Recommendations for Managing Endodontic Emergencies during Coronavirus Disease 2019 Outbreak

Impact of the COVID-19 Pandemic on the Dental Preferences of Patients at Private University Hospitals in Riyadh, Saudi Arabia

Studies that particularly look into how the pandemic has affected Saudi Arabian patients' dental preferences are scarce. The majority of the research done so far has focused on the pandemic's broad effects on oral health rather than the specific changes in patient preferences for dental care. Therefore, the primary goal of the study was to examine how patients at a private university dental hospital underwent dental procedures both before and after the pandemic. The study is a retrospective analysis of patient data from March 2019 to February 2022 obtained from electronic hospital records (Dentoplus). The data extracted information pertaining to the number of patients and their periodic visits. The data was examined via statistical tests. At 0.05, the significance level was chosen. According to the research, compared to non-lockdown times, lockdown times saw a considerable drop in the number of patients scheduling appointments. There was also a significant decrease in the number of first-time patients during lockdown periods. The study also revealed a significant increase in the number of cancelled appointments and patients who discontinued treatment during lockdown periods. The age and gender of the patients did not have a significant effect on these findings. The study's findings suggest that dental professionals need to be aware of these changes in patient behavior and adapt their services accordingly. Dental clinics may need to focus on promoting their services and ensuring that patients feel safe and comfortable seeking dental care during the pandemic.

Acupuncture for Management of Endodontic Emergencies: a Review

Root canal treatment (RCT) employed for painful endodontic conditions like apical periodontitis and irreversible pulpitis is associated with a high incidence of postoperative pain. Pharmacological management for this purpose is effective, but not entirely free from side effects and in some cases may fail to provide adequate relief. Furthermore, concerns have been raised regarding the transmission of coronavirus disease-2019 (COVID-19) as a result of the aerosols generated and prolonged chair side time required for RCT. Acupuncture is a traditional Chinese therapy commonly employed as an alternative for the treatment of pain. And what's more, the use of acupuncture has been recently reported as treatment for the management of endodontic pain as well as on the anesthetic success in patients with irreversible pulpitis. This review aims to evaluate the current evidence for acupuncture in endodontics and its potential role in emergency pain relief and management for patients. To combat this, a thorough search for literature within the field was performed in five electronic databases. Retrieved studies were screened according to the pre-defined eligibility criteria. After both an electronic and manual search, five studies were selected for review. These studies reported the beneficial effects of acupuncture in reducing the failure of nerve block in patients with irreversible pulpitis and in controlling both intraoperative and postoperative pain following RCT. In addition, it was also reported to reduce anxiety surrounding the dental procedure and minimized the intake of analgesics after the endodontic procedure, which can result in some unwanted side effects. However, more in depth clinical research is required before any recommendation regarding the application of acupuncture in endodontic patients can be made.

Aerosols generated by high-speed handpiece and ultrasonic unit during endodontic coronal access alluding to the COVID-19 pandemic

To investigate the dispersion and contamination of aerosols generated during coronal access performed by high-speed handpiece and ultrasonic device. To measure the aerosol dispersion, a red dye or an Enterococcus faecalis culture broth inside the bottle of the water system of the dental and ultrasonic unit were used. Bovine extracted teeth were allocated in six groups according to the coronal access: G1: diamond bur in high-speed handpiece (HS) with aspiration (A); G2: ultrasonic (US) inserts with aspiration; G3: combined coronal access with HS and US with aspiration; and G4, G5, and G6 were performed without aspiration (WA). The distance reached by the aerosol with the dye was measured in centimeters, and for environment contamination, agar-plates were arranged at standardized distances for counting colony-forming units (CFU/mL). The ANOVA followed by the Tukey tests were applied (α = 0.05). The coronal access with HS generated higher aerosol dispersion and contamination, even with simultaneous A (P < 0.05), while US generated less aerosol even WA (P < 0.05). The aspiration did not reduce the aerosol statistically. HS is a great source of aerosols in dental clinic during the coronal access and the use of US device should be encouraged.

Impact of the COVID-19 Pandemic on the Dental Preferences of Patients in the Private Sector

Proper oral health care has an impact on the health of the entire body. The COVID-19 pandemic has affected the functioning of the healthcare sector, including dental services. The aim of this study was to analyse the behaviour of patients with regard to their use of dental services during the pandemic. The data were obtained from paper registration forms taken from five dental offices in the city of Cracow between March 2019 and February 2021. During the analysed periods, interest among first-time patients in dental services decreased to 37% (during the month when interest in dental services was at its lowest) compared to the year preceding the COVID-19 pandemic. The number of cancelled visits increased by between 15% and 50% compared to the pre-pandemic period. During the pandemic, appointments made by existing patients increased by up to 84% compared to 2019. The decision by patients to postpone dental treatment not only has adverse effects on their oral and body health, but in turn results in higher health care costs. Given the potential for another pandemic, further long-term research is required to develop and implement special protocols to make the public aware of the safety of health care.

Provision of Endodontic Treatment in Dentistry amid COVID-19: A Systematic Review and Clinical Recommendations

Background

The risk of acquiring COVID-19 during a pandemic is a major concern among health care workers. Dental professionals being in close proximity to the patients had been exposed more than other health care workers. Hence, all the standard operating procedures (SOPs) are strictly advised to be followed.

Methods

A detailed relevant literature search was conducted in international databases such as PubMed, Web of Science, and Science Direct, from January 2020 to November 2020. All the studies that provided recommendations regarding endodontic procedures during the COVID-19 pandemic were included, and those that were not in the English language, case reports, book chapters, and short communications were excluded in this review. In the end, only 6 articles were selected for the systematic review considering that complete information regarding the provision of dental care in the time of COVID-19 with diagnostic accuracy (STARD) was provided.

Results

Endodontic treatments were restricted to only emergency dental procedures, and all other patients have advised medications and catered through teledentistry. Endodontic emergencies were advised to be carried out with minimal aerosol production procedures.

Conclusion

Provision of endodontic care during COVID-19 restricted to only emergency dental procedures by strictly following standard operating procedures. A protocol for COVID-19 prevention was followed by all the dentists and the dental staff in the dental clinics.

Knowledge, Perception, and Experience of Dentists About Teledentistry

OBJECTIVES

This study aimed to evaluate the level of knowledge, perception, and experience of teledentistry amongst Brazilian dentists with the ongoing COVID-19 pandemic.

METHODS

Between June and July 2020, an online questionnaire was used to collect information on the demographic and professional profiles of dentists and their levels of knowledge, perception, and attitudes towards teledentistry. Descriptive statistics were reported as percentages, and Chi-squared test was used to compare responses amongst general practitioners, specialists, and those with varying levels of professional experience.

RESULTS

This study included 575 dentists, the majority of whom were from the southeast region of Brazil (73.4%) and had a specialist degree (70.4%). Approximately 42.4% of the study sample had graduated more than 10 years ago, 39.3% between 2 and 10 years ago, and 18.3% up to 2 years ago. In general, the majority of dentists exhibited only a superficial awareness of the resolution that regulates teledentistry in Brazil. A greater number of specialists were aware of the resolution (P = .007) and felt confident performing teledentistry (P = .000) compared to general practitioners, whilst those with more experience (graduated more than 10 years ago) exhibited greater knowledge (P = .012) and preparation (P = .000). More than 60% of the dentists, regardless of dental specialty and clinical experience, had no knowledge of providing prescriptions via teledentistry. The majority of general practitioners (89.5%) and specialists (81.4%) had no previous experience using teledentistry.

CONCLUSIONS

The findings of this study suggest that Brazilian dentists are inadequately prepared for the implementation of teledentistry.

The New Normalcy in Dentistry after the COVID-19 Pandemic: An Italian Cross-Sectional Survey

Background: After the first lockdown, Italian dentists resumed their practice while handling several challenges. Reducing contagion risk by complying with the stringent measures recommended by the Italian Ministry of Health for dental activity while also balancing patient needs was a difficult task. This work aims to understand the procedures that were adopted in the second phase of the COVID-19 pandemic (5 May–30 September 2020) and the dentists’ expectations and concerns about returning to normalcy. Methods: A national survey with 38 questions was conducted from November 2020 to January 2021 and comparisons were performed among the five main Italian geographic areas. Results: Located mainly in northwest Italy, 1028 dentists were included in the survey. About 83% of the Italian dentists fully restarted their activities after the lockdown. The resumption was significantly marked in North Italy and the Center than in the South (p < 0.01). Over 80% adopted the recommended precautional guidelines, modifying them according to the specific dental treatment executed. Fifty percent of dentists were confident in returning to normalcy after the COVID-19 crisis. Many precautions adopted during the pandemic will be continued, especially in South Italy and the Islands (p < 0.01). Conclusions: Italian dentists reported excellent autonomous organizational skills and the maintaining of high-quality precautions during the reopening phase.

SARS-CoV-2 Seropositivity among Dental Staff and the Role of Aspirating Systems

INTRODUCTION

Health care workers (HCWs) are at a high risk of infection owing to occupational exposure to patients and virus-contaminated surfaces.

OBJECTIVES

The study was aimed to reveal and compare the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among patient-facing HCWs across 3 dental clinics equipped with different types of aspirating systems.

METHODS

This retrospective cohort study included 157 HCWs (43.58 ± 1.66 y) from 3 dental clinics in Ekaterinburg (Russian Federation) who reported to work during the coronavirus disease pandemic. All HCWs underwent serological testing once a week to detect immunoglobulin G and M antibodies against the SARS-CoV-2. The V6000 aspirating system with a vacuum controller (dry or semidry mode) and high-efficiency particulate air (HEPA) filters was used at clinics A and B, and the aspirated aerosol and air were evacuated and dissipated into the atmosphere. The VS900 aspirating vacuum pump without HEPA filters was used at clinic C. The aspirated aerosol and air were evacuated and dissipated into the operatories. All dental clinics followed the same recommendations for dental patient management and types of personal protective equipment used.

RESULTS

The estimated prevalence of SARS-CoV-2 infection was 11.5% (19 HCWs) over a 5-mo follow-up (May to August 2020). The prevalence of infection was unaffected by sex or the role of the member in the dental team (dentist/dental assistant). The prevalence of SARS-CoV-2 infection (+) was significantly higher at clinic C (equipped with an aspirating vacuum pump without HEPA filters) than at other clinics.

CONCLUSION

The type of aspirating system used and the presence of HEPA filters could affect the prevalence of SARS-CoV-2 infection across dental clinics. Therefore, we recommend the use of aspirating systems installed with HEPA filters, which evacuate and dissipate aerosols into specialized areas.

KNOWLEDGE TRANSFER STATEMENT

This report confirms that dentists, being patient-facing HCWs, are at a high risk of acquiring the SARS-CoV-2 infection and identifies gaps in the protection of patients and staff in dental settings.