The Impact of COVID-19 Related Lockdown on Dental Practice in Central Italy-Outcomes of A Survey

A systematic review of dentists' psychological wellbeing during the COVID-19 pandemic

Background The COVID-19 pandemic presented significant challenges to healthcare workers worldwide, including the effect on the psychological wellbeing of dentists.Aims To evaluate the impact of the early phases of the pandemic on the psychological health, long-term wellbeing and clinical service provision of dentists, as well as the identification of the key risk and protective factors for adverse mental health outcomes (MHOs) in this group.Methods A systematic review of cross-sectional studies (n = 53) from public and private dentistry sectors was employed to delineate the risk and protective factors for adverse MHOs.Results Self-reports from these studies (1 December 2019 to 31 December 2021), involving 45,671 dentists worldwide were analysed. Study findings were classified according to their psychological impact (as risk or protective factors), categorised as 'operational' or 'organisational' and subdivided into 'psychosocial', 'occupational', 'sociodemographic' and 'environmental' elements. A GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) certainty of evidence score was calculated for all the identified factors.Conclusions This review confirmed the negative impact of the pandemic on the MHOs of dentists worldwide. Pivotal risk factors included fear of infection, transmission to families, lack of personal protective equipment and possible direct contact with infected patients. Enhanced infection control protocols, individual resilience and organisational support were identified as important protective factors.

Disparity in access for people with disabilities to outpatient dental care services: a retrospective cohort study

BACKGROUND

People with disabilities face difficulties in oral health management and gaining access to dental care. The availability of a regular source of dental care (RSDC) is an important factor that influences the access to health services and care management. The purpose of this study was to determine the effect of the availability of RSDC on the number of annual dental visits and dental expenses per visit among people with disabilities.

METHODS

Data of 7,896,251 patients with dental problems in South Korea were analyzed using the 2002-2018 National Health Insurance claims data. A generalized estimating equation was applied to analyze the repeated-measurement data, and the interaction effect between RSDC and the disability severity was evaluated.

RESULTS

The number of annual dental visits was higher among people with (2.62) than among those without (2.23) disabilities. Despite their increased dental needs, both annual dental visits and dental expenses per visit were low among older individuals (p < 0.001). The proportion and frequency of annual dental visits was lower among women than among men with disabilities. RSDC had differential effects on the severity of disability. Compared to people without disabilities, RSDC increased the number of annual dental visits (p = 0.067) and the dental expenses per visit (p < 0.05) among those with severe disabilities, but the effect on the number of annual dental visits was not significant among those with mild disabilities (p = 0.698).

CONCLUSIONS

Our results suggest a need for a special dental care system for people with disabilities, to ensure an RSDC, particularly for women and for older people with disabilities.

A Survey on forensic odontologists' activity in Italy during the COVID-19 pandemic

Few information on virus contagion at the beginning of the covid-19 pandemic led to severe restrictions in the dental and forensic activity in Italy, the introduction of procedural guidelines and implementation of preventive measures. A specific survey on Italian forensic odontologists (FOds) activity was conducted to investigate the COVD-19 pandemic impact on daily practices, the preventive measures adopted to manage the risks of contagion procedures performed on living and dead people and the possible peculiar cases that required the intervention of a medical examiner. A total of 122 FOds answered, mostly males over 46 years coming from northern Italy. The results highlight the lack of specific guidelines for the procedures on living people compared to those on the dead but the regulations for the daily clinical practice resulted more than sufficient: in fact, more than 80% of FOds adopted the preventive and safety measures provided for dental practices. The forensic activity significantly decreased during the initial period (more than 75%) and gradually normalized to pre-pandemic numbers in approximately 50% of cases after the implementation of the vaccination campaign. 13 cases of occupational contagion have been reported, most of them (more than 85%) in northern and central Italy. In two cases members of the dental staff sued the employer for responsibility in the contagion. The decrease of the overall ID activity during the pandemic time can be more likely attributed to the of the dental data than the real impact of the pandemic regulations. The use of telematic tools, such as teleconferences, for many procedures proved to be an important resource useful for application even in post-pandemic times.

Teledentistry: A bibliometric analysis of the scientific publication's trend

Introduction

Teledentistry is a specialized area within telemedicine employs digital technology and telecommunications to remotely manage dental patients, offering care, advice, education, and treatment. The significance of teledentistry escalated during the COVID-19 pandemic.

Objective

This study presents a bibliometric analysis of teledentistry, based on a retrospective search of the Scopus database.

Materials and methods

The research utilized Bibliometrix and VOSviewer software.

Results

Publications on teledentistry have shown a recent surge, particularly since 2020, attributed to the pandemic. Out of 369 articles, just 28 (7.5%) were single-authored, while most involved collaborative efforts. These articles were dispersed across 160 journals, with the Journal Of Telemedicine And Telecare, International Journal Of Environmental Research And Public Health, and Telemedicine And E-Health each publishing over 15 articles. Remarkably, 66% of the journals featured open-access content. The University of Western Australia emerged as the most prolific institution, with 12 publications, while the United States, Chile, and Brazil led in the number of published documents.

Conclusions

The growing interest in teledentistry, mainly fueled by the pandemic, has promising implications for dental practice. Despite the existing limitations, it holds potential. This bibliometric analysis provides a comprehensive overview of the field and offers valuable quantitative insights for shaping future research and funding strategies, especially concerning protocol development and digital risk assessment.

The COVID-19 outbreak on dental practice in State of São Paulo, Brazil

Brazil has become the epicenter of coronavirus disease, and the São Paulo State has the worst scenario. This study evaluated the effect of the COVID-19 in dentists of São Paulo State, Brazil. A self-administered web-based survey with 33 multiple-choice questions was sent to dentists. Descriptive statistics were used to assess the 302 valid responses. Data were analyzed by Chi-square, McNemar and Wilcoxon tests (α = 0.05). Most of the participants aged until 34 years (61.6%) and were female (74.5%). They reduced work to less than 20 h per week. Monthly remuneration was reduced (86.8%). Personal protective equipment at the office was changed (p < 0.05). A few dentists (7.6%) had COVID-19, and more than 99% were aware of the disease. Most of the participants (90.2%) were insecure about being contaminated. The dentists of São Paulo State had coronavirus knowledge and have adopted strict biosafety protocols, but the pandemic affected their financial and psychological features.

Changes in dental and medical visits before and during the COVID-19 pandemic among U.S. children aged 1-17 years

OBJECTIVES

The COVID-19 pandemic has tremendously impacted the U.S. healthcare system, but no study has examined the impact of the pandemic on utilization of dental care among U.S. children. Changes in past-year dental versus medical visits and perceived unmet health needs between 2019 and 2020 among U.S. children aged 1-17 years were examined.

METHODS

National and state representative, cross-sectional data from the National Survey of Children's Health conducted during June 2019-January 2020 (i.e. pre-pandemic, n = 28 500) and July 2020-January 2021 (i.e. intra-pandemic, n = 41 380) were analysed. Any past-year visit and perceived unmet needs (i.e. delay or inability to receive needed care) were reported by the parent proxy. Weighted prevalence estimates were compared using two-tailed chi-squared tests at p < .05. Poisson regression analyses were used to explore the relationship between having dental and/or medical unmet needs during the pandemic and indicators of poor health and social wellbeing.

RESULTS

Between 2019 and 2020, a significantly reduced prevalence of past-year medical (87.2%-81.3%) and dental visits (82.6%-78.2%) among U.S. children aged 1-17 years (all p < .05) were observed. Correspondingly, perceived unmet needs increased by half for dental care (from 2.9% in 2019 to 4.4% in 2020) and almost one-third for medical care (from 3.2% to 4.2% in 2020). Subgroups with the highest prevalence of unmet dental need included those with low socio-economic status, living with their grandparents, uninsured and living with a smoker.

CONCLUSIONS

Unmet health needs increased in general but increased more for dental than for medical care among U.S. children aged 1-17 years. Enhanced and sustained efforts will be needed to deliver targeted services towards disadvantaged segments of the population to narrow existing disparities.

Teledentistry during COVID-19 pandemic: scientometric and content analysis approach

Introduction

During Covid-19 pandemic, people have been reluctant to visit dentist due to the fear of infection. Dentists have also suffered from severe turmoil. Teledentistry has been considered as a key strategy for managing people’s oral health. The aim of this study was to investigate teledentistry services in the world during the Covid-19 pandemic and to learn from different experiences.

Materials and methods

The Web of Science database was searched by scientometric analysis approach, using keywords such as Covid-19, telemedicine, teledentistry and synonymous keywords derived from MeSH. Consequently, 94 articles were extracted from which, 15 articles related to teledentistry during Covid-19 were included in the study, considering the inclusion and exclusion criteria.

Results

Scientometric analysis and illustration of retrieved articles were performed to identify authors, organizations and countries, and to review cooperation and collaboration networks in this field. Teledentistry was studied during Covid-19 in countries such as China, United States, Japan, Italy and United Kingdom. Types of the software used for communication between dentists and patients were WeChat, BigWord telephone translator, iGAM, WhatsApp, Attend Anywhere (AA), DeRS. The software used for data storage were Mouthwatch TeleDent, and Proforma. For data processing and decision making decision tree algorithms, automated algorithms were employed.

Conclusion

Teledentistry has the potential to improve the provision of dental services. A fundamental review and careful planning is required to provide such services, particularly in developing countries. Furthermore teledentistry needs more in-depth studies in order to overcome existing and future obstacles and risks while taking advantage of its benefits.

Oral healthcare-seeking behavior during the COVID-19 lockdown period: A cross-sectional study from Eastern Saudi Arabia

Objective

Methods

Results

Conclusion

COVID-19 Effects on Income and Dental Visits: A Cross-sectional Study

OBJECTIVES

In April 2020, the Japanese government declared a state of emergency owing to the outbreak of the novel coronavirus disease (COVID-19) pandemic, which resulted in reduced workforce and job losses. Furthermore, income is one of the most consistent predictors of dental visits. Therefore, this study examined the association between income changes and dental clinic visits during the COVID-19 state of emergency in Japan.

METHODS

An online, self-reported cross-sectional survey about health activities including dental visits during the first COVID-19 state of emergency was conducted in Osaka, Japan (June 23 to July 12, 2020). Among participants with toothaches, the assessment for the association between "refrained from visiting a dentist despite wanting treatment for toothache during the state of emergency (refrained treatment)" and income changes before and after the state of emergency using a multivariate Poisson regression model adjusted for sex, age, self-rated health, frequency of regular dental visits, and employment status.

RESULTS

Among 27,575 participants, 3,895 (14.1%) had toothaches, and 1,906 (6.9%) reported refrained treatment. Among people with decreased income (n = 8,152, 29.6% of overall participants), the proportions of the refrained treatment group were 8.0% (income decreased by 1%-49%), 9.9% (50%-99% decreased), and 9.1% (100% decreased). Among participants with toothache, after adjusting for all variables, compared with participants with no income change, we observed significantly higher prevalence ratios (PRs) for refrained treatment in those who experienced a decreased income owing to COVID-19 (1%-49% decrease: PR = 1.08; 95% confidence interval [CI], 1.005-1.17; 50%-99% decrease: PR = 1.18; 95% CI, 1.06-1.32; 100% decrease: PR = 1.18; 95% CI, 1.04-1.33).

CONCLUSION

Decreased income was associated with refrained dental treatment during the COVID-19 state of emergency in Osaka, Japan. The economic damage related to the COVID-19 pandemic could lead to oral health inequalities.

KNOWLEDGE TRANSFER STATEMENT

Our study found that individuals with decreased income owing to COVID-19 before and after the state of emergency showed significantly higher prevalence ratios for refraining from visiting a dentist despite wanting treatment for toothache. We believe that our study makes a significant contribution because it provides novel, basic data that economic damages related to the COVID-19 pandemic might expand to oral health inequalities.

Dental Care and Education Facing Highly Transmissible SARS-CoV-2 Variants: Prospective Biosafety Setting: Prospective, Single-Arm, Single-Center Study

With the arrival of the highly transmissible Omicron variants (BA.4 and BA.5), dentistry faces another seasonal challenge to preserve the biosafety of dental care and education. With the aim of protecting patients, students, teachers and healthcare professionals, this paper introduces a prospective sustainable biosafety setting for everyday dental care and education. The setting developed by dental clinicians, epidemiologists, and teachers of dentistry consists of a combination of modern technologies focused on the air-borne part of the viral pathway. The introduced biosafety setting has been clinically evaluated after 18 months of application in the real clinical environment. The protocol has three fundamental pillars: (1) UVC air disinfection; (2) air saturation with certified virucidal essences with nebulizing diffusers; (3) complementary solutions including telehealth and 3D printing. A pseudonymous online smart form was used as the evaluation method. The protocol operates on the premise that everybody is a hypothetical asymptomatic carrier. The results of a clinical evaluation of 115 patient feedbacks imply that no virus transmission from patient to patient or from doctor to nurse was observed or reported using this protocol, and vice versa, although nine patients retrospectively admitted that the clinic visit is likely to be infectious. Despite these promising results, a larger clinical sample and exposition to the current mutated strains are needed for reliable conclusions about protocol virucidal efficiency in current dental environments.

Is Teledentistry a Method for Optimizing Dental Practice, Even in the Post-Pandemic Period? An Integrative Review

Background: For the past two and half years, dentists all across the world, along with their patients, have faced numerous challenges. In this context, the aim of this integrative review was to assess if dentists’ and patients’ attitudes regarding teledentistry (TD) have changed since the COVID-19 outbreak, and if the use of TD will continue to rise, even in the post-pandemic period; (2) Methods: A literature search was performed between August 2021 and January 2022. The PubMed, Scopus, and Science Direct databases were searched for articles published between 2012 and 2022 using a combination of the following Mesh terms: “COVID-19”, “pandemic”, “oral telemedicine”, “teledentistry”; (3) Results: Among the 52 included papers, nine papers were published between 2011 and 2019, and 43 articles were published after 2020 (12 were published in 2020, 29 papers were published in 2021, and two in 2022). Among the articles published before 2020, seven out of nine included papers were reviews, and two were original research. Among the 43 papers published after 2020, 18 were reviews and 25 original research. (4) Conclusions: Based on the results of this integrative review, there is clear evidence that the interest in teledentistry and teleassistance in the dental field has increased rapidly, especially in the context of the COVID-19 pandemic. Therefore, while dental practitioners should be encouraged to keep themselves updated about new technologies, patients should also be constantly informed about their options for receiving special oral health care.

Effect of Intraoral Humidity on Dentin Bond Strength of Two Universal Adhesives: An In Vitro Preliminary Study

This study investigated the effect of intraoral humidity on microtensile bond strength (μTBS) to dentin of two universal adhesives applied in self-etch (SE) mode. Forty extracted human molars were selected for this study. Dentin specimens were allocated into four groups, standardized and then bonded with two commercial multimode adhesives, according to two humidity conditions (50% relative humidity (RH) and 90% RH). Following composite resin build-up and 24 h of water storage, the μTBS of the bonded interface was analyzed. The 50% RH was higher for Scotchbond Universal (SBU) than Prime&Bond Universal (PBU), while for 90% RH, SBU had significantly lower values than PBU. With PBU, the mean bond strength was not significantly different between both humidity settings tested (p > 0.05), while for SBU, the mean bond strength was significantly different between both conditions tested (p < 0.05); μTBS was significantly higher for 50% RH than for the other group. Within the limitation of this in vitro study, it can be concluded that: 1) the bonding performance of adhesives systems depends on the humidity settings; 2) increased RH exerts a detrimental effect on the bond strength of 2-hydroxyethyl methacrylate (HEMA)-containing adhesive tested. However, this phenomenon was not observed for HEMA-free adhesive tested; 3) further research in this area is needed to investigate different adhesive systems, temperatures and humidity settings.

Presentations of Routine Dental Interventions in Children over a Six-Year Period

Aim

To evaluate over a six-year period, the prevalence of the dental procedures in primary and mixed dentitions, in males and females.

Materials and Methods

A retrospective descriptive study on dental treatments in primary and mixed dentitions was conducted in the Department of Pediatric Dentistry at the Faculty of Dental Medicine, Lebanese University, from 2015 to 2020. The total number of children was 1291. Data were classified and reviewed according to the dentition type, gender, and type of dental treatment.

Results

The number of children decreased from 741 for the period 2015–2017 to 550 during the period 2018–2020 (279 males and 271 females). No significant association was found between the admission periods and the genders. A significant relationship was found between the number of treatments performed in both genders and the dentition types (p value = 0,015). Males were slightly more likely than females to present for the treatment in mixed dentition (54.58% versus 45.2%, respectively). Results portrayed a significant relationship between surgical treatment and gender (p value = 0.049). However, no significant relationship between gender and other treatment types was noted. The comparison between the 2 time frames and the types of treatments showed a significant association in composite fillings (p value = 0.043), extractions (p value < 0.0001), sealants (p value = 0.039), preventive resin restoration (p=0.011), pulp therapies (p value < 0.0001), pediatric crowns (p value < 0.0001), and surgical interventions (p value = 0.013). A nonsignificant relationship was recorded for the appliances and composite crowns (p value = 0.45 and 0.14, respectively).

Conclusion

The present study points out the implications of the COVID-19 outbreak and Lebanon's economic collapse on children's dental status, with the number of children receiving dental care dropping remarkably. A decrease in all types of dental procedures was noted in mixed dentition, whereas an increase in dental treatments related to aggravated carious lesions was reported in primary dentition. More medical and financial aids are required to encourage and support parents' attitude towards children dental care during unprecedented crises.

How the COVID-19 Pandemic Affects Risk Awareness in Dentists: A Scoping Review

Dentists are on the frontline of infection, especially when it comes to respiratory viruses like the new coronavirus. The purpose of this paper is to conduct a scoping review to better understand dentists’ risk awareness, awareness of COVID-19 symptoms, preventive measures, and effective methods of COVID-19 infection prevention and management. This paper systematically assesses the published literature on dentistry and COVID-19. Various electronic databases including Ovid MEDLINE, Scopus, Embase, and MEDLINE via PubMed were searched up to 9 September 2021. Overall, 39 papers were included. Almost the entirety of dentists (94.5%) reported awareness of the three most common COVID-19 symptoms, and a risk awareness score of about 90% was shown, while 88.2% of dentists reported adopting preventive measures. More than 50% did not want to treat infected people. While 70.3% of dentists recommended usage of N95 masks, the rate of dentists using them was below 40%. Sufficient awareness of risks during the pandemic was found in dentists. Although they were using preventive measures, there remains upside potential for adopting all recommended measures. Further, the usage of N95 masks is improvable, even though the benefit of wearing them could not be confirmed.

COVID-19 Vaccination among Czech Dentists

This work describes and evaluates vaccination against COVID-19 among members of the Czech Dental Chamber during the pre-booster vaccination phase. A cross-sectional online survey was conducted between 23 June and 4 September 2021, among 2716 participants, representing 24.3% of all chamber members. A total of 89.5% of respondents stated that they were registered for vaccination against COVID-19, their vaccination had started or been completed, or had a medically relevant reason to avoid vaccination. A total of 79.6% of respondents stated that they were fully vaccinated, most of them with the Comirnaty (Pfizer−BioNTech) vaccine (88.3%). The vaccination rate among males was significantly higher than among females (p = 0.001, OR 1.48). The main reasons for vaccination were professional (91.5%). The share of fully vaccinated participants was significantly higher (p < 0.0001, OR = 8.17) compared to the Czech general population (30.8%). A COVID-19 vaccine breakthrough infection rate was 0.42%. The study shows that both the willingness to vaccinate and the proportion of fully vaccinated individuals among Czech dentists are high, and only about 10% of them refused vaccination based on reasons classified as not medically relevant.

Development and Validation of Oral Health Knowledge, Attitude and Behavior Questionnaire among Indian Adults

Background and objectives: The Indian population faces numerous challenges to attain better oral hygiene due to a lack of oral health literacy. For the past 10 years, the prevalence of dental-related conditions in India has become a considerable problem in every state of India. A health-education-based oral health promotion strategy will be an ideal choice for the Indian population instead of endorsing conventional oral health promotion. The use of unsuitable tools to measure may lead to misleading and vague findings that might result in a flawed plan for cessation programs and deceitful effectiveness. Therefore, the research aimed to develop and validate an instrument that can assess the oral health knowledge, attitude and behavior (KAB) of adults in India. Materials and Methods: This study was carried among adults in India, who live in Chennai, Tamil Nadu. A questionnaire was fabricated and then validated using content, face, as well as construct. The knowledge domain was validated using item response theory analysis (IRT), whereas exploratory factor analysis (EFA) was used to validate the behavior domain and attitude. Results: Four principal sections, i.e., knowledge, attitude, demography and behavior, were used to fabricate a questionnaire following validation. Following analysis of item response theory on the knowledge domain, all analyzed items in the domain were within the ideal range of difficulty and discrimination. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.65 for the attitude and 0.66 for the behavior domain. A Bartlett's test of sphericity was conducted and demonstrated that outcomes for both domains were highly significant (p < 0.001). The factor analysis resulted in three factors with a total of eight items in the attitude domain and three factors with a total of seven items in the behavior domain depicting satisfactory factor loading (>0.3). Across the three factors, i.e., knowledge, attitude and behavior, internal consistency reliability was tested using Cronbach's alpha, and the values obtained were 0.67, 0.87, 0.67, and 0.88, respectively. Conclusions: The findings of this study that assessed validity and reliability showed that the developed questionnaire had an acceptable psychometric property for measuring oral health KAB among adults in India.

Comorbidities, Associated Diseases, and Risk Assessment in COVID-19-A Systematic Review

It is considered that COVID-19's pandemic expansion is responsible for the particular increase in deaths, especially among the population with comorbidities. The health system is often overwhelmed by the large number of cases of patients addressing it, by the regional limitation of funds, and by the gravity of cases at subjects suffering from this pathology. Several associated conditions including diabetes, cardiovascular illnesses, obesity, persistent lung condition, neurodegenerative diseases, etc., increase the mortality risk and hospitalization of subjects suffering from COVID-19. The rapid identification of patients with increased risk of death from the SARS-CoV-2 virus, the stratification in accordance with the risk and the allocation of human, financial, and logistical resources in proportion must be a priority for health systems worldwide.

Comprehensive Knowledge and Preparedness among Dental Community to Confront COVID-19-A Multicentric Cross-Sectional Study

The healthcare policy changes need to be updated for better management of the COVID-19 outbreak; hence, there is an urgent need to understand the knowledge and preparedness of healthcare workers regarding the infection control COVID-19. Therefore, the present study aims to assess the knowledge and preparedness towards COVID-19 among dentists, undergraduate, and postgraduates in dental universities one year after the COVID-19 outbreak. The multi-centric cross-sectional study was conducted by evaluating 395 structured, pre-coded, and validated questionnaires obtained from sample units comprising full-time dental students (undergraduates, interns, and postgraduates) and dentists who were currently in practice and who were able to comprehend the languages English or Arabic. The first part of the questionnaire included questions related to demographic characteristics. The second part of the survey consisted of questions that address knowledge concerning COVID-19. The third part of the survey addressed questions based on the preparedness to fight against COVID-19 including sharp injuries during this period. Comparing the knowledge scores of dentists, dental undergraduates, and postgraduates using the ANOVA test, dentists have higher knowledge and preparedness scores than postgraduates and undergraduates (p-value < 0.05). Univariate logistic regression analysis demonstrated that undergraduates and postgraduates were 2.567 and 1.352 times less aware of the personal protective measures against COVID-19 than dentists, respectively. Dentists had the comparatively better perception in knowledge and awareness of COVID-19 than undergraduates and postgraduates.

One Year of the COVID-19 Pandemic in Dental Medical Facilities in Germany: A Questionnaire-Based Analysis

(1) Background: The COVID-19 pandemic forced healthcare workers to adapt to challenges in both patient care and self-protection. Dental practitioners were confronted with a potentially high possibility of infection transmission due to aerosol-generating procedures. This study aims to present data on healthcare worker (HCW) screening, infection status of HCWs, pre-interventional testing, the use of personal protective equipment (PPE) and the economic impact of the pandemic in dental facilities. (2) Methods: Dental facilities were surveyed nationwide using an online questionnaire. The acquisition of participants took place in cooperation with the German Society for Dentistry, Oral and Maxillofacial Medicine. (3) Results: A total of 1094 private practices participated. Of these, 39.1% treated fewer than 600 patients per quarter and 59.9% treated over 600 patients per quarter. Pre-interventional testing was rarely performed in either small (6.6%) or large practices (6.0%). Large practices had a significantly higher incidence of at least one SARS-CoV-2-positive HCW than small practices (26.2% vs.14.4%, p < 0.01). The main source of infection in small practices was the private environment, and this was even more significant in large practices (81.8% vs. 89.7%, p < 0.01). The procedure count either remained stable (34.0% of small practices vs. 46.2% of large practices) or decreased by up to 50% (52.6% of small practices vs. 44.4% of large practices). Revenue remained stable (24.8% of small practices vs. 34.2% of large practices) or decreased by up to 50% (64.5% of small practices vs. 55.3% of large practices, p = 0.03). Overall, employee numbers remained stable (75.5% of small practices vs. 76.8% of large practices). A vaccination readiness of 60-100% was shown in 60.5% (n = 405) of large practices and 59.9% (n = 251) of small practices. (4) Conclusion: Pre-interventional testing in dental practices should be increased further. Economic challenges affected small practices as well as large practices. Overall, a steady employee count could be maintained. Vaccination readiness is high in dental practices, although with some room for improvement.

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.

An Assessment of the Level of COVID-19 Anxiety among Pregnant Women in Poland: A Cross-Sectional Study

Introduction: The COVID-19 pandemic has caused general anxiety worldwide. Pregnant women are at a much higher risk of developing the infection due to multiple changes that occur in the body during this period. The consequences of the disease can be dramatic not only for the expectant mothers, but also for their unborn children. SARS-CoV-2 infection is generally known to cause serious concerns about future health and life. The data on the severity of COVID-19 pandemic-related anxiety in pregnant women are insufficient. The aim of the study was to assess the level of COVID-19-related anxiety among pregnant women in Poland. Materials and Methods: The study included 173 pregnant women who volunteered for the research. The research was conducted by means of an online diagnostic survey containing an original questionnaire and the following standardized tools: State-Trait Anxiety Inventory (STAI), Short Health Anxiety Inventory (SHAI), and General Anxiety Disorder-7 (GAD-7). Results: Women hospitalised during pregnancy differed statistically significantly in terms of STAI-X1 scores. Primiparas obtained statistically significantly higher SHAI scores than multiparas. Women with higher education had higher SHAI scores. In the GAD-7 scale, 13.3% of respondents obtained a score suggesting a suspected generalised anxiety disorder. Conclusions: Pregnant women are concerned about both developing COVID-19 and the consequences of infection for themselves and their unborn children. The study demonstrated anxiety of varying severity (depending on the tool used). Hospital stay during pregnancy is an additional stressor in expectant women. Further studies are needed to assess the level of COVID-19-related anxiety to assess this phenomenon in Poland in more detail.

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.

Knowledge and Attitude of Polish Dental Healthcare Professionals during the COVID-19 Pandemic

Objectives: This study analyzed Polish dentists’ knowledge of the SARS-CoV-2 virus and the main problems in their work during the early phase of the pandemic. Methods: Dentists responded to an online anonymous survey consisting of 57 questions relating to socio-demographics, knowledge about COVID-19, and office procedures. The obtained data were analyzed using basic descriptive statistics, significance of dependencies and Chi square and Mann–Whitney tests; p < 0.05. Results: Ultimately, responses from 730 dentists were included. The mean age was 43.62 ± 11.57. Almost 3/4 of the respondents followed the information on COVID-19. A total of 95.5% had knowledge about COVID-19. Genetic testing was the basic test according to 69.2%. Further, 56.0% were concerned about the pandemic, and 23.6% were significantly anxious. In addition, 42.1% considered a risk of infection with the SARS-CoV-2 in the workplace as very high. A total of 84.0% admitted patients performing a triage and using personal protective equipment (PPE). Further, 44.5% planned to become vaccinated. Continuing the work during the pandemic was strongly correlated with age, sector, and location and duration of work. Conclusions: Most Polish dentists follow the information on the COVID-19 protocol and have sufficient knowledge about COVID-19. Dentists are concerned and anxious about the situation. The vast majority admitted patients during the pandemic and use PPE. Only almost half plan to be vaccinated.

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.

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.

Dispersion of Aerosols Generated during Dental Therapy

The novel coronavirus pandemic has resulted in an urgent need to study the risk of infection from aerosols generated during dental care and to conduct a review of infection controls. However, existing studies on aerosol particles related to dental treatment have mainly evaluated only the scattering range. Few studies have been conducted on the specifics of the generation of aerosol particles in clinical settings, their mechanisms and patterns of distribution throughout open or enclosed spaces, the duration that they remain suspended in air, and the amount and size of particles present. To minimize the influence of background particles, laser lights, a high-sensitivity camera, and particle counters were used in a large super clean laboratory to investigate the dynamics of aerosols generated during the operation of dental micromotors. The results indicate that aerosols tend to scatter upward immediately after generation and then gradually disperse into the surroundings. Most of the particles are less than 5 µm in size (only a few are larger), and all particles are widely distributed over the long term. Our research clearly elucidates that aerosols produced in dental care are distributed over a wide area and remain suspended for a considerable time in dental clinics before settling.

Traditional Removable Partial Dentures versus Implant-Supported Removable Partial Dentures: A Retrospective, Observational Oral Health-Related Quality-of-Life Study

Removable partial dentures (RPD) are still a valid alternative for the restoration of missing teeth. Additionally, implant-supported removable partial dentures (ISRPD) represent a valid alternative as it allows to avoid the use of clasps and increase stability. The objective of this study was to evaluate through an OHIP-14 questionnaire the level of satisfaction and quality of life (QoL) of patients treated before RPD and then with ISRPD. Twenty patients were rehabilitated with traditional RPDs, and after one year the prosthesis was modified into ISRPD, by inserting an implant and a ball or locator attachment. At the end of both phases, patients completed the Oral Health Impact Profile (OHIP-14) questionnaire. The collected data were statistically analyzed through the Wilcoxon U test, as overall OHIP score and difference between treatments. The mean of the OHIP summary (range from 0 to 56) in the RPD Group was 20.95 (±5.27). In the ISRPD Group it was 13.95 (±3.91), with a statistically significant difference (p < 0.05) between the two Groups. The same findings were highlighted for the differences between groups in every domain question. Patients showed significant improvements after rehabilitation in all areas of investigation, stating how the transformation of a removable prosthesis into an implant-supported one can improve patients’ QoL with benefits in chewing ability, aesthetics and self-satisfaction.

Clinical Experience, Knowledge, Attitudes and Practice of Turkish Pediatric Dentists during the COVID-19 Pandemic

Background and Objectives: “Coronavirus Disease 2019” (COVID-19) is a critical public health problem that has affected all fields, including dentistry. The dental management of children has become even more difficult during the COVID-19 pandemic. The purpose of this study was to evaluate the current knowledge, attitudes and practices of Turkish pediatric dentists who have been providing dental treatments to children during the COVID-19 pandemic. Materials and Methods: After receiving ethical approval, this cross-sectional study was conducted using the Google Forms online survey instrument. An online questionnaire link was sent to all the members of the Turkish Society of Paediatric Dentistry by e-mail and through social media. Statistical analyses were performed using descriptive statistics and Chi-square test; a p-value less than 0.05 was considered statistically significant. Results: A total of 200 pediatric dentists participated in this study and most of them (82%) only performed emergency dental treatments, whereas 18.5% performed both emergency and routine dental practices during the COVID-19 pandemic. The vast majority (72.5%) of pediatric dentists prescribed antibiotics and analgesics to their patients who were not cooperative with non-pharmacological behavior management techniques. The findings of the current study showed that the Turkish pediatric dentists had a good level of knowledge about COVID-19, satisfactorily conducted most of the infection control measures before and after the dental treatments, and attached importance to the use of PPEs; however, infection control measures during the dental treatments could be implemented better. Conclusions: Along with all precautions, the vaccination of healthcare workers and requesting a recent test result from patients showing a lack of COVID-19 disease before dental appointments could be used as effective infection control measures. Additionally, pediatric dentists should continue to follow local and universal guidelines, and education programmes should be frequently implemented in order to keep their COVID-19 management strategies up to date.

Air Quality in a Dental Clinic during Er:YAG Laser Usage for Cavity Preparation on Human Teeth-An Ex-Vivo Study

Chemical air pollution in dental clinics consists of the emission of gases and particulate matter (PM), both generated by dental equipment and tooth tissues. One basic application of Erbium Laser devices is cavity preparation on human teeth due to its strong affinity to water and hydroxyapatite. The objective of this study was the evaluation of indoor air quality during the application of an Er:YAG laser, as a dentin removal instrument, in a Dental Clinic. Particulate Matter (PM) was measured using the standard method of EN legislation. In order to measure total Volatile Organic compounds (VOCs), a portable monitor was used. In the first experiment, PM10 and PM2.5 concentrations were increased by approximately 10 and 15 times, respectively. From the second experiment it can be concluded that neither of the measured particle concentrations exceeded the recommended indoor limit values while windows were open, although laser influence was still detectable. Within the limitations applied herein, it was found that Er:YAG laser activity for hard dental tissue removal was associated with high PM and TVOCs concentration values in the working environment, under insufficient or no ventilation. Physical ventilation in the aforementioned setting proved to be an important key factor in improving air quality, as both PM and TVOCs concentrations decreased significantly.

Effects of COVID-19 Pandemic on Working Conditions of Dentists in Poland and Turkey

Background and Objectives: Due to the specific working conditions dental professionals represent a group of high risk of infection and COVID-19 pandemic in many ways have influenced their working environment. The aim of this study was to evaluate effects of COVID-19 pandemic on working conditions of dentists in Poland and Turkey. Materials and Methods: The study was an anonymous online questionnaire conducted among thedentists in two countries: Poland and Turkey. The survey consisted of general questions, COVID-19 pandemic infection and working history as well as working conditions before and during pandemic. Chi-square test, Fisher’s Exact test, Fisher Freeman Halton test and Continuity (Yates) Correction were used to compare qualitative data. Results: The study was conducted with a total of 400 participants, 162 (40.5%) men and 238 (59.5%) women, aged between 23 and 67. The mean age of the participants was 42.39 ± 9.99 years. Positive COVID-19 test results among dentists in Poland were found to be significantly higher than in Turkey. Time of dental procedures during the COVID-19 pandemic in Poland and Turkey was significantly increased. The usage of N95/FFP2 or N99/FFP3 masks and surgical gowns during COVID-19 pandemic compared to pre-COVID-19 periods was clearly higher (p < 0.05). Reusable full-face and half-face elastomeric respirators are increasingly used in Turkey. During the COVID-19 pandemic a 25% decrease in dentists’ income in Poland (81%) was significantly high than in Turkey (47.5%). Conclusions: COVID-19 pandemic has influenced working conditions of dentists. Many dentists got infected during the pandemic, dental procedures’ time has increased, and protective equipment usage has become higher. Further studies analyzing the working conditions of dentists during COVID-19 pandemic should be conducted for better planning of future decisions taken by governments and authorities.

Occupational Infections among Dental Health Workers in Germany-14-Year Time Trends

Dental health workers (DHW) are at increased risk of acquiring occupational infections. Due to various protective measures, it can be assumed that infections have decreased over the past 14 years. Secondary data from a German accident insurance company was analyzed in terms of reported and confirmed occupational diseases (OD) in DHW from 2006 to 2019. A total of 271 claims were reported, of which 112 were confirmed as OD, representing an average of eight per year. However, the number of claims and confirmed ODs has decreased by 65.6% and 85.7%, respectively. The decrease was most evident for hepatitis B (HBV) and C (HCV) infections, while tuberculosis (TB) infections were stable. A total of 44 HCV, 33 HBV, 6 TB and 24 latent TB infections were confirmed as ODs. For DHW, 0.05, and for hospital workers, 0.48 claims per 1000 full-time equivalents (FTE) were registered in 2019. In a separate documentation system, between March 2020 and February 2021, 155 COVID-19 claims were registered, and 47 cases were confirmed as ODs. For DHW, 0.7, and for hospital workers, 47.3 COVID-19 claims per 1000 FTE were registered since 2020. Occupational infectious diseases rarely occur among DHW. Nevertheless, new infectious diseases such as COVID-19 pose a major challenge for DHW. Continued attention should be paid to infectious disease prevention.

In Vivo Study of Aerosol, Droplets and Splatter Reduction in Dentistry

Oral health care workers (OHCW) are exposed to pathogenic microorganisms during dental aerosol-generating procedures. Technologies aimed at the reduction of aerosol, droplets and splatter are essential. This in vivo study assessed aerosol, droplet and splatter contamination in a simulated clinical scenario. The coolant of the high-speed air turbine was colored with red concentrate. The red aerosol, droplets and splatter contamination on the wrists of the OHCW and chests of the OHCW/volunteer protective gowns, were assessed and quantified in cm2. The efficacy of various evacuation strategies was assessed: low-volume saliva ejector (LV) alone, high-volume evacuator (HV) plus LV and an extra-oral dental aerosol suction device (DASD) plus LV. The Kruskal-Wallis rank-sum test for multiple independent samples with a post-hoc test was used. No significant difference between the LV alone compared to the HV plus LV was demonstrated (p = 0.372059). The DASD combined with LV resulted in a 62% reduction of contamination of the OHCW. The HV plus LV reduced contamination by 53% compared to LV alone (p = 0.019945). The DASD demonstrated a 50% reduction in the contamination of the OHCWs wrists and a 30% reduction in chest contamination compared to HV plus LV. The DASD in conjunction with LV was more effective in reducing aerosol, droplets and splatter than HV plus LV.

Impact of COVID-19 on Czech Dentistry: A Nationwide Cross-Sectional Preliminary Study among Dentists in the Czech Republic

This work evaluates the impact of the COVID-19 pandemic on Czech dentistry from March 2020 to March 2021. The assessment was based on questionnaires filled out by 3674 Czech dentists representing 42.6% of practicing dentists in the country. During March-May, 2020 (the first COVID-19 wave), 90.7% of dental practices remained open; however, only 22.8% of the practices continued to operate with no changes, 46.5% had fewer patients, 21.4% treated only acute cases, and 3.8% were closed. During September 2020-May 2021 (the second wave of COVID-19), 96.1% of dental practices remained open, 60.8% operated with no changes, 34.5% had fewer patients, 0.8% treated only acute cases, and 0.5% were closed. The reasons leading to the closure of Czech dental practices during the whole pandemic were a shortage of personal protective equipment (50.5%), a COVID-19 outbreak in the workplace (24.5%), fear of a possible self-infection (24.0%), and quarantine (20.5%). The time range of Czech dental practices closure during the whole pandemic was: 1-2 weeks (49.9%), 2-4 weeks (21.2%), and >1 month (0.8%). The greatest professional difficulties of Czech dentists during the pandemic were crisis operating management (55%), health safety and hygiene concerns (21%), shortage of personal protective equipment (21%), and difficulty working with the protective equipment (15%). In addition, 47.3% of dentists also observed a declining interest in preventive dental care, and 16.9% of them observed worse oral care of patients. These results show that despite the lack of protective equipment, dental care was maintained throughout the pandemic. Additionally, the pandemic negatively affected the patients' approach to dental care, indicating a deterioration in oral health as a possible delayed outcome of the COVID-19 pandemic.

Classification of Approximal Caries in Bitewing Radiographs Using Convolutional Neural Networks

Dental caries is an extremely common problem in dentistry that affects a significant part of the population. Approximal caries are especially difficult to identify because their position makes clinical analysis difficult. Radiographic evaluation-more specifically, bitewing images-are mostly used in such cases. However, incorrect interpretations may interfere with the diagnostic process. To aid dentists in caries evaluation, computational methods and tools can be used. In this work, we propose a new method that combines image processing techniques and convolutional neural networks to identify approximal dental caries in bitewing radiographic images and classify them according to lesion severity. For this study, we acquired 112 bitewing radiographs. From these exams, we extracted individual tooth images from each exam, applied a data augmentation process, and used the resulting images to train CNN classification models. The tooth images were previously labeled by experts to denote the defined classes. We evaluated classification models based on the Inception and ResNet architectures using three different learning rates: 0.1, 0.01, and 0.001. The training process included 2000 iterations, and the best results were achieved by the Inception model with a 0.001 learning rate, whose accuracy on the test set was 73.3%. The results can be considered promising and suggest that the proposed method could be used to assist dentists in the evaluation of bitewing images, and the definition of lesion severity and appropriate treatments.

Dentists' Perceptions of Their SARS-CoV-2 Risk and Infection Control Needs

Objective

Rapid worldwide dissemination of SARS-CoV-2 has prompted dental professionals to optimise their infection control procedures. To help identify areas of opportunity for protecting dentists and their patients, the aim of this investigation was to analyse Mexican dentists’ early perceptions of their risk of exposure to SARS-CoV-2 and their need for comprehensive infection control education.

Methods

This cross-sectional survey was conducted from May 9 to June 3, 2020, during the social distancing phase in Mexico. The survey adhered to relevant guidelines for ethical research design. The questionnaire was designed with Google Surveys and applied online in Spanish. The questionnaire included items on demographics and clinical specialisation. To obtain time-sensitive perceptions, statements were preceded by “While SARS-CoV-2 circulates in the community and new COVID-19 cases are reported”; responses were collected in a 5-point Likert-type scale.

Results

The survey's link received 1524 “clicks.” Over 25 days, 996 dentists participated (39% men; 89% working in Mexico and 11% in other Spanish-speaking Latin American countries). Most participants (73%) fully agreed that “Looking after patients will pose a risk for the dentist.” Total agreement was more common (P = .0001) amongst dentists in Mexico (76%) than amongst those in other countries (53%). Knowing someone with COVID-19 was more common amongst Mexican dentists (P = .0008). The perceived need for enhanced infection control procedures increased with age (P = .0001). Forty-nine percent totally agreed that they sterilise dental handpieces between patients. One-third expressed total agreement that everyone in their clinic was trained in infection control.

Conclusions

Amongst this nonprobabilistic self-selected sample of dentists, age and country of work influenced their perceptions about occupational exposure to SARS-CoV-2 and infection control needs. This survey revealed areas of opportunity to improve infection control education and training for dental professionals.

Effects of Natural Ventilation and Saliva Standard Ejectors during the COVID-19 Pandemic: A Quantitative Analysis of Aerosol Produced during Dental Procedures

The novel Coronavirus Disease 2019 (COVID-19) pandemic has renewed attention to aerosol-generating procedures (AGPs). Dental-care workers are at high risk of contamination by SARS-CoV-2. The aim of this study was to evaluate the efficacy of standard saliva ejectors and natural ventilation in reducing particulate matter (PM) concentration during different routine dental procedures in the pandemic period. The DustTrak monitor was used to measure PM1, PM2.5, PM10, and breathable (<4 microns) total dust during 14 procedures performed with and without the presence of natural ventilation in a dental unit. Moreover, measurements were performed near the practitioners or near the standard saliva ejectors during the different procedures. In the latter condition, reduced levels of PM10 were recorded (82.40 ± 9.65 μg/m³ vs. 50.52 ± 0.23 μg/m³). Moreover, higher levels of PM (53.95 ± 2.29 μg/m³ vs. 27.85 ± 0.14 μg/m³) were produced when the dental unit's windows were open. At the same time, the total level of PM were higher during scaling than during other procedures (data suggest not to adopt natural ventilation-both window and door opened-during dental procedures). It was also demonstrated that the use of standard saliva ejectors can considerably reduce the total released amount of PM10.

Reopening Oral Health Services during the COVID-19 Pandemic through a Knowledge Exchange Coalition

BACKGROUND

The COVID-19 novel coronavirus closed oral health care in Nova Scotia (NS) Canada in March 2020. Preparing for a phased reopening, a knowledge exchange coalition (representing government, academia, hospitals, oral health professions, and regulators) developed return-to-work (RTW) guidelines detailing the augmentation of standard practices to ensure safety for patients, oral health care providers (OHPs), and the community. Using online surveys, this study explored the influence of the RTW guidelines and related education on registered NS OHPs during a phased return to work.

METHODS

Dissemination of R2W guidelines included website or email communiques and interdisciplinary education webinars that coincided with 2 RTW phases approved by the government. Aligned with each phase, all registered dentists, dental hygienists, and dental assistants were invited to complete an online survey to gauge the influence of the coalition-sponsored education and RTW guidelines, confidence, preparedness, and personal protective equipment use before and after the pandemic.

RESULTS

Three coalition-sponsored multidisciplinary webinars hosted 3541 attendees prior to RTW. The response to survey 1 was 41% (881/2156) and to survey 2 was 26% (571/2177) of registrants. Survey 1 (82%) and survey 2 (89%) respondents "agreed/strongly agreed" that R2W guidelines were a primary source for guiding return to practice, and most were confident with education received and had the skills needed to effectively treat patients during the COVID-19 pandemic. Confidence and preparedness improved in survey 2. Gowns/lab coat use for aerosol-generating procedures increased from 26% to 93%, and the use of full face shields rose from 6% to 93% during the pandemic.

CONCLUSIONS

A multistakeholder coalition was effective in establishing and communicating comprehensive guidelines and web-based education to ensure unified reintegration of oral health services in NS during a pandemic. This multiorganizational cooperation lay the foundation for responses to subsequent waves of COVID-19 and may serve as an example for collaboratively responding to future public health threats in other settings.

KNOWLEDGE TRANSFER STATEMENT

The return-to-work strategy that was developed, disseminated, and assessed through this COVID-19 knowledge exchange coalition will benefit oral health practitioners, professional regulators, government policy makers, and researchers in future pandemic planning.

Dental Workload Reduction during First SARS-CoV-2/COVID-19 Lockdown in Germany: A Cross-Sectional Survey

An observational cross-sectional survey was planned to analyze the weekly workload reduction of German dentists during lockdown due to the global COVID-19 pandemic. Participants were predominantly members of the Free Association of German Dentists and filled in an online questionnaire. The questionnaire was sent to a total of 9416 dentists, with a response rate of 27.98% (n = 2635). Respondents were divided into seven macro areas by gross domestic product. Nearly two-thirds of dentists (65.16%) reported a reduction in their practice workload of more than 50% compared to the pre-pandemic period with statistically significant differences between German macro areas (p < 0.01). Weekly workload was reduced during the lockdown in 93.00% of study participants, while 55.33% dental care centers with multiple employed dentists under the direction of a non-dentist general manager had only a 40% reduction in weekly workload compared to a solo practice or a practice of a dentist with an employed dentist (30.24% and 28.39%, respectively). Dentists in Germany drastically reduced their practice activity during the first wave of the COVID-19 lockdown, both in rural and urban areas. Short, medium, and long-term effects of the pandemic on dental practices, dental staff as well as patient care need to be further investigated.

Access to Dental Care-A Survey from Dentists, People with Disabilities and Caregivers

The literature highlights differences in the dental conditions of people with disabilities compared with the general population. The aim of this study was to provide an overview of the dental health of people with disabilities in order to understand if their needs are met and to identify their most critical issues as per dentists. A paper and a Google Form platform were used in conducting a survey in Central Italy (the Abruzzo region), by performing an analysis on different points of view as reported by people with disabilities and dentists. The results showed that only 69.2% of dentists treat persons with disabilities. Of these, 73.5% treat less than 10 patients with physical disabilities per year. However, 54% of dentists do not treat people with cognitive impairment and a poor ability to collaborate during treatment. More than 80% of respondent dentists report that people with disabilities do not have good oral hygiene. On the other hand, 49.1% of people with disabilities (or their caregivers in cases where the patient was unable to answer) report that they rarely or never go to the dental office. Moreover, when they do go, it is mainly for emergencies. Despite this, respondents are well aware of their dental problems. However, they have difficulties in communicating their dental problems to their dentist. The 50% of dentists who treat people with cognitive impairment do not include them in follow-up, while only 20% of these patients reported being regularly recalled. This illustrates the importance of the implementation of follow-up. In addition, training courses could help clinicians to reduce this gap and create barrier-free dental offices.

The Impact of SARS-CoV-2 Outbreak on the Polish Dental Community's Standards of Care-A Six-Month Retrospective Survey-Based Study

Currently, SARS-CoV-2 is the primary pathogen worldwide, disrupting most of our everyday activities. The study aim was to evaluate its impact on the Polish dental community, standards of care, health, and welfare. Methods: A Google Forms survey was conducted among 303 dental practitioners. Results: Of respondents, 54.93% curbed the number of patients in the last six months, 34.21% declared no changes, and 10.86% reported an increase; whereas 70.7% of the respondents reported a treatment price increase within the same period (27.96% and 1.32% reported no changes and a decrease, respectively). Of the respondents, 15.5% did not close their businesses during the first wave of the pandemic. Most declared 1 or 2 month break, 30.7% and 34.7%, respectively. Some reported 3, 4, or 5 month breaks (15.84%, 1.32%, and 0.99%, respectively), and only two respondents (0.66%) did not admit patients at all. Headache episodes were more frequent among female dentists before the pandemic; after the pandemic, headache frequency increased among both sexes. Temporomandibular disorders (TMDs) were more frequent among women (p = 0.017). Conclusions: Most Polish dentists followed SARS-CoV-2 recommendations and restricted their practices to admitting only patients with pain or incomplete treatment. Decreased sleep parameters, head, back, and neck pain, were observed. This situation may affect dental health conditions in Polish society over time.

Dentistry 4.0 technologies applications for dentistry during COVID-19 pandemic

The term, Dentistry 4.0, coincides with Industry 4.0, in which the traditional methods of manufacturing and information are made more precise to enhance process efficiency by using automation and advanced computer technologies. The main of this paper is to discuss the major potential of Dentistry 4.0 technologies in the field of dentistry during Coronavirus (COVID-19) Pandemic. Thereon, Dentistry 4.0 is advancing on its way with the use of advanced technologies in dentistry. Dental healthcare makes an essential part of the overall health of the masses. New technological advancements are essential to make the dentist work quicker, patient comfortable, and process reliable. So, we introduced the concept of Dentistry 4.0 to improve efficiency and impart innovation in dentistry during this pandemic. This paper briefs about the Dentistry 4.0 technologies helpful for the COVID-19 pandemic. Further discusses various issues and challenges in implementing Dentistry 4.0 for dentistry during the COVID-19 pandemic. Finally, the paper identifies and discussed fifteen significant applications of Dentistry 4.0 technologies for dentistry during the COVID-19 pandemic. With the onset of the pandemic, globally, the healthcare sector is taking initiatives to strengthen affordable and high-speed data connectivity. This up-gradation and investment will also help dentists to access patients' data from smaller towns or villages using Dentistry 4.0 technologies. Thus, globally there is the onset of the fourth dentistry revolution, and we understand that this will change the trend of dentistry during and post-COVID-19 Pandemic. Dentistry 4.0 technologies are helpful during the COVID-19 pandemic to create teledentistry, virtual clinical practice and connect all dental devices to improve health conditions. This approach is to help progress towards the integrated capabilities, patient-centric remedies with predicted results in an easier way than the traditional way of the health care industry.

Knowledge and Practice of COVID-19 Infection Control Among Dental Students and Interns: A Cross-Sectional Survey

INTRODUCTION

To assess the knowledge and practice of dental students and interns regarding coronavirus disease (COVID-19) based on academic level and university.

MATERIALS AND METHODS

A cross-sectional survey was carried out among interns and dental students using self-administered, structured questionnaire regarding knowledge and clinical practice with respect to COVID-19 pandemic.

RESULTS

A total of 126 completed questionnaires were received. A majority of the study participants (98.4%) stated they were aware of the COVID-19 infection control policies. Most participants (83.3%) had attended training or lectures about COVID-19. Most of them stated that the N59 mask is the best mask against the disease (81.7%). Significant variations between academic years and genders were revealed regarding the clinical practice. Uncertainty existed regarding quarantining, preprocedural mouth wash, and handwashing versus desensitizing.

CONCLUSION

The level of knowledge of the participants was reasonable. Areas of deficiency in knowledge were observed among junior dental students. Further training in infection control measures and formulation of new guidelines are recommended to increase the knowledge and preparation of dental students regarding COVID-19 in dental settings, as well as reduce the transmission of infection.

COVID-19 challenges to dentistry in the new pandemic epicenter: Brazil

A nationwide survey of dentists was carried out in Brazil, a new pandemic epicenter, to analyze how dental care coverage has been affected in public versus private networks, changes in routine and burdens, and how local prevalence of COVID-19 affects dental professionals. Dentists were recruited via email and Instagram®. Responses to a pre-tested questionnaire were collected May 15-24, 2020. COVID-19 case/death counts in the state where respondents work was used to test associations between contextual status and decreases in weekly appointments, fear of contracting COVID-19 at work, and current work status (α = 0.05). Over 10 days, 3,122 responses were received (response rate ~2.1%) from all Brazilian states. Work status was affected for 94%, with less developed regions being more impacted. The pandemic impact on clinical routine was high/very high for 84%, leading to varied changes to clinic infrastructure, personal protective equipment use, and patient screening, as well as increased costs. COVID-19 patients had been seen by 5.3% of respondents; 90% reported fearing contracting COVID-19 at work. Multilevel models showed that greater case and death rates (counted as 1000 cases and 100 deaths per million inhabitants) in one's state increased the odds of being fearful of contracting the disease (18% and 25%). For each additional 1000 cases/100 deaths, the odds of currently not working or treating only emergencies increased by 36% and 58%. The reduction in patients seen weekly was significantly greater in public (38.7±18.6) than in private clinics (22.5±17.8). This study provides early evidence of three major impacts of the pandemic on dentistry: increasing inequalities due to coverage differences between public and private networks; the adoption of new clinical routines, which are associated with an economic burden for dentists; and associations of regional COVID-19 incidence/mortality with fear of contracting the disease at work.

SARS-CoV-2 and Oral Manifestation: An Observational, Human Study

The correlation between SARS-CoV-2 and oral manifestations is still controversial. The aim of this observational study was to determine the oral manifestation of the hospitalized patients for COVID-19. A total of 20 patients met the inclusion criteria and gave their signed informed consent. A questionnaire of 32 questions regarding the oral and systemic health condition was administrated to these patients during the convalescence. A descriptive statistic was performed. Data were analysed through the use of χ² test, to assess the statistical significance. A statistically significant increase of about 30% of reporting xerostomia during hospitalization was observed (p = 0.02). Meanwhile, a decrease of oral hygiene was observed during the hospitalization, even if a non-statistically significant difference was shown between the two study time points (before and after hospitalization). During the hospitalization period, 25% of patients reported impaired taste, 15% burning sensation, and 20% difficulty in swallowing. An interesting result was that among the systemic conditions, hypertension was observed in 39% of patients and mostly in female patients (62.5%). Further studies are necessary to better understand the symptoms of this new virus in order to faster detect its presence in humans. Probably, a multidisciplinary team following the COVID-19 patients could be of key importance in treating this disease.