The dental office: A safe place against COVID19 and other future pandemics

Background: The pandemic caused by the spread of COVID19 generated throughout the world great changes in all areas of life. Social distancing was carried out very drastically in some countries, and even in the field of dental care, some countries prohibited the practice of dentistry. Objective(s): To demonstrate that the dental office is safe regarding the possibility of contagion of Sars-Cov-2 as long as good biosecurity protocols are used. Method(s): A structured survey of 19 questions was applied to 103 patients who subsequently attended a periodontics and oral and maxillofacial surgery office in Mexico, to receive care from these specialties between April 2020 and July 2021. The questions posed in this survey were aimed at knowing the opinion of the patients regarding the measures that this establishment has for the prevention of the transmission of COVID19, as well as questions regarding the possible effects of attending this office in contagion of the disease from patients and their families. Result(s): A total of 18 (17.5%) patients reported having suffered COVID19, and none reported that they fell ill after the consultation. None of the clinic's specialists and assistants have fallen ill with COVID-19 during the pandemic. Conclusion(s): It is not necessary to suspend or condition dental care during times of pandemics such as what happened with COVID19, as long as strict safety protocols are observed within clinical facilities.Copyright © 2022 The Authors

Antibody response to BNT162b2 mRNA vaccine in gingival crevicular fluid.

BACKGROUND: This prospective cohort study aimed to evaluate the antibody responses in non-invasive gingival crevicular fluid (GCF) and unstimulated whole saliva to the SARS-CoV-2 Spike unit 1 receptor-binding domain (S1-RBD) protein following administration of the mRNA BNT162b2 vaccine. METHODS: This longitudinal study recruited 37 participants with no prior COVID-19 exposure (eight people recruited prior to the COVID-19 pandemic - labeled pre-COVID, 16 vaccinated and 13 non-vaccinated participants). An enzyme-linked immunosorbent assay (ELISA) was used to determine antibody levels against S1-RBD in saliva (n=90) and GCF (n=80) samples obtained at 1 and 3 weeks after dose 1, and 3 days, 7 days, and 3 weeks after dose 2. To determine previous SARS-CoV-2 infection status, anti-nucleocapsid (N) Ig levels were determined in samples from the pre-COVID (saliva as reference), non-vaccinated (saliva and GCF), and vaccinated (saliva and GCF) participants at 1-week post-dose 1 using ELISA. RESULTS: Salivary levels of anti-N antibodies measured in samples from vaccinated and nonvaccinated participants were comparable to those in pre-COVID saliva samples collected between October 2018 and September 2019, thus confirming that all study participants had no prior SARS-CoV-2 infection. Overall, the levels of anti-S1-RBD antibodies peaked at 3 weeks after dose 2 in both saliva and GCF for all three immunoglobulin isotypes. Notably, the concentration of anti-S1-RBD antibodies in GCF was significantly higher than in saliva at all time points. CONCLUSION: This study establishes GCF and saliva as viable alternative non-invasive sources to monitor levels of antibodies following vaccination, with GCF demonstrating feasibility as a biofluid source for the detection of antibodies against SARS-CoV-2 S1-RBD antigen.

Mental Health Issues in Health Care Providers

In 2017, the National Academy of Medicine (NAM) created the Clinician Well-being Collaborative as response to epidemic levels of mental health issues including burnout, depression and suicide being experienced by clinicians across all health care disicplines.1-2 In 2014 it was suggested that the much-celebrated Triple Aim of health care could not be successful without a fourth aim that included improving the work life of clinicians and staff.3 Why, after so many decades is it still somewhat of a novel concept that those providing care need care and support for their own wellness? Perhaps more important than the lack of research on the mental health and well-being of oral health providers, is the lack of attention given to the mental health and well-being of women in the oral health care professions, particularly in dental hygiene. Danielle Rulli, RDH, MS, DHSc is a member of the Journal of Dental Hygiene Editorial Advisory Board and a clinical associate professor and Director, Graduate Dental Hygiene Program, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.

Candida associated periodontitis in COVID- 19 era

Background: New Classification of Periodontal and Peri-implant Diseases and Conditions having worked into 2017 has defined candida-associated periodontal lesions as “Non-plaque-induced gingival diseases” associated with specific infection (list point 2.3). Patients with diagnosis Periodontal candidosis have been observed at the Division of Periodontology SPBGMU and City Periodontal Center “PAKS” more than for 25 years with an average quantity of 3-5 new cases a year. There had been formed a typical pattern for setting diagnosis and treatment. As a risk group was recognized, patients who predominantly had such general conditions as diabetes, immunosuppressive therapy, and heavy smokers. Since 2020 the pattern has been completely changed due to changing general conditions of the patients who consisted of the group and increasing quantity of periodontal candidosis about threefold. The core of the group has consisted of predominantly patients who recently had COVID-19 and/or underwent immunosuppressive therapy. Description of the procedure: Diagnostic procedure: Level 1. Anamnesis, clinical record, standard periodontal charting, estimation of periodontal and hygienical indices, absence or present mucosa lesions. CBCT Level 2. Clinical fluorescence diagnostic-wave length 400 ± 10 nm estimation gingival and mucosa condition. The cultural test for Candida detecting. Level 3. Cytology Treatment: in addition to SRP procedure there prescribed local and systemic antifungal therapy. 1. Photodynamic therapy (toluidine blue photosensitizer) 2. Local antifungal therapy - rinsing by Clotrimazole solution 3. Systemic antifungal therapy - Fluconazole 150 mg once in day 4. Modification of host response - Imudon 6 six in day 5. Toothpaste with the alkalic antifungal agent -sodium bicarbonate. Outcomes: Outcome control: Clinical investigation, the cultural test for Candida. Case: Female age 47 had a severe COVID-19 case, 3 months later she had rising level of activity periodontitis without response on usual periodontal therapy. Conclusions: Candida-associated periodontitis is difficult for diagnostic and treatment disease which use to occur quietly rare but nowadays have vastly increased.

Post-COVID-19 lockdown: A process audit of standard operating procedures in the department of periodontology

Background and Aim: This study aims to audit the process of patient management with aerosol generating procedure (ultrasonic scaling) while adherence to the guidelines for healthcare workers during the COVID-19. Methods: Audits records at the Department of Periodontology at University College of Dentistry Hospital Lahore - Pakistan were collected (prospectively) over the period of 1 October to 30 November 2020 (1st cycle) and 14 December 2020 to 12 February 2021 (2nd cycle). The audit was divided into three components based on the guidelines: (i) Physical environment, (ii) patients/appointments and (iii) COVID SOPs related to HCWs. Results: The recommended physical layout and procedural factors, as suggested by the guidelines for dental clinics, were observed during the first cycle of audit, and discrepancy of ventilation system was fixed after the first cycle. Only one house officer got COVID positive (PCR) on 3rd day of house job. There were four procedural slots per day with three fallow time of half an hour each in the first cycle. Audit team reported the observance of fallow time three times daily, which revealed that 83.3% observance of fallow time. Later in the 2nd cycle when the extra oral high volume air evacuator was installed, the fallow time was reduced to 15 min and not only we did five procedural slots per day but our fallow time was also observed 100% of the time. There were few occasions in each cycle where the appointed patients had to wait more than 10 min before they were seated, and waiting time decreased in the cycle 2 when the dental staff were sensitized with its importance repeatedly as part of our weekly dissemination of knowledge. Conclusions: Following the standard guidelines resulted in more efficient working environment and lesser risk for health care workers while performing aerosol-generating procedures.

Knowledge, sources and clinical practice of university students in relation to COVID-19 (Spain)

Background and Aim: The pandemic caused by the SARS-CoV-2 virus has generated a social, economic, health and educational collapse of unsuspected dimensions, paralyzing teaching in dental schools around the world and modifying their clinical protocols. To evaluate the knowledge of the students of the University Clinic of Dentistry of the University of Oviedo (CLUO) about the infection by SARS-CoV-2. Methods: A descriptive observational study was carried out through a survey made in “GOOGLE FORMS.” Five sections were included: demographic data, questions about the acquisition of knowledge about COVID-19, questions about general knowledge of COVID-19, questions about knowledge of COVID-19 in dentistry and resolution of clinical COVID-19 cases. Results: A total of 110 surveys were collected. The predominant age range was 18 to 28 years (82.7%) and female the predominant sex (72.6%). Television and the internet were the media where they were first informed about the pandemic. The general knowledge about Covid-19 of the surveyed students (67.93% correct) was higher than the specific knowledge (COVID-19 in dentistry) (27.5% correct). At the clinical cases, the area of less knowledge about the specific COVID-19 management was those applied to Periodontology. Conclusions: Our results indicate that the students had a moderate knowledge about COVID-19, suggesting the need to increase basic training on infection control and promote workshops on protection measures based on the risks inherent to the specific dental practice.

Case based learning in undergraduate curriculum of periodontology

Background & Aim: Assessment and acceptance of phantom based periodontal education due to COVID-related restrictions in undergraduate treatment courses. Methods: 48 undergraduate students (mean age: 24 ± 2 years) in semester 7 (n = 20) and 9 (n = 24) were asked to evaluated case based education under simulated conditions as a partial substitute in times of Covid-19. Four complex periodontal scenarios were [MW1] simulated based on the four quadrants of the Frasaco AP-Z model. The following information was provided: medical and dental history, primary concern, X-ray and oral hygiene findings. Periodontal examination and subgingival instrumentation were performed in the AP-Z model. The evaluation form consisted of nine questions of the ADEE criteria domain III (Likert scale) and additionally, a global score from one to six (German school grade equivalent) should be given. [MW1] Hier würde ich Stichworte der vier Fälle nennen, damit man das versteht. Results: 44 of 48 students (92%) completed the questionnaire. 91% rated integration of the simulated cases as a valuable addition to their daily clinical routine and 71% reported being more confident in clinical treatment. The learning effect in the following competences was found to be higher in simulated cases than in clinical situations: Diagnosis finding, risk analysis and treatment planning. Diagnostic assessment and subgingival instrumentation were reported to be superior in clinical patients, although there were differences between 7th and 9th semester students (p < .05). Students in the 9thsemester rated the usefulness of psychomotoric training lower, whereas both groups rated the simulated periodontal education superior to clinical treatments. Overall, adjunctive simulated periodontal education was rated as “good” (1.9).7 Conclusions: The adjunctive use of simulated periodontal cases was highly valued by undergraduate students. In this simulated setting, case discussions of more complex periodontal cases with defined learning goals are a valuable and accepted supplement in the periodontal curriculum especially under pandemic situations with restrictive patient treatment.

How can biophotonics help dentistry to avoid or minimize cross infection by SARS-CoV-2?

Biophotonics is defined as the combination of biology and photonics (the physical science of the light). It is a general term for all techniques that deal with the interaction between biological tissues/cells and photons (light). Biophotonics offers a great variety of techniques that can facilitate the early detection of diseases and promote innovative theragnostic approaches. As the COVID-19 infection can be transmitted due to the face-to-face communication, droplets and aerosol inhalation and the exposure to saliva, blood, and other body fluids, as well as the handling of sharp instruments, dental practices are at increased risk of infection. In this paper, a literature review was performed to explore the application of Biophotonics approaches in Dentistry focusing on the COVID-19 pandemic and how they can contribute to avoid or minimize the risks of infection in a dental setting. For this, search-related papers were retrieved from PubMED, Scielo, Google Schoolar, and American Dental Association and Centers for Disease Control and Prevention databases. The body of evidence currently available showed that Biophotonics approaches can reduce microorganism load, decontaminate surfaces, air, tissues, and minimize the generation of aerosol and virus spreading by minimally invasive, time-saving, and alternative techniques in general. However, each clinical situation must be individually evaluated regarding the benefits and drawbacks of these approaches, but always pursuing less-invasive and less aerosol-generating procedures, especially during the COVID-19 pandemic.

Effectiveness of remote simulation-based learning for periodontal instrumentation: A non-inferiority study.

OBJECTIVES: While numerous virtual/remote simulation-based learning (SBL) modules were implemented due to the COVID-19 pandemic, limited data on their effectiveness are available. This study aimed to investigate the effectiveness of a remote SBL module for periodontal instrumentation compared to traditional onsite SBL modules. METHODS: Calibrated faculty members have instructed in all modules. Synchronous remote SBL activities using a secure videoconferencing application, which replaced onsite practices, were conducted in a small group setting in the remote SBL module for the class of 2023. After the class took the onsite second-year practical examination, a set of multiple and logistic regression analyses (N = 389) were conducted to test if the second-year practical examination scores and the passing rates were significantly different between the remote SBL (class of 2023) and onsite SBL I and II (class of 2019 and 2022) groups. RESULTS: Both mean practical examination score and passing rate from the remote SBL group (class of 2023) were significantly higher than those from the onsite SBL II group (class of 2022) when their first-year practical examination scores were not considered (p < 0.05). Once the first-year practical examination scores were considered, the remote SBL group was not significantly different from the onsite SBL I and II groups with respect to the mean second-year practical examination score and the passing rate. CONCLUSION: The proposed remote SBL module achieved the comparable student learning outcomes compared to the onsite SBL modules while it utilized less staff, time, and material expenditure.

The clinical association between Periodontitis and COVID-19.

OBJECTIVES: The study aimed to clinically assess the association between periodontitis and COVID-19-related outcomes. MATERIAL AND METHODS: Data pertaining to patient demographics, medical history, blood parameters, periodontal clinical examination and aMMP-8 point-of-care diagnostics (both site-level and patient-level) was recorded for eighty-two COVID-19-positive patients. COVID-19-related outcomes such as COVID-19 pneumonia, death/survival, types of hospital admission and need of assisted ventilation were also assessed. RESULTS: Males were predominantly afflicted with COVID-19, with advanced age exhibiting a greater association with the presence of periodontitis. Higher severity of periodontitis led to 7.45 odds of requiring assisted ventilation, 36.52 odds of hospital admission, 14.58 odds of being deceased and 4.42 odds of COVID-19-related pneumonia. The aMMP-8 mouthrinse kit was slightly more sensitive but less specific than aMMP-8 site-specific tests. CONCLUSIONS: Based on the findings of the present study, periodontitis seems to be related to poorer COVID-19-related outcomes. However, within the constraints of this work, a direct causality may not be established. Periodontitis, by means of skewing the systemic condition for a number of comorbidities, may eventually influence COVID-19 outcomes in an indirect manner. CLINICAL RELEVANCE: The study is the first to clinically, and by means of a validated point-of-care diagnostic methodology, assess the association between periodontal health and COVID-19-related outcomes. Assessment of the periodontal status of individuals can aid in the identification of risk groups during the pandemic along with reinforcing the need to maintain oral hygiene and seeking periodontal care.

Effectiveness of Pre-procedural Mouth Rinses in Reducing Aerosol Contamination During Periodontal Prophylaxis: A Systematic Review.

Background: Aerosol-producing dental procedures are of concern in the spread of infections, especially during the COVID-19 pandemic. Periodontal prophylaxis is the most common aerosol-producing procedure conducted in dental practice globally. During COVID-19, many national and international organizations advocated the use of pre-procedural mouth rinsing to prevent the spread of infections from aerosol-generating procedures in the dental setting; however, many questioned the scientific basis for such recommendations. Objective: This systematic review aimed to evaluate the effectiveness of pre-procedural rinsing when preforming periodontal prophylaxis in reducing aerosol contamination in the dental setting. Methods: A comprehensive standardized search strategy was employed, informed by a defined PICO question across four electronic databases. The review of the literature was conducted using the PRISMA framework. Agreement between assessors was determined throughout. Synthesis of study characteristics and key outcomes were conducted. Cochrane's risk-of-bias tool for randomized trials (RoB 2) was employed to assess the quality/bias among studies. Results: The initial search yielded 731 citations across the four databases; 95 potentially effective studies were identified, with 56 effective studies found. Thirty randomized control trial studies were identified, 21 with a focus on effectiveness of pre-procedural mouth rinsing, involving 984 participants (aged 18-70). Agreement between assessors was high (Kappa >0.80). Various pre-procedural mouth rinses were tested, most frequently chlorhexidine (CHX) in 18 studies. The concentrations, volume, and prescribed duration of rinsing varied among studies, hampering meta-analyses. Nonetheless, all studies identified significant reductions in bacterial contamination, as measured by colony forming units (cfu). The effectiveness of CHX over other agents was evident with more than half of the studies (7/15) reporting over a 70% reduction in bacterial contamination (cfu). There were concerns over the risk of bias in most studies (76.2%); 19.0% had a high risk of bias and 4.8% were of low risk of bias. Conclusion: There is substantial evidence to support pre-procedural mouth rinsing, such as with chlorohexidine, to effectively reduce aerosol contamination when performing periodontal prophylaxis compared to mouth rinsing with water or not rinsing.

Impact of the coronavirus disease 2019 pandemic on periodontal practice: A questionnaire survey.

AIM: This cross-sectional study sought to investigate the factors possibly related to the impact caused by the coronavirus disease 2019 pandemic in the practice of periodontists, in two countries. MATERIALS AND METHODS: A total of 254 periodontists with active periodontics licensing in Brazil and the United States participated in the survey. Data were collected through an online questionnaire and the dependent variable was the perceived impact of the pandemic on periodontists' practice routines. Odds ratios were assessed by logistic regression analysis. RESULTS: Periodontists in private practice were 83% less likely to report a significant impact of the pandemic on their clinical routine as compared with professionals who work in the public sector or in academic institutions (CI 95%: 0.05-0.47). The financial impact of the pandemic was significantly associated with a perceived severe impact of the pandemic on their routines (OR: 1.36; CI 95%: 1.16-1.61). Professionals who have enhanced their hand-washing routine were more likely to report a significant impact of the pandemic by 3.41 times (CI 95%: 1.28-9.04) relative to those who have not altered their hand-washing protocols. CONCLUSION: The pandemic is associated with a negative impact on the practice of periodontists, especially those working in public sectors and academic institutions.

The perceived impact of Covid-19 on periodontal practice in the United Kingdom: A questionnaire study.

INTRODUCTION: COVID-19 has impacted dentistry in unprecedented ways. OBJECTIVE: The following research aimed to investigate the impact of the COVID-19 pandemic on periodontal practice in the United Kingdom using the COM-B (Capability Opportunity Motivation-Behaviour) model as the basis for a questionnaire. BASIC RESEARCH DESIGN: An online survey link was sent to all members of the British Society of Periodontology and Implant Dentistry. A total of 358 responses were received and analysed. RESULTS: The great majority of participants thought that the pandemic had an impact on their profession, while only 4.7 % had no concerns. The main worries related to financial concerns and ability to provide appropriate levels of care. More than 80 % of respondents agreed that their establishment was compliant with infection control procedures. Some participants felt benefits mainly in terms of more time for CPD activities. It was felt that some of the changes needed will need to be sustained long-term. CONCLUSIONS: Respondents were generally worried. However, they perceived they had the physical and psychological ability to effect changes to their practice, higher than the physical and social opportunities that they were afforded. Although the COVID-19 pandemic is causing profound changes and worries for the profession of Periodontology, clinicians are clear about their capability to control the situation and feel they have the motivation to make the required changes. CLINICAL SIGNIFICANCE: COVID-19 has presented clinicians with novel challenges. Investigating the professional response to change and expected impact is of interest in the current climate as we navigate the 'new normal'. Assessing the results could be useful in informing support strategies moving forward.