Risks of Aerosol Contamination in Dental Procedures during the Second Wave of COVID-19-Experience and Proposals of Innovative IPC in Dental Practice

COVID-19: An overview on possible transmission ways, sampling matrices and diagnosis

COVID-19 is an RNA virus belonging to the SARS family of viruses and includes a wide range of symptoms along with effects on other body organs in addition to the respiratory system. The high speed of transmission, severe complications, and high death rate caused scientists to focus on this disease. Today, many different investigation types are performed on COVID-19 from various points of view in the literature. This review summarizes most of them to provide a useful guideline for researchers in this field. After a general introduction, this review is divided into three parts. In the first one, various transmission ways COVID-19 are classified and explained in detail. The second part reviews the used biological samples for the detection of virus and the final section describes the various methods reported for the diagnosis of COVID-19 in various biological matrices.

Detection of Visually Imperceptible Blood Contamination in the Surgical Area Using Luminol Among Different Oral Surgical Procedures: An Observational Study

Introduction Oral surgeons often encounter a significant occupational risk of exposure to potentially harmful infectious diseases during minor oral surgical procedures. These diseases can be transmitted through direct contact with body fluids and aerosolized splatters that may not be visibly detectable. The likelihood of transmission is heightened for clinicians, healthcare workers, and patients alike. The reported prevalence of exposure to blood-borne infections in this field is as high as 90%, with half of these exposures being visually imperceptible. Aim The aim was to detect visually imperceptible blood contamination on personal protective equipment (PPE) and clinical surfaces using the chemiluminescence agent luminol during oral surgical procedures. Materials and methods Thirty minor oral surgical procedures were performed in the Oral and Maxillofacial Surgery Department after obtaining approval from the Institutional Ethics Committee (IEC), Vinayaka Mission's Sankarachariyar Dental College, Vinayaka Mission's Research Foundation, Salem, India. The surgeon, assistant, patient, and clinical surfaces (comprising 15 subsites within the surgical field) wore PPE. The PPE was scrutinized for traces of visually imperceptible blood contamination using luminol. The results of blood splatter on PPE and clinical surfaces in different oral surgical procedures between the non-aerosol and aerosol groups of different durations were analyzed statistically using the chi-square test with p < 0.05 considered significant. Results We observed that visually imperceptible blood contamination in non-aerosol procedures was detected on the assistant PPE kit (46.7%, n = 14), assistant face shield (40%, n = 12), suction apparatus (50%, n = 15), wall (30%, n = 9), and floor (56.7%, n = 17), in both aerosol and non-aerosol procedures. The p-value has been considered statistically significant at p < 0.05 between both the groups (aerosol and non-aerosol). Conclusion Our study results confirmed the presence of undetected blood spillage during aerosol procedures of 30 minutes and non-aerosol surgical procedures of more than 30 minutes over an area of 3.1 feet horizontally and 4.8 feet vertically. So, we strongly emphasize that PPE kits and face shields are mandatory for both surgeon and assistant while performing oral surgical procedures in order to prevent the risk of cross infections, proper infection prevention control protocol for the clinical surfaces also needs to be followed as a standard protocol in all operations.

SARS CoV-2 IgG seropositivity post-vaccination among dental professionals: a prospective study

BACKGROUND

The COVID-19 pandemic has spread very rapidly around the world. Various regional and national lockdowns were imposed to control the spread. Meanwhile, vaccine development and population vaccination were the next steps for pandemic control. Workers in the dental field, both dentists and dental assistants, however, were close to the sources of aerosol generated during dental procedures and thus were the group of workers the most exposed to COVID-19 infection. The aim of our study was to monitor the immune response before and after the vaccine in a high-risk population, composed by dental professionals.

METHODS

A clinical prospective study was carried out among dental professionals at the Academic Dental Polyclinic, Wroclaw Medical University (Wrocław, Lower Silesia region, Poland). Blood samples were collected at an interval of one year - March/April 2020, before the vaccination against COVID-19, and April 2021, after the vaccination. The analysis was performed on serum with four different methods: qualitative, semi-quantitative, and quantitative IgG count for SARS-CoV-2, and SARS-CoV-2 neutralizing antibodies.

RESULTS

A total of 42 healthy adult volunteers participated in the study. The results showed a statistically significant difference (p < 0.05) in antibody levels before and after vaccination (1st and 2nd measurement) for each test method. The tests that were used affected the results and the test that showed the strongest relationship with the result was the Qualitative test.

CONCLUSIONS

Dental professionals are the adult working population most at risk for COVID-19. Monitoring SARS-CoV-2-status-related seropositivity can provide useful information occupational risk factors for dental professionals.

Evaluating the Dental Hygienists' Exposure to the Risk of Musculoskeletal Disorders

OBJECTIVES

 The aim of the study was to evaluate dental hygienists' exposure to the risk of musculoskeletal disorders (MSDs), by the worksheets compatible with the Rapid Entire Body Assessment (REBA).

MATERIALS AND METHODS

 The research included 272 dental hygienists aged 23 to 52 years from the two administrative regions of Poland.

STATISTICAL ANALYSIS

 STATISTICA 12 and Microsoft Excel were used to analyse the results. The level of significance was p<0.05. The normality of the distribution was tested with the Shapiro-Wilk test. The relationships between the variables were assessed with the χ2 test. Due to the lack of "normality" of the REBA risk distribution, the Mann-Whitney test was used to verify the hypotheses.

RESULTS

 Overall, 48.5% of the examined showed a neck flexion >20, torsion of 80.1%, and 37.5% declared the presence of both types of loads. Also, 14.3% of the examined kept a vertical position, 53.7% flexion to the torso up to 20degrees, 31.4% to 60degrees, and 2.1% to >60degrees. Further, 78.3% of people indicated that they twist the torso. Then, 7% marked the low load's arms position, 45.6% marked the range from 20 to 45degrees, and 39.7% marked the range from 45 to 90degrees. Over 55% showed additional load related to the raising or abduction of the shoulders. Overall, 43% showed a wrong position of forearms. Also, 62.9% showed wrists flexed <15° and the rest showed >15degrees. Again, 79% showed additional twisting and flexion of the wrists. Almost 75% of the examined are exposed to overloads associated with the static load. The examined are not exposed to excessive loads resulting from sudden exertion. REBA scores indicate that the negligible MSDs risk concerns 0.7% examined; low risk, 5.5%; medium risk, 33,1%; high risk, 49.3%; and very high risk, 11.4%. The correlation coeffcients analysis showed that exposure risk is strongly correlated with the overloads on the tested parts of the body in both groups.

CONCLUSION

 The levels of MSDs risk indicate that hygienists more often should be subjected to periodic check-ups in the workplace. They also need ergonomic interventions (education, preventive technique, physical activity, and improvement of the working environment) and modifications of hygienist's college programs in the field of work ergonomics can be also considered.

Factors of Compliance of Dental Patients in Primary Health Care Services during the Pandemic

The compliance of dentists with good hygiene practices during the COVID-19 pandemic was essential to minimize the transmission of SARS-CoV-2 strains, and the pandemic has significantly interrupted the provision of oral health care to many individuals. We aimed to examine, in a cross-sectional study, factors affecting dental patients' compliance in primary dental health settings during the pandemic period. The present study was conducted on 300 dental patients visiting four private dental offices in the city of Larissa in Central Greece during the period October-December 2021. The patients in the study sample were of an average age of 45.79 years with a standard deviation of 15.54 years, and 58% of the sample were females. A significant proportion of the participants, 22%, reported that they would be influenced if they knew that the dentist had been ill with COVID-19 despite being fully recovered. A total of 88% of the participants reported that they would feel safe if they knew their dentist was vaccinated against COVID-19. Regarding the information received by dentists, 88% of the participants agreed that the dentist's role is important in dealing with the COVID-19 pandemic, and 89% of them agreed that the information they received from the dentist about the COVID-19 pandemic was sufficient. One-third of the total sample reported that COVID-19 negatively impacted keeping dental appointments, and 43% of the sample kept scheduled appointments. A total of 98% reported that the dentist followed all health protocols against COVID-19 and that their office was equipped to follow health protocols. In the present study, we observe that dentists had adequate knowledge of, attitudes towards, and practices of infection control protocols against COVID-19 during the second wave, according to patients' perceptions.

Microbial Air Contamination in a Dental Setting Environment and Ultrasonic Scaling in Periodontally Healthy Subjects: An Observational Study

The risk of microbial air contamination in a dental setting, especially during aerosol-generating dental procedures (AGDPs), has long been recognized, becoming even more relevant during the COVID-19 pandemic. However, individual pathogens were rarely studied, and microbial loads were measured heterogeneously, often using low-sensitivity methods. Therefore, the present study aimed to assess microbial air contamination in the dental environment, identify the microorganisms involved, and determine their count by active air sampling at the beginning (T0), during (T1), and at the end (T2) of ultrasonic scaling in systemically and periodontally healthy subjects. Air microbial contamination was detected at T0 in all samples, regardless of whether the sample was collected from patients treated first or later; predominantly Gram-positive bacteria, including Staphylococcus and Bacillus spp. and a minority of fungi, were identified. The number of bacterial colonies at T1 was higher, although the species found were similar to that found during the T0 sampling, whereby Gram-positive bacteria, mainly Streptococcus spp., were identified. Air samples collected at T2 showed a decrease in bacterial load compared to the previous sampling. Further research should investigate the levels and patterns of the microbial contamination of air, people, and the environment in dental settings via ultrasonic scaling and other AGDPs and identify the microorganisms involved to perform the procedure- and patient-related risk assessment and provide appropriate recommendations for aerosol infection control.

Comparison of conventionally and digitally completed patient consent-anamnesis forms in terms of surface contamination

BACKGROUND

With the development of modern technology, the use of software-based applications in the field of health has become increasingly widespread. For this reason, computer-assisted personal registration forms have been developed using software programs.

OBJECTIVE

The aim of this study was to compare surface contamination during the filling of orthodontic anamnesis-consent forms, traditionally on paper and digitally on a tablet equipped with a software application, measured in confined spaces using the 3M Clean-Trace Luminometer device.

METHODS

In order for the participants to complete the orthodontic anamnesis-consent forms, two separate identical cabins with standard flat surfaces were prepared. In the first cabin, the participants conventionally completed these forms on paper (conventional group), while in the second cabin, the other group used a tablet equipped with a software program for this purpose (digital group). After the form completion process, surface pollution of the predetermined areas was measured in both cabins using a 3M Clean-Trace Luminometer device.

RESULTS

Surface contamination was found to be statistically significantly higher in all measurement areas in the conventional group than in the digital group. Despite a statistically significant difference between the two groups in relation to the measurements performed using the pens (conventional or electronic), this was not as strong as those found for the remaining surfaces.

CONCLUSION

The completion of orthodontic anamnesis-consent forms over tablets significantly reduced surface contamination in the close environment. This study reflects the importance of digitization - which has become beneficial in many fields - in reducing the spread of infections.

Monkeypox: An Unfamiliar Virus-Clinical and Epidemiological Characteristics, Diagnosis, and Treatment with Special Emphasis on Oral Health

With the recent increased prevalence of human outbreaks, monkeypox has been recognized for decades as an infectious disease with substantial pandemic potential. The majority of cases of this virus have been observed in the European region (11,865), with few cases in the Western Pacific (54). Various governing health agencies are striving to restrain the fatal monkeypox virus (MPXV). Health practitioners around the world are learning about the many clinical manifestations of this infection, and its potential therapies. Despite the plethora of new evidence and rising cases, the essential questions remain unsolved. Thus, in this review, we have modernized the outlook for monkeypox, which will be helpful for various medical practitioners. In the light of continuing outbreaks around the world, we have also presented our assessment of the readiness of India against this outbreak, with a special focus on its effects on oral health.

Virucidal activity in vitro of mouthwashes against a feline coronavirus type II

Transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can occur through saliva and aerosol droplets deriving from the upper aerodigestive tract during coughing, sneezing, talking, and even during oral inspection or dental procedures. The aim of this study was to assess in vitro virucidal activity of commercial and experimental mouthwashes against a feline coronavirus (FCoV) strain. Commercial and experimental (commercial-based products with addition of either sodium dodecyl sulfate (SDS) or thymus vulgaris essential oil (TEO) at different concentrations) mouthwashes were placed in contact with FCoV for different time intervals, that is, 30 s (T30), 60 s (T60), and 180 s (T180); subsequently, the virus was titrated on Crandell Reese Feline Kidney cells. An SDS-based commercial mouthwash reduced the viral load by 5 log10 tissue culture infectious dose (TCID)₅₀ /50 µl at T30 while a cetylpyridinium (CPC)-based commercial mouthwash was able to reduce the viral titer of 4.75 log10 at T60. Furthermore, five experimental mouthwashes supplemented with SDS reduced the viral titer by 4.75-5 log10 according to a dose- (up to 4 mM) and time-dependent fashion.

Assessment of Psychosocial Factors in Brazilian Dentists Facing Risk of SARS-CoV-2 Infection in the Public and Private Sectors

Dentists are at high risk of SARS-CoV-2 infection due to their close proximity to patients. Thus, the fear of contamination or spreading the virus to family members, coupled with financial need, can lead professionals to experience significant overload and psychological suffering. We investigated the perceptions of dental professionals in the public and private sectors regarding fear and anxiety related to patient care and the risk of infection in the face of the COVID-19 pandemic. Based on the previous literature, we interviewed 302 dentists online using sociodemographic and professional questions. Among the professionals evaluated, 80.8% had suspended their activities for some time, 74.8% were afraid of infection at work, 86.1% feared transmitting the virus to their families, 30.1% had already been infected, 54% felt afraid when they heard the news of death caused by SARS-CoV-2, and 63.9% reported having the protective knowledge necessary to avoid infection. Dentists who worked only in the public sector and those who worked in both sectors were more afraid of being infected than professionals who worked only in private offices. Our results highlight the impact of the COVID-19 pandemic on emotional health in dentists. This study highlights the need for more support in the psychosocial field to enable dentists to overcome difficulties and maintain the provision of good dental care for the population. Continuing education should update professions with the requisite scientific and clinical knowledge to face the pandemic and achieve greater reflection on their role within this new context to improve their professional and emotional performance.

Are aerosol control devices effective in preventing the spread of dental aerosol?

Background

In dental clinics, aerosols produced from dental instruments have become a matter of concern following breakout of coronavirus disease 19 (COVID-19) evolving into a pandemic. This study compared aerosol reduction systems and in terms of their ability to reduce Enterococcus faecalis (E. faecalis) contaminated aerosol in a simulated dental office set-up.

Methods

Closed clinic model with manikin and mandibular molar typodont was simulated. For 10 min, the air and water dispersed by the rotating bur mounted on an aerator was contaminated by pouring the suspension containing 1-3 × 10⁸ CFU/mL E. faecalis directly on the bur. During and after the procedures, the air within the cabin was also sampled. CFU count was recorded and scored. The mean CFU scores obtained from agar plate count and air sampling device was compared using Kruskal-Wallis H test among groups with 5% significance threshold.

Results

The use of WS Aerosol Defender device led to greater CFU scores on the agars levelled to patient's chest compared to other directions (p = 0.001). Combined use of VacStation and WS Aerosol Defender resulted in significantly decreased CFU score in the air samples compared to experimental and positive control groups (p = 0 < 0.05).

Conclusions

Although the devices prevented the spread of aerosol around the patient to some extent, they could not completely eliminate the contaminated aerosol load in the cabin environment.

In vitro virucidal activity of mouthwashes on SARS‐CoV‐2

Objectives

Materials and Methods

Results

Conclusions

SARS-CoV-2 IgG Among Dental Workers During the COVID-19 Pandemic

Objectives

Since the SARS-CoV-2 outbreak in 2019, special safety protocols have been introduced in dentistry. Dental professionals were determined to be mostly at risk for contracting the virus due to aerosol-generating procedures used. This preliminary study starts the cycle of the laboratory protocols describing the quality and efficacy of laboratory tests in the SARS-CoV-2 immunoglobulin G (IgG) detection in the serum of asymptomatic dental personnel during the last quarter of 2020.

Methods

IgG levels were measured with the use of a semi-quantitative enzyme-linked immunosorbent assay (ELISA) in vitro diagnostic kit in the serum of a study group that consisted of 127 employees of the dental clinic divided into 3 subgroups: SUB1: dentists (n = 67); SUB2: dental assistants, dental hygienists, nurses, laboratory workers (n = 40); SUB3: administrative workers (n = 20). Pearson analysis of results from the questionnaires attached to the study protocol were provided to assure that the results compare to the participants’ impressions about their general health.

Results

Positive ELISA IgG results were found in 6% (n = 4) of the SUB1 group, 7.50% (n =3) of the SUB2 group, and 5% of the SUB3 group. The percentage of participants without work interruption from the beginning of the pandemic was 54% of dentists and 60% of chairside assistants.

Conclusions

Serum IgG prevalence with the use of a semi-quantitative test was low, and further research on the biobanked samples should follow to determine the levels of IgG with quantitative methods and/or to evaluate the presence of neutralising antibodies in dental personnel. Because of the low representation of seropositivity studies in this group, it will be crucial to confirm the risk of COVID-19 transmission in dental offices.

Dentists' Practices and Attitudes Toward Using Personal Protection Equipment and Associated Drawbacks and Cost Implications During the COVID-19 Pandemic

Objectives: During the COVID-19 pandemic, dentists have had to work under stressful conditions due to the nature of their work. Personal protection equipment (PPE) has become mandatory for work in the dentistry field. This study aimed to examine dentists' practices and attitudes regarding the use of PPE and the associated drawbacks and cost implications during the pandemic.

Methods: A questionnaire-based survey was used and was divided into five sections dedicated to collect demographic variables and to examine the dentists' practices, attitudes toward PPE, drawbacks, and cost of using PPE. Mann-Whitney U and Kruskal-Wallis tests were used to compare different sections of the questionnaire and linear regression was used to determine the predictors of the dentists' practices and attitudes toward PPE.

Results: The mean of practices regarding use of PPE was 5.41 ± 1.71 (median 6), attitude toward using PPE scored 2.26 ± 0.90 (median 2), while the means of drawbacks and cost recorded equal scores of 5.22 ± 1.24 (median 5) and 1.68 ± 0.74 (median 2), respectively. The recently graduated dentists, those with postgraduate degrees and those working in the private sector demonstrated higher levels of practices on PPE than their counterparts. Regression analysis revealed that practices of PPE can be predicted on the basis of qualifications and work place, whereas attitude toward PPE is significantly influenced by qualification only.

Conclusions: The study participants demonstrated satisfactory levels of practices and positive attitudes toward PPE. While complaints from using PPE and their cost were moderately affected.

An experimental approach to analyze aerosol and splatter formations due to a dental procedure

Throughout 2020 and beyond, the entire world has observed a continuous increase in the infectious spread of the novel coronavirus (SARS-CoV-2) otherwise known as COVID-19. The high transmission of this airborne virus has raised countless concerns regarding safety measures employed in the working conditions for medical professionals. Specifically, those who perform treatment procedures on patients which intrinsically create mists of fine airborne droplets, i.e., perfect vectors for this and other viruses to spread. The present study focuses on understanding the splatter produced due to a common dentistry technique to remove plaque buildup on teeth. This technique uses a high-speed dentistry instrument, e.g., a Cavitron ultrasonic scaler, to scrape along the surface of a patient's teeth. This detailed understanding of the velocity and the trajectory of the droplets generated by the splatter will aid in the development of hygiene mechanisms to guarantee the safety of those performing these procedures and people in clinics or hospitals. Optical flow tracking velocimetry (OFTV) method was employed to obtain droplet velocity and trajectory in a two-dimensional plane. Multiple data collection planes were taken in different orientations around a model of adult mandibular teeth. This technique provided pseudo-three-dimensional velocity information for the droplets within the splatter developed from this high-speed dental instrument. These results indicated that within the three-dimensional splatter produced there were high velocities (1-2 m/s) observed directly below the intersection point between the front teeth and the scaler. The splatter formed a cone-shape structure that propagated 10-15 mm away from the location of the scaler tip. From the droplet trajectories, it was observed that high velocity isolated droplets propagate away from the bulk of the splatter. It is these droplets which are concerning for health safety to those performing the medical procedures. Using a shadowgraphy technique, we further characterize the individual droplets' size and their individual velocity. We then compare these results to previously published distributions. The obtained data can be used as a first step to further examine flow and transport of droplets in clinics/dental offices.

Dental Education during the COVID-19 Pandemic in a German Dental Hospital

Due to the SARS-CoV-2 pandemic, dental treatment performed by undergraduate students at the University of Marburg/Germany was immediately stopped in spring 2020 and stepwise reinstalled under a new hygiene concept until full recovery in winter 2020/21. Patient treatment in the student courses was evaluated based on three aspects: (1) Testing of patients with a SARS-CoV-2 Rapid Antigen (SCRA) Test applied by student assistants (SA); (2) Improved hygiene regimen, with separated treatment units, cross-ventilation, pre-operative mouth rinse and rubber dam application wherever possible; (3) Recruitment of patients: 735 patients were pre-registered for the two courses; 384 patients were treated and a total of 699 tests with the SCRA test were performed by SAs. While half of the patients treated in the course were healthy, over 40% of the patients that were pre-registered but not treated in the course revealed a disease being relevant to COVID (p < 0.001). 46 patients had concerns to visit the dental hospital due to the increase of COVID incidence levels, 14 persons refused to be tested. The presented concept was suitable to enable patient treatment in the student course during the SARS-CoV-2 pandemic.

Dental Education in the Time of COVID-19 Pandemic: Challenges and Recommendations

Moving within the second wave of the coronavirus (COVID-19) pandemic, dental education delivery has been profoundly affected by this crisis, so has the structure, evaluation, and future of dental education. Both pre-clinical and clinical dental education have experienced challenges ranging from fully online educational content to limited dental training for senior dental students. This crisis appears to be a tipping point that produced confusion in dental teaching especially clinical sciences. Although medical institutions immediately started to adapt to the unexpected COVID-19 crisis, dental and oral health educational services are profoundly impaired due to the dental team's propinquity to the patient and the aerosols generated during routine dental therapeutic procedures. Dental students unlike other medical students are considered to be at the highest risk due to the nature of their clinical training that includes working in the oral cavity of patients using aerosol-generating equipment. Some dental schools have taken the leadership and documented their modifications during this pandemic; however, there is a serious need for further investigation and wide range screening of the situation in the dental schools during the COVID-19 crisis. The aim of this mini-review is to present these challenges and how academic dental institutions have implemented strategies to overcome them.

Dissemination of Aerosol and Splatter in Clinical Environment during Cavity Preparation: An In Vitro Study

Dental health care workers around the world are in a constant state of fear and anxiety because they work in a constrained space of the dental practice. During routine dental procedures, they are exposed to aerosol and splatter. These airborne particles pose a great risk of transmitting contagious infections to health care workers and patients, especially in an era of social distancing due to COVID-19. The current study was conducted to evaluate contamination amount, duration, the distance of aerosol, and splatter produced after cavity preparation using a two-hole and four-hole handpiece. The study was performed on a dental manikin in a dental simulation laboratory at the College of Dentistry, King Faisal University Al Ahsa. The dental manikin was set to a reclined position to simulate the clinical operatory position of the patient for dental restorative procedures. Aerosol and splatter were collected on Grade 1 qualitative cotton cellulose filter paper. These were placed on adhesive tape extending from the headrest of the dental manikin in six different directions (2, 4, 6, 8, 10, and 12 o’clock) for up to 60 inches and on certain positions of the operator and assistant such as the chest, head, forearms, upper leg, and inside facemask. Class V cavity preparation was done by the principal investigator at a specific time of 3 min on tooth #11 using a two-hole high-speed handpiece, then on the next day, Class V cavity preparation was performed on tooth #21 by a four-hole handpiece. High volume suction was used throughout the cavity preparation. Immediately after cavity preparation, the first filter paper disc was replaced with new ones in all positions. The second set of filter papers was removed after 30 min. Transparent grids were used to count the contamination area on the filter paper disc. No statistically significant difference was found in the mean amount of aerosol and splatter produced by both handpieces, however, a statistically significant difference was found in an amount of aerosol and splatter produced at a 12, 24, and 36 inches distance immediately after cavity preparation and 30 min after cavity preparation, regardless of the type of handpiece used. It is advisable to refrain from removing the personal protective barriers immediately after the procedure within the vicinity of the dental practice. The use of other adjuncts such as high volume suction to reduce the spread of aerosol and splatter is also recommended.

Musculoskeletal Disorders among Italian Dentists and Dental Hygienists

Dental professionals often perform physically and mentally demanding therapeutical procedures. They work maintaining muscular imbalance and asymmetrical positions for a long time. The aim of the study was to describe the prevalence and the factors associated to work-related musculoskeletal disorders (WMSD) among Italian dental professionals and the most affected body regions. A cross-sectional observational study was conducted between March 2019 and February 2020. The Nordic Musculoskeletal questionnaire (NMQ) was implemented with questions related to working habits (dental occupation, working hours per week and per days, years of work) and lifestyle (practiced physical activity, including frequency and duration, mobilization activities, and knowledge of ergonomic guidelines) was used. The-chi square test was carried out to detect any statistically significant difference (p < 0.05). Logistic regression was carried out to detect the most significant factors associated to WMSD occurrence. A total of 284 questionnaires have been used for the analysis. A high proportion of dental professionals (84.6%) were affected by WMSD in the last 12 months. A higher prevalence was found in females (87%) when compared to males (80%). The prevalence of WMSD was correlated to the working hours/day and hour/week, with a higher risk for operators working >5 h/day and >30 h/week. In addition, a high prevalence was found in operators working for 2–5 years after graduation. Most of the surveyed dental professionals practiced physical activity (70.1%) but only a few had satisfactorily knowledge of ergonomic guidelines (12.7%). Interestingly, participants who practiced yoga or stretching as physical activities demonstrated lower WMSD (77%) when compared to other physical activities (84%). We can highlight that generic physical activities have no functional effect on WMSD for dental professionals. The most affected body areas were neck (59.9%), shoulders (43.3%), lumbar region (52.1%), dorsal region (37.7%) and wrists (30.6%). Considering the magnitude of the problem, there is an urgent need to implement the education in ergonomics among dental professionals, that may be achieved by teaching biomechanics, posturology and integrative functional therapies (such as yoga) during the university education and by promoting holistic health of dental operators.

Indoor Air Pollution with Fine Particles and Implications for Workers’ Health in Dental Offices: A Brief Review

(1) Background: Indoor air pollution can affect the well-being and health of humans. Sources of indoor pollution with particulate matter (PM) are outdoor particles and indoor causes, such as construction materials, the use of cleaning products, air fresheners, heating, cooking, and smoking activities. In 2017, according to the Global Burden of Disease study, 1.6 million people died prematurely because of indoor air pollution. The health effects of outdoor exposure to PM have been the subject of both research and regulatory action, and indoor exposure to fine particles is gaining more and more attention as a potential source of adverse health effects. Moreover, in critical situations such as the current pandemic crisis, to protect the health of the population, patients, and staff in all areas of society (particularly in indoor environments, where there are vulnerable groups, such as people who have pre-existing lung conditions, patients, elderly people, and healthcare professionals such as dental practitioners), there is an urgent need to improve long- and short-term health. Exposure to aerosols and splatter contaminated with bacteria, viruses, and blood produced during dental procedures performed on patients rarely leads to the transmission of infectious agents between patients and dental health care staff if infection prevention procedures are strictly followed. On the other hand, in the current circumstances of the pandemic crisis, dental practitioners could have an occupational risk of acquiring coronavirus disease as they may treat asymptomatic and minimally symptomatic patients. Consequently, an increased risk of SARS-CoV-2 infection could occur in dental offices, both for staff that provide dental healthcare and for other patients, considering that many dental procedures produce droplets and dental aerosols, which carry an infectious virus such as SARS-CoV-2. (2) Types of studies reviewed and applied methodology: The current work provides a critical review and evaluation, as well as perspectives concerning previous studies on health risks of indoor exposure to PM in dental offices. The authors reviewed representative dental medicine literature focused on sources of indoor PM10 and PM2.5 (particles for which the aerodynamic diameter size is respectively less than 10 and 2.5 μm) in indoor spaces (paying specific attention to dental offices) and their characteristics and toxicological effects in indoor microenvironments. The authors also reviewed representative studies on relations between the indoor air quality and harmful effects, as well as studies on possible indoor viral infections acquired through airborne and droplet transmission. The method employed for the research illustrated in the current paper involved a desk study of documents and records relating to occupational health problems among dental health care providers. In this way, it obtained background information on both the main potential hazards in dentistry and infection risks from aerosol transmission within dental offices. Reviewing this kind of information, especially that relating to bioaerosols, is critical for minimizing the risk to dental staff and patients, particularly when new recommendations for COVID-19 risk reduction for the dental health professional community and patients attending dental clinics are strongly needed. (3) Results: The investigated studies and reports obtained from the medical literature showed that, even if there are a wide number of studies on indoor human exposure to fine particles and health effects, more deep research and specific studies on indoor air pollution with fine particles and implications for workers’ health in dental offices are needed. As dental practices are at a higher risk for hazardous indoor air because of exposure to chemicals and microbes, the occupational exposures and diseases must be addressed, with special attention being paid to the dental staff. The literature also documents that exposure to fine particles in dental offices can be minimized by putting prevention into practice (personal protection barriers such as masks, gloves, and safety eyeglasses) and also keeping indoor air clean (e.g., high-volume evacuation, the use of an air-room-cleaning system with high-efficiency particulate filters, and regularly maintaining the air-conditioning and ventilation systems). These kinds of considerations are extremely important as the impact of indoor pollution on human health is no longer an individual issue, with its connections representing a future part of sustainability which is currently being redefined. These kinds of considerations are extremely important, and the authors believe that a better situation in dentistry needs to be developed, with researchers in materials and dental health trying to understand and explain the impact of indoor pollution on human health.

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.