Assessment of dental personal protective equipment (PPE) and the relationship between manual dexterity and dissemination of aerosol and splatter during the COVID-19 pandemic.

Background/purpose: Asymptomatic COVID-19 patients visit the dental clinic for routine treatment, during which, high-speed handpieces, and third-use sprayers can produce aerosols. We focused on the effect and possible inadequacy of personal protective equipment (PPE) while cleaning teeth and assessed whether doctors' proficiency was related to the range of spraying droplets. Materials and methods: Doctors were divided into three different groups: attending physicians, residents, and intern respectively. Each doctor treated 15 patients; each group comprised 30 patients. The dentists wore leg covers, shoe covers, medical masks, haircaps, full masks, waterproof barrier gowns, and gloves. Each patient was covered with a waterproof hole towel, and the upper edge was fixed to the patient's nose with a medical tape. After cleaning the teeth with water contained red pigment, the spattering distance and range of droplets were calculated. Concurrently, we examined whether there was any droplet contamination on the PPE. Results: With the exception of shoe covers, haircaps, and medical surgical masks, pigment splash marks were found on both the dentist and assistant's PPE. The interns performed cleaning for a significantly longer time than the residents and attending physicians, with a significant statistical difference (P < 0.05). The spatter distance for the interns was significantly larger than the residents (P < 0.05). Conclusion: It is recommended that the hole towel be centered on the patient's nose tip, at least larger than a radius of 54.9-64.5 cm. The dentist's proficiency did cause differences in the duration of teeth cleaning, which further affects the spatter distance.

Development and questionnaire-based evaluation of virtual dental clinic: a serious game for training dental students.

BACKGROUND: The volume of literature about serious gaming in dental education has increased, however, none of the previous studies have developed a serious game for closing the gap between preclinical and clinical training. OBJECTIVE: Virtual Dental Clinic (VDC) is a serious game that was created to help develop clinical reasoning skills in dental students. This study aimed to evaluate VDC as an educational tool and its effectiveness on clinical skill and knowledge gain among clerkship dental students. METHODS: The following three stages of VDC design and testing were addressed from 2016 to 2020: development, validation, and application. The VDC was developed using Unity game engine. In the validation stage, the content validity was reviewed by five visiting staff; construct validity and face validity were examined by 9 postgraduate-year dentists and 14 clerkship dental students. Concurrent validity and predictive validity were examined by 34 fifth-year dental students during their clerkship from September, 2018 to May, 2019, the associations between VDC experiences, clerkship performance, and the score on a national qualification test were explored. In the application stage, the VDC was set up as a self-learning tool in the Family Dentistry Department from August, 2019, quantitative and qualitative analyses were conducted using the 92 clerkship students' feedback. RESULTS: The VDC showed good validity and a high potential for education in practice. Students who have used VDC received significantly higher scores on qualification test (p = 0.029); the VDC experiences significantly predicted higher performance score on periodontics (p = 0.037) and endodontics (p = 0.040). After the outbreak of COVID-19 pandemic, significantly higher proportion of students confirmed the value of VDC as an assistant tool for learning clinical reasoning (p = 0.019). CONCLUSIONS: The VDC as an educational tool, and the effectiveness on clinical reasoning skills and knowledge gain among clerkship dental students has been validated and confirmed in this study.

The impact of the COVID-19 epidemic on the utilization of dental services and attitudes of dental residents at the emergency department of a medical center in Taiwan.

BACKGROUND/PURPOSE: Dental visits are a high risk activity during the COVID-19 pandemic. This study investigated the utilization of emergency dental services and clinical practical attitudes of dental residents in this period. MATERIALS AND METHODS: Retrospective chart data from 13th November 2019 to 31st March 2020 in Kaohsiung Medical University Hospital, Taiwan were used. We obtained electronic medical records to review data from 515 patients who visited the emergency department with dental complaints and we contacted the 26 residents assigned to act as primary care providers to participate in this study. RESULTS: After the COVID-19 outbreak, 17% fewer patients had dental emergency utilization at a hospital emergency center relative to the previous period. A survey of residents also showed a decline in the number of patients. There were no significant differences of patients' problems and diagnoses between the two periods. After the COVID-19 outbreak, 61.5% of the residents were afraid of being infected by a patient's disease and the proportions of dentists wearing waterproof gowns, face shields, and surgical hair caps were 76.9%, 88.5%, and 76.3%, respectively. These variables increased significantly after the outbreak of COVID-19. CONCLUSION: Despite the trend of a decreased number of patients, their utilization of dental emergency services seems to be similar before and after the COVID-19 outbreak, possibly related to strict hospital infection control policies and the relatively low number of COVID-19 confirmed patients internationally at that time.