The impact of the COVID-19 pandemic on dental practice in Brazil / O impacto da pandemia de COVID-19 na prática odontológica no Brasil

INTRODUCTION: Dentists are at high risk of contamination by COVID-19 due to the proximity to the patients' oral cavity and airways. OBJECTIVE: To elucidate thebehaviors and adversities experienced by dentists because of the COVID-19 pandemic. METHODS: This descriptive study invited 1.811 dentists affiliated with professional associations, dental cooperatives, and health insurance providers from São Paulo State, Brazil, in 2020 of which 473 agreed to participate. The data collection, using Google Forms, included the variables: sociodemographic conditions; characteristics of dental work; level of healthcare and sources of information about the pandemic; changes in the work process, financial impact with personal protective equipment (PPE) andbiosafety measures; and consequences of the pandemic in the professional practice. RESULTS: The 473 dentists (40.36±13.44 years), were mostly women (52.22%), had a specialty (55.60%), and were self-employed professionals (73.36%). It was observed that 78.01% of professionals had a reduction in their monthly income. The average ofpatients treated daily decreased by 35.48%. It was found that 30.44% of professionalshad difficulty with the use of PPE, 3.59% contracted COVID-19, and 53.03% decided to postpone the appointment if the patient with suspected or confirmed COVID-19 sought treatment, even in emergencies. The use of high-speed handpieces was reported by most professionals (n=428; 90.48%). CONCLUSION: Behaviors: dentists used PPE and assigned very high or high levels of precaution about COVID-19. Adversities: dentists reported an increase in operating costs, changes in the work process, a decrease in appointments, and a reduction in the monthly income.

INTRODUÇÃO: Os cirurgiões-dentistas apresentam alto risco de contaminação pelo COVID-19 devido à proximidade com a cavidade oral e vias aéreas dos pacientes. OBJETIVO: Elucidar os comportamentos e adversidades vivenciados por cirurgiões-dentistas devido à pandemia de COVID-19. MÉTODOS: A pesquisa descritiva envolveu 1.811 cirurgiões-dentistas de associações profissionais, cooperativas odontológicas e convênios do Estado de São Paulo, Brasil, em 2020, dos quais 473 concordaram em participar. A coleta de dados, por meio do Formulários Google, incluiu as variáveis: condições sociodemográficas; características do trabalho odontológico; nível de atenção e fontes de informação sobre a pandemia; mudanças no processo de trabalho, impacto financeiro com equipamentos de proteção individual (EPI) e medidas de biossegurança; e consequências da pandemia na prática profissional. RESULTADOS: Dos 473 dentistas (40,36±13,44 anos), a maioria era mulher (52,22%), especialista (55,60%) e trabalhava como autônomo (73,36%). Observou-se que 78,01% dos profissionais apresentaram redução na renda mensal. A média de pacientes atendidos diminuiu 35,48%. Constatou-se que 30,44% dos profissionais tiveram dificuldade com o uso de EPI, 3,59% contraíram COVID-19 e 53,03% postergaram o atendimento de paciente com suspeita ou confirmação de COVID-19, mesmo em emergências. O uso de peça de alta rotação foi relatado pela maioria dos profissionais (n=428; 90,48%). CONCLUSÃO: Como comportamentos: os dentistas usaram EPI e atribuíram níveis muito altos ou altos de cuidados sobre o COVID-19. Como adversidades: os dentistas relataram aumento nos custos operacionais, mudanças no processo de trabalho, diminuição no atendimento e redução na renda mensal.

COVID-19 among workers assisting homeless and socially vulnerable people

ABSTRACT Objective To describe the profile of professionals assisting homeless and socially vulnerable populations tested for COVID-19, and to determine potential associations with exposure at the workplace, on the way to work, or at home, among infected professionals. To describe disease symptoms and progression and to investigate potential associations with age, sex and exposure at the workplace, on the way to work, or at home. Methods A retrospective analysis of data of 173 workers employed by Serviço Franciscano de Solidariedade tested for SARS-CoV-2. Between May 20 and June 2, 2020, professionals and volunteers were tested for anti-SARS-CoV-2 IgG and IgM antibodies, by means of qualitative rapid chromatographic immunoassay in whole blood. A questionnaire was used to collect data on demographic characteristics and working conditions, history and date of onset of symptoms and risk factors. Quantitative variables were expressed as mean and standard deviation, or median, maximum, and minimum values. Data normality was investigated using the Kolmogorov-Smirnov test. Results A total of 46 (26.6%) participants had positive serologic tests. Of participants with negative serologic test results, 109 (85.8%) were asymptomatic. History of symptoms was the most significant independent factor associated with positive serology. Serologic test results and symptoms differed significantly according to housing (p=0.045) and working (p<0.001) conditions. More than half of participants (52.4%) living in shared households tested positive, compared to 23% of participants living in family households. Participants working remotely from home did not test positive. In seropositive participants, onset of symptoms was associated with workplace exposure and shared housing conditions. Conclusion History of symptoms was associated with positive serology for COVID-19. Shared housing conditions tended to be associated with higher risk of infection. Onset of symptoms was associated with higher levels of workplace exposure and shared housing conditions in seropositive participants.

La práctica estomatológica en tiempos de coronavirus en Cuba / Dental practice in times of coronavirus disease 2019 in Cuba

RESUMEN La COVID-19 es causada por el nuevo coronavirus (SARS-CoV-2) y su brote ha sido declarado una emergencia de salud pública internacional. La transmisión interhumana ha sido documentada incluso entre trabajadores de la salud; se cree que los procedimientos generadores de aerosoles pueden tener un papel crucial en la diseminación de la enfermedad. El propósito de esta investigación fue ofrecer una actualización sobre la práctica estomatológica en tiempos de coronavirus, y proporcionar recomendaciones de cuidados específicos que deben seguir los profesionales. Los estomatólogos y técnicos se exponen a un enorme riesgo de infección debido a la comunicación cara a cara y la exposición a la saliva, la sangre y otros fluidos corporales. Para mitigar la propagación de esta afección es necesario conocer medidas de prevención adecuadas. Es de vital importancia realizar una capacitación a los profesionales sobre la práctica estomatológica segura en tiempo de coronavirus.

ABSTRACT COVID-19 is caused by the new coronavirus (SARS-CoV-2) and its outbreak has been declared an international public health emergency. Interhuman transmission has been documented even among health workers; aerosol-generating procedures are believed to play a crucial role in the spread of the disease. The purpose of this research was to offer an update on dental practice in times of coronavirus disease 2019 and to provide specific care recommendations to be followed by professionals. Dentists and technicians expose themselves to an enormous risk of infection due to face-to-face communication and exposure to saliva, blood, and other body fluids. It is necessary to know adequate prevention measures in order to mitigate the spread of this condition. It is also important to train professionals on the safe dental practice in times of this coronavirus.

Actitud ante la COVID-19 en la práctica dental rutinaria / Attitude towards COVID-19 in routine dental practice

RESUMEN Introducción: el principal modo de transmisión de la pandemia de la COVID-19, causada por el nuevo coronavirus SARS-CoV-2, lo constituyen las pequeñas gotas de saliva expulsadas al respirar, hablar, toser o estornudar. El profesional estomatólogo está expuesto al contagio y propagación de la infección al trabajar directamente con las mucosas. Objetivo: describir el manejo de los pacientes en la consulta de Estomatología. Desarrollo: se revisaron 165 artículos publicados entre enero y marzo del 2020, en PubMed y guías de la Comisiones Nacionales de Salud. Se tomaron en cuenta criterios relacionados con la atención odontológica. La información obtenida concuerda en que, la mejor forma evitar el contagio y la propagación es la prevención a través de una adecuada identificación del paciente, protección personal, limpieza, desinfección y manejo de desechos. Conclusiones: el profesional estomatólogo juega un papel importante en la prevención de la transmisión mediante el correcto empleo de normas de bioseguridad y protección.

ABSTRACT Introduction: the main way of transmission of the COVID-19 pandemic, caused by the novel SARS-CoV-2 coronavirus, is through small droplets of saliva expelled when breathing, speaking, coughing or sneezing. The dental professional is exposed to the spread of infection by working directly with the mucous membranes. Objective: to describe the management of patients in the dental surgery. Development: 165 articles published between January and March 2020 in PubMed and National Health Commission guidelines were reviewed. Considering the criteria related to dental care. The information obtained agrees that the best way to avoid contagion and spread is prevention through the adequate identification of patient, personal protection, cleaning, disinfection and waste management. Conclusions: the dental professional plays an important role in preventing transmission by the correct procedures of biosecurity and protection standards.