[Droplets and aerosols in dental clinics and prevention and control measures of infection]

Optimizing Safe Dental Practice During the COVID-19 Pandemic: Recommendations Based on a Guide Developed for Dental Practices in China

The current global coronavirus disease 2019 (COVID-19) outbreak is still exerting severe global implications, and its development in various regions is complex and variable. The high risk of cross-infection poses a great challenge to the dental practice environment; it is therefore urgent to develop a set of pandemic prevention measures to ensure dental practice safety during the COVID-19 outbreak. Therefore, we combined the epidemiological characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), public emergency measures for COVID-19, characteristics of dental practice, and relevant literature reports to develop a set of dynamic practice measures for dental practices in high-, medium-, and low-risk areas affected by COVID-19. This will help dental practices to achieve standard prevention and ensure their safe and smooth operation during the pandemic. It is hoped that these measures will provide a reference basis for dental hospitals and dental clinics in their care and pandemic prevention work.

Emergency Management in a Dental Clinic During the Coronavirus Disease 2019 (COVID-19) Epidemic in Beijing

Background

In mid-March 2020, the World Health Organization declared that COVID-19 was to be characterised as a pandemic. The purpose of this article is to recommend emergency management procedures for dental clinics during this public health emergency.

Materials and Methods

We have implemented a series of emergency management measures to prevent cross-infection in our dental clinic during the COVID-19 pandemic, including personnel scheduling, division of the clinic into functional areas, limitation or delay of non-emergency patients, staff protection and infection controls, clinical environmental disinfection, and the use of online consultation services, among others.

Results

Due to public health policy and dental emergency management, the number of dental visitors to our clinic dropped sharply, and no COVID-19 suspected cases or high-risk patients received treatment. There have been no reports of infection of dental staff or patients during dental treatment in China to date.

Conclusion

These public health policies and dental emergency management measures were effective in controlling cross-infection of COVID-19 in the dental clinic.

Practical Implications

We share control measures for COVID-19, and hope that they will be helpful for dental professionals worldwide to continue to provide dental care in a safe and orderly manner.

Topical Oral and Intranasal Antiviral Agents for Coronavirus Disease 2019 (COVID-19)

With the largest viral loads in both symptomatic and asymptomatic patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) present in the oral and nasal cavities, agents that act on these two areas have the potential for large therapeutic and prophylactic benefit. A literature review was conducted to elucidate the possible agents useful in treatment of SARS-CoV-2. These agents were evaluated for their current applications, adverse reactions, their current state of study, and any future considerations in their management of coronavirus disease 2019 (COVID-2019). Our review has found that, while there are many promising agents with proven efficacy in their in-vitro efficacy against SARS-CoV-2, more clinical trials and in-vivo studies, as well as safety trials, must be conducted before these agents can be effectively implemented.

A clinical study measuring dental aerosols with and without a high-volume extraction device

Introduction External high-volume extraction (HVE) devices may offer a way to reduce any aerosol particulate generated.Aims The aim of this study was to measure the particle count during dental aerosol generating procedures and compare the results with when a HVE device is used.Design A comparative clinical study measuring the amount of PM1, PM2.5 and PM10 aerosol particulate with and without the use of an external HVE device was undertaken.Materials and methods In total, ten restorative procedures were monitored with an industrial Trotec PC220 particle counter. The intervention was an external HVE device.Main outcome methods The air sampler was placed at the average working distance of the clinicians involved in the study - 420 mm.Results In the present study, aerosol particulate was recorded at statistically significantly increased levels during dental procedures without an external HVE deviceversus with the device.Discussion The null hypothesis was rejected, in that significant differences were found between the results of the amount of aerosol particle count with and without a HVE device.Conclusion If the results of the present study are repeated in an in vivo setting, an external high-volume suction device may potentially show a lower risk of transmission of viral particulate.

Is the oral cavity relevant in SARS-CoV-2 pandemic?

Objectives

Recent scientific evidences suggest a relevant role of the oral cavity in the transmission and pathogenicity of SARS-CoV-2.

Methods

A literature search was performed in PubMed, up to April 30, 2020, focusing on SARS-CoV-2, COVID-19, oral cavity, and antimicrobial agents.

Results

Oral viral load of SARS-CoV-2 has been associated with the severity of COVID-19, and thus, a reduction in the oral viral load could be associated with a decrease in the severity of the condition. Similarly, a decrease in the oral viral load would diminish the amount of virus expelled and reduce the risk of transmission, since (i) during the first 10 days, the virus mainly accumulates at the nasal, oral, and pharyngeal area; (ii) the number of angiotensin-converting enzyme (ACE2) receptor is greater in the salivary glands as compared with the lungs; and (iii) salivary droplets represent the most relevant transmission route. To reduce the oral viral load, antiseptic agents may be used, although the evidence on its efficacy is indirect and weak.

Conclusions

Antiseptic mouth rinses, such as those containing cetylpyridinium chloride or povidone-iodine, may be able to decrease the severity of COVID-19 by reducing oral viral load in infected subjects and decreasing the risk of transmission by limiting viral load in droplets, generated in normal life, or in aerosols, produced during dental procedures. Well-designed clinical and preclinical research must be conducted to support these hypotheses.

Clinical relevance

Antiseptic mouth rinses may help in decreasing the severity of COVID-19 and in reducing the risk of transmission.