Infection Risk Prediction Model for COVID-19 Based on an Analysis of the Settlement of Particles Generated during Dental Procedures in Dental Clinics

Aerosol-generating procedures and associated control/mitigation measures: Position paper from the Canadian Dental Hygienists Association and the American Dental Hygienists' Association

Background

Since the outbreak of COVID-19, how to reduce the risk of spreading viruses and other microorganisms while performing aerosolgenerating procedures (AGPs) has become a challenging question within the dental and dental hygiene communities. The purpose of this position paper is to summarize the evidence of the effectiveness of various mitigation methods used to reduce the risk of infection transmission during AGPs in dentistry.

Methods

The authors searched 6 databases-MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar-for relevant scientific evidence published between January 2012 and December 2022 to answer 6 research questions about the risk of transmission, methods, devices, and personal protective equipment (PPE) used to reduce contact with microbial pathogens and limit the spread of aerosols.

Results

A total of 78 studies fulfilled the eligibility criteria. The literature on the risk of infection transmission including SARS-CoV-2 between dental hygienists and their patients is limited. Although several mouthrinses are effective in reducing bacterial contaminations in aerosols, their effectiveness against SARS-CoV-2 is also limited. The combined use of eyewear, masks, and face shields is effective in preventing contamination of the facial and nasal region while performing AGPs. High-volume evacuation with or without an intraoral suction, low-volume evacuation, saliva ejector, and rubber dam (when appropriate) have shown effectiveness in reducing aerosol transmission beyond the generation site. Finally, the appropriate combination of ventilation and filtration in dental operatories is effective in limiting the spread of aerosols.

Discussion and Conclusion

Aerosols produced during clinical procedures can pose a risk of infection transmission between dental hygienists and their patients. The implementation of practices supported by available evidence will ensure greater patient and provider safety in oral health settings. More studies in oral health clinical environments would shape future practices and protocols, ultimately to ensure the delivery of safe clinical care.

A COVID-19 University-Based Dental Clinic Experience and Infection Control Protocol Modification for Safe Clinical Education

OBJECTIVES

 The aim of the study was to share our experience of the development and application of a modified infection control protocol at the Dental Teaching Hospital, Umm Al-Qura University (UQUDENT) during the second wave of the COVID-19 pandemic. A second aim was to evaluate the impact of the implemented strategies on preparations for future requirements in clinical dental education.

MATERIALS AND METHODS

 In this descriptive study, we evaluated the challenges facing dental practice and categorized them into four domains: challenges facing dental practice during the pandemic, the risk of acquiring COVID-19 infection, the design of student clinics, and the financial challenges. The impact of strategies established to deal with such challenges was studied by comparing the number of treated patients from September 1, 2020, to March 01, 2021, with the number treated during the same months pre-COVID-19. The COVID-19 polymerase chain reaction (PCR) confirmed students and health care workers (HCWs) were expressed in numbers and percentages in each category of the study group.

RESULTS

 Policies were set up to deal with the challenges in each domain, after training all the hospital personnel in mitigation of the spread of infection within the hospital. We left a non-working clinic between every two operating clinics, and the patient risk was assessed by triage scoring and health status checks by a Saudi mobile application at the entrance. The hospital delivered more personal protective equipment and obligated all students and HCWs to wear KN95 or N95 masks during procedures. Over 1,500 patients were treated during the study period with more than a 30% reduction in comparison to those in the pre-COVID-19 period, but only 20 UQUDENT personnel had confirmed COVID-19 infection, and all proved to be community-acquired by contact tracing.

CONCLUSION

 The measures implemented in this study proved effective. With the challenges and limited resources, UQUDENT managed to resume the operation of its dental clinics and training while preventing cross-infection, and it ensured that dental students graduated with the required competency. Sharing experiences between educational institutes will help to graduate safe competent practitioners.

Utilization of rapid antigen tests for screening SARS-CoV-2 prior to dental treatment

Potential aerosols containing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral particles can be generated during dental treatment. Hence, patient triage is essential to prevent the spread of SARS-CoV-2 in dental clinical settings. The present study described the use of rapid antigen tests for SARS-CoV-2 screening prior to dental treatment in an academic dental clinical setting in Thailand during the pandemic. The opinions of dental personnel toward the use of rapid antigen test screening prior to dental treatment were also assessed. From August 25 to October 3, 2021, dental patients who were expected to receive aerosols generating dental procedures were requested to screen for SARS-CoV-2 using a rapid antigen test before their treatment. A total of 7,618 cases completed the screening process. The average was 212 cases per day. Only five patients (0.07%) were positive for SARS-CoV-2 in the rapid antigen screening tests. All positive cases exhibited mild symptoms. For the questionnaire study, experienced dental personnel frequently and consistently agreed with the use of the rapid antigen test for SARS-CoV-2 screening, which made them feel safer during their patient treatment. However, implementing rapid antigen tests for SARS-CoV-2 may increase the total time spent on a dental appointment. In conclusion, a rapid antigen test could detect the infected individual prior to dental treatment. However, the specificity of rapid antigen tests for SARS-CoV-2 must be taken into account for consideration as a screening process before dental treatment. The enhanced infection control protocols in dental treatment must be consistently implemented.