Furin, diagnosis, topical treatment, vaccine and the related words for relevant publications. Data extraction and quality valuation of articles were performed by the author. The review addressed seven major domains: periodontal structures as SARS‐CoV‐2 infection site, the periodontal changes under SARS‐CoV‐2 infection, potential associations between periodontitis and Covid‐19, periodontal oral care in Covid‐19, crevicular fluid as potential transmission factor and preventive measures. The search process in PubMed and Scopus was updated up to 31 March 2022. Finally 68 articles were retrieved for the final analysis, from the initial database searches. According to the inclusion criteria articles in English language without any date restriction were included. The included studies were mostly original articles, and published in 2020 and 2021 with the aim to describe Covid‐19 and SARS‐CoV‐2 infection in periodontology. As a conclusion it can be stated that gingival tissues may play a role in SARS‐CoV‐2 infection.

Assessment of biological risk among dentists during the COVID-19 Pandemic-A cross-sectional study

Background

The health and life of a healthcare worker are repeatedly under threat due to the rising number of epidemics and pandemics. The COVID-19 pandemic is said to be fatal in people with a risky biological, demographic profile and working environment. This study is the first of its kind carried out on the dentist population from India, who were most affected during the COVID-19 pandemic.

Aims and Objective

The present study aims to assess the biological risk of dentists based on the objective risk stratification (ORS) tool developed by Strain et al.

Materials and Methods

This was a cross-sectional study of dentists in government dental colleges of Kerala using the online form of the ORS tool consisting of questions which included certain demographic characteristics and comorbid conditions of the individual. An additional question was added to the tool, to categorise the work of the dentist depending on the exposure to aerosol (non-aerosol, minimal aerosol and aerosol).

Results

Out of the 74 dentists, 48.6% reported high aerosol and 31% with minimal aerosol. The median score of the study participants was 2 (ranging from 1 to 12). Using the ORS tool, 16.2% had medium risk and only 2.7% had high risk. When the ORS tool was stratified with the aerosol generation, 5.4% had minimal and 6.7% had significant with medium-risk scores. Also, 2.7% with a high-risk score had minimal aerosol generation.

Conclusion

Identifying the high-risk category to allocate duties accordingly and decrease the morbidity and mortality among dentists has to be kept a top priority in the event of a pandemic.

Comparison of Different Waves during the COVID-19 Pandemic: Retrospective Descriptive Study in Thailand

Background

Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus. An outbreak is called an epidemic when there is a sudden increase in cases. Many countries have experienced a two-wave pattern in the reported cases of COVID-19. The spread of COVID-19 in Thailand was a cluster event distributed over multiple locations. This study aims to compare the characteristics of different waves during the COVID-19 pandemic in Thailand.

Methods

A retrospective cohort study was conducted from January 2020 to May 2021 (17 months) to determine the number of COVID-19 screenings and confirmed cases and deaths as well as sociodemographic characteristics such as gender, age, nationality, and source population at risk factors. The categorical data were compared using a chi-square test.

Results

Three waves of the COVID-19 pandemic occurred within 17 months in Thailand, and the number of cases increased by over 100,000 due to source population at risk factors such as close contact with a previously confirmed patient, community risk, cluster communities, and active and community surveillance. The chi-square test revealed significant differences between the three waves (p < 0.01).

Conclusion

Significant differences between pandemic phases or waves may be due to weak social distancing policies and the lack of public health interventions. A COVID-19 vaccination plan is needed for people at risk of suffering severe symptoms and the general population in outbreak areas to increase immunity.

Characterization and mitigation of aerosols and spatters from ultrasonic scalers

BACKGROUND

Dental procedures often produce aerosols and spatter, which have the potential to transmit pathogens such as severe acute respiratory syndrome coronavirus 2. The existing literature is limited.

METHODS

Aerosols and spatter were generated from an ultrasonic scaling procedure on a dental manikin and characterized via 2 optical imaging methods: digital inline holography and laser sheet imaging. Capture efficiencies of various aerosol mitigation devices were evaluated and compared.

RESULTS

The ultrasonic scaling procedure generated a wide size range of aerosols (up to a few hundred μm) and occasional large spatter, which emit at low velocity (mostly < 3 m/s). Use of a saliva ejector and high-volume evacuator (HVE) resulted in overall reductions of 63% and 88%, respectively, whereas an extraoral local extractor (ELE) resulted in a reduction of 96% at the nominal design flow setting.

CONCLUSIONS

The study results showed that the use of ELE or HVE significantly reduced aerosol and spatter emission. The use of HVE generally requires an additional person to assist a dental hygienist, whereas an ELE can be operated hands free when a dental hygienist is performing ultrasonic scaling and other operations.

PRACTICAL IMPLICATIONS

An ELE aids in the reduction of aerosols and spatters during ultrasonic scaling procedures, potentially reducing transmission of oral or respiratory pathogens like severe acute respiratory syndrome coronavirus 2. Position and airflow of the device are important to effective aerosol mitigation.

Tongue ulcer in a patient with COVID-19: a case presentation

BACKGROUND

The emergence of COVID-19 has devastated many parts of the world. From asymptomatic to symptomatic, the virus causes a wide spectrum of presentations. COVID-19 patients may present with oral manifestations. In Afghanistan, where COVID-19 has severely strained the health care system, much of the population lacks proper oral hygiene. This makes the oral cavity a perfect site for SARS-CoV-2 to manifest clinical signs.

CASE PRESENTATION

A 62-year-old male was evaluated in the Dentistry Teaching Clinic of Kabul University of Medical Sciences for a painful erosive lesion on dorsal surface of his tongue. He also complained of fever, cough, and taste alteration. He was referred to Afghan Japan Hospital for COVID-19 testing and tested positive. He was followed on for the treatment of SARS-CoV2. After 2 weeks, the patient tested negative and returned to the dentistry clinic for follow-up. Although there were no other signs of COVID-19, the painful erosive lesion on his tongue persisted. Oral evaluation were performed and the patient was advised to practice good hygiene. After 10 days, we observed an asymptomatic geographic tongue without fever and myalgias and the lesion of dorsal surface of tongue improved from severe condition to moderate.

CONCLUSION

In conclusion, patients with suspected or confirmed SARS-CoV-2 should be screened for symptoms and physical findings in the oral mucosa To prevent such an outcome, awareness programs need to be implemented for the diagnosis and management of clinical symptoms among patients.