Infection Control in Dental Practice During the COVID-19 Pandemic

The Response of the Indonesian Dental Community to the COVID-19 Pandemic

OBJECTIVE

The aim of this study was to assess the response of dental health care workers in Indonesia to the COVID-19 pandemic through (1) a countrywide web-based, questionnaire survey of their knowledge, attitude, and infection control (IC) practices during the pandemic and (2) a focus group discussion (FGD) on the latter aspects with infected personnel, as well as (3) archival data collection on the epidemiology of COVID-19 amongst dentists in Indonesia.

METHODS

A questionnaire survey using a web platform was conducted in May 2020 using a simple random sample of 3586 dentists working in different regions of Indonesia. The questionnaire attempted to elicit their knowledge and attitudes towards COVID-19, implementing IC measures, and providing dental care during the outbreak. The questionnaire comprised sections assessing participants' knowledge, awareness, and IC practice. In this study, the data were subjected to analysis through descriptive statistics and one-way analysis of variance (ANOVA) with a predetermined significance level of <.05. The study's second phase involved an FGD with dentists who had contracted the disease to discuss the impediments they faced during dental practice. We collected data on the number of dentists with COVID-19 from May 2020 to March 2022.

RESULTS

The questionnaire survey revealed that the dentists had a satisfactory understanding of COVID-19 spread and the IC measures required to curb disease spread in the dental clinic. Of note, some dentists lacked knowledge of the incubation period of 5 days (21.19%). The vast majority of the respondents (>80%) were aware of the nature of the SARS-CoV-2 virus. Community health centres and the personnel who served there were the most exposed health care providers.

CONCLUSIONS

Results suggest that the vast majority of the dental care professionals in Indonesia had adequate knowledge and awareness of COVID-19. However, some aspects of practice need to be improved in IC and related aspects.

Management of SARS-CoV-2 Prevention Methods in Dental Offices-A Cross-Sectional Study in Bucharest, Romania

We compared the managing of prevention methods for SARS-CoV-2 infections in dental offices before and immediately after the COVID-19 pandemic. The purpose of this study was to find out the varieties of infection prevention methods used by dentists before and during the pandemic and compare them. We designed a digital transversal questionnaire with 15 closed questions that was sent to 150 dentists in Bucharest, Romania. We received n = 112 valid answers during July-August 2021 from dentists of all age groups (25-60 years), with a sex ratio of 0.36, which agreed to anonymously participate in this study. The results showed an increase in types and amount of personal protection equipment (i.e., ocular/facial protection, supplemental gown, and upgrading the FFP1 masks to FFP2 or FFP3). Ocular protection showed statistical significance by gender but not by age group. Vaccination rate against SARS-CoV-2 was at 80% of the participant dentists at the time of the survey and had statistical significance. However, vaccination status of the patients did not alter dentists' protection protocol.

Enhanced personal protective equipment and dental students' experience and quality of a restorative procedure in a simulated clinical setting

OBJECTIVES

To evaluate the effects of enhanced personal protective equipment (Enhanced_PPE) on student-operator's experience and restorative procedure.

METHODS

Student-operators (N = 29 Year 3 dental students) performed Class II composite restorations (SimpliShade, Kerr) in typodont upper molars (OneDental) equipped with N95 respirators, full-face shields, disposable headwear and gowns (Enhanced_PPE) or surgical masks, protective glasses/goggles and non-disposable gowns (Standard_PPE) 2 weeks later. Cavity dimensions were measured on cone beam computed tomography images. The quality of composite restorations was assessed using selected FDI criteria and Vickers hardness. A questionnaire assessed the operators' discomfort, anxiety, confidence, ability to perform, and procedure outcome. Data were analyzed using paired t-test and McNemar test (alpha = 0.05).

RESULTS

Student-operators experienced greater discomfort and anxiety, reduced confidence and ability to perform, and rated the procedure as less satisfactory with Enhanced_PPE (p < 0.05). Differences in proximal box width were marginally significant (Enhanced_PPE 1.8 ± 0.4 mm, Standard_PPE 1.6 ± 0.3 mm) (p = 0.047). Other cavity dimensions were similar between groups (p > 0.05) as were restorations regarding surface luster, anatomical form, marginal adaptation, proximal contour, and contact (p > 0.05). There were no differences in the hardness of composite restorations (top p = 0.349, bottom p = 0.334).

CONCLUSIONS

Enhanced_PPE led to student-operator discomfort, anxiety, and reduced confidence, but did not impact the quality of Class II preparation and composite restorations versus Standard_PPE.

Assessment of dental students' knowledge of infection control and prevention during the COVID-19 pandemic

INTRODUCTION

Since the start of the COVID-19 pandemic, new guidelines for dental practice were published. This research aims to examine the knowledge of dental students and their attitudes towards current guidelines.

MATERIALS AND METHODS

The study involved 76 fourth-year dental medicine students from three public universities in Croatia. A survey questionnaire was developed based on in-depth interviews and a pilot pretesting. The online questionnaire consisting of 36 questions was published using Google Forms. The survey data were analysed using Microsoft Excel and presented with descriptive statistics.

RESULTS

Survey data showed the dental students' knowledge of the guidelines for dental practices is at an insufficient level (average score of 67% correct answers). Students who have come across the guidelines outside the faculty environment through assistantships have demonstrated lesser knowledge (65%) of the guidelines than the ones who do not (68%). A similar trend is observed with dental students who grew up in a family of doctors of dental medicine (61%) and ones who did not (68%). Students also independently assessed their knowledge of the guidelines as moderate (3.15 out of 5), while evaluating the application of current guidelines as very important (4.38 out of 5).

CONCLUSION

Awareness of dental students should be improved by adapting the curriculum of dental studies and increasing the availability of information on current guidelines. Dental students need to be motivated to independently inform themselves about the current guidelines for dental practices, thus improving their clinical work.

Analysis of sterilizer allocation and related factors in dental health-care settings in Yunnan Province, China: a cross-sectional study

OBJECTIVE

To investigate the status and related factors of sterilizers in dental health-care settings in Yunnan Province, with the aim of providing a theoretical basis for the health administrative department to formulate regional quality control programs and systems, proposing reasonable suggestions for optimizing the allocation of sterilizer resources in Yunnan's dental health-care settings, thereby improving resource utilization efficiency.

METHODS

This cross-sectional survey was conducted in 2600 dental health-care settings in Yunnan Province in March 2020. Uni-variable linear regression, multi-variable linear regression, curve fitting and threshold effect analysis were used to understand the relationship between dental units and sterilizers.

RESULTS

A total of 2600 dental health-care settings were included. The disinfection and sterilization work were mainly completed by the dental department in 1510(58.1%) institutions. 44(1.7%) institutions were not allocated sterilization equipment, and 1632 (62.8%) had only one sterilizer. The median allocation of sterilizers was 1.0. Uni-variable linear regression showed significant differences in covariates such as dental unit, dental handpiece, disinfection equipment, dentist, and dental assistant, which were more sensitive (p < 0.001) and statistically significant. The adjusted model was more stable in the multi-variable linear regression, and the differences in covariates between different settings were statistically significant. Curve fitting revealed an S-shaped curvilinear relationship between the number of dental units and sterilizers in oral healthcare settings.

CONCLUSION

The disinfection and sterilization work was mainly completed by the dental department in dental health-care settings in Yunnan Province. Sterilizer allocation increases with the number of dental units, but some institutions have insufficient allocation of sterilizer and manpower resources, resulting in certain risks of infection control. Thus, it is necessary to strengthen supervision, inspection and regional quality control work in infection control of dentistry.

Effects of the COVID-19 pandemic on senior dental students in Korea: Examining stress, burnout, and depression

Background/purpose

The COVID-19 pandemic has had a profound and enduring impact on various aspects of society, including medical education and the training of dental students. The field of dentistry, given its nature, is particularly susceptible to the challenges posed by a pandemic. Prolonged exposure to the pandemic is believed to have increased stress and burnout among medical and dental students. This study aimed to investigate and analyze the relationship between COVID-19 and stress, burnout, and depression in Korean dental students.

Materials and methods

A cross-sectional survey was conducted among 162 third and fourth-grade students from the School of Dentistry at Seoul National University. The survey comprised four main sections: general information, the Maslach Burnout Inventory (MBI), the Patient Health Questionnaire-9 (PHQ-9), and the Impact of Event Scale-Revised (IES-R).

Results

The results indicated significant differences in age, study time, career satisfaction, and counseling needs between third and fourth-grade students. The fourth-grade students exhibited higher scores in the IES-R survey, PHQ-9 total score, emotional exhaustion, and depersonalization subscale items of the MBI. Furthermore, the group with abnormal responses to COVID-19 demonstrated lower levels of career satisfaction.

Conclusion

Fourth-grade dental students experienced higher levels of depression, vulnerability to the effects of COVID-19, and burnout. These findings highlight the need for addressing the mental health challenges faced by dental students during the COVID-19 pandemic.

Respiratory infection transmission risk and indoor air quality at outpatient departments and emergency treatment units of Sri Lankan teaching hospitals

Indoor carbon dioxide (CO2) concentration has been used as a proxy of the degree of ventilation and, by extension, as an indicator of the risk of contracting respiratory infections. No publications exist regarding indoor air quality (IAQ) parameters of Sri Lankan hospitals.We measured the levels of CO2 and seven other IAQ parameters during morning rush hours for three days, in outpatient departments (OPDs) and emergency treatment units (ETUs) of all 21 teaching hospitals of Sri Lanka. We measured the same parameters of outdoor air also. We calculated the mean values of those parameters. We looked for correlations between outdoors and OPD and ETU levels of selected air quality parameters.The average CO2 levels of outdoors, OPDs and ETUs respectively were 514ppm (ppm = parts per million), 749ppm and 795ppm. The average levels of PM2.5 (particulate matter with diameters <2.5μm) outdoors, OPDs and ETUs respectively, were 28.7μg/m3,32μg/m3 and 25.6 μg/m3. The average levels of PM10 (particulate matter with diameters <10μm) outdoors, OPDs and ETUs respectively, were 49.4μg/m3, 55.5μg/m3 and 47.9 μg/m3. The median levels of formaldehyde outdoors, OPDs and ETUs respectively, were 0.03mg/m3, 0.04mg/m3 and 0.08mg/m3. The median levels of total volatile organic compounds (VOC) outdoors, OPDs and ETUs respectively were 0.12mg/m3, 0.19mg/m3 and 0.38mg/m3.CO2 levels of air in OPDs and ETUs generally were below the national ceilings but above the ceilings used by some developed countries. Outdoors, OPDs and ETUs air contain PM10, PM2.5 levels higher than WHO ceilings, although below the national ceilings. VOC and formaldehyde levels are generally below the national ceilings. Air in OPDs and ETUs is hotter and humid than national ceilings. Outdoor PM10, PM2.5 levels influence OPDs and ETUs levels. We propose methods to reduce the risk of nosocomial respiratory infections and to improve IAQ of Sri Lankan OPDs and ETUs.

Dental aerosol-producing treatments: Comparison of contamination patterns of face shields and surgical masks

During the COVID-19 pandemic, dental face shields were recommended to protect the eyes. This study aimed to examine to what extent face shield and mask contamination differ when a pre-procedural mouth rinsing with Chlorhexidine (CHX) is conducted before treatment. In this prospective, randomized study, three groups of subjects were formed (rinsing with 0.1% CHX, water, or no rinsing (control) before aerosol-producing treatments). After each of the 301 treatments, the practitioner's face shield was swabbed with eSwab and the mask was brought into contact with agar plates. Sampling was done from the exterior surface only. Samples were cultured for 48 h at 35 °C under aerobic and anaerobic conditions. Bacteria were classified by phenotypic characteristics, biochemical test methods, and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Colony-forming units were counted and mean values were compared (WSR, H-test, U-test, p < 0.05). Within each subject group, face shields showed significantly more contamination than surgical masks (control group: 350 CFU, 50 CFU; intervention water: 270 CFU, 40 CFU; intervention CHX: 250 CFU, 30 CFU). Comparison of face shields of the different subject groups did not reveal any statistically significant differences. However, CHX resulted in a statistically significant bacterial reduction on surgical masks compared to the water and control group (control: 50 CFU, intervention water: 40 CFU, intervention CHX: 30 CFU). Contamination of face shields and surgical masks was highest in the control group, followed by the water group, and lowest in the intervention group with CHX. Streptococcus spp. and Staphylococcus spp. dominated, representing the oral and cutaneous flora. Contamination of masks worn with or without face shields did not differ. Presumably, face shields intercept first splashes and droplets, while the masks were mainly exposed to bioaerosol mist. Consequently, face shields protect the facial region and surroundings from splashes and droplets, but not the mask itself. A pre-procedural mouth rinse with CHX had no statistically significant reducing effect on contamination of the face shield, but a statistically significant reducing effect was observed on contamination of the mask.

Risk evaluation of venue types and human behaviors of COVID-19 outbreaks in public indoor environments: A systematic review and meta-analysis

Despite increasing vaccination rates, the incidence of breakthrough infections with COVID-19 has increased due to the continued emergence of new variants of the SARS-CoV-2 coronavirus. Therefore, Non-pharmaceutical interventions remain the most effective measures for coping with the ever-changing pandemic. The lifting of compulsory interventions has made individuals primary responsibility for their own health, which highlights the importance of increasing awareness of the infection risk from the environment in which they live and their individual behaviors. We systematically searched PubMed, Web of Science, ScienceDirect, and Scopus on April 17, 2023, for all studies reporting COVID-19 outbreaks in public indoor venues. The study outcome was the attack rate. A total of 42 studies, which included cross-sectional studies, cohort studies, and case studies, reporting data on 1951 confirmed cases in 64 COVID-19 outbreaks satisfied the meta-analysis and were included in the review. A random-effect model was used in the meta-analysis, and subgroup analyses were conducted to investigate factors affecting attack rates. We found a strong level of evidence (p < 0.01) supporting a higher pooled attack rate in recreation-related venues (0.44, 95% CI: 0.30 to 0.60) than in work-related venues (0.21, 95% CI: 0.16 to 0.27). Compared to those outbreaks without that, outbreaks with high-intensity exercise, vocalization, contact behavior, or close body proximity had a higher attack rate of 0.51, 0.55, 0.33, and 0.39, respectively. Further studies suggest that different attack rates across different types of settings may be the result of heterogeneity in exposed people's behaviors. There were significant heterogeneities that may limit the interpretation of connections between influencing factors and outbreak outcomes. The identification of key behaviors that may contribute to transmission risk, and their correlation with venue type, has important implications for the development of future public health interventions and individual prevention strategies for respiratory infectious diseases such as COVID-19.

The Role of Socioeconomic and Health Services Organizational Factors on Infection Control Structure Score, Brazil

This study aimed to analyze possible associations between the Infection Control Structure Score (ICSS), health services, and social characteristics of the municipalities in Brazil. Secondary data from the third cycle 2017-2018 of the Brazilian National Program for Improving Primary Care Access and Quality (PMAQ) was analyzed. Six independent variables - FIRJAN Index of Municipal Development, number of inhabitants, number of family health teams receiving a financial incentive from the federal government, healthcare expenditure per capita, and number of Oral Health Teams modalities 1 and 2 - were included to assess their influence on ICSS, measured for each Brazilian town. Data analysis used the Classification and Regression Tree model performed with IBM SPSS 25. A total of 4,900 municipalities were included, and the mean ICSS was 0.905 (±0.092). A positive relationship was observed between healthcare expenditure per capita, municipal development, and the outcome. Conversely, towns with a higher number of family health teams receiving a financial incentive from the federal government showed lower mean ICSS. The findings suggest that inequalities in the infection control structures exist within the country, and they were related to the health services and social characteristics of the municipalities.

Dental clinicians' perceptions on the use of tele-dentistry consultations during COVID-19 within public dental clinics in Sydney, Australia

BACKGROUND

Although well accepted by clinicians and patients, teledentistry is not currently a widely used model of care within Australian public oral health services. This qualitative study aimed to review and evaluate dental clinicians' perceptions, by determining the acceptability and appropriateness of teledentistry as a model of care.

METHODS

A purposive sample of 12 public dental practitioners employed by a Local Health District in Sydney, and who had participated in teledentistry consultations, were recruited to participate in focus groups. Focus group discussions were transcribed verbatim and subjected to thematic analysis.

RESULTS

Teledentistry was a novel concept for most participants and was well accepted. Participants valued the use of a standardized consultation template as well as effective communication with other dental clinicians to support the practice of teledentistry. However, many found attempting contact with patients over the telephone difficult as well as the perceived patient frustration with the administration process and technological difficulties experienced.

CONCLUSION

Teledentistry has the potential for growth and expansion in the public health system. From the opinions in this study, the authors propose further research is needed into the efficacy of teledentistry to assist with the development of a model of care that would be beneficial for dental clinicians and their patients. © 2023 Australian Dental Association.

Psychological Impacts of Teaching Models on Ibero-American Educators during COVID-19

Educational systems globally, and notably in the Ibero-American context, underwent significant adaptations in response to the myriad challenges imposed by the COVID-19 pandemic. The pedagogical evolution unfolded through three discernible phases: predominantly online, hybrid, and ultimately, a return to face-to-face instruction. While these phases were universally apparent, cultural, socio-economic, and health disparities across regions subtly influenced the quality and experiential aspects of teaching and learning within these models. This study seeks to illuminate the psychological profiles and evaluative perspectives regarding teaching and learning quality among university educators during COVID-19's tri-phase educational transformation. Engaging 601 university instructors from various Ibero-American countries, a comprehensive questionnaire mapped demographic, academic, and psychological landscapes across the pandemic's distinctive epochs. The pivot to online educational methodologies, supplanting traditional modalities, permeated numerous facets of the educational endeavor, particularly impacting faculty life and wellbeing. Data underscored a prevalent sentiment of loneliness, indicative of broader mental health challenges, especially pronounced among educators in Latin American nations. Notwithstanding these hurdles, Latin American educators demonstrated a predilection towards online instruction, in stark contrast to their European peers, who exhibited a preference for in-person pedagogy. This study unveils the divergent pedagogical preferences and mental health challenges among university educators in the Ibero-American realm during COVID-19's educational shifts, underlining the need for adaptable educational frameworks and robust mental health support, attuned to the region's distinct socio-cultural and economic contexts.

Toward safe dental service: risk perception and practice modification among Egyptian dental students during the COVID-19 pandemic

BACKGROUND

COVID-19 was declared a major public health crisis and a challenge to healthcare systems especially dental services where dentists working close to patients face a greater risk of infection. This cross-sectional study aimed to assess the risk perception and practice modifications of undergraduate dental students at Tanta University to ensure safe dental practice during the COVID-19 pandemic.

METHODS

A convenience sample of 450 dental students from practical academic years at Tanta University, Egypt responded to a self-administered pre-designed validated and pretested questionnaire from the 11th of February 2022 to the end of April 2022 to assess some sociodemographic data, risk perception, and their practice during the COVID-19 pandemic.

RESULTS

Females reported significantly higher levels of fear than males concerning; contracting COVID-19 infection from patients (97.3% vs. 93%) (P = 0.028, 95% CI = 95.6(93.2-97.3), anxiety while treating symptomatic patients (95.1% vs. 90.3%) (P = 0.050, 95% CI = 93.1(90.4-95.3), and fear of infecting their families (94.7% vs. 89.8%) (P = 0.049, 95% CI = 92.7(89.9-94.9). More than half of the students (53.7%) had good practice scores, followed by 44% with average practice and 2.2% with poor practice. A good practice score was significantly associated with the age and academic year (P = 0.044, P = 0.044). Significant predictors of a good practice score in the logistic regression analysis were; updating knowledge with current guidelines for cross-infection regarding COVID-19 (P = 0.001, 95% CI = 53.20, 2.733), asking every patient's travel history before performing treatment (P = 0.021, 95% CI = 21.149, 1.286), deferring patients showing suspicious symptoms (P = 0.042, 95% CI = 20.688, 1.054), following routine universal precautions of infection for every patient (P = 0.016, 95% CI = 36.469, 1.438), using high-volume suction for every patient (P = 0.025, 95% CI = 20.826, 1.226) and using safety glasses or visor (P = 0.036, 95% CI = 21.673, 1.106).

CONCLUSION

The dental students exhibited anxiety and fear while caring for patients during the COVID-19 pandemic. Additionally, considerable changes in dental practices based on the standard guidelines were observed among the students. It is strongly advised that all dental schools have student counselors who are accessible for in-person and online counseling sessions. Peer support is a great approach to spot problems with stress and anxiety in pupils and start solving them.

Assessment of SARS-CoV-2 (COVID-19) Clinical Mouthwash Protocol and Prevalence of the Oral Pathogen Scardovia wiggsiae: A Pilot Study of Antibacterial Effects

One protocol in healthcare facilities and dental offices due to the COVID-19 pandemic for reducing the amount of detectable oral SARS-CoV-2 has been gargling with mouthwash for 60 s. This protocol lasts longer than the daily routine for most patients and may have unexpected benefits in reducing oral microbes as a result. This project evaluated the prevalence of the newly identified oral pathogen Scardovia wiggsiae before and after this procedure to determine any measurable effects. Using an approved protocol, n = 36 pre-mouthwash patient samples, n = 36 matched post-mouthwash samples, and n = 36 matched recall samples were identified (total sample number n = 108). DNA was isolated from each sample (pre-, post-mouthwash, and recall). Screening using qPCR and validated primers revealed n = 10/36 or 27.8% tested positive for Scardovia among the pre-mouthwash (Sample A) isolates with n = 3/36 or 8.3% testing positive among the post-mouthwash (Sample B) isolates. Screening of the recall (Sample C) samples has revealed n = 10/36, or 27.8% once again tested positive for Scardovia, demonstrating that this pathogen was found among a significant proportion of pediatric patient samples. Moreover, the COVID-19-related procedure of requiring sustained mouth washing prior to clinical treatment appears to reduce the levels of detectable Scardovia, at least initially. However, this study found no long-term effects using this isolated protocol.

Changes in COVID-19 Perception and in TMD Prevalence after 1 Year of Pandemic in Italy

OBJECTIVES

 The study aims to report the perception of dental practices and assess the individual's psychological stress level and related temporomandibular disorders (TMD) symptoms by evaluating the changes that occurred during the year following the first lockdown (May 2020).

MATERIALS AND METHODS

 An online questionnaire was submitted to the Italian population between 20 March and 20 April 2021. It was sent via online platforms and included 14 questions.

STATISTICAL ANALYSIS

 The data were analyzed using a chi-squared test and a comparison of the current data with the May 2020 survey data was performed using independent samples t-tests. The level of significance was set at p < 0.05.

RESULTS

 Forty-three percent of subjects (872) considered the dental practice to be a place with a high risk of infection. Temporomandibular pain and joint sounds were reported by 35.7% (724) of the population; of these more frequently were women (71.8%, 520/724, p < 0.001). About 31% of the participants had moderate/severe psychological distress and, among them, it was found that 46.4% (294/634) reported TMD pain (p < 0.001) and 34.9% (221/634) complained of temporomandibular joint sounds (p < 0.001).

CONCLUSIONS

 Most participants did not consider dental practices as a place with a higher risk of coronavirus disease 2019 transmission and, in contrast to the data from a previous study, people were less afraid to go to dental practices. After the first year of the pandemic, the level of stress and depression increased and the prevalence of TMD pain and joint sounds increased, in association with gender, age, and level of distress.

Effect of COVID-19 on dental service delivery in Fiji: Perspective of Dental Officers (Dos) and Dental Managers (DMs)

BACKGROUND

Corona Virus Disease 2019 (COVID-19) was declared a global pandemic by the World Health Organization (WHO) has had significant impact on dentistry in Fiji. Due to lack of previous study, this study aims to explore the perspective of Dental Officers (DOs) and Dental Managers (DMs) on the effects of COVID-19 on dental service delivery in Fiji Islands.

METHODS

This qualitative study was conducted amongst 30 DOs and 17 DMs between 9th August to 12th September, 2021. It was conducted in the government dental clinics, private dental clinics and the School of Dentistry and Oral Health clinic (SDOH), in the Central Division, Fiji. The study settings were randomly selected. Purposive sampling method was used for the selection of participants who met the study criteria. Semi-structure open ended questionnaires were used for data collection through in-depth interviews via zoom. Manual thematic analysis of the data was conducted to derive themes and codes.

RESULTS

The participants interviewed for the study included more female DOs (66.7%) and male DMs (58.8%). Seven themes emerged from data analysis: range of services delivered, appointment versus walk-in patients for aerosol generating procedures (AGPs), impact of pandemic on clinic opening hours, impact of COVID-19 on patient numbers, quality of services delivered, resources and infrastructure, perceptions about the burden of disease.

CONCLUSION

COVID-19 has significantly affected dental service delivery. Mostly emergency dental services were delivered. AGPs were delivered on appointment basis. Most participants stated the quality of services had improved. Participants stated that they were not given adequate resources and the infrastructure was not up to standard to provide dental services during the pandemic. The dental disease burden had increased during the pandemic as per the participants. Future research can be conducted amongst other dental professionals in other divisions of the country.

Frequency and Difficulty in the Usage of Face Shields Among Oral and Maxillofacial Surgeons During the COVID-19 Era: An Online Survey

Aim

During the COVID-19 era, personal protective equipment (PPE) has become a necessary part of surgeons' routines, and face shields are considered an additional barrier to prevent disease transmission via aerosols. This study aimed to evaluate how often oral and maxillofacial surgeons (OMFS) use face shields and the challenges they face while using them.

Methods

An online survey consisting of fourteen questions was distributed to OMFS, and the responses were collected and analyzed using the chi-square test to determine any associations between categorical variables. A P-value of ≤ 0.05 was considered statistically significant.

Results

Out of the 310 OMFS who responded to the survey (181 males, 129 females, 235 residents, 10 fellows, and 65 practitioners), 42.9% (133/310) and 39.4% (122/310) reported using face shields for minor and major surgical procedures, respectively. The majority of the respondents (74.1%, 230/310) reported decreased efficiency while using a face shield. Reasons for non-compliance included vision-related issues, headache, difficulties with disinfection, and ergonomic factors.

Conclusion

Based on the survey results, the regular use of face shields by OMFS was less frequent, and almost three-fourths of the surgeons found it challenging to use due to various reasons. The reduced compliance with face shield usage highlights the need for more ergonomic face shields to improve compliance.

Infection Control in Dental Practice during the COVID-19 Pandemic: What Is Changed?

The COVID-19 pandemic has profoundly changed our lives. Since the SARS-CoV-2 was discovered, many studies have been done on the transmission mode, its replication within humans, and its survival even in the outside environment and on inanimate surfaces. Undoubtedly, health care workers have faced the greatest risks because of their close contact with potentially infected patients. Of these, dental health care professionals are certainly among the most vulnerable categories, precisely because infection occurs with the airborne virus. The treatment of patients within the dental office has changed profoundly, respecting all preventive measures towards the patient and the practitioners themselves. The aim of this paper is to understand whether the protocols changed for the prevention of SARS-CoV-2 infection among dentists remained even after the most acute phase of the pandemic. In particular, this study analyzed habits, protocols, preventive measures, and any costs incurred in the COVID-19 era for the prevention of SARS-CoV-2 infection among dental workers and patients.

Impact of the COVID-19 Pandemic on the Oral Health Workforce: A Multicenter Study from the Southern Region of Brazil

The aim of this study was two-fold: (1) to describe the surveillance and biosafety measures adopted by dentists, dental hygienists, and dental assistants who worked in the Southern Region of Brazil and (2) to evaluate access to information in the context of the COVID-19 pandemic. This was a multicenter and cross-sectional design, using a self-applied and validated online questionnaire. The availability of health-care-related supplies and the adoption of biosafety measures recommended by the Technical Note of the National Health Surveillance Agency No. 04/2020 were analyzed. A total of 2560 Brazilian workers participated (75.8% dentists, 15.7% dental assistants and 8.5% dental hygienists), 52.7% from the public and 37.7% from the private sector. Approximately 70% of the individuals reported being away from work during the pandemic. The surveillance measures adopted with higher mean scores were the investigation of respiratory infection symptoms when scheduling appointments and the adoption of distancing in the waiting room. Of the biosafety measures to avoid aerosols, the procedures with lower compliance were those related to the use of intraoral radiographs and rubber dams. Moreover, the correct use of personal protective equipment at work seems to be related to self-perceived stress and anxiety. Worryingly, high access to information through non-governmental documents was observed. Permanent health education policies should reinforce safe practices and encourage workers to implement biosafety and surveillance measures in health services.

Awareness of Students and Dentists on Sustainability Issues, Safety of Use and Disposal of Dental Amalgam

Among the pillars of sustainability in health care units is environmental protection. Although an EU-wide dental amalgam phase-out legislation exists, quantities of this material are still to be found in the market, dental offices or in the mouths of patients. The purpose of this study is to record the views of dentists and dental students in Greece regarding the use and safety of dental amalgam for people and the environment as well as their attitudes towards its restriction and disposal.

MATERIALS AND METHODS

Two different questionnaires, through Google forms, were filled by each group. Descriptive statistics were used to describe the variables. The chi-square test or the chi-square test with Yates correction was used to examine potential differences per group (p-value = 0.05). Overall, 564 people participated in this study; 462 (81.9%) dentists (N1) and 102 (18.1%) dental students (N2).

RESULTS

Both groups agreed that they no longer use dental amalgam often. Dentists (39.8%) and students (36.4%) consider amalgam to have a moderate burden on the environment. This answer differed significantly per year of profession and year of undergraduate studies, respectively, with dentists from 6-25 years in the profession and 4th-year students, being the least aware on the environmental footprint of dental amalgam. Further, professionals (70%) and students (60%) believe that dental amalgam has a hazardous impact on patient's health, at all or to a small extent. For staff health, dentists reported at a moderate degree dangerous impact (32.9%) while students (36.4%), respectively. The impact on patients and staff health, were found to differ significantly per region of practicing dentistry for both groups. Finally, there were suggestions made from both groups about the necessity of information sharing on amalgam and mercury safety and the impact on the environment at the level of professional organizations.

CONCLUSIONS

Students, younger dentists and those living in non-urban regions seem to be more sensitive to the environmental impact of amalgam use, disposal, and health of people. Environmental issues should be addressed thoroughly by professional organizations, enhancing relevant activities for all people involved.

Factors affecting the infection control behaviours of Korean dental hygienists in response to the coronavirus disease 2019 pandemic

OBJECTIVES

This study aimed to identify the factors affecting the prevention of cross-infection with coronavirus disease-19 (COVID-19) among Korean dental hygienists.

METHODS

The level of knowledge about COVID-19 (KNW_CO ), level of awareness of infection control (AWR_IC ), degree of performance for infection control (PRF_IC ), and organizational factors for infection control (OFW_IC ) of clinical dental hygienists in Korea to prevent COVID-19 transmission were investigated. A self-written online questionnaire was administered to dental hygienists currently working in dental clinics or hospitals, and the survey results of 263 participants were analysed. Pearson's correlation coefficients were calculated for relationships between the KNW_CO , AWR_IC , PRF_IC , and OFW_IC . Multiple linear regression analysis was performed to identify the factors affecting the PRF_IC . Statistical significance was set at p < 0.05.

RESULTS

Knowledge about COVID-19, AWR_IC , PRF_IC , and OFW_IC were significantly correlated with each other. OFW_IC (β = 0.491, p < 0.001), followed by AWR_IC (β = 0.428, p < 0.001) and KNW_CO (β = 0.095, p = 0.013), had the greatest impact on PRF_IC with regard to the prevention of COVID-19 transmission.

CONCLUSIONS

Organizational factors for infection control and AWR_IC should be strengthened to improve PRF_IC and prevent COVID-19 transmission during dental care.

Clinical-Epidemiological Profile of Dental Professionals Associated with COVID-19 Infection in Southern Peru: A Cross-Sectional Study

Dental professionals have been identified as being at high risk for COVID-19 infection due to close contact with patients and the nature of dental treatments. However, the prevalence of infected dentists in Peru has not been determined. An online electronic survey was sent to dentists registered with the College of Dentists of Arequipa to collect sociodemographic data, medical conditions, and employment characteristics during the COVID-19 pandemic. The clinical characteristics and adverse effects of dentists diagnosed with COVID-19 were also recorded. The overall prevalence of COVID-19 infection was 44%. The highest number of diagnosed patients ranged in age from 31 to 40 years (n = 111; 48.9%). A total of 45.9% of female and 41.6% of male dentists were diagnosed with COVID-19 (p = 0.425). A relationship was found between the district of origin and infection, and dentists working in the public sector during 2021 showed a greater trend of becoming infected (57.6%) (p < 0.05). The antigen swab test was the diagnostic test most frequently used (38%), and cough was the symptom most reported. Only 0.6% reported being hospitalized, 10.6% reported needing oxygen during hospitalization, and 0.6% were admitted to an intensive care unit. As in previous studies in other countries, the rate of COVID-19 infection among Peruvian dentists is high. It is recommended that dentists carry out infection control measures while ministries of health and dental associations take measures to ensure their safety.

COVID-19 Related Information on Pediatric Dental Care including the Use of Teledentistry: A Narrative Review

In addition to the direct impact of the SARS-CoV-2 infection, the COVID-19 pandemic reports multiple effects on people's health and psycho-physical well-being. In the dental field, oral hygiene sessions, regular dental check-ups, and aerosol-generating procedures were commonly postponed, thus resulting in repercussions on oral health also favored by the changing eating and oral hygiene habits during the multiple lockdowns. Furthermore, dental settings and practices were generally perceived as at high risk for SARS-CoV-2 transmission, thus unsafe, and by general and pediatric dentists themselves. Last, the consequences of stress related to deprivation of social life and playful activities should not be underestimated in children, exposing them to the deleterious effects of bad oral habits, with repercussions on the balanced growth and development of the stomatognathic system. The present work intends to analyze the medium-term and long-term impact of COVID-19 on pediatric oral and dental care provision, reviewing pediatric dentistry practice and oral and dental needs of pedodontics patients during the first peak and the various waves of the COVID-19 pandemic, and lessons learned.

Human Monkeypox: Oral Implications and Recommendations for Oral Screening and Infection Control in Dental Practice

The World Health Organization declared the spread of the human monkeypox virus (MPXV) an "emerging threat of moderate health concern" on 23 June 2022. Although about 20,000 cases of Monkeypox (MPX) were recorded in Europe and more than 28,000 in the United States from May to October 2022, their number is still small compared to the number of dental patients treated annually. Therefore, the likelihood of oral healthcare workers encountering an MPX case is relatively low in not endemic regions. In addition, MPX-positive individuals are considered contagious only during the prodromal or acute phase. However, the exact shedding and transmission routes of MPX and the associated risk of transmission in the dental setting remain unclear. Moreover, infected subjects whose disease is confined to the head and neck may require oral and dental care because they complain of lymphadenopathy involving the cervical lymph nodes. Furthermore, MPX lesions may first appear in the oral cavity or perioral area. Therefore, given the recent spread of MPXV in non-endemic areas where dentists are not used to considering this disease in the differential diagnosis and taking appropriate preventive measures, all oral healthcare providers nowadays should be aware of the oral presentation of MPX for adequate oral screening and appropriate preventive measures for infection control in the dental practice.

Evaluation of Comprehensive COVID-19 Testing Program Outcomes in a US Dental Clinical Care Academic Setting

IMPORTANCE

Although many academic institutions have implemented infection control and prevention protocols, including regular asymptomatic self-testing, in response to the COVID-19 pandemic, the outcomes of mandatory surveillance testing programs at academic dental institutions that offer direct patient-facing clinical care has not yet been reported.

OBJECTIVE

To report the findings of a comprehensive surveillance COVID-19 testing program at an academic dental institution by assessing SARS-CoV-2 positivity rates and the potential association of test positivity with individual-level characteristics such as age, sex, and role.

DESIGN, SETTING, AND PARTICIPANTS

A retrospective cohort study was conducted using SARS-CoV-2 self-testing data from a mandatory surveillance program at the Harvard School of Dental Medicine. Test results obtained between August 24, 2020, and February 28, 2022, from students, faculty, and staff members were analyzed. Testing cadence varied from 1 to 3 times per week depending on risk status. The association of individual characteristics with test positivity was evaluated with univariate analyses and a bayesian multilevel logistic regression model.

EXPOSURES

Age by decade, sex, and role or position category (staff members, faculty, and students stratified by their involvement in clinical care activities), testing cadence, and testing date.

MAIN OUTCOMES AND MEASURES

Positive results from SARS-CoV-2 real-time reverse transcription-polymerase chain reaction self-tests were assessed.

RESULTS

Of the 390 study participants, 210 (53.8%) were women. Participants were grouped by age as follows: 20 to 29 years (190 [48.7%]), 30 to 39 years (88 [22.6%]), 40 to 49 years (44 [11.3%]), 50 to 59 years (42 [10.8%]), and 60 years or older (26 [6.7%]). Test results demonstrated an overall 0.27% positivity rate (61 test-positive cases), with a peak weekly positivity rate of 5.12% in the first week of January 2022. The mean (SD) test positivity rate among those involved in clinical activities was 0.25% (0.04) compared with 0.36% (0.09) among nonclinical participants. When adjusting for all considered covariates, test positivity was significantly associated with testing frequency (3 times vs 1 time per week: odds ratio [OR], 1.51 [95% credible interval (CrI), 1.07-3.69]) and timing of the test (after vs during the Alpha wave: OR, 0.33 [95% CrI, 0.11-0.88]; and Omicron vs Alpha: OR, 11.59 [95% CrI, 6.49-22.21]) but not with individual characteristics (age, sex, and role).

CONCLUSIONS AND RELEVANCE

These findings suggest that implementing an adaptive testing cadence based on the risk status of individuals may be effective in reducing the risk of SARS-CoV-2 infection within an institution. In this study, involvement in clinical activities did not pose additional risk of SARS-CoV-2 infection compared with other in-person activities in the presence of these control measures.

Assessment of dental health care personnel protocol deviations and self-contamination during personal protective equipment donning and doffing

BACKGROUND

Dental health care personnel (DHCP) may be at increased risk of exposure to severe acute respiratory syndrome coronavirus 2, the virus that causes COVID-19, as well as other clinically important pathogens. Proper use of personal protective equipment (PPE) reduces occupational exposure to pathogens. The authors performed an assessment of PPE donning and doffing practices among DHCP, using a fluorescent marker as a surrogate for pathogen transmission.

METHODS

Participants donned PPE (that is, disposable gown, gloves, face mask, and eye protection) and the fluorescent marker was applied to their palms and abdomen. DHCP then doffed PPE according to their usual practices. The donning and doffing processes were video recorded, areas of fluorescence were noted, and protocol deviations were assessed. Statistical analyses included frequency, type, and descriptions of protocol deviations and factors associated with fluorescence.

RESULTS

Seventy DHCP were enrolled. The donning and doffing steps with the highest frequency of protocol deviations were hand hygiene (66% of donning and 78% of doffing observations involved a deviation) and disposable gown use (63% of donning and 60% of doffing observations involved a deviation). Fluorescence was detected on 69% of DHCP after doffing, most frequently on hands. An increasing number of protocol deviations was significantly associated with increased risk of fluorescence. DHCP with a gown doffing deviation, excluding doffing out of order, were more likely to have fluorescence detected.

CONCLUSIONS

DHCP self-contamination was common with both donning and doffing PPE.

PRACTICAL IMPLICATIONS

Proper use of PPE is an important component of occupational health.

Education during the COVID-19 pandemic: the perception of Italian dental and medical students

BACKGROUND

During COVID-19 pandemic many dental and medical students continued their education from home. From several studies it emerges that students prefer face-to-face teaching, due to the better interaction with teachers, the least number of distractions and due to the negative effect of social isolation on the psychological aspect. The aim of this study was to evaluate the perception of Italian dentistry and medicine students about teaching and training in this scenario.

METHODS

Two online questionnaires were sent to medical and dental students of all Italian universities to investigate the limits and advantages of distance learning and the experience regarding the internship. A chi-square test was used to assess the association between gender, year of the course and region of residence (P<0.05).

RESULTS

One thousand one hundred thirty-eight students answered the first survey, and 292 the second one. Most students preferred face-to-face teaching due to the difficult to maintain attention during online lessons. Many students reported that the online internship was not adequate for their education.

CONCLUSIONS

Distance learning disadvantages are the greater number of sources of distraction, low level of interaction, and absence of the relationship with the patient during the practical training. Furthermore, isolation has strongly affected psychosocial balance of the students. The advantages are the greater comfort, the reduction of transport costs, the decrease in pollution, and the possibility of reviewing the lessons. Most Italian students considered appropriate to provide distance learning during the pandemic but believed that the best teaching method was teaching in presence.

Impact of the COVID-19 Pandemic on Paediatric Dental Treatment: A Retrospective Study in Banja Luka, Bosnia and Herzegovina

Dentists are at significant risk of COVID-19 infection. It was difficult to find a balance between dental care, especially preventive and other non-urgent dental procedures, and prevention of potential exposure to SARS-CoV-2 infection. The aim of the present study was to assess the influence of the COVID-19 pandemic on dental treatment in children in the Dental Clinic of the University of Banja Luka, and to compare it before and during the first and second years of the pandemic. All dental records of paediatric patients who attended the Dental Clinic (for the period March 2019 to March 2022) were analysed. The data on selected dental treatment procedures were divided into three groups per year and compared. The results during the first year of the COVID-19 pandemic showed a reduction in single treatments compared to the year before, while in the second year there was an increase in some interventions such as oral hygiene training and patient motivation, deciduous tooth extraction, and glass ionomer filling. Although the number of dental treatments in the clinic in the second year nearly returned to pre-pandemic levels, preventive and restorative interventions are the most appropriate strategy to improve the oral health of children after the COVID-19 pandemic.

A Cross-Sectional, Questionnaire-Based Survey on Air Infection Control among Romanian People

(1) Background: Infection control should be one of the main objectives in the comprehensive medical approach. (2) Methods: A cross-sectional study was conducted from June-July 2022. A questionnaire including 22 questions with multiple answers was applied online to 202 subjects selected at random. The questionnaire collected data on the subjects' knowledge about protective measures against airborne infections. For this study, a descriptive statistic was performed. Pearson's Chi-square test was used for data comparison. (3) Results: Only 61.39% (124) of the subjects consider that protective equipment is mandatory for the dental team, 40.10% (81) know to a very large extent and 44.06% (89) to a large extent that when talking, a respiratory infection can be transmitted. A rather large percentage of the subjects take into account the cost of the protective mask to a very large extent 39.60% (80). Only 30.20% (61) of the subjects would vaccinate to a very large extent and 24.75% (50) to a large extent against micro-organisms transmitted by air p > 0.05. (4) Conclusions: Most people know the aspects related to air decontamination, the priority being the promotion of control methods of airborne infections, and it is necessary to improve the level of knowledge on a large scale within the population.

Disinfection Effect of Hexadecyl Pyridinium Chloride on SARS-CoV-2 in vitro

The novel coronavirus (COVID-19 or 2019-nCoV) is a respiratory virus that can exist in the mouth and saliva of patients and spreads through aerosol dispersion. Therefore, stomatological hospitals and departments have become high-infection-risk environments. Accordingly, oral disinfectants that can effectively inactivate the virus have become a highly active area of research. Hexadecyl pyridinium chloride, povidone-iodine, and other common oral disinfectants are the natural primary choices for stomatological hospitals. Therefore, this study investigated the inhibitory effect of hexadecyl pyridinium chloride on severe acute respiratory syndrome coronavirus (SARS-CoV-2) in vitro. Vero cells infected with SARS-CoV-2 were used to determine the disinfection effect; the CCK-8 method was used to determine cytotoxicity, and viral load was determined by real-time PCR. The results showed that hexadecyl pyridinium chloride has no obvious cytotoxic effect on Vero cells in the concentration range of 0.0125-0.05 mg/mL. The in vitro experiments showed that hexadecyl pyridinium chloride significantly inhibits the virus at concentrations of 0.1 mg/mL or above at 2 min of action. Thus, the results provide experimental support for the use of hexadecyl pyridinium chloride in stomatological hospitals.

COVID-19 as an opportunity for minimally-invasive dentistry: a national cross-sectional survey

Background

During the COVID19 pandemic, the Latvian government issued first absolute restrictions (elective treatments prohibited, only emergency care) and later relative restrictions (preference for non-aerosol-generating procedures (AGP) and emergency care) on dental care. This study aims to assess the impact of these restrictions on the decision made by Latvian dentists about caries treatment.

Methods

A Survey-based cross-sectional study was used. A minimum sample size of 174 dentists was estimated for national representativeness (N = 1524). The questionnaire was developed by experts and sent three times via email to Latvian dentists from July to September 2020 and was also delivered in printed form at two national conferences in September and October 2020. Descriptive statistics were calculated.

Results

We received 373 completed questionnaires, with a total response rate of 24.5%. Under the recommendation to reduce AGP for the treatment of uncomplicated caries, 10% of the dentists stated that they would stop attending, 54% would only attend emergencies, and 36% would attend as usual. Under prohibition, the percentages are 15%, 74%, and 11%, respectively. Regarding the type of treatment, more than 75% would opt to proceed with selective caries removal for both primary and permanent teeth and 10% for extraction.

Conclusion

Latvian dentists are willing to treat patients with caries during the pandemic and state that they prefer to use non- or minimally invasive and less aerosol-generating methods for caries treatment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02432-7.

Anesthetic-, irrigation- and pain-free dentistry? The case for a femtosecond laser enabled intraoral robotic device

By leveraging ultrashort pulse laser and micro-electromechanical systems (MEMS) technologies, we are developing a miniaturized intraoral dental robotic device that clamps onto teeth, is remotely controlled, and equipped with a focusing and scanning system to perform efficient, fast, and ultra-precise laser treatments of teeth and dental restorative materials. The device will be supported by a real-time monitoring system for visualization and diagnostic analysis with appropriate digital controls. It will liberate dentists from repetitive manual operations, physical strain and proximity to the patient's oro-pharyngal area that potentially contains infectious agents. The technology will provide patients with high-accuracy, minimally invasive and pain-free treatment. Unlike conventional lasers, femtosecond lasers can ablate all materials without generating heat, thus negating the need for water irrigation, allowing for a clear field of view, and lowering cross-infection hazards. Additionally, dentists can check, analyze, and perform precise cutting of tooth structure with automatic correction, reducing human error. Performing early-stage diagnosis and intervention remotely will be possible through units installed at schools, rural health centers and aged care facilities. Not only can the combination of femtosecond lasers, robotics and MEMS provide practical solutions to dentistry's enduring issues by allowing more precise, efficient, and predictable treatment, but it will also lead to improving the overall access to oral healthcare for communities at large.

Alginate-Based Bio-Composites and Their Potential Applications

Over the last two decades, bio-polymer fibers have attracted attention for their uses in gene therapy, tissue engineering, wound-healing, and controlled drug delivery. The most commonly used bio-polymers are bio-sourced synthetic polymers such as poly (glycolic acid), poly (lactic acid), poly (e-caprolactone), copolymers of polyglycolide and poly (3-hydroxybutyrate), and natural polymers such as chitosan, soy protein, and alginate. Among all of the bio-polymer fibers, alginate is endowed with its ease of sol–gel transformation, remarkable ion exchange properties, and acid stability. Blending alginate fibers with a wide range of other materials has certainly opened many new opportunities for applications. This paper presents an overview on the modification of alginate fibers with nano-particles, adhesive peptides, and natural or synthetic polymers, in order to enhance their properties. The application of alginate fibers in several areas such as cosmetics, sensors, drug delivery, tissue engineering, and water treatment are investigated. The first section is a brief theoretical background regarding the definition, the source, and the structure of alginate. The second part deals with the physico-chemical, structural, and biological properties of alginate bio-polymers. The third part presents the spinning techniques and the effects of the process and solution parameters on the thermo-mechanical and physico-chemical properties of alginate fibers. Then, the fourth part presents the additives used as fillers in order to improve the properties of alginate fibers. Finally, the last section covers the practical applications of alginate composite fibers.

The prevalence of positive patients to COVID-19 rapid nasopharyngeal antigen testing in private dental practices

BACKGROUND

A quick diagnosis is crucial in effectively limiting the spread of SARS-CoV-2. The study aims to assess the prevalence of positive rapid tests in private dental practices.

METHODS

This is an observational study. 532 COVID-19 rapid nasopharyngeal antigen tests were carried out in the Veneto region of Italy. Patients of 4 dental practices in different cities (Caorle, Montebelluna, Treviso and Vicenza) were screened with a rapid test (Rapid Test COVID-19 Ag immunochromatographic assay, Techno Genetics) throughout November and December 2020. All the positive results from rapid tests were further investigated with a molecular test (PCR). All the patients tested showed no symptoms associated with SARS-CoV-2 infection and had already undergone triage and temperature measurement. In total 532 tests were taken: 202 in Caorle (Venice), 130 in Montebelluna (Treviso), 100 in Treviso, and 100 in Vicenza. Statistical analysis was carried with the computing environment R version 3.2.1 (R Foundation for Statistical Computing, Vienna, Austria). In particular, R was used for estimating the P value of the χ² test. The test was considered significant if the P value was lower or equal to 0.05.

RESULTS

The prevalence of the rapid tests that resulted positive was 7.14% (38 out of 532 in total, 22 out of 202 in Caorle, 6 out of 130 in Montebelluna, 4 out of 100 in Treviso and 6 out of 100 in Vicenza). Among these patients, 36 tested positive also with a molecular test (94.74%), in particular, 21 in Caorle, 5 in Montebelluna, 4 in Treviso, and 6 in Vicenza.

CONCLUSIONS

The prevalence of positive patients screened with a rapid test in private dental practices stands at 7.14% and it was confirmed in most of the patients with molecular tests. Therefore, in high-risk environments like dental practices, it is imperative to follow all the precautionary measures, and having every patient tested with a rapid test could be taken into consideration to limit the spread of COVID-19 infection.

The Attitudes of Children Undergoing Orthodontic Treatment toward Face Mask Wearing during the COVID-19 Pandemic: A Cross Sectional Study

During the COVID-19 pandemic, the protective face mask has proven to be essential. The protective face masks cover the lower part of the face, including teeth and, for orthodontic patients, the orthodontic appliances. The aim of this study was to assess the impact that the restrictive measures that were imposed during the COVID-19 pandemic and, especially, wearing a protective face mask had on a sample of Romanian children, and to compare the results previously obtained on a sample of Romanian teenagers with the results obtained after investigating children under the age of 12 years. The cross-sectional survey was conducted in two orthodontic offices from the city of Oradea, Romania. The study sample included children with ages between 8 and 11.9 years that were undergoing an orthodontic treatment with removable or fixed orthodontic appliances. After obtaining the results, comparisons were made with the answers provided by a group of adolescents previously investigated. The questionnaires consisted of 9 items that investigated children’ attitudes toward protective face mask wearing and other aspects related to the COVID-19 pandemic. Two hundred fifty-six children were included in the study (53.1% female patients, 46.9% male patients). Most of the children were not worried that face masks would hide their orthodontic appliances (Item 1—Never, 40.2%; Rarely, 28.9%) and did not consider that the necessity of face mask wearing negatively impacted their desire to undergo an orthodontic treatment, despite the fact that it covered the appliances (Item 2—Never, 37.1%; Rarely, 31.6%). However, 44.5% of children were not happy because they had to wear a face mask during the orthodontic treatment, considering the fact that it covered the orthodontic appliance (Item 6), and most patients (49.2%) did not want the face mask to continue to be mandatory (Item 7). Although children were not happy that they had to wear a face mask that covered the orthodontic appliances, protective face masks were generally well tolerated by Romanian children.

CHX and a Face Shield Cannot Prevent Contamination of Surgical Masks

Background

Bacterial contamination on surgical masks puts a threat to medical staff and patients. The aim of the study was to investigate its contamination during dental treatments, wearing a face shield and performing a pre-procedural mouth rinsing with chlorhexidine (CHX).

Methods

In this prospective, randomized study, 306 treatments were included, 141 single-tooth (restorations) and 165 total dentition treatments (preventive or periodontal supportive ultrasonic application). A total of three groups (each: n = 102) were formed: participants rinsed for 60 s with 0.1 % CHX or with water before treatment, and, for control, a non-rinsing group was included. In view of the COVID-19 pandemic, a face shield covering the surgical mask enhanced personal protective equipment. After treatment, masks were imprinted on agar plates and incubated at 35°C for 48 h. Bacteria were classified by phenotypic characteristics, biochemical assay methods, and matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS). Colonies (CFU) were counted and mean values were compared (Kruskal–Wallis-, U test, p < 0.05).

Results

Chlorhexidine led to a statistically significant reduction of bacterial contamination of the surgical mask (mean: 24 CFU) in comparison with water (mean: 47 CFU) and non-rinsing (mean: 80 CFU). Furthermore, rinsing with water reduced CFU significantly in comparison with the non-rinsing group. There were no significant differences between single or total dentition treatments. Streptococcus spp., Staphylococcus spp., Micrococcus spp., and Bacillus spp. dominated, representing the oral and cutaneous flora.

Conclusion

A pre-procedural mouth rinse is useful to reduce the bacterial load of the surgical mask. However, contamination cannot be prevented completely, even by applying a face shield. In particular, during pandemic, it is important to consider that these additional protective measures are not able to completely avoid the transmission of pathogens bearing aerosols to the facial region. If antiseptic rinsing solutions are not available, rinsing with water is also useful.

Prevalence of SARS-CoV-2 IgG antibodies among dental teams in Germany

OBJECTIVES

During the corona pandemic, dental practices temporarily closed their doors to patients except for emergency treatments. Due to the daily occupational exposure, the risk of SARS-CoV-2 transmission among dentists and their team is presumed to be higher than that in the general population. This study examined this issue among dental teams across Germany.

MATERIALS AND METHODS

In total, 2784 participants provided usable questionnaires and dry blood samples. Dry blood samples were used to detect IgG antibodies against SARS-CoV-2. The questionnaires were analyzed to investigate demographic data and working conditions during the pandemic. Multivariable logistic mixed-effects models were applied.

RESULTS

We observed 146 participants with positive SARS-CoV-2 IgG antibodies (5.2%) and 30 subjects with a borderline finding (1.1%). Seventy-four out of the 146 participants with SARS-CoV-2 IgG antibodies did not report a positive SARS-CoV-2 PCR test (50.7%), while 27 participants without SARS-CoV-2 IgG antibodies reported a positive SARS-CoV-2 PCR test (1.1%). Combining the laboratory and self-reported information, the number of participants with a SARS-CoV-2 infection was 179 (6.5%). Though after adjustment for region, mixed-effects models indicated associations of use of rubber dams (OR 1.65; 95% CI: 1.01-2.72) and the number of protective measures (OR 1.16; 95% CI: 1.01-1.34) with increased risk for positive SARS-CoV-2 status, none of those variables was significantly associated with a SARS-CoV-2 status in fully adjusted models.

CONCLUSIONS

The risk of SARS-CoV-2 transmission was not higher among the dental team compared to the general population.

CLINICAL RELEVANCE

Following hygienic regulations and infection control measures ensures the safety of the dental team and their patients.

A retrospective study on the effect of the COVID-19 pandemic on dental treatments in adults

Background

The aim was to analyze the prevalence of dental treatments that were not performed in a dental care university referral center in the capital of Spain during the first wave of the COVID-19 pandemic.

Methods

This was a retrospective observational study based on the registry of medical records. Sex, age, nationality, and the type of treatment that was not performed in the service of the Integrated Adult Dental Clinic subject of the Dentistry degree at the Rey Juan Carlos University of Madrid were analyzed.

Results

A total of 392 medical records were analyzed. The prevalence of the treatments that were not performed was 58.67% (95% CI 53.74–63.44) of conservative treatments, 47.45% (95% CI 42.55–52.39) of periodontal treatments, 27.30% (95% CI 23.12–31.91) and 13.52% (95% CI 10.49–17.26) of clinical activities. The patients most affected by the absence of dental treatment ranged in age from 35 to 74 years. Age, sex, and nationality were not influential in not performing dental treatments.

Conclusions

The COVID-19 pandemic could have negatively influenced treatments, such as conservative and periodontal treatments, that increasing the risk of tooth loss in adults.

Dual-site ligation-assisted loop-mediated isothermal amplification (dLig-LAMP) for colorimetric and point-of-care determination of real SARS-CoV-2

A probing system has been developed based on dual-site ligation-assisted loop-mediated isothermal amplification (dLig-LAMP) for the selective colorimetric detection of SARS-CoV-2. This approach can induce false-positive and -negative detection in real clinical samples; dLig-LAMP operates with improved selectivity. Unlike RT-LAMP, the selectivity of dLig-LAMP is determined in both the ligation and primer binding steps, not in the reverse transcription step. With this selective system in hand, we developed a colorimetric signaling system for point-of-care detection. We also developed a colorimetric probe for sensing pyrophosphate, which arises as a side product during the LAMP DNA amplification. Thus, dLig-LAMP appears to be an alternative method for improving the selectivity problems associated with reverse transcription. In addition, combining dLig-LAMP with colorimetric pyrophosphate probing allows point-of-care detection of SARS-CoV-2 within 1 h with high selectivity.

Adherence to COVID-19 Preventive Measures among Dental Care Workers in Vietnam: An Online Cross-Sectional Survey

An online cross-sectional survey using a "snowball" sampling method was carried out to assess the adherence to COVID-19 preventive measures among dental care workers (DCWs) during the pandemic. Six questions concerning the COVID-19 preventive guidelines issued by the Vietnam Ministry of Health were used to evaluate DCWs' adherence to preventive measures at dental care clinics. The quality of life of DCWs was assessed using the WHO-5 questionnaire and was defined as low if the total score was less than 13 points. Factors relating to adherence to COVID-19 prevention measures of DCWs were determined by multivariate linear regression analysis. In total, 514 DCWs completed the questionnaire. A total of 37% DCWs rated their quality of life as low. Regression analysis suggested that older age, a better quality of life, living in an urban area, and training on COVID-19 prevention were associated with better adherence to COVID-19 preventive measures, while being a dentist and lack of personal protective equipment was associated with less adherence to COVID-19 preventive measures. The pandemic had a significant negative impact on the physical and mental health of DCWs. Therefore, specific national guidelines for the prevention and control of the spread of COVID-19 in dental facilities should be issued.

Effect of hepatitis C antiviral therapy on oral lichen planus and hyposalivation in inmates

Background

Oral lichen planus (OLP) and hyposalivation have been reported as extrahepatic manifestations of hepatitis C virus (HCV) infection. Our study evaluated the effect of direct antiviral agents (DAAs) on OLP and hyposalivation in convicts with chronic hepatitis C, examining patients before, during and after the antiviral treatment period with direct acting antiviral agents (DAAs).

Methods

We screened 198 inmates for the presence of the HCV antibody. Patients found to be positive underwent a quantitative HCV-RNA test and HCV genotype typing, as well as an oral cavity examination using a scoring system for OLP (REU score) and the clinical oral dryness score (CODS). Subsequently, all patients underwent DAA therapy and a systematic physical examination of the oral cavity at 1, 3 and 6 months from the beginning of treatment.

Results

Fifty patients (25.25%) had a positive HCV-RNA test. At baseline, OLP was detected in 4 patients (8%), with a mean REU score of 10.13±4, and different degrees of hyposalivation were seen in 17 patients (34%), with a mean CODS score of 4.71±1.72. Six months after the start of DAA therapy, we observed resolution of OLP in 3 patients (75%) and improvement in the remaining subject with a significantly lower mean REU score (2±4). Hyposalivation disappeared in 5 patients, improved in 10, and remained unchanged in 2 patients with a significantly lower mean CODS score (0.06±0.24).

Conclusion

This study demonstrated the effectiveness of DAAs in the treatment of OLP and hyposalivation.

Pros and Cons of CAD/CAM Technology for Infection Prevention in Dental Settings during COVID-19 Outbreak

The purpose of this commentary is to update the evidence reported in our previous review on the advantages and limitations of computer-aided design/computer-aided manufacturing technology in the promotion of dental business, as well as to guarantee patient and occupational safety. The COVID-19 pandemic led to an unprecedented focus on infection prevention; however, waves of COVID-19 follow one another, asymptomatic cases are nearly impossible to identify by triage in a dental setting, and the effectiveness of long-lasting immune protection through vaccination remains largely unknown. Different national laws and international guidelines (mainly USA-CDC, ECDC) have often brought about dissimilar awareness and operational choices, and in general, there has been very limited attention to this technology. Here, we discuss its advantages and limitations in light of: (a) presence of SARS-CoV-2 in the oral cavity, saliva, and dental biofilm and activation of dormant microbial infections; (b) the prevention of SARS-CoV-2 transmission by aerosol and fomite contamination; (c) the detection of various oral manifestations of COVID-19; (d) specific information for the reprocessing of the scanner tip and the ward from the manufacturers.

The influence of microclimate conditions on ozone disinfection efficacy in working places

In recent years, the sanitization of environments, devices, and objects has become mandatory to improve human and environmental safety, in addition to individual protection and prevention measures. International studies considered ozone one of the most useful and easy sanitization methods for indoor environments, especially hospital environments that require adequate levels of disinfection. The purpose of this work was to evaluate the microclimate influence on sanitizing procedure for indoor settings with ozone, to prevent infections and ensure the safe use of the environments. The concentration of ozone was measured during sanitization treatment and estimation of microorganisms' survival on the air and different contaminated plates after the sanitization operations were performed. The results demonstrated a significant reduction in the microbial count that always fell below the threshold value in different conditions of distance, temperature, and relative humidity.

Aerosol generated by dental procedures: A scoping review

BACKGROUND

The current pandemic has raised awareness of aerosol dispersion in dental offices. This scoping review was conducted to assess the amount and spread of aerosol generated by dental procedures.

METHODS

This scoping review followed the PRISMA-ScR protocol and was conducted by searching multiple databases adopting a core search structure for each database. Detailed eligibility criteria were applied. The authors placed no restrictions on study design, year of publication, and study location. The literature search was updated on September 15, 2021.

RESULTS

A total of 51 papers were included in this scoping review. The risk of bias assessment was not conducted as per guidelines. The majority of studies found microorganisms, bloodstains, splatters of aerosol, and particles in the air part of the search strategy. Publication dates ranged from 1969 to 2021. Data came from different dental settings locations. Several factors were identified that have an effect on the amount and spread of the aerosol and spatter.

CONCLUSION

Although it is clear that the microbial contamination occurred mainly during aerosol-generating dental procedures, our understanding of the contamination level, spread, and half-life are limited.

Operational Implications and Risk Assessment of COVID-19 in Dental Practices

The unprecedented situation of the coronavirus pandemic has impacted the entire world, with dental practice being significantly affected. In this study, we aim to evaluate the operational implications and risk assessment of the coronavirus in dental practice. This observational study comprised the electronic distribution of two surveys, one to patients and the second to dental professionals. The first questionnaire consisted of demographics along with 15 closed-ended questions. The second questionnaire consisted of demographics along with 43 questions from eight domains: financial impact, psychological impact, patient satisfaction, hygiene, patient management, COVID-19 lockdown, perspective, and practicing dentistry after the COVID-19 pandemic. The statistical analysis was performed using SPSS-25. A linear regression test was applied to assess the effect of the dependent variable (patient's satisfaction with the dental practice) on independent variables (age, gender, education). The ANOVA test was applied to assess the effect of the independent variables (financial impact, psychological impact, patient satisfaction, hygiene, patient management, lockdown, perspective, and post-COVID-19) on the dependent variables (age, gender, education, experience of dentists, qualification of dentists). A total of 711 patients and dental professionals participated in this study, with a response rate of 88.87%. Approximately 67.9% of the patients felt comfortable in the dental clinic, with 74.5% being satisfied with the dental clinic's services. The majority (77.4%) of the dentists were psychologically affected. Many of the participants chose to use masks, gowns, respiratory equipment, and face shields for protection. Teledentistry was preferred by the majority of dentists in non-emergency cases. Many of the dentists chose alternative procedures to minimize the generation of aerosols. The majority of the dentists suggested changes in the dynamics of dentistry in the post-COVID era, such as the suggestion that the management of the finances of a dental practice along with infection control protocols should be practiced more optimally. Patients and dental professionals were well aware of the necessary precautionary measures required to combat the coronavirus, as well as the implications of different operational measures along with performing risk assessment, keeping in mind the changing dynamics of dentistry.

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.

Revealing Distress and Perceived Stress among Dentists at the Outset of the COVID-19 Pandemic: A Cross-Sectional Factor Analytic Study

Dentists' perceptions about the stressfulness of clinical practice are well-documented, but literature on perceived stress and psychological distress experienced during the COVID-19 pandemic is scarce. This study aims to explore the emotions and attitudes, and the socio-demographic, dental, and COVID-related factors that are associated with the emergence of perceived stress and psychological distress that have been experienced by dentists during the COVID-19 pandemic. General demographic and dental-related data, and specific questions measuring the potential factors regarding dental professionals' concerns and opinions about their professional circumstances during the pandemic, were electronically collected from 182 dental practitioners. Exploratory and confirmatory factor analyses were used to assess whether dentists' emotions and attitudes during the pandemic measure the same construct: psychological distress, while linear regression models were built on the exploration of the effects of COVID-related factors on perceived stress and psychological distress. Facets of impulsiveness, lack of interest in social connections, emotional disengagement, mood swings, and acknowledgment of emotional exhaustion due to the pandemic, were measurements of the same construct and manifested in a singular factor: psychological distress. Two aspects, the fear of aerosol propagation and insecurities of financial status, increased the likelihood of the emergence of heightened levels of perceived stress and distress, while years spent in dental practice and age seemed to be protective factors against perceived stress and distress.

Stopping the COVID-19 pandemic in dental offices: A review of SARS-CoV-2 transmission and cross-infection prevention

Due to the essential role of dentists in stopping the COVID-19 pandemic, the purpose of this review is to help dentists to detect any weaknesses in their disinfection and cross-contamination prevention protocols, and to triage dental treatments to meet the needs of patients during the pandemic. We used PRISMA to identify peer-reviewed publications which supplemented guidance from the center for disease control about infection control and guidelines for dentists. Dentists must triage dental treatments to meet the needs of patients during the pandemic. The ongoing pandemic has changed the practice of dentistry forever, the changes make it more cumbersome, time-consuming, and costly due to the possible pathways of transmission and mitigation steps needed to prevent the spread of COVID-19. Dental chairside rapid tests for SARS-CoV-2 are urgently needed. Until then, dentists need to screen patients for COVID-19 even though 75% of people with COVID-19 have no symptoms. Despite the widespread anxiety and fear of the devastating health effects of COVID-19, only 61% of dentists have implemented a change to their treatment protocols. As an urgent matter of public health, all dentists must identify the additional steps they can take to prevent the spread of COVID-19. The most effective steps to stop the pandemic in dental offices are to; vaccinate all dentists, staff, and patients; triage dental treatments for patients, separate vulnerable patients, separate COVID-19 patients, prevent cross-contamination, disinfect areas touched by patients, maintain social distancing, and change personal protective equipment between patients.

COVID-19 and Its Repercussions on Oral Health: A Review

In 2019, a new type of coronavirus, SARS-CoV-2, the causing agent of COVID-19, was first detected in Wuhan, China. On 11 March 2020, the World Health Organization declared a pandemic. The manifestations of COVID-19 are mostly age-dependent and potentially more severe in cases with involved co-morbidities. The gravity of the symptoms depends on the clinical stage of the infection. The most common symptoms include runny nose and nasal congestion, anosmia, dysgeusia or hypogeusia, diarrhea, nausea/vomiting, respiratory distress, fatigue, ocular symptoms, diarrhea, vomiting, and abdominal pain. These systemic conditions are often accompanied by skin and mucosal lesions. Oral lesions reported in patients with COVID-19 include: herpex simplex, candidiasis, geographic tongue, aphthous-like ulcers, hemorrhagic ulcerations, necrotic ulcerations, white hairy tongue, reddish macules, erythematous surfaces, petechiae, and pustular enanthema. It is still unclear if these manifestations are a direct result of the viral infection, a consequence of systemic deterioration, or adverse reactions to treatments. Poor oral hygiene in hospitalized or quarantined COVID-19 patients should also be considered as an aggravating condition. This narrative review is focused on presenting the most relevant data from the literature regarding oral manifestations related to SARS-CoV-2, as well as the challenges faced by the dental system during this pandemic. A routine intraoral examination is recommended in COVID-19 patients, either suspected or confirmed, as, in certain cases, oral manifestations represent a sign of severe infection or even of a life-threatening condition. It is our belief that extensive knowledge of all possible manifestations, including oral lesions, in cases of COVID-19 is of great importance in the present uncertain context, including new, currently emerging viral variants with unknown future impact.

Practical Applicability of Teledentistry in Pediatric Patients Amidst Pandemic : A Narrative Review

The coronavirus disease-2019 (COVID-19) pandemic has imposed a situation where all healthcare facilities except emergency services remain suspended. These times generated the necessity for the implementation of a healthcare delivery system that can be accessed digitally and, thus, benefit the majority of children as well as healthcare professionals. This review aims to propose a sound model of less technique sensitive, safe and handy strategies for dental traumatic injuries, endodontic and restorative concerns, and orthodontic urgencies until complete clinical help can be sought. Five hundred thirty articles were obtained from the PubMed, Google Scholar, Embase, Lilacs, and Cochrane databases published from 2011 to 2021. Nineteen articles that described teledentistry in the COVID-19 era were included. Teledentistry can serve as a vital patient management strategy that can aid in triaging urgent and elective patient treatment needs, ultimately easing the burden of clinics and at the same time providing a safer means of consultation.