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

Global oral health policies and recommendations for children with special health care needs and their applicability and effectiveness during the COVID -19 pandemic: a systematic review

AIM

This systematic review aims to assess effectiveness of oral health policies, recommendations and guidelines in safeguarding oral health of children with special healthcare needs during COVID-19.

BACKGROUND

This systematic review evaluated the adaptation of global oral health policies for children with special healthcare needs (SHCN) during the COVID-19 pandemic, to provide evidence-based insights to inform policymakers and healthcare providers amid the ongoing global health crisis. The study focused on assessing the effectiveness of these adaptations in ensuring equitable access to quality dental care for this vulnerable group.

METHODS

A PRISMA guided online search through LILIACS, PubMed, Scopus, COCHRANE and grey literature was conducted. The search strategy incorporated a combination of subject headings (MeSH terms) and free-text terms related to "oral health," "dental health," "policy," "effectiveness," "dental practice guidelines," "oral health policies," and "special care needs children." Eligibility criteria included oral health policies, recommendations and guidelines targeting individuals/children with special care needs. Both qualitative and quantitative studies published in English from 2008 to 2023 were included.

RESULTS

Sixteen guidelines, recommendations and policies, from six authorities were identified. These documentations addressed six different areas mentioned broadly as comprehensive care, ethical considerations, preventive and therapeutic measures, equity, patient-centric treatment, and reducing disparities signaling a paradigm shift. International collaborations and standardization of guidelines indicated a unified approach. The review also emphasized on a commitment to continuous improvement through quality measurement, systematic referral management, and needs assessment. With the exception of two documents, the remaining guidelines did not address COVID-19 or provide specific adaptations for it. The lack of emphasis on individual condition was notable, as the guidelines generally took a more generalized approach toward individuals with special healthcare needs.

CONCLUSIONS

In conclusion, this review assessed the impact of COVID-19 on oral healthcare for individuals with special needs. It underscores global and local efforts for equitable access, patient-centric care, and preventive measures. The lessons learned advocate for a resilient, inclusive healthcare framework capable of meeting diverse needs.

PROSPERO REGISTRATION

CRD 42023452475.

Analysis of Pediatric Pulpotomy, Pulpectomy, and Extractions in Primary Teeth Revealed No Significant Association with Subsequent Root Canal Therapy and Extractions in Permanent Teeth: A Retrospective Study

Recent evidence suggests that an ever-growing number of pediatric patients require invasive treatments such as root canal therapy (RCT) in their permanent dentition, albeit with little information about risk factors such as prior invasive treatments of pulpotomy or pulpectomy in their primary dentition. Therefore, the primary objectives of this study were to determine the number of pediatric patients who have had any type of invasive treatment in their primary teeth, to assess their association with any subsequent invasive treatment (root canal therapy, extractions) in their permanent dentition, and to assess these trends over time. This retrospective study utilized summary data from a clinical pediatric patient pool (ages 0-17) over the period of 2013-2022. This analysis revealed that pediatric patients requiring pulpotomies and pulpectomies in primary dentition declined between 2013 (n = 417, n = 156) and 2022 (n = 250, n = 12), while root canal therapy (RCT) in permanent dentition increased six-fold from n = 54 to n = 330. In addition, few (7.8%) patients with RCT had a previous history of pulpotomy or pulpectomy, which suggests that invasive treatments performed in primary dentition have no direct association with the subsequent need for invasive treatments in permanent dentition, although more research is needed to determine the explanations for these observations.

Orthodontic Risk Perspectives among Orthodontists during Treatment: A Descriptive Pilot Study in Greece and Slovakia

This study explores orthodontists' perspectives on risks associated with orthodontic treatment, as described by Greek and Slovak orthodontists. Informed by the foundational importance of effective communication of risk perspectives in health sciences, particularly in facilitating valid consent and shared decision-making, this research addresses gaps identified in the literature concerning the consistent communication of potential treatment risks based on demographic and cultural characteristics. This study identifies 15 potential critical risks during orthodontic treatment. These risks include root resorption; temporary undesired changes to the occlusion; sleep difficulties; not achieving an ideal result; development of black triangles between teeth; taking additional X-rays; speech difficulties; using a protective splint during sports; duration of treatment; number of visits; transmission of infectious diseases; and swallowing orthodontic appliances. A questionnaire, distributed electronically to orthodontists in Greece (N1 = 570) and Slovakia (N2 = 210) from September 2022 to December 2022, aimed to assess risk communication practices, taking into consideration socio-demographic factors, such as country, gender, age, and academic-degree-related variations. A total of 168 valid questionnaires (91 from Slovakia and 77 from Greece) were obtained, indicating significant disparities in the risks emphasized and preferred forms of consent. The Greek orthodontists focused more on the risks involved, such as relapse, root resorption, temporal occlusal changes, and failure of desired movement, while the Slovak practitioners tended to be more interested in sleeping difficulties, temporal occlusal changes, and not achieving an ideal result. They also obtained written or digital consent from patients or their parents/guardians more frequently than the Greek team. Male orthodontists discussed specific risks more frequently, including relapse and extractions, whereas females preferred written or digital consent. PhD-trained orthodontists prioritized certain risks, indicating the need for tailored approaches. This study underscores the dynamic nature of risk assessment in orthodontic practice, emphasizing its ethical and strategic dimensions. The findings advocate for tailored risk communication strategies that recognize individual, contextual, and cultural factors, and the need for an orthodontic informed consent protocol for a tailored communication approach for patients to elevate the standard of care in European orthodontics. The reliance on digital tools reflects contemporary trends in enhancing patient understanding, thereby supporting ongoing innovation in orthodontic practices.

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.

Disinfection of intraoral photostimulable phosphor plates with 70% ethyl alcohol and 70% isopropyl alcohol alters image contrast and produces image artifacts

OBJECTIVE

This study evaluated changes in image quality and the presence and size of artifacts on radiographs obtained with photostimulable phosphor (PSP) plates after disinfection with 70% ethyl alcohol and 70% isopropyl alcohol.

STUDY DESIGN

Eight PSP receptors (4 Express and 4 VistaScan) were used for the investigation. Two Express and 2 VistaScan receptors were disinfected with 70% ethyl alcohol, and 2 Express and 2 VistaScan receptors were disinfected with 70% isopropyl alcohol. Before disinfection and after every 5 disinfections, 2 radiographs of an aluminum stepwedge and 2 radiographs of an acrylic block were acquired using each receptor. The gray values of the radiographs were analyzed regarding contrast, density, uniformity, and noise. Four oral radiologists evaluated the images for the presence of artifacts, and 2 measured the artifacts.

RESULTS

Differences in image contrast were significantly larger with isopropyl alcohol (P < .0001). Artifact size was significantly greater with the VistaScan system when isopropyl alcohol was used as the disinfectant (P < .0001). The correlation between the number of disinfections and artifact size was moderately positive with the Express system (P < .05) and strongly positive with the VistaScan system (P < .05) with both disinfectants.

CONCLUSIONS

Small artifacts restricted to the edges of the image were observed with disinfection using both types of alcohol, and a positive correlation was found between artifact size and the number of disinfections. However, artifacts appeared earlier and of greater size with the VistaScan system when disinfected with 70% isopropyl alcohol. Thus, we recommend using 70% ethyl alcohol to disinfect PSP receptors, with attention placed on its action and evaporation times.

Knowledge and attitude toward oral health behavior of overseas students during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has impacted overseas students, including their oral health. Due to movement restrictions, limited living allowances, dental treatment costs, and health insurance fees, overseas students might be more concerned about their oral health. The objective of the present study was to determine the association of knowledge and attitude toward oral healthcare behavior of overseas university students staying in Thailand between January 2020 to July 2022 and explore the experiences of their oral health problems.

METHODS

A cross-sectional study was conducted using an online survey in English operated through the Google platform by convenience sampling among overseas Chulalongkorn University students. A newly developed self-administered questionnaire on knowledge and attitude toward oral health-related behavior and experiences in oral health problems was completed voluntarily. Descriptive statistics, Chi-square test, t-test, ANOVA, and Pearson correlations were employed using IBM SPSS version 29.

RESULTS

Of 311 overseas students, 55.6% were male. The average age of students was 27.5 ± 4.5 years. 68.81% of students were from ASEAN countries, and 73.31% studied in non-health science programs. The study fields, health and non-health sciences, were associated with knowledge score (p < 0.001) and attitude score (p = 0.004), whereas the type of health insurance had an association with behavior score (p = 0.014) and the student's perspective about dental visits (p = 0.014). Three hundred fifty-nine cases of oral health problems were experienced by 47.3% of overseas students. These problems consisted primarily of tooth hypersensitivity (21.2%), gingivitis (15.3%), caries (14%), cracked or broken tooth (10%), severe toothache (9%), fallen out filling (8%), and wisdom tooth pain (7.8%). There was an association between oral healthcare behavior and oral health problems (p < 0.001), and a negative correlation was found between behavior score and the number of oral health problems (p < 0.001, r=-0.204).

CONCLUSION

The oral healthcare habits of overseas university students correlated positively with knowledge and attitude. A negative correlation was observed between behavior and the number of oral health problems. Furthermore, studying in health science programs impacted students' knowledge and attitude toward oral health, while dental treatment coverage insurance affected decisions for dental visits.

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.

Impact of COVID-19 on Dental Practices in El Salvador and Mexico: A Comprehensive Survey Analysis

BACKGROUND AND OBJECTIVES

This study aimed to identify the relationship between prevention measures and protective barriers in dental practice in El Salvador and Mexico during the COVID-19 pandemic in 2020 and 2021.

MATERIALS AND METHODS

A longitudinal study was conducted from June 2020 to December 2021, involving 1,719 dentists divided into four groups based on location and year. A 20-question survey in Spanish was utilized and validated with a Cronbach's alpha value of 0.84.

RESULTS

The use of phone triage (OR = 1.3), thermometers (OR = 1.4), physical distancing (OR = 1.7), and face shields (OR = 2.6) was significantly associated with dental practice in both countries during the pandemic.

CONCLUSIONS

During 2020 and 2021, dental care in El Salvador and Mexico was significantly linked to COVID-19 preventive measures. Phone triage, thermometers, distancing, and face shields positively correlated with dental services. National health agencies should promote the use of minimum preventive measures in dental care, preparing for potential reinfections or new pandemics from emerging virus variants.

Oral manifestations of COVID-19 and its management in pediatric patients: A systematic review and practical guideline

OBJECTIVES

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus causes coronavirus disease 2019 (COVID-19), a respiratory infection that has spread worldwide and is responsible for a high death toll. Although respiratory symptoms are the most common, there is growing evidence that oral signs of COVID-19 can also be seen in children. The purpose of this systematic review is to provide a comprehensive analysis of the available data on the oral manifestations of COVID-19 in children and to recommend appropriate methods of diagnosis and treatment.

METHODS

A systematic search of the MEDLINE, EMBASE, Scopus, and Web of Science databases was done to discover relevant papers published between their establishment and January 2023. Articles detailing oral symptoms in pediatric patients with confirmed COVID-19 infection were included, and data on clinical characteristics, diagnosis, treatment, and outcomes were extracted and evaluated.

RESULTS

A total of 24 studies involving 2112 pediatric patients with COVID-19 were included in the review. The most common presentations are oral lesions, taste and smell disorders, oral candidiasis, hemorrhagic crust, tongue discoloration, lip and tongue fissuring, gingivitis, and salivary gland inflammation. These manifestations were sometimes associated with multi-system inflammatory syndrome in children (MIS-C) or Kawasaki disease (KD). Management strategies varied depending on the severity of the oral manifestation and ranged from symptomatic relief with topical analgesics to systemic medications.

CONCLUSION

Oral symptoms of COVID-19 are relatively prevalent in juvenile patients and can be accompanied by severe systemic diseases, such as MIS-C or Kawasaki illness. Early detection and adequate care of these oral symptoms are critical for the best patient results. Understanding the underlying pathophysiology and developing targeted treatments requires more investigation.

Knowledge, Attitude and Practice towards COVID-19 Pandemic among Patients Attending Dental Outpatient Department of M.G.M. Medical College and Hospital, Jamshedpur, Jharkhand, India

Background

The 2019 coronavirus disease (COVID-19) is an extremely contagious illness that spreads mostly via the dentistry practice. Patients in need of dental care are at a higher risk of becoming infected with and becoming carriers of the illness.

Aim

To assess the COVID-19-related knowledge, attitude, and practice (KAP) of patients visiting dental outpatient department of M.G.M. Medical College and Hospital, Jamshedpur, Jharkhand, India.

Materials and Methods

In this cross-sectional study, patients visiting dental outpatient department of M.G.M. Medical College and Hospital, Jamshedpur, Jharkhand, India were included. The questionnaire had four sections including demographic information, knowledge, attitudes, and practice in relation to COVID-19. Along with computation of descriptive statistics, data analysis was performed using unpaired t-test.

Results

A total of 332 people took part in the research. The female respondents were higher in number (53.01%) and the highest percentage of the respondents belongs to the age group 18-40 years (55.72%). Nearly, 98% of respondents were vaccinated. The highest percentage of KAP level was recorded for knowledge (74.95%) followed by that of attitude (50.84%) and practices (37.05%).

Conclusion

While respondents' overall knowledge was high but their enthusiasm for taking preventative measures was low, and their efforts to stem the pandemic were lagging at best. Future campaigns should focus more on reaching out to marginalized populations, such as those with less education or higher poverty rates.

The psychological toll of the COVID-19 pandemic on dental care providers in Iran: A multicenter cross-sectional study

Background/Purpose

The COVID-19 pandemic affects social and psychological resources. Healthcare workers, especially dental personnel, are more at risk for mental issues due to anxiety, pressure, and frustration. This study assessed mental health outcomes during the COVID-19 epidemic among Iranian dental care providers, focusing on insomnia, anxiety, depression, and posttraumatic stress disorder (PTSD).

Methods

In this multicenter cross-sectional survey, the Insomnia Severity Index, the Hospital Anxiety and Depression Scale, and the Global Psychotrauma Screening were masured. Six hundred thirty-eight dental care providers (dental specialists, general dentists, dental hygienists, dental assistants, and dental students) from different parts of Iran (Tehran, Shiraz, Tabriz, and Mashhad) were investigated by the stratified sampling method. The univariate analysis was incorporated as independent in binary logistic regression models to analyze the data. In this study, the significance level was set at 0.05.

Results

Among all the participants, 42.8% were dental students or residents, 21.9% were general or specialist dentists, 18.7% were dental assistants, and 16.6% were nonclinicians. The prevalence of insomnia, anxiety, and depression was 31.3%, 40.8%, and 54.9%, respectively. The frequency of participants in the low, moderate, and high levels of PTSD resulting from LCA 56.6%, 33.7%, and 9.7%, respectively.

Conclusions

This study found a significant frequency of mental health issues among Iranian dentists. Females, participants whose relatives have COVID-19, and those with a higher workload were more likely to develop mental health symptoms. As mental problems among dental professionals might affect the quality of patient care, diagnostic, supportive, and therapeutic interventions should be taken.

Oral manifestations associated with Novel Coronavirus Disease - 2019 (COVID-19): A questionnaire based hypothetical study

Background: Since the Coronavirus disease 2019 (COVID-19) outbreak in 2019, the virus has evolved drastically, presenting with sets of mutations that influence its properties, including transmissibility and antigenicity. The oral mucosa is postulated as probable portal entry and several oral manifestations have been identified, which places dental professionals in a position to recognize probable COVID-19 patients depending on oral signs and symptoms in the initial phases of the disease itself. As co-existing with COVID-19 seems to be a new reality, greater understanding is required regarding early oral signs and symptoms which can be predictors for timely intervention and prevention of complications in COVID-19 patients. The objective of the study is to identify the distinguishing oral signs and symptoms among COVID-19 patients and to establish possible correlation between severity of COVID-19 infection and oral symptoms. Methods: This study recruited 179 ambulatory, non-hospitalized COVID-19 patients from the Kingdom of Saudi Arabia's Eastern Province's designated hotels for COVID-19 and home isolated patients from the same region using a convenience sample method. Data was collected by qualified and experienced investigators, including two physicians and three dentists, using a validated comprehensive questionnaire through telephonic interviews with the participants. The X ² was used to assess the categorical variables, and odd's ratio was calculated to determine the strength of the association between general symptoms and oral manifestations. Results: Oral and nasopharyngeal lesions or conditions like loss of smell and taste, xerostomia, sore throat, and burning sensation were predictors of COVID-19-related systemic symptoms such as cough, fatigue, fever, and nasal congestion were identified to be statistically significant (p<0.05). Conclusions: The study reveals the occurrence of olfactory or taste dysfunction, dry mouth, sore throat, and burning sensation along with COVID-19 generic symptoms, should be considered as suggestive yet not conclusive indicators of COVID-19.

Learning from Covid 19 in a level 1 oral and maxillofacial trauma centre - Insights for the future

The coronavirus disease 2019 caused by the Severe Acute Respiratory Syndrome Coronavirus-2 has resulted in many confirmed cases around the world. Sars-CoV-2 remains viable and infectious in aerosols dispersed in air and is viable on surfaces up to several days. Symptomatic patients are the main reservoir for transmission. Evidence suggests that asymptomatic patients and patients during their incubation period can shed and transmit Sars-CoV-2. The infective potential can be reduced through the use of personal protective equipment. Healthcare professionals especially the oral maxillofacial surgeons are at increased risk of being infected by the virus. Oral maxillofacial injuries typically involve vital structures in the upper aerodigestive tract and are emergent. Facial trauma surgery cannot be delayed or deferred in a pandemic. This review focuses on precautions surgeons should adopt while managing facial trauma patients in the emergency department and whilst performing emergency surgeries on these patients during the current COVID-19 pandemic. Strict and effective infection control protocols for facial trauma management are needed to minimise this risk of transmission. This review was part of the lecture given by Professor Melvyn Yeoh at the 14th Asian congress on Oral and Maxillofacial Surgery recently held virtually in Singapore due to the pandemic.

Prevalence of ongoing or previous SARS-CoV-2 infection among dental personnel - the Swedish experience

CONCLUSIONS

The seroprevalence of SARS-CoV-2 infection was approximately similar to that in healthcare personnel, and approximately equal compared to that in the general population.

MATERIALS AND METHODS

We carried out an observational cohort study from March to June 2020, including 341 employees randomly selected from Public Dental Service in the County of Stockholm. The primary outcome variable was the prevalence of SARS-CoV-2 RNA and/or antibodies against SARS-CoV-2. Throat samples were analysed for SARS-CoV-2 RNA. Venous blood was collected to detect antibodies against SARS-CoV-2 using the Luminex analysis tool (immunoassay) and ELISA. Logistic regression analysis was used to compare the independent groups and calculate the unadjusted odds ratio.

OBJECTIVE

To investigate whether personnel in a public dental clinic had a higher frequency of ongoing or previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection than hospital healthcare workers or the general public in Stockholm during weeks 23-25 in 2020.

RESULTS

The mean age of the participants was 50.1 years, and 11.7% were male. The prevalence of SARS-CoV-2 RNA and/or antibodies against SARS-CoV-2 was 12.0% (95% confidence interval 8.8-16.0). Among them, 82.5% reported symptoms and 85.4% were on sick-leave between March and June 2020.

Effect of the COVID-19 pandemic on depression, perceived stress and hypochondria of frontline dental staff (FDS): A cohort study

BACKGROUND

The coronavirus 2019 (COVID-19) pandemic had several mental effects on medical staff.

OBJECTIVE

This study intended to evaluate deviations in Frontline Dental Staff (FDS) depression, perceived stress and hypochondria during the COVID-19 outbreak, and to assess whether the existence of potential risk-factors influenced these symptoms over time.

METHODS

This prospective cohort study surveyed FDS three periods from February 1, 2021 to April 8, 2022. FDSs' mental health was assessed through Beck Depression Inventory, Cohen Perceived Stress and the Evans Self-Illness Questionnaires; multivariate linear regression were used to identify potential factors associated with changes on each outcome (depression, perceived stress and hypochondria) over time. All analyses were performed in STATA ver.14.

RESULTS

In a total of 635 FDS, about 69%, 83%, and 71% reported relative depression, 77%, 87%, and 64% reported moderate to high stress level, and 60%, 76% and 74% reported moderate hypochondriac from first, second, and third survives, respectively. The mean and standard deviation of the variables increased dramatically at second survive (July 17 to October 21, 2021) and decreased again at third survive significantly. Being female, working in public sector, and low socioeconomic level were main predictors of higher levels of depression (p < 0.001) and perceived stress (p < 0.001). Perceived stress was a strong predictor of high-level depression (t  =  7.79, p < 0.001).

CONCLUSION

FDSs' depression, stress and hypochondria were high and positively associated with being female, working in public-sector, and low socioeconomic level. To increase the effectiveness and decrease work burnout, psychological support should be provided.

State of the Oral Implantology Practice in Spain during the COVID-19 Pandemic: A Cross-Sectional Survey

At the beginning of the COVID-19 pandemic, strict measures of confinement and social distancing were taken. Dentists were considered essential personnel and their activity was restricted to emergency treatment. The present observational study aims to determine the situation of oral implantology practice in Spain during the initial period of the COVID-19 pandemic. This is a cross-sectional observational study based on the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. An electronic survey consisting of three blocks of questions was sent to all members of the Spanish Society of Implants. The data were analyzed using descriptive analysis. A total of 237 participants (14.3%) responded to the questionnaire. The majority of participants (60.8%) only attended emergencies during the first 9 months of the pandemic. Despite this, 77.2% reported having performed dental implant surgeries and 75.5% indicated that they performed non-essential treatments. The activity was fully recovered by 64.1% of the surveyed dentists. The majority of dentists (90.7%) considered that sufficient/adequate preventive measures were carried out at their workplace, which possibly contributed to the fact that 49.3% were not afraid of becoming infected. This concern was significantly and directly proportionally associated with the age of the surveyed dentists. The oral implant practice was affected to a greater extent during the first 9 months of the pandemic, especially in urban areas, with a greater impact on the workload of professionals with less specialised training in oral implantology.

COVID-19 infection rates and mitigation strategies in orthodontic practices

BACKGROUND

COVID-19 has impacted and increased risks for all populations, including orthodontic patients and providers. It also changes the practice management and infection control landscape in the practices. This study aimed to investigate the COVID-19 infection and vaccination status of orthodontic providers and mitigation approaches in orthodontic practices in the United States during 2021.

METHODS

A validated 50-question research electronic data capture (REDCap) browser-based questionnaire was distributed to 12,393 orthodontists and pediatric dentists who reported actively providing orthodontic treatment. Questions were designed to collect demographic data of respondents, evaluate the COVID-19 mitigation approaches, and evaluate the history of COVID-19 infection and vaccination status of the orthodontic providers. Associations of demographic and the COVID-19 mitigation approaches were assessed using chi-square tests at the significance level of 0.05.

RESULTS

Four hundred fifty-seven returned the survey (response rate 3.69%) for analysis. Most respondents were vaccinated, and increased infection control measures in response to the pandemic. Half of the respondents practiced teledentistry and switched to digital impression systems. Two-thirds reported difficulties in attaining PPEs due to the increased cost and scarcity of PPEs. About 6% of respondents reported a history of COVID-19 infection, and 68.9% of their staff had COVID-19 infection. Statistically significant associations were found between increased practice experience with difficulties in acquiring PPE (p = .010). There were no significant associations between races of respondents, geographic location, and years of practicing when cross-tabulated with vaccination status or COVID-19 infection rate (p > .05).

CONCLUSION

Increased infection control strategies were employed in almost all orthodontic practices in addition to existing universal precaution. Most of the orthodontic providers and their staff members were vaccinated. While staff's infection rates were an issue, doctors' infection rates remained low.

Orthodontic emergencies and mental health of patients undergoing orthodontic treatment during COVID-19 pandemic: A questionnaire study

Objectives

To evaluate the impact of COVID-19 pandemic on orthodontic treatment and mental health of patients undergoing orthodontic treatment and to compare their mental health with the age-matched control group.

Materials and methods

484 orthodontic patients (245 males and 239 females) and 200 age-matched control subjects were divided into two age groups. Group 1 had 14-18 years of adolescents (N = 274) and 100 control participants (Group 2) and Group 3 comprised of 19 years above adults (N = 210) and 100 control participants (Group 4). Group 1 and 3 patients filled the 4 sections of the questionnaire related to orthodontic emergencies (Sections 1-3) and mental distress (Kessler Psychological Distress Scale-Section 4), while groups 2 and 4 were asked to fill only Section-4. The comparison of mental distress on high/low Kessler scores was made using the Chi-Square test/Fisher's exact test. The factors which came out to be significant were put to bivariate logistic regression analysis.

Results

The percentage of patients with high Kessler scores among Group 1 and Group 3 were 9.9% and 17.2% respectively, and their differences with age-matched control groups were non-significant. The mean differences of Kessler score were significantly higher for Group 3 compared to group 1. The higher Kessler score was associated with age, higher education, a feeling of concern for non-availability of appointments, increased treatment duration, its effect on the quality of treatment, and sabotaging of definitive future plans.

Conclusions

The orthodontic treatment and emergencies may not be a significant factor contributing to increased stress among patients during the lockdown.

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.

COVID-19 incidence and vaccination rates among Canadian dental hygienists

BACKGROUND

Oral health care settings potentially carry a high risk of cross-infection due to close contact and aerosol-generating procedures. There is limited evidence of the impact of COVID-19 among dental hygienists. This longitudinal study aimed to 1) estimate COVID-19 incidence rates among Canadian dental hygienists over a 1-year period; and 2) estimate vaccination rates among Canadian dental hygienists.

METHODS

A prospective cohort study design was used to collect self-reported COVID-19 status from 876 registered dental hygienists across Canada via an online baseline survey and then 6 follow-up questionnaires delivered between December 2020 and January 2022. Bayesian Poisson and binomial models were used to estimate the incidence rate and cumulative incidence of self-reported COVID-19.

RESULTS

The estimated cumulative incidence of COVID-19 in dental hygienists in Canada from December 2020 to January 2022 was 2.39% (95% CrI, 1.49%-3.50%), while the estimated cumulative incidence of COVID-19 in corresponding Canadian provinces was 5.12% (95% CrI, 5.12%-5.13%) during the same period. At last follow-up, 89.4% of participants self-reported that they had received at least 1 dose of a COVID-19 vaccine.

CONCLUSION

The low infection rate observed among Canadian dental hygienists between December 2020 and January 2022 is reassuring to the dental hygiene and general community.

Adaptations in dental public health services during the COVID-19 pandemic in municipalities of Southern Brazil: a grounded theory and collaborative research

The aim of this study was to analyze oral health actions in four municipalities in Brazil during the COVID-19 pandemic according to a theoretical framework model on oral healthcare management. It was a qualitative study carried out in two stages. A theoretical-empirical model on the significance of oral healthcare management was developed, following the Grounded Theory method. Fourteen dentists and five healthcare managers participated, through open interview. Subsequently, collaborative research was performed, and the model was applied to analyze the documents produced to address the pandemic by each of four municipalities in Santa Catarina State. The model provided a framework for analyzing actions for coping with the pandemic regarding oral health services. Actions were identified in all dimensions of the model: reduction in supply of dental care due to restricted access to elective services; search for biosafety care standards; dissemination of standardized science-based guidelines; attempt to maintain comprehensive dental assistance through re-adaptation of specialized services and collective actions; and relocation of oral health professionals to assist in other sectors. The oral health care management framework can serve as a reference for redesigning oral health actions and services in other municipalities during the COVID-19 pandemic, in a broader perspective.

Droplet Distribution in a University Dental Clinic Setting: The Importance of High-Volume Evacuation

The purpose of this study is to compare droplet distribution during a piezoelectric ultrasonic debridement procedure using either high-volume or slow-volume evacuation. Droplet distribution during a crown preparation with slow-volume evacuation is also examined. Fluorescein dye is added to the water reservoir and the procedures are performed by a single operator for 15 min on a dental manikin with artificial upper and lower teeth. Placement of filter paper squares (10 cm × 10 cm) in radiating lines away from the oral cavity of the dental manikin allows for visualization of droplet dispersion. Results show minimal difference in the spread of the droplets between the two evacuators during the debridement procedure; however, the slow-volume evacuator produces a higher concentration of droplets than the high-volume evacuator. An even higher concentration of droplets in the vicinity of the dental chair is observed during the crown preparation procedure. This study recommends the use of a high-volume evacuator where possible during professional debridement and crown preparation to reduce contamination around the dental chair from potentially pathogenic microorganisms.

Aerosol and splatter generation with rotary handpieces used in restorative and orthodontic dentistry: a systematic review

Introduction

The COVID-19 pandemic has caused major disruptions in dental care globally, in part due to the potential for contaminated aerosol to be generated by dental activities. This systematic review assesses the literature for changes in aerosol-contamination levels when rotary instruments are used, (1) as distance increases from patient’s mouth; (2) as time passes after the procedure; and (3) when using different types of handpieces.

Methods

The review methods and reporting are in line with PRISMA statements. A structured search was conducted over five platforms (September 2021). Studies were assessed independently by two reviewers. To be eligible studies had to assess changes in levels of aerosol contamination over different distances, and time points, with rotary hand instruments. Studies’ methodologies and the sensitivity of the contamination-measurement approaches were evaluated. Results are presented descriptively.

Results

From 422 papers identified, 23 studies were eligible. All investigated restorative procedures using rotary instruments and one study additionally looked at orthodontic bracket adhesive material removal. The results suggest contamination is significantly reduced over time and distance. However, for almost all studies that investigated these two factors, the sizes of the contaminated particles were not considered, and there were inconclusive findings regarding whether electric-driven handpieces generate lower levels of contaminated particles.

Conclusion

Aerosol contamination levels reduce as distances, and post-procedure times increase. However, there was sparce and inconsistent evidence on the clearing time and no conclusions could be drawn. High-speed handpieces produce significantly higher levels of contamination than slow-speed ones, and to a lesser extent, micro-motor handpieces. However, when micro-motor handpieces were used with water, the contamination levels rose and were similar to high-speed handpiece contamination levels.

Experimental and numerical evaluation of a new visor concept with aerodynamic sealing to protect medical professionals from contaminated droplets and aerosols

The fast spreading of the SARS-CoV-2 virus led to a significant increase in the demand for personal protective equipment (PPE). Healthcare professionals, mainly dentists, work near the patients, increasing their risk of infection. This paper investigates the effectiveness of an air-curtain sealing effect in a newly designed visor developed to reduce the risk of contracting a respiratory infection. This PPE was developed by computational fluid dynamics (CFD) modeling. CFD results show that the aerodynamic sealing in this PPE device effectively protects the user's face by 43% from a contaminated environment. The experiments considered two different tests: one using a tracer gas (CO₂ ) to simulate a gaseous contaminant inside and outside the PPE face shield and a second test using smoke to simulate aerosol transport and evaluate the PPE efficiency. The particle concentration within the aerodynamically sealed PPE was evaluated and compared with the protection efficiency of other PPE. Results show similar protection levels for particles in the 1-5 μm range between the prototype and a KN95 respirator. The combined use of this novel PPE with aerodynamic sealing and a physical mask (KN95 or surgical) produced protection efficiency values within the range of 57%-70% for particles greater than 0.5 μm. This study reveals the potential of using an air curtain combined with a face shield to reduce the risks from contaminated environments.

The impact of a pandemic on dental professionals' work and personal lives: A qualitative study with implications for primary healthcare workers

During a pandemic, dentists face enormous challenges due to restrictions placed on their practice and the need to comply with biosafety measures. This study aimed to explore the impact of the COVID-19 pandemic and infection control measures on dentists and their practice in Jordan and the global implications for other primary healthcare workers. A qualitative exploratory study employing face-to-face or telephone interviews, was conducted with ten dentists from the 9^th May to 20^th September 2020. An inductive thematic approach to analysis was used identifying three themes, each with two accompanying subthemes: (1) Response to COVID-19 pandemic: (1a) Government response and (1b) People's response; (2) The effects of the pandemic and response measures: (2a) Impact on work and practice and (2b) Impact on personal and social life; (3) The unanticipated gains: (3a) Altruism and (3b) Leadership and change. Stringent infection control measures were implemented to slow the spread of the virus, however limited government support made implementation unsustainable and caused financial hardship. Lack of clear guidelines, changes in practice, social distancing measures, and altered social interactions, adversely impacted daily life, triggering mental distress. Misinformation influenced response to COVID safety measures. Despite the negatives, working during the pandemic reaffirmed dental professionals' roles and purpose, with strong leadership boosting morale. Education, adequate biosafety resources and clear guidelines or policies to support and sustain stringent infection control procedures are crucial in ensuring that measures are implemented to meet the safety requirements of the pandemic response. Promoting the well-being of the healthcare workforce is equally important. Finally, altruism and strong leadership among healthcare workers can contribute to a meaningful and humane pandemic response.

Psychological Distress and Coping Among Dental Practitioners During the COVID-19 Pandemic: A Survey From India

Aim: Most dental procedures are aerosol-generating and hence highly risky for spreading SARS-CoV-2 (COVID-19) infection. This can lead to sufficient psychological distress, avoidance of risky procedures, and impact on dental practice. We intend to examine the effect of the COVID-19 pandemic on dental practice and psychological distress among dental practitioners.

Methods: An online survey was conducted by an email-based survey link; 1257 registered dental practitioners were contacted across the country.

Results: Most dental practitioners continue to practice during the COVID-19 pandemic (81.08%). Postgraduate specialists significantly outnumber undergraduates in performing dental procedures (p=.001). Career-related anxiety was considerably high among postgraduates (61.96%; p=.036) during the initial phase of the SARS-CoV-2 pandemic in India. In contrast, self-efficacy was significantly better among postgraduates than undergraduates (p=.027).

Conclusion: Dental practitioners suffered considerable impact due to the COVID-19 pandemic. It is important to enhance coping and self-efficacy strategies among dental practitioners.

Influence of the COVID-19 Pandemic on Learning Preferences and Perspectives of Generation Y and Z Students in Dental Education

Objectives

For the first time in history, the COVID‐19 pandemic required students at The University of Texas School of Dentistry (UTSD) to move to remote education. Based on a literature review, it was assumed that younger generations of students would prefer virtual teaching models over in‐classroom formats. The purpose of this study is to assess students' perspectives of remote learning during COVID‐19 in dental education relative to their generation and programme.

Methods

An electronic survey was administered to all UTSD dental and dental hygiene students via Qualtrics. The survey collected information on demographics, pre‐pandemic learning preferences, remote learning experiences during the pandemic, and a free response section. Descriptive statistics and Fisher's exact test were used to analyse data.

Results

The survey received a 60% response rate (n = 290). Over 95% of respondents belonged to Generations Y and Z. There were no significant differences in responses between generations. However, significant differences in responses between programmes arose with more dental hygiene students agreed that they liked learning in a classroom setting compared to dental students (p < 0.01). Significantly more dental students agreed that they stayed organized, were less stressed, and felt that the transition to online learning was easy compared to dental hygiene students (p < 0.01).

Conclusion

Although the majority of students surveyed belong to Generations Y and Z, there are still preferences for traditional, in‐person learning. Both cohorts recognized the benefits and challenges of distance learning, and the findings from this study shed light on how students are handling remote learning in dental education.

Dental Service and Resource Needs during COVID-19 among Underserved Populations

Introduction:

In response to the coronavirus disease 2019 (COVID-19) outbreak, dental services in British Columbia, Canada, were restricted to urgent and emergency cases between March 16 and May 18, 2020. It is unclear how the curtailment of oral health services has affected underserved populations who already often have limited access to dental care due to cost, fear, stigma, and discrimination.

Objectives:

To explore the experiences of underserved populations and their community organizations when accessing oral health services and information in British Columbia and identify their coping mechanisms employed during the curtailment of oral health care services.

Methods:

Semistructured, remote interviews were conducted with 13 staff and 18 members from 6 community-based organizations. These organizations serve men and women with a history of incarceration and/or experiencing poverty and homelessness, persons living with human immunodeficiency virus/AIDS, adults living with mental illness, and older adults in long-term care facilities. The interviews were audio-recorded, transcribed verbatim, and coded for emerging themes using NVivo 12 software. Thematic analysis was performed.

Results:

The pandemic raised concerns and hesitancy among underserved populations and further reduced access to care. In turn, those with unmet dental needs resorted to coping mechanisms, including turning to community support or medical services, self-management of dental issues, and not dealing with dental issues altogether. Community organizers and members outlined needed resources such as assistance navigating the dental care system, having a contact for dental-related questions, and member preparation for dental service changes, while emphasizing the importance of positive relationships with dental providers.

Conclusion:

Underserved populations who already face barriers to oral health care services experienced increased difficulty in addressing their oral health needs and concerns during the beginning of the COVID-19 pandemic. Strategies aimed at reaching out to this population and those who support them are needed to help mitigate negative coping strategies and increased oral health disparities.

Knowledge Transfer Statement:

This study depicts ways of addressing unmet oral health–related issues during the COVID-19 pandemic for underserved populations and their community organizations with policy implications as well as practical strategies.

Assessment of Quality of Life and Supporting Structures in Implant Retained Mandibular Overdenture: A 5-Year Cohort Study

Aim

To assess oral health-related quality of life (OHRQoL), marginal bone loss (MBL), and changes in soft tissue including probing pocket depth and implant stability in 2 implants retained mandibular overdentures during 5 years follow-up periods.

Methods

Forty completely edentulous patients with age 51-64 years were recruited for that longitudinal cohort study. Complete dentures were performed for all participants. Two implants (3.6 × 11.5 mm) were installed in the canine areas of the mandible. OHRQoL and MBL measures were performed every 1 year for 5 years, while clinical measures were made every 6 months for 60 months. Data were examined using repeated ANOVA and Friedman test.

Results

Thirty-seven patients had 74 implants; with mean age 56 ± 3.6 years; 43% females (n = 16) and 57% males (n = 21) accomplished the study. There were statistically significant differences in OHRQoL, MBL, and changes in soft tissue, including probing pocket depth and implant stability in 2 implants retained mandibular overdentures during 5 years follow-up periods, p ≤ 0.05.

Conclusion

Mandibular overdentures retained by 2 implants provide a positive long-term effect on OHRQoL, MBL, probing pocket depth, and implant stability.

Analysis of 256 pediatric oral and maxillofacial emergency in-patients during the outbreak of COVID-19

Background/Aims

Pediatric oral and maxillofacial surgeons have faced severe challenges in ward management due to their high risk of exposure during the COVID‐19 epidemic. The aim of this study was to analyze and summarize the treatment methods and infection prevention and control measures applied in emergency cases in the Department of Pediatric Oral and Maxillofacial Surgery, Children's Hospital of Chongqing Medical University, during the COVID‐19 epidemic.

Methods

In this retrospective study, information was collected from 256 pediatric emergency patients who were treated from January 23, 2020 to August 9, 2021. The patients' data were statistically analyzed according to age, gender, disease and pathogenesis, operation time, and the main treatment applied in pediatric oral and maxillofacial emergency cases during the COVID‐19 epidemic.

Results

During the epidemic period, 256 pediatric emergency patients were successfully treated. Among them, there were 170 boys and 86 girls. In all, 182 patients were diagnosed with oral or facial lacerations; 43 had jaw fractures; 26 had maxillofacial infections; and five had dento‐alveolar fractures. A total of 246 patients underwent surgery under negative pressure with level 3 protection standards. No doctors or patients infected with COVID‐19 were found throughout the stury period.

Conclusions

Pediatric oral and maxillofacial emergency in‐patients mainly experienced maxillofacial trauma during the COVID‐19 epidemic, followed by infection. Effective diagnosis and treatment, and avoidance of COVID‐19 infection can be achieved by strictly following epidemic prevention and treatment procedures.

Further observations on hydrogen peroxide antisepsis and COVID-19 cases among healthcare workers and inpatients

Background

The use of prophylactic antisepsis to protect against coronavirus disease 2019 (COVID-19) has been suggested. This study investigated hydrogen peroxide antisepsis (HPA) at two hospitals in Ghana.

Methods

Cases of COVID-19 among healthcare workers (HCWs) using hydrogen peroxide (HP-HCWs) or not using hydrogen peroxide (NHP-HCWs), vaccinated or unvaccinated, were recorded at Shai-Osudoku Hospital (SODH), Dodowa, and Mount Olives Hospital (MOH), Techiman, between May 2020 and December 2021. The effect of HPA in all inpatients at MOH was also observed. Permutation tests were used to determine P values.

Findings

At SODH, there were 62 (13.5%) cases of COVID-19 among 458 NHP-HCWs but no cases among eight HP-HCWs (P=0.622) from May to December 2020. Between January and March 2021, 10 (2.7%) of 372 NHP-HCWs had COVID-19, but there were no cases among 94 HP-HCWs (P=0.206). At MOH, prior to HPA, 17 (20.2%) of 84 HCWs and five (1.4%) of 370 inpatients had COVID-19 in July 2020. From August 2020 to March 2021, two of 54 (3.7%) HCWs who stopped HPA had COVID-19; none of 32 NHP-HCWs contracted COVID-19. At SODH, none of 23 unvaccinated HP-HCWs and 35 (64%) of 55 unvaccinated NHP-HCWs had COVID-19 from April to December 2021 (P<0.0001). None of 34 vaccinated HP-HCWs and 53 (13.6%) of 390 vaccinated NHP-HCWs had COVID-19 (P=0.015). No inpatients on prophylactic HPA (total 7736) contracted COVID-19.

Conclusion

Regular, daily HPA protects HCWs from COVID-19, and curtails nosocomial spread of SARS-CoV-2.

COVID-19 vaccination acceptance among dental students and dental practitioners: A systematic review and meta-analysis

BACKGROUND

Dental practitioners and dental students are classified as high-risk exposure to COVID-19 due to the nature of dental treatments, but evidence of their acceptance towards COVID-19 vaccination is still scarce. Hence, this systemic review aims to critically appraise and analyse the acceptability of COVID-19 vaccination among dental students and dental practitioners.

MATERIALS AND METHODS

This review was registered in the PROSPERO database (CRD42021286108) based on PRISMA guidelines. Cross-sectional articles on the dental students' and dental practitioners' acceptance towards COVID-19 vaccine published between March 2020 to October 2021 were searched in eight online databases. The Joanna Briggs Institute critical appraisal tool was employed to analyse the risk of bias (RoB) of each article, whereas the Oxford Centre for Evidence-Based Medicine recommendation tool was used to evaluate the level of evidence. Data were analysed using the DerSimonian-Laird random effect model based on a single-arm approach.

RESULTS

Ten studies were included of which three studies focused on dental students and seven studies focused on dental practitioners. Four studies were deemed to exhibit moderate RoB and the remaining showed low RoB. All the studies demonstrated Level 3 evidence. Single-arm meta-analysis revealed that dental practitioners had a high level of vaccination acceptance (81.1%) than dental students (60.5%). A substantial data heterogeneity was observed with the overall I2 ranging from 73.65% and 96.86%. Furthermore, subgroup analysis indicated that dental practitioners from the Middle East and high-income countries showed greater (p < 0.05) acceptance levels, while meta-regression showed that the sample size of each study had no bearing on the degree of data heterogeneity.

CONCLUSIONS

Despite the high degree of acceptance of COVID-19 vaccination among dental practitioners, dental students still demonstrated poor acceptance. These findings highlighted that evidence-based planning with effective approaches is warranted to enhance the knowledge and eradicate vaccination hesitancy, particularly among dental students.

Assessment of a Biosafety Device to Control Contamination by Airborne Transmission during Orthodontic/Dental Procedures

During the COVID-19 pandemic, dental professionals have faced high risk of airborne contamination between dentists, staff, and patients. The objective of this study was to evaluate the effect of an individual biosafety capsule in dentistry (IBCD) on reducing the dispersion of droplets and aerosols during orthodontic treatment and evaluate the clinician and patient’s perception of using the IBCD. For the in-vitro part of the study, aerosol quantification was performed with and without the IBCD, using a nonpathogenic bacterial strain and viral strain in the reservoir and high-speed dental handpiece. Petri dishes with MRS agar were positioned from the head of the equipment at distances of 0.5, 1, and 1.5 m. After 15 minutes of passive aerosol sampling, the dishes were closed and incubated using standard aerobic conditions at 37°C for 48 hours to count colony forming units (CFUs). For the clinical part of the study, a questionnaire was sent to clinicians and patients to understand their perception of orthodontically treat and receive treatment using the barrier. The use of IBCD showed an effective means to reduce the dispersion of bacterial and viral contamination around 99% and 96%, respectively, around the main source of aerosol ( $p<0.05$ ). Clinical results showed a 97% bacterial reduction during patient’s consultations ( $p<0.05$ ). The vast majority of clinicians and patients understand the importance of controlling the airborne dispersion to avoid contamination.

How does antiseptic mouthwashes against SARS-COV-2 affect the bond strength of universal adhesive to enamel?

This study compares the effect of different mouthwashes that have been recommended during the Coronavirus disease 2019 (COVID-19) pandemic on shear bond strength (SBS) of universal adhesive to enamel in regards to self-etch (SE) and etch-and-rinse (ER) modes. Flat enamel surfaces were obtained from 100 sound human maxillary central incisors. They were randomly allocated to five groups according to the different mouthwashes (no mouthwash/control [Ctrl], 0.2% chlorhexidine 1.5% hydrogen peroxide [H2 O2 ], 0.2% povidone-iodine [PVP-I], Listerine [L]), and adhesive application modes (ER and SE) (n = 10). After the application of a universal adhesive (single bond universal), composite resin (Filtek Z250) was bonded by a cylinder-shaped mold (height: 2 mm, diameter: 2.4 mm). They were subjected to SBS test using a universal testing machine (AGS-X, Shimadzu Corp.) (crosshead speed: 1 mm/min). The resin-enamel interfaces were observed with a scanning electron microscope (SEM). The semiquantitative chemical microanalyses were performed with energy-dispersive spectroscopy (EDS). The data were statistically analyzed by two-way analysis of variance and Bonferroni test (p < .05). In SE mode, Group Ctrl revealed significantly higher SBS than all mouthwash groups (p < .05). In ER mode, Group Ctrl showed significantly higher SBS than H2 O2 and PVP-I groups (p < .05). ER mode caused significantly higher SBS than SE mode in all mouthwash groups (p < .05). The SEM observations highlighted that Group Ctrl had a regular and intact hybrid layer with resin tag formation while the H2 O2 and PVP-I groups exhibited a thin hybrid layer in both modes. EDS analysis indicated that in SE mode, all mouthwash groups presented increased O content compared to Group Ctrl. H2 O2 and PVP-I that were suggested for preprocedural use during the COVID-19 pandemic, reduced the enamel bond strength of the universal adhesive in ER mode.

Knowledge of COVID-19 Infection Guidelines among the Dental Health Care Professionals of Jazan Region, Saudi Arabia

BACKGROUND

This study aimed to assess the knowledge about guidelines related to COVID-19 infection control procedures among dental health care professionals (DHCPs) in the Jazan region.

METHODS

A cross-sectional study involving DHCPs (dental students, interns, and dentists) of the Jazan region between January and March 2021. A questionnaire with 35 items was developed and circulated online among the DHCPs. The dimensionality of the questionnaire was assessed using exploratory factor analysis (EFA). The level of awareness (LOA) was compared across the genders, level of professional experience, and exposure to guidelines. Participants were considered to have high LOA when they responded to 26 or more items correctly.

RESULTS

A total of 363 DHCPs participated in the survey. The questionnaire was found to be valid and reliable. EFA revealed a distinct three-factor structure. Moreover, 61.2% of the respondents had high LOA related to COVID-19 infection prevention. Among those who had high LOA, dentists (65.5%) were relatively more than the students (62.5%) and interns (46.2%). Among the six guideline statements related explicitly to operative dentistry, more than 50% of the respondents were aware of 3 guideline statements, while less than 50% of the respondents were aware of the remaining statements.

CONCLUSIONS

Most DHCP had a high LOA for general COVID-19 infection prevention and control guidelines. Dentists, males, and those who read the guidelines had higher LOA than their counterparts.

The Effect of the COVID-19 Pandemic on Patient Selection, Surgical Procedures, and Postoperative Complications in a Specialized Dental Implant Clinic

During the coronavirus disease 2019 (COVID-19) pandemic, aerosol-generating procedures, including dental implant treatments, are considered high-risk. With dental implant treatment mostly an elective procedure, we aimed to assess whether the pandemic influenced patient selection, surgical procedures, and postoperative complications. We compared dental implant treatments during (March to December 2020) and before (December 2018 to February 2020) the COVID-19 pandemic based on patient and implant parameters, as well as postoperative complications. For analysis, we used the Chi-squared test with the Holm–Sidak correction for multiple comparisons. The number of implants placed during the COVID-19 pandemic (696 implants in 406 patients, 70 implants per month) was comparable to pre-pandemic levels (1204 implants in 616 patients, 80 implants per month). Regarding patient parameters, there were no significant differences in respiratory (p = 0.69) and cardiovascular conditions (p = 0.06), diabetes (p = 0.69), and smoking (p = 0.68). Regarding implant parameters, there was a significant difference in the distribution of augmentative procedures (no augmentation, guided bone regeneration, and sinus floor elevation, p = 0.01), but no significant differences in the types of edentulous spaces (p = 0.19) and the timing of implant placement (p = 0.52). Regarding complications, there were significantly fewer minor complications (p < 0.001) and early (i.e., before loading) implant failures (p = 0.02) compared with pre-pandemic levels. Our results suggest that the COVID-19 pandemic had no effect on patient selection and only a slight effect on the surgical procedures. However, postoperative complications, including early failures, were significantly less prevalent during the pandemic.

Brazilian dental students and COVID-19: A survey on knowledge and perceptions

OBJECTIVE

This study evaluated the knowledge and perceptions of Brazilian dental students about COVID-19 and the undergraduate clinical practice during the COVID-19 outbreak by a self-administered Web-based questionnaire.

METHODS

A social network campaign on Instagram was raised to approach the target population. The survey covered demographic and academic profile, general knowledge, preventive measures and perception about COVID-19. Descriptive statistics were used to identify frequencies and distributions of variables, which were compared by type of institution and current year of enrolment using the Chi-square or Fisher's exact tests (α = 0.05).

RESULTS

A total of 833 valid responses were received over 10 days. Students were able to identify the incubation period, main symptoms and contagious routes of the disease but struggled in recognising the name of the virus responsible for the pandemic. Hand washing before and after a dental appointment with a patient (97.7%) followed by the use of barriers to protect mucosa (97.2%) were the more frequently recognised measures to prevent COVID-19 spread in the dental office. As for the perception of COVID-19, 73.2% of the dental students perceived the disease as severe, whilst only 11.1% of them thought that COVID-19 is severe only for people presenting risk factors. Dental student's knowledge and perception were associated with the type of institution and year of enrolment.

CONCLUSION

In summary, the dental students demonstrated an acceptable general knowledge about COVID-19, but dental schools will need to address gaps in knowledge, preventive measures, and perceptions to ensure a safer return to in person activities.

Changes in Oral Health Policies and Guidelines During the COVID-19 Pandemic

The aim of this study was to describe the changes in oral health policies and guidelines in response to the Coronavirus disease 2019 (COVID-19) pandemic in different countries and regions around the world. Information on oral health policies and guidelines from 9 countries (Canada, China including Hong Kong, Egypt, India, Japan, New Zealand, Nigeria, Switzerland, and Thailand) were summarized, and sources of the information were mostly the national or regional health authorities and/or dental council/associations. The changes made to the oral health guidelines depended on the severity of the COVID-19 pandemic. This included suspension of non-emergency dental care services at the peak of the COVID-19 outbreak, and easing the restrictions on non-essential and elective dental care when the pandemic became under control. The COVID-19 risk mitigation strategies include strict adherence to infection control practices (use of hand sanitizers, facemask and maintaining social distancing), reducing the amount of aerosol production in the dental setting, and managing the quality of air in the dental treatment rooms by reducing the use of air conditioners and improving air exchange. The COVID-19 pandemic has shown a major impact on dental practice. Dental professionals are trying to adapt to the new norms, while the medium to long-term impact of COVID-19 on dentistry needs further investigation.

The Relationships Among Periodontitis, Pneumonia and COVID-19

Periodontitis is a chronic inflammatory disease of the supporting structures of the teeth that affects approximately half of adults 30 years and older. There is increasing interest in the direct and indirect relationships between periodontitis and systemic diseases, including respiratory diseases. The aim of this study was to assess the evidence on links among periodontitis, pneumonia, and COVID-19. Oral and periodontal bacteria may be linked to respiratory disease directly by aspiration of pathogens into the lungs causing pneumonia. As SARS-CoV-2 began to spread worldwide in 2020, questions have arisen of how periodontal disease may also be connected to SARS-CoV-2 infection and severity, including potential replication and dissemination of the virus from periodontal pockets. Some proposed mechanisms include the oral cavity acting as a reservoir or point of entry for SARS-CoV-2, overgrowth of periodontal pathogens, and increased production of proinflammatory cytokines. Due to potential links between periodontal disease and respiratory infections like pneumonia and SARS-CoV-2, oral hygiene and management of periodontitis remain essential to help reduce infection and transmission of SARS-CoV-2.

The COVID-19 experience of orthodontists in the UK

OBJECTIVE

To understand and compare the perceived impact and ongoing effects of the COVID-19 pandemic on orthodontic clinical services in the UK.

DESIGN

Descriptive cross-sectional survey.

SETTING

Online electronic questionnaire.

PARTICIPANTS

Members of the British Orthodontic Society (BOS).

METHODS

Electronic questionnaires were circulated between March and June 2021. The UK survey was distributed via emails from the BOS, Orthodontic Managed Clinical Networks and WhatsApp groups.

RESULTS

A total of 560 unique responses were received. There were more respondents who were aged over 50 years (52%) then respondents who were aged below 50 years (48%) with the median age range being 50-54 years (20%). The main causes of disruption to clinical practice were felt to be national restrictions (85%), increased cross-infection measures (84%), social distancing (80%) and professional guidance (80%). Respondents felt more negatively in their opinions regarding dentistry's preparedness for the pandemic (5%) and how dentistry coped in the crisis (35%), when compared to orthodontic services specifically (8% and 58%, respectively). The respondents were not confident about the potential beneficial effects of a vaccination programme on orthodontic clinical service provision (21%). Telephone consultations (84%) and video consultations (61%) were the main adaptations used by the respondents during the pandemic.

CONCLUSIONS

Respondents felt that COVID-19 will have long-term societal, clinical and professional implications. The majority of our respondents supported the vaccination and weekly testing of the orthodontic team. Respondents felt that during the pandemic there had been a deterioration in care provision and were not optimistic about a vaccination programme restoring services to pre-pandemic levels of activity. During the pandemic, patients in active orthodontic treatment have been prioritised but at the expense of new and review patients, and as services recover respondents were concerned about the difficulty of arranging dental extractions.

Comparison of Dental Anxiety While Visiting Dental Clinics before and after Getting Vaccinated in Midst of COVID-19 Pandemic

Vaccination is critical to control the rate of coronavirus transmission and infectivity. Dental practices are a high-risk area for contracting coronavirus; this fact generates psychological disturbances amongst patients. In this study, we aimed to assess the levels of anxiety of patients while visiting dental practices before and after getting vaccinated. This cross-sectional study was carried out between March and December 2021. An electronic survey was distributed among the vaccinated individuals who visited dental clinics before and after getting vaccinated. The survey consisted of the following four parts: demographic characteristics, questions related to coronavirus, and anxiety scores before and after getting vaccinated. SPSS-25 was used to perform the statistical analysis, where paired t-test was used to compare the anxiety scores, and Mann–Whitney U test to assess the association of gender with anxiety scores. A p-value of ≤0.05 was considered to be statistically significant. A total of 400 vaccinated individuals participated in this study, with a response rate of 88.23%. The majority of the respondents (71.0%) did not test positive for coronavirus. More than half of the participants (54.0%) reported to not be suffering from any coronavirus-related symptoms. About 100 (25.0%) of the individuals stated that dental clinics are an environment in which there is a high risk of contracting coronavirus. In regards to the comparison of the mean MDAS scores of the participants before and after getting vaccinated, a significant difference (p = 0.001) was found. Vaccination has been recommended for all eligible individuals to control the transmission and infectivity of coronavirus. Vaccinations have decreased the dental anxiety of patients while visiting dental clinics. However, the protective measures are still valid and should be followed, regardless of the vaccination status.

COVID-19 Vaccines in Indonesia: Knowledge, Attitudes, and Acceptance Among Dental Professionals

Background: At the time of writing, the number of Coronavirus Disease 2019 (COVID-19) cases in Indonesia has exceeded 2 million. The COVID-19 pandemic has caused severe disruptions in and unprecedented challenges to healthcare systems, including the one in Indonesia. Healthcare professionals, especially dentists, have an increased risk of contracting the virus. Many dental professionals in Indonesia have been exposed to the virus through close contact with aerosols and droplets from the oral cavities of their patients and have subsequently become infected. The Indonesian government commenced its COVID-19 vaccination program in January 2021. It is necessary to achieve high COVID-19 vaccination coverage rates among health workers. However, immunizations are voluntary, and some healthcare workers may be reluctant to receive them. The aim of this study was to evaluate the knowledge, attitudes, and acceptance of dental professionals of COVID-19 vaccines.

Materials and Methods: A cross-sectional study was conducted among dentists taking part in the Indonesia Dental Association webinar in June 2021. Google Docs was used to create an online questionnaire, which was disseminated to the participants at the end of the webinar. The questionnaire consisted of 15 questions developed after being reviewed by experts. The questionnaire collected demographic data (age, gender, location, and affiliation/institution) and data on the dental professionals' knowledge and acceptance of COVID-19 vaccines in Indonesia as well as their attitudes toward COVID-19 vaccines. The respondents selected one option (agree/neutral/disagree) in response to each statement in the questionnaire. For data analysis, the respondents were divided into three groups according to their professional activity/employment category: national hospital (GOV), private hospital (PRIVATE), or academic faculty in a dental school (ACADEMIC). The data were analyzed using descriptive statistics and expressed as frequencies and percentages. A chi-square test was used to investigate the association between professional activity and acceptance of COVID-19 vaccines.

Results: In total, 779 dentists from 34 provinces in Indonesia completed the questionnaire. There were 646 (83%) females and 133 (17%) males, with an age range of 24–73 years. In terms of the distribution of professional affiliations, the respondents included 23 (3%) academics, 285 (36.5%) private hospital/private practice practitioners, and 471 (60.5%) national hospital practitioners. In the statistical analysis, unadjusted odds ratios (ORs) were calculated with their 95% confidence intervals (CIs).

Conclusions: Acceptance of COVID-19 vaccines is an essential determinant of vaccine uptake and the likelihood of controlling the COVID-19 pandemic. There is agreement between dental professionals in private hospitals and academic faculties (dental school) regarding the need for COVID-19 vaccination. Developing strategies to reduce public hesitation and increase trust is vital for implementing vaccination programs, and dentists can play a role in increasing the uptake of COVID-19 vaccines.

Knowledge, attitude and preparedness to combat COVID-19 infection among dental professionals: A student-centric pilot study

Background

In the COVID-19 age, attempts are being made to raise student awareness and improve best practices to contain the outbreak.

Methodology

The target population was interns and 3^rdyear undergraduate students from JSS Dental College and Hospital, Mysuru. COVID-19 knowledge, awareness and attitude of the students and interns and the preparedness to tackle the current COVID 19 pandemic were assessed.

Results

120 respondents responded via a contented validated self-administered questionnaire with regard to knowledge, attitude and practices and preparedness to address the COVID 19 pandemic by undergraduates and interns. The student participants irrespective of their years into practice were aware of the guidelines being issued by Health care authorities and to address the COVID 19 pandemic. Among the respondents, 57.5% were 3^rd year dental students and 42.5% were interns. Regarding knowledge about COVID infection, 42.9% (3^rd year students) and 57.1% of the interns were aware of the recent developments, 34.1% of the III year students were aware of the safe distance to be maintained between patients, 42.4% of the students and 57.6% of interns were aware of the authority to be contacted with suspected COVID 19 infections. The participants were also aware of the vaccine trial which was conducted. Most of the respondents (64.3% of the students and 78.6% of the interns) were aware of fumigation in clinical or high-contact areas on a daily basis and biweekly in nonclinical areas.

Conclusions

The results suggest a strong need to encourage the current training program among students in health care-related fields.

Alraqibah M, A. Alharbi B, A. Alyahya R, N. Alrudhayman S, Albisher R. Role of dentist: COVID19 and mucormycosis

Dental practice has evolved over time and has adapted to the challenges that it has faced. The risk of infection spread via droplet and airborne routes poses a significant risk to the dentist who works close to patients. The risk of cross-infection between dental health-care personnel and patients can be very high due to the peculiar arrangements of dental settings. Dental clinics should have air purification systems with high volume excavators and negative pressure rooms for COVID-19 screening. Mucormycosis is a fungal disease that mostly occurs in immunocompromised individuals and those with uncontrolled diabetes. Dental extraction can trigger the occurrence. Increased occurrence of mucormycosis is seen in COVID-affected patients. This article gives a review on the dentistry-related transmission of COVID 19, the relation of COVID and mucormycosis.

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.

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.