Occupational COVID-19 risk to dental staff working in a public dental unit in the outbreak epicenter

The impact of COVID-19 on Italian dentists: A cross-sectional survey on 2443 participants

OBJECTIVE

To evaluate the impact of COVID-19 pandemic among a sample of Italian dentists in terms of infection, strategies for infection control, organization of the dental clinic, attitude, and behavior.

MATERIAL AND METHODS

This was a cross-sectional survey. The sample consisted of 8000 Italian dentists selected among 63,375 using a computerized random sampling method. An electronic informed consent had to be signed. The questionnaire categories were on demographic, infection risk management, organization, and dentists' attitude and behavior. Geographic macro-areas were used for subgroup analysis.

RESULTS

Among 8000 invited dentists, 2443 agreed to participate to the survey (30.6%). Mean age was 51.2 years, women were 34.5%. A total of 6.1% self-reported COVID-19 experience and higher rate of infection was reported in north Italy compared to the south (p < 0.05). FFP2/FFP3 respirators (97.1%) and visors (97.4%) were used by almost all dentists. While, natural ventilation and mouthwashes were the most frequent approaches used to reduce the infection risk. Most of the dentists reported positive attitude, nevertheless 83.6% felt an increased responsibility.

CONCLUSION

The self-reported COVID-19 prevalence was 6.1% with some differences among geographic areas. COVID 19 had a deep impact on preventive strategies, dental office organization, and behavior within this sample.

SARS-CoV-2 TEST OUTCOMES AMONG DENTISTS AND DENTAL HYGIENISTS WITH COVID-19-LIKE COMPLAINTS - A RETROSPECTIVE ANALYSIS FROM THE NETHERLANDS

OBJECTIVE

This retrospective analysis aimed to evaluate, among individuals with COVID-19-like symptoms, the percentage of SARS-CoV-2 positive oral health care workers relative to health care workers in general and a non-close-contact occupation reference group in the Netherlands.

MATERIALS AND METHODS

Data was retrospectively analyzed based on data extracted from the CoronIT database. This contained mass testing data for those experiencing symptoms compatible with COVID-19 recorded from June 2020 up to February 2021. The total number of tests taken and the number of SARS-CoV-2 positive tests were assessed. Sub-analyses were performed for oral health care and health care workers based in professional working locations, long-term care facilities, hospitals, or elsewhere.

RESULTS

In total, data from 1,999,390 tests were obtained. Overall, 9.4% tested positive for SARS-CoV-2 in the three occupational groups. This was 9.2% for oral health care workers, 9.5% for health care workers, and 9.3% for the non-close-contact occupation reference group. For the three occupational groups the adjusted odds ratio with the month as covariate varied from 0.76 to 1.12. The odds ratio for oral health care workers compared to health care workers was 1 [95% CI:0.95;1.05] and 0.97 [95% CI:0.92;1.02] compared to the non-close-contact occupation reference group. Interpretation of the magnitude of the odds ratio indicates that the observed differences are none to very small.

CONCLUSION

During the pandemic oral health care providers were required to adhere to the COVID-19-specific amendments to the national infection control guidelines. Based on the data gathered, dentists and dental hygienists with COVID-19-like symptoms do not test SARS-CoV-2 positive more often than other health care workers or those with a non-close-contact occupation. This supports the assumption that working during the pandemic using the Dutch standard hygiene guideline supplemented with the COVID guideline for oral health care is adequately safe.

Self‐reported factors for improving patient's dental care: A pilot study

Objectives

Patient‐centered approach can offer valuable information in improving dental care, but literature is scarce. This study aimed to evaluate self‐reported factors beneficial for attendance in dental care.

Material and Methods

Survey data were collected during the summer of 2020 comprising both structured questionnaires and an open question on factors considered beneficial for dental attendance. Voluntary patients over 15 years of age (n = 196, 98%) agreed to fill the questionnaires, and n = 112 of them (57%) also gave open commentary in an urgent dental care clinic, City of Oulu, Finland, comprising the study population. Dental fear was assessed by Modified Dental Anxiety Scale (MDAS) sum scores (min 5, max 25). All utterances (n = 181) on an open question were evaluated by inductive content analysis to create sub‐ and main categories. Covid‐19 pandemic case counts in Finland were low at the time of the survey, but their effect on seeking dental care was asked. The distribution of patients was evaluated by cross‐tabulation, considering their age, gender, and dental fear status; the significance level was p < .05.

Results

Females dominated slightly the study population (57%). The mean age of the respondents was 44 years. Half (50%) had moderate (MDAS score 10−18), and 10% had severe dental fear (≥19). The open responses could be categorized into four main categories. The largest main category by patient count concerned factors related to personnel (29%), followed by the patient (28%) and treatment (25%) related, and administrative factors (19%). Males chose factors falling into categories of administration and treatment while females chose patient and personnel‐related factors (p = .048). Compared to the rest, fearful persons (MDAS > 9) reported more often factors related to personnel and treatment (p = .03). Of all participants, 17% reported seeking less dental care during the pandemic.

Conclusions

Patients value dental personnel and treatment‐related factors, specifically those with fear.

Aerosol exposure of staff during dental treatments: a model study

Background

Due to exposure to potentially infectious aerosols during treatments, the dental personnel is considered being at high risk for aerosol transmitted diseases like COVID-19. The aim of this study was to evaluate aerosol exposure during different dental treatments as well as the efficacy of dental suction to reduce aerosol spreading.

Methods

Dental powder-jet (PJ; Air-Flow^®), a water-cooled dental handpiece with a diamond bur (HP) and water-cooled ultrasonic scaling (US) were used in a simulation head, mounted on a dental unit in various treatment settings. The influence of the use of a small saliva ejector (SE) and high-volume suction (HVS) was evaluated. As a proxy of aerosols, air-born particles (PM10) were detected using a Laser Spectrometer in 30 cm distance from the mouth. As control, background particle counts (BC) were measured before and after experiments.

Results

With only SE, integrated aerosol levels [median (Q25/Q75) µg/m³ s] for PJ [91,246 (58,213/118,386) µg/m³ s, p < 0.001, ANOVA] were significantly increased compared to BC [7243 (6501/8407) µg/m³ s], whilst HP [11,119 (7190/17,234) µg/m³ s, p > 0.05] and US [6558 (6002/7066) µg/m³ s; p > 0.05] did not increase aerosol levels significantly. The use of HVS significantly decreased aerosol exposure for PJ [37,170 (29,634/51,719) µg/m³ s; p < 0.01] and HP [5476 (5066/5638) µg/m³ s; p < 0.001] compared to SE only, even reaching lower particle counts than BC levels for HP usage (p < 0.001).

Conclusions

To reduce the exposure to potentially infectious aerosols, HVS should be used during aerosol-forming dental treatments.