Staff Knowledge and Attitudes Towards COVID-19 New Biosafety Practices at a Brazilian Dental School

ABSTRACT Objective To evaluate knowledge and attitudes towards biosafety recommendations during the COVID-19 pandemic at a Brazilian dental school. Material and Methods A cross-sectional study was performed in 2020 with the clinical staff of a Brazilian dental school. The whole clinical staff was sent pre-tested self-administered online questionnaires about knowledge and attitudes towards the recommendations for biosafety in dental settings in the context of the COVID-19 pandemic. Descriptive statistical analyses were carried out for proportion calculation. Results Disposable head covering caps, isolation gowns, and gloves were the most frequently reported personal protective equipment (PPE). The rates ranged from 52.9% to 88.5% for N95 respirators, from 68.6% to 92.6% for face shields, from 47.4% to 67.5% for conventional eye protection shields, and 45.1% to 77.4% for eye protection with solid side shields. Chlorhexidine gluconate was the most frequent mouthwash indicated before clinical dental care. The percentage of agreement to provide clinical care to patients with suspected COVID-19 varied from 23.5% to 50.0%. The percentage of respondents who agreed that bioaerosol-generating procedures should be avoided was higher than 74.5%. Less than 50% knew the correct sequence for doffing of PPE. Conclusion This study revealed important gaps in knowledge and attitudes towards prevention and control measures against infection in dental environments in the context of COVID-19, indicating the need for improvements.

Combined application of montmorillonite powder and Kangfuxin liquid for the treatment of stomatitis complicated by oral ulcer in 62 patients / 中国基层医药

Objective:To investigate the clinical application value of montmorillonite powder combined with Kangfuxin liquid in the treatment of stomatitis complicated by oral ulcer. Methods:A total of 124 patients with stomatitis complicated by oral ulcer who received treatment in Zhoushan Women and Children Hospital, China between January 2019 and October 2020 were included in this study. They were randomly assigned to receive treatment either with montmorillonite powder alone (control group, n = 62) or montmorillonite powder and Kangfuxin liquid (observation group, n = 62). Visual Analogue Scale score before and after treatment, duration of ulcer pain and wound recovery time, curative effect and adverse reactions were compared between the two groups. Results:After treatment, Visual Analogue Scale score in each group was significantly decreased compared with before treatment ( t = 5.862, 8.223, both P < 0.05). After treatment, Visual Analogue Scale score in the observation group was significantly lower than that in the control group [(0.72 ± 0.23) points vs. (1.22 ± 0.47) points, t = 2.667, P < 0.05]. The time to ulcer pain relief and the time to wound recovery in the observation group were significantly shorter than those in the control group ( t = 3.467, 2.667, both P < 0.05). Effective rate in the observation group was significantly higher than that in the control group [96.77% (60/62) vs. 85.48% (53/62), χ2 = 4.888, P < 0.05]. There were no adverse reactions in each group. Conclusion:Combined application of montmorillonite powder and Kangfuxin liquid for the treatment of stomatitis complicated by oral ulcer can effectively mitigate wound pain, accelerate wound healing, and improve the quality of life. This study is of significant innovation and science. Therefore, the treatment method used in this study is worthy of clinical promotion.

Repercussões da epidemia de COVID-19 nos atendimentos odontológicos de urgência do Sistema Único de Saúde em Piracicaba, 2020 / Repercusiones de la epidemia de COVID-19 en la atención odontológica de emergencia del Sistema Único de Salud en Piracicaba, Brasil, 2020 / Repercussions of the COVID-19 epidemic on Brazilian National Health System urgent dental care in Piracicaba, Brazil, 2020

Objetivo: Avaliar as repercussões da pandemia de COVID-19 nos procedimentos realizados por um serviço público odontológico de urgência (SPOU). Métodos: Estudo transversal, utilizando-se dados do SPOU de Piracicaba, SP, Brasil, relativos a dois períodos, anterior (fevereiro e março de 2020) e durante a pandemia (março e abril de 2020). Diferenças no perfil de atendimentos, entre os períodos pré-COVID-19 e COVID-19 selecionados, de acordo com sexo, idade e procedimentos odontológicos, foram analisadas pelo teste qui-quadrado de Pearson. Também foi calculado o tamanho do efeito Cramer's V. Resultados: Houve redução de 51% no número de atendimentos, entre o período anterior (n=824) e o período da pandemia de COVID-19 observado (n=404). O percentual de exodontias reduziu-se, de 14,7 para 8,9%, enquanto o de selamento provisório de cavidades aumentou de 22,9 para 33,2%, entre ambos períodos. Conclusão: A pandemia de COVID-19 repercutiu na quantidade e no padrão de procedimentos realizados pelo serviço odontológico de urgência do município.

Objetivo: Evaluar el impacto de la pandemia COVID-19 en los procedimientos realizados por un servicio de odontología pública de emergencia (SOPE). Métodos: Estudio transversal, utilizando datos del SOPE de Piracicaba, SP, Brasil, para los períodos anteriores (febrero y marzo 2020) y durante la pandemia (marzo y abril 2020). Las diferencias en el perfil de atención entre los períodos Pre-COVID-19 y COVID-19, según sexo, edad y procedimientos dentales, se analizaron mediante la prueba Chi-cuadrado de Pearson. También se calculó el tamaño del efecto de Cramer V. Resultados: Hubo una reducción del 51% en el número de visitas entre el período anterior (n=824) y el período de la pandemia de COVID-19 (n=404). El porcentaje de extracciones se redujo del 14,7% al 8,9%, mientras que el porcentaje de sellado provisional de cavidades aumentó del 22,9% al 33,2%, entre estos períodos. Conclusión: La pandemia de COVID-19 afectó la cantidad y patrón de procedimientos realizados en el servicio de odontología de emergencia de la ciudad.

Objective: To evaluate the repercussions of the COVID-19 pandemic on procedures performed by a public urgent dental care service (PUDS). Methods: This was a cross-sectional study, using data from the PUDS in Piracicaba, SP, Brazil, prior to the pandemic (February-March 2020) and during the pandemic (March-April 2020). Differences in the care profile between the pre-COVID-19 period and the COVID-19 period, according to sex, age and dental procedures were analyzed using Pearson's Chi-square test. Effect size was also measured using Cramer's V. Results: There was a 51% reduction in the number of visits between the pre-COVID-19 period (n=824) and the COVID-19 period (n=404). The percentage of extractions reduced from 14.7% to 8.9%, while the percentage of temporary cavity fillings increased from 22.9% to 33.2%, between the two periods. Conclusion: The COVID-19 pandemic had repercussions on the amount and pattern of procedures performed at the city's urgent dental care service.

Prosthodontic practice during the COVID-19 pandemic: prevention and implications

Abstract: The objective of this review is to identify preventive measures for COVID-19 to safeguard dental professionals providing prosthodontic dental care. Electronic searches were performed in PubMed, Scopus, and Cochrane databases using the following descriptors and/or words: "COVID-19," "SARS-CoV-2," "Dental practice," "Prosthodontics," and "Dental infection control." Prosthodontists are at high risk for exposure to the novel coronavirus through aerosols and possibly contaminated surfaces and indirect contact with dental laboratories and dental technicians through impressions, dental stone casts, and fixed and removable prosthetic appliances. Therefore, preventive measures should be implemented, including performing emergency treatments only, rescheduling patients with suspected disease, disinfecting surfaces and prosthodontic materials with biocidal substances, and using protective equipment such as N95 masks, disposable gowns, and face-shields.

Biosafety in Dental Practices Versus COVID-19 Outbreak

ABSTRACT Objective: To evaluate the dentists' knowledge about biosafety considering the SARS-CoV-2 and the risks of increasing the COVID-19 outbreak by dental practices during the pandemic in Brazil. Material and Methods: A cross-sectional study was performed by internet-based snowball sampling technique. A questionnaire with questions about different content was applied, and then analyzed the following two parameters: participants' Brazilian region and professional's specialty. Results: A total of 413 e-questionnaires from all Brazilian regions were considered valid. There were no significant differences among biosafety measures adopted by participants from different Brazilian regions (p≥0.05), except for those from North region, which have applied less previous oral antisepsis, temperature screening, and specific anamnesis tracking COVID-19 symptoms (p<0.05). The unique use of N95 mask was positively associated with North region (p<0.05). Expert participants of Groups 2 (oral surgery and correlate areas) and 4 (orthodontics, oral radiology and facial jaw orthopedics) were more updated than other ones (p<0.05). Conclusion: The biosafety protocols applied by participants were not adequate for the epidemiologic status of COVID-19 in each region of Brazil, from 13th May to 17th June 2020. Specialties linked to microbiology area or structured social networks have better applied preventive measures for COVID-19.

Profile of victims of accidents with biological material in a course of Dentistry / Perfil das vítimas de acidentes com material biológico em um curso de Odontologia

ABSTRACT Objective: To identify the epidemiological profile of accidents with biological material occurring in the dental clinic of a university in the southern region of the country. Methods: This is a descriptive, cross-sectional, retrospective study, which analyzed the reports of the Epidemiological Surveillance (SINAN) that occurred between March 2013 and December 2016. We analyzed the demographic variables and data related to the notification of accidents with biological material in the SINAN file, such as: age, sex, race, occupation (student, teacher, oral health technician, residents), time and place of occurrence of the accident, agent causing the perforation, total or partial use of PPE (personal protective equipment) at the time of accident, contact with organic material, contact agent and up-to-date vaccination against hepatitis B and treatment withdrawal. The data obtained were analyzed in EpiInfo Software. Statistical analysis included descriptive and inferential analysis, with significance level of p?0.05 and confidence interval (CI) of 95%. Results: In total there were 55 reports of accidents with piercing-cutting materials, of which 12 were men (21.82%) and 43 were women (78.18%). The mean age of the sample population was 24.2 (± 6.3) years. Regarding the occupation, 80% (n = 44) were undergraduate students, 12.72% were residents, 5.45%, teachers and 1.82%, oral health technicians. The majority (61.8%) were perforated during the dental procedure, 21.82% during material washing and 16.36% during surgery, but 20% claimed that they did not use any personal protective equipment. Regarding the organic material, there was a high prevalence of contact with blood, 70.9%, the needle was the main agent (n = 26; 47.3%). Still, 3.7% stated that they were not vaccinated against hepatitis B. In the bivariate analysis, the site of the accident was associated with the use of personal protective equipment (p = 0.01). Conclusion: The results showed that the number of incidents is high and can be attributed to several factors, such as lack of experience of students and the non-use of personal protective equipment. As a result, it is necessary to establish a permanent education program focused on education and accident prevention strategies to minimize these problems.

RESUMO Objetivo: Identificar o perfil epidemiológico dos acidentes com material biológico ocorridos na clínica odontológica de uma universidade na região sul do país Métodos: Foi realizado um estudo descritivo, transversal, retrospectivo, analisando as notificações da Vigilância Epidemiológica (SINAN) ocorridas entre março de 2013 a dezembro de 2016. Foram analisadas as variáveis demográficas e os dados referentes a notificação de acidentes com material biológico contidas na ficha do SINAN, tais como: idade, sexo, raça, ocupação (estudante, professor, técnico em saúde bucal, residentes), momento e local da ocorrência do acidente, agente causador da perfuração, uso total ou parcial de EPI no momento do acidente, contato com material orgânico, agente do contato e vacinação em dia contra hepatite B e abandono do tratamento. Os dados obtidos foram analisados pelo Software EpiInfo. A análise estatística incluiu a análise descritiva e inferencial, com nível de significância de p?0,05 e intervalo de confiança (IC) de 95%. Resultados: No total houve 55 notificações de acidentes com materiais pérfuro-cortantes, sendo doze homens (21,82%) e 43 mulheres (78,18%). A idade média da população amostral era de 24,2 (±6,3) anos. Quanto à ocupação, 80% (n=44) eram estudantes de graduação, 12,72% residentes, 5,45% professores e 1,82% técnico em saúde bucal. A maioria (61,8%) se perfurou durante o procedimento odontológico, 21,82% durante a lavagem dos materiais e 16,36% durante uma cirurgia, porém 20% alegaram que não utilizavam o equipamento de proteção individual. Em relação ao material orgânico, houve grande prevalência do contato com o sangue 70,9%, sendo a agulha o principal agente (n=26; 47,3%). Ainda, 3,7% afirmaram não estavam vacinados contra hepatite B. Na análise bivariada, o local do acidente esteve associado com o uso do equipamento de proteção individual (p=0,01). Conclusão: Os resultados mostraram que o número de incidentes é elevado e podem ser atribuídos a diversos fatores, como a falta de experiência dos estudantes e a não utilização de equipamentos de proteção individual. Em decorrência disso, é necessário estabelecer um programa de educação permanente focado em estratégias de educação e prevenção de acidentes para minimizar esses agravos.

Índice c. e. o. d de niños en situación de discapacidad y su relación con hábitos de higiene y frecuencia de controles odontológicos en Instituto Teletón Santiago-Chile / DMFT index in children with disabilities and its associationwith hygiene habits and frequency of dental controls in Instituto Teletón, Santiago

Introduction: The American Academy of Pediatric Dentistry considers that people with disabilities have a higher risk of developing oral diseases. Objectives: To establish the prevalence of caries in 4 and 5 year-old children with disabilities attending Instituto Teletón in Santiago, and determine the association with oral hygiene habits and frequency of visits to the Baby Clinic (preventive program from the first year of life). Patients and Method: A descriptive, cross-sectional study was carried out with 101, 4 and 5 year-old children with disabilities and active dental treatment in Instituto Teletón in Santiago. The presence of caries was assessed between October and December 2015, according to WHO criteria. Data obtained were recorded in a patient assessment form. Legal tutors completed a survey on hygiene habits and the clinical record was reviewed to account for the visits made to the Baby Clinic. Results: Prevalence of caries was 27.7 percent with an average DMFT index of 2.71 (CI 95 percent:1.89-3.74). A significant association was established between this index, and age and attendance to the Baby Clinic (p < 0.05), but not with hygiene habits (p > 0.05). Conclusions: The DMFT index obtained is similar to that of healthy patients of the same age in other studies at national level. Age and attendance to dental controls in the Baby Clinic are determining factors of caries in children with disabilities.

Introducción: La Academia Americana de Odontología Pediátrica considera que las personas en situación de discapacidad tienen un riesgo mayor de desarrollar enfermedades bucodentales. Objetivos: Determinar la prevalencia de caries en niños de 4 y 5 años en situación de discapacidad atendidos en Instituto Teletón Santiago, y establecer asociación con hábitos de higiene y frecuencia de visitas a la Clínica del bebé (Programa preventivo desde el primer año de vida). Pacientes y Método: Se realizó un estudio descriptivo, transversal, con 101 pacientes de 4 y 5 años de edad, en situación de discapacidad y tratamiento odontológico activo en Instituto Teletón Santiago. Se evaluó presencia de caries entre los meses de octubre y diciembre 2015 según los criterios de la OMS. Los datos obtenidos se registraron en un formulario de evaluación de pacientes. El tutor legal completó una encuesta de hábitos de higiene y se revisó la ficha clínica para determinar visitas a la Clínica del bebé. Resultados: Se obtuvo una prevalencia de caries del 27,7 por ciento con un índice c.e.o.d. promedio de 2,71 (IC 95 por ciento:1,89-3,74). Se estableció una relación significativa entre éste y edad y asistencia a la Clínica del bebé (p < 0,05), pero no para hábitos de higiene (p > 0,05). Conclusiones: El c.e.o.d obtenido es similar a pacientes sanos de la misma edad de otros estudios nacionales. La edad y la asistencia a controles dentales en la Clínica del bebé son factores determinantes para la caries dental de niños en situación de discapacidad.

Factors of oral infection in elderly patients with head and neck radiotherapy for malignant lymphoma / 中华老年医学杂志

Objective To investigate the factors relating to oral infection in elderly patients treated with head and neck radiotherapy for malignant lymphoma and to provide the clinical basis for the prevention and treatment of oral infections.Methods A total of 97 patients treated with head and neck radiotherapy for malignant lymphoma from March 2007 to March 2012 were enrolled.The factors relating to oral infection after head and neck radiation therapy were analyzed.Results Totally 25 patients (25.77％,25/97) had oral infections.The single-factor analysis showed that education degree,occupation,cancer staging,oral self-cleaning,oral environment,chemotherapy were the important factors relating to oral infection (x2 =8.634,6.863,9.237,11.870,7.563,8.012,P＜0.01).The incidence of oral infection had no significant differences between male and female patients.Conclusions There are many factors relating to oral infection in elderly patients treated with head and neck radiotherapy for malignant lymphoma,and poor oral self-cleaning,history of gum disease and chemotherapy are the important related factors.

Fractal analysis of the surgical treatment of ligature-induced peri-implantitis in dogs / 대한구강악안면방사선학회지

PURPOSE: To evaluate the effect of surgical treatment of ligature-induced peri-implantitis in dogs using fractal analysis. Also, the capabilities of fractal analysis as bone analysis techniques were compared with those of histomorphometric analysis. MATERIALS AND METHODS: A total of 24 implants were inserted in 6 dogs. After a 3-months, experimental periimplantitis characterized by a bone loss of about 3 mm was established by inducing with wires. Surgical treatment involving flap procedure, debridement of implants surface with chlorhexidine and saline (group 1), guided bone regeneration (GBR) with absorbable collagen membrane and mineralized bone graft (group 2), and CO2 laser application with GBR (group 3) were performed. After animals were sacrificed in 8 and 16 weeks respectively, bone sections including implants were made. Fractal dimensions were calculated by box-counting method on the skeletonized images, made from each region of interest, including five screws at medial and distal aspects of implant, were selected. RESULTS: Statistically significant differences in the fractal dimensions between the group 1 (0.9340+/-0.0126) and group 3 (0.9783+/-0.0118) at 16 weeks were found (P<0.05). The fractal dimension was statistically significant different between 8 (0.9395+/-0.0283) and 16 weeks in group 3 (P<0.05). These results were similar with the result of the evaluation of new bone formation in histomorphometric analysis. CONCLUSION: Treatment of experimental peri-implantitis by using CO2 laser with GBR is more useful than other treatments in the formation of new bone and also the tendency of fractal dimension to increase relative to healing time may be a useful means of evaluating.

Preventing HIV Transmission in Nigeria: Role of the Dentists

Background: As healthcare providers, dentists are in a unique position to foster behavioural changes that are needed to stem the spread of HIV infection. This study was conducted to assess the role of dentists in the prevention of HIV transmission in Nigeria. Methods: This descriptive cross-sectional survey was conducted from June 2006 to January 2007. A multi-stage sampling technique was used to select 300 practising dentists from all parts of Nigeria. Data were collected through a self-administered questionnaire that focused on dentist demographic details, attitudes towards treating HIV-infected persons, involvement in public or clinic-based patient education on HIV and infection control. Results: Two hundred and fifty-seven questionnaires were returned completed, constituting an 86% response rate. The majority of respondents (77.8%) had their dental practice in the southern part of Nigeria, and 89% were in the age bracket of 21–40 years. HIV education by dentists was ranked as poor, as less than a quarter of respondents routinely educated patients on HIV in the clinic. Only a few dentists (33.3%) were involved in public enlightenment programme on HIV in the previous 12 months. Most of the respondents (93%) reported a willingness to treat HIV-infected patients while observing universal precautions. Good infection barrier practices were adopted by 89.9% of dentists, and disposable cartridges for local anaesthetic agents and dental needles were not reused by 93.4% of the respondents. Autoclaving was the most widely used sterilization method (73.2%), but less than half of the respondents knew how to ascertain whether sterilization was effective. Conclusion: This study revealed that efforts by Nigerian dentists to prevent HIV transmission are presently less than optimal. Therefore, there is a need for sensitisation and motivation through seminars, workshops and lectures.

Eficácia da estufa de Pasteur como equipamento esterilizante em consultórios odontológicos / Efficacy of the pasteur oven as sterilization equipment in dental offices

Este estudo objetivou avaliar a eficácia do uso da estufa de Pasteur, como equipamento esterilizante, em consultórios odontológicos, por meio de monitoramento biológico. Para esta avaliação foram consideradas: adequação no carregamento dos materiais no equipamento, tempo/temperatura utilizados e manutenção preventiva da estufa. Os dados foram coletados em 101 consultórios odontológicos, no Distrito Central de Goiânia-GO, Brasil, por meio de observação, entrevista e realização de teste com indicador biológico. Os resultados demonstraram não-padronização de algumas condutas preconizadas pelo Ministério da Saúde (MS), para esterilização dos artigos em estufa, e positividade do teste biológico em 46 (45,5 por cento) dos ciclos testados. Os fatores intervenientes, com maior significância, relativos às falhas da esterilização foram: ausência do termômetro acessório para o controle da temperatura dos ciclos e a inobservância das relações tempo/temperatura recomendados para o ciclo de esterilização, por calor seco.

This study was aimed at assessing the efficacy of the use of the Pasteur oven as sterilization equipment in dental offices through biological monitoring. For this assessment were taken into account how adequately the material is loaded into the equipment; time/temperature used; and preventive maintenance of the oven. The data were collected in 101 dental offices in the Central District of Goiânia, in the State of Goiás, through observation, interviews and performance of tests with biological indicator. The results showed a lack of standardization of some of the procedures recommended by the Ministry of Health for sterilization of items in the oven, and positive results of the biological test in 46 (45.5 percent) of the tested cycles. The intervening factors with most significance regarding sterilization problems were: absence of an accessory thermometer to control the cycles' temperature and non-observance of the time/temperature relations recommended for the sterilization cycle through dry heat.

Este estudio tuvo como objetivo evaluar la eficacia de la estufa de Pasteur, como equipamiento esterilizante, en consultorios odontológicos, por medio del monitoreo biológico. Para esta evaluación se consideraron: adecuación en el cargamento de los materiales en el equipamiento, tiempo/temperatura utilizados y mantenimiento preventivo de la estufa. Los datos fueron obtenidos en 101 consultorios de odontología, en el Distrito Central de Goiânia-Goiás-Brasil, por medio de la observación y la entrevista, así como la realización de un test con indicador biológico. Los resultados demostraron la no patronización de algunas conductas preconizadas por el Ministerio de Salud (MS), para la esterilización de los artículos en estufa, y la prueba biológica positiva en 46 (45,5 por ciento) de los ciclos probados. Los factores de mayor intervención significativa, relativos a las fallas de la esterilización fueron: ausencia del termómetro accesorio para el control de la temperatura de los ciclos y la no observación de las relaciones tiempo/temperatura recomendadas para el ciclo de esterilización, por el calor seco.

The artificial antimicrobial peptides having potential application to preventing oral infection / 中国医师杂志

Objective To observe the antibacterial activity of artificial antimicrobial peptides (AMPs) to Blastomyces albicans, E. coli and Staphylococcus aureus in oral infection in vitro. Methods The AMPs were dissolved into PBS or sterilized saliva, then the inhibi-tion of different concentration AMPs to E. coil was evaluated by tube testing. The inhibition effect of different concentration of AMPs to Staph-ylococcus aureus and Blastomyces albicans were evaluated by antibiotic-susceptive test paper. Results When the concentration of AMPs added to broth of E. coli is from 150μmol/L to 300μmol/L , the bacterium count is 0 while the number in control is 6700 ～ 9200cfu/ml. At 100μg/tablet AMPs, the diameter of inhibitor zones of Staphylococcus aureus and Blastomyces albicans are 13mm and 11 mm. At 300μg/ tablet, the diameter are 16 mm and 17mm. AMPs dissolved in PBS and saliva have similar antimicrobial activity. Gonclusions The AMPs is effective to prevent Blastomyces albicans, E. coli and Staphylococcus aurcus in oral infection in vitro.