Prevalence of dry socket associated with urgent dental extractions due to pain performed at an emergency service in the Buenos Aires Metropolitan Area during the mandatory preventive social isolation for the COVID-19 pandemic in Argentina

Objective: To evaluate the prevalence of dry socket as a postoperative complication in cases where there was intense local pain in the preoperative state, during the preventive mandatory social isolation (PMSI) for the COVID-19 pandemic in Argentina. Method(s): This was a descriptive study, which included 1209 walk-in patients at the emergency and orientational service at Buenos Aires University School of Dentistry during the PMSI from March 20 to June 20, 2020, with indication for dental extraction as well as intense acute pain at the surgical site. The presence of dry socket was exploratoryly associated with the variables age, sex, smoking and chronic medication use. Result(s): 1209 patients were operated, resulting in a total 1372 dental extractions. Average patient age was 41 years. The prevalence found in this study was 1.06%. Conclusion(s): The prevalence of dry socket was 1%, not being higher than other experiences where pain was not considered a condition prior to extraction.Copyright © 2023 Duke University Press. All Rights Reserved.

Oral and Dental Needs and Teledentistry Applications in the Elderly: Real-Time Surveillance Using Google Trends

Featured ApplicationThe present cross-sectional analysis aimed to evaluate the level of interest in oral and dental needs and teledentistry applications among the elderly, as well as whether COVID-19 pandemic outbreaks were influenced by real-time surveillance, using Google Trends. As the number of elderly dental patients continues to increase, there is a growing need for specific interventions that address the biological and psychological issues of this population. Teledentistry represents a healthcare delivery system that can overcome these problems, although the oral and dental care provision methods involved are still unknown to most people. Indeed, there is a need to raise awareness of the indications for teledentistry, the available interventions, and the potential benefits for the oral and dental care of elderly patients.Considering the increasing need for oral and dental care in the elderly, teledentistry has been proposed to improve the education of elderly patients in oral health maintenance and risk factor control, identify patients' concerns in advance, facilitate monitoring, and save time and money. The present cross-sectional analysis of Google search data through real-time surveillance with Google Trends aimed to determine Google users' interest in oral and dental needs and teledentistry applications in the elderly, and to compare search volumes before and after the COVID-19 outbreak. Extracted CVS data were qualitatively analyzed. Pearson and Spearman correlation analyses were performed between searches for "elderly” and "teledentistry”, and all the oral and dental needs and teledentistry applications. The Mann–Whitney U test compared search volumes in the 36 months before and after the beginning of the COVID-19 pandemic. Google users' interest in the elderly and related oral and dental needs was diffusely medium–high, while teledentistry and its applications were of lower interest. Interest in teledentistry and its applications was strongly related to interest in the older population, which is consistent with the assumption that older adults represent the population segment that could benefit most from these tools. A positive correlation was also found between searches for "Elderly” and searches for almost all oral and dental needs typical of the geriatric population. Search volumes increased significantly after the outbreak of the COVID-19 pandemic. More information about teledentistry should be disseminated to increase knowledge and awareness, especially among older patients, about its indications, applications, and advantages.

A comparison of pre-radiotherapy extractions prior to and during the pandemic at charing cross hospital

Osteoradionecrosis has considerable morbidity and can adversely affect the quality of life of patients who undergo radiotherapy as part of the treatment for their head and neck cancer. This can be reduced by a thorough dental assessment and extractions of teeth with poor prognosis prior to radiotherapy, ideally at least ten days before radiotherapy commences. Aim and objectives: The dental department at Charing Cross Hospital has an established pathway to assess patients prior to radiotherapy. The aim of the audit was to evaluate whether during the coronavirus pandemic there was timely dental assessment prior to radiotherapy and extractions carried out in sufficient time before start of radiotherapy in accordance with the Royal College of Surgeons 2012 guidelines. Method(s): Data was collected retrospectively from patient records over two eight monthly periods (May 2019 -Jan 2020 prior to the pandemic and April 2020 - November 2020 during the pandemic). Parameters analysed included: the number of patients referred;time interval between referral and assessment;number of patients requiring extractions and time interval between extraction completion and commencement of radiotherapy. Result(s): Seventy-six patients with head and neck cancer were referred for dental assessment over the audit period. The most recent audit showed 96.4% of patients were assessed within ten days of referral. Extractions were undertaken on 63.6% of patients, 92.9% were in excess of ten days before radiotherapy, 42.9% over 20 days. Conclusion(s): National guidelines for extractions are being met in 92.9% of cases and the majority in excess of minimum timing recommended. The dental clinic is providing quality care for this patient group as measured by this audit, showing a positive service outcome.Copyright © 2021 The Authors

Use of ATP bioluminescence to survey the contamination of dental goggles in surgical removal of impacted mandibular third molars

The importance of protecting the eyes from infectious agents in patients' blood and saliva during dental surgery has long been known, but the global COVID-19 pandemic has made this even more important. The use of ATP bioluminescence to investigate the contamination of dental goggles during the surgical removal of impacted teeth in the present study indicates their importance for protecting the eyes from aerosols from the front, from above, and from the sides.Copyright © 2021 The Author(s)

Clinical and Cytopathological Traits of Herpes Zoster: A Report of Two Cases

Introduction: Varicella zoster virus is a highly infectious alpha-herpesvirus, pathogenic only to humans. The primary infection of varicella zoster virus causes chickenpox, which is contagious and primarily infects children and adolescents in India. Following the primary infection, the virus remains dormant in sensory root ganglia. Activation of the dormant virus in later stages of life causes herpes zoster infection which may vary from subclinical infection to typical zoster, scattered vesicles, zoster sine herpete or disseminated zoster, which depends on the individual's immune status. Case report: In this case series, we present two patients with herpes zoster involving the mandibular branch of the trigeminal nerve. Cytology revealed characteristic features of the infection including nuclear moulding, multinucleated giant cells and ballooning degeneration. Conclusion(s): More recently, patients presenting with herpes zoster have been reported to have sub-clinical Covid-19 infection, suggesting a possibility that herpes zoster might be an indicator for latent Covid-19. Timely detection and treatment of this infection can reduce the risk of post herpetic neuralgia.Copyright © 2022 Sciendo. All rights reserved.

Teledental Consultations Using a Messaging Application during the COVID-19 Pandemic: Experience from a Singapore COVID-19 Community Care Facility

Introduction: During the 'Circuit Breaker' period of the COVID-19 pandemic in Singapore from April to June 2020, governmental policies restricted the practice of dentistry nationwide to the provision of emergency treatment only, regardless of the patient's COVID status. As such, teledentistry was used as an alternative means to continue providing some form of dental care to COVID-19-positive patients who were admitted to a COVID-19 Community Care Facility. Description: The patients were physically triaged by physicians who would send clinical photos to the author via a messaging application, who would in turn triage the patients and assess if they required referral for emergency dental treatment. For patients who did not meet the criteria for referral, the author would advise the physicians on the subsequent management plan which included, but was not limited to, the provision of symptomatic relief. Conclusion(s): This article shows the feasibility of undertaking teledental consultations using clinical photos transmitted via a messaging application. The practical implication is a reduced barrier for patients and healthcare professionals to access teledentistry, without having to resort to sophisticated equipment. Hopefully, this will translate into the continued provision of some form of dental care to patients during the ongoing pandemic as opposed to no care at all.Copyright © The Author(s) 2022.

Patients Attitude Towards Orthodontics Treatment Post Covid

With COVID-19 declared as a worldwide pandemic, a nationwide lockdown was implemented overnight in India on March 24, 2020. With no prior warning or anticipation, patient appointments were temporarily ceased as institutions and clinics were indefinitely closed. Thus, with no prior warning or anticipation, orthodontic appointments were temporarily ceased. In the field of orthodontics, treatment is generally not considered an emergency. However, what is not understood is the importance of regular check-ups or monthly appointments, as well as the impact of restrictions put on patients concerning visiting their orthodontists in times of need. Understanding whether patients realize the importance of regular follow-ups, feel the need for orthodontic treatment to be regarded as emergencies, or assess the reasons for fear or inconveniences in the minds of patients undergoing orthodontic treatment in a time where they are entirely restricted to the confines of their homes are grey areas that are left unexplored. A set of 12 questions was formulated and distributed among the study. The participants were asked to fill the questionnaire. The survey was conducted in an online forum. A total of 100 validated entries were collected. Data was entered into Microsoft Excel and analyzed in SPSS V20. Associations between categorical variables were determined using Chi-square. P<0.05 was considered statistically significant.85% of the population are aware of orthodontic treatment, 93% of the population responded that they are concerned about their facial appearance. 84% of the population believes orthodontic treatment is must. 76% of the population responded that orthodontic treatment affects their hygiene system. 63% of the population felt safe to visit dental clinics post COVID, 52% of the population are not aware of permanent teeth extraction during orthodontic treatment. Orthodontic treatment is required mainly in smile correction or any other dental problems like elimination of malocclusion, trauma, periodontitis. Hence awareness on orthodontic treatment post COVID was improved.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Getting to the root of it: contact anaphylaxis from polyethylene glycol in a dental lubricant

A 46-year-old man with no known allergies or history of atopy was referred for the investigation of a severe anaphylactic reaction following root canal dental treatment. The procedure had been done under local anaesthetic and involved drilling the tooth, removal of dental pulp, cleaning and insertion of a temporary filling. Preliminary skin prick tests (SPTs) and intradermal tests were negative to natural rubber latex, articaine (the local anaesthetic used for his procedure), lidocaine and chlorhexidine. He had negative specific IgE to chlorhexidine and latex, and a negative lidocaine challenge, confirming that he was not allergic to lidocaine. He returned for further dental treatment, which was done without local anaesthetic. As the procedure was completed, he developed severe anaphylaxis again. He made a full recovery and his dentist was asked for detailed information and samples of all the materials used during the procedure. Subsequent SPT showed a positive weal of 12 x 6 mm to the dental lubricant, Glyde, which was used on both occasions. Its ingredients included polyethylene glycol (PEG) 4253. SPT to other high-weight macrogol-containing products showed positive reactions to a 5% lidocaine ointment, Movicol, EMLA cream and Depomedrone. On further questioning he recalled minor immediate irritation after using a brand of children's shampoo, but a SPT to the shampoo was negative. An open test, closed test and SPT to a lower-molecular-weight patch-test allergen (PEG400 in petrolatum) were negative. PEGs or 'Macrogols' are hydrophilic polymers used in food, cosmetics and pharmaceutical reagents. They have recently attracted attention as they are excipients in several COVID-19 vaccines and have been suggested as a possible cause of anaphylaxis. Anaphylaxis to higher-molecular-weight PEGs has been reported from the use of bowel preparations and parenteral steroids. There are a handful of reports of contact urticaria to PEG-containing medicaments. We report this case to raise awareness of severe immediate hypersensitivity to these apparently innocuous ingredients and a novel source of exposure. A low index of suspicion, lack of standardized nomenclature and commercial reagents for testing are current barriers to diagnosis.

Assessment of Endodontic Emergency Care in a COVID-19 Pandemic

Objective: This study compared the aerosol-generating and non-aerosol-generating endodontic emergency procedures' success and assessed the outcome of endodontic treatments initiated before a pandemic but could not be completed in the targeted time. Material(s) and Method(s): Emergency treatments were performed according to symptoms of teeth. Treatment success or failure was determined according to patients whether not re-referral with untimely pain. Short-term outcome and complications arising from teeth, which endodontic treatments were prolonged were also recorded. A chi-square test was used in the statistical analysis, and p<0.05 was considered significant. Result(s): The aerosol-generating procedure group's success rate was 86.2%, while it was 70.0% in the non-aerosol generating procedure group (p=0.050). The short-term survival rate of teeth was 83.7% in patients whose endodontic treatment had been prolonged. Conclusion(s): Considering the pros and cons, each emergency patient should be evaluated case-by-case. Copyright ©Meandros Medical and Dental Journal, Published by Galenos Publishing House.

Droplets adhesion to surgical masks during standard oral surgery.

The most common routes of transmission of coronavirus disease 2019 are droplet and contact infections. During dental treatment, many instruments are used that generate droplets of saliva and blood. Several droplets are generated during extraction of an impacted third molar (M3). Surgical masks are often used during tooth extraction; however, the surface structure of surgical masks against droplets is not fully understood. Therefore, we analyzed the droplets adhered to surgical masks during impacted M3 extraction using electron microscopy. A surgical mask used during impacted M3 extraction was studied. The collected surgical mask was divided into three layers and observed using electron microscopy. The outer and inner layers had a similar mesh-like structure, while the middle layer had a denser three-dimensional structure. Droplets ranging from 20-100 µm in size generated during the extraction adhered to the fibers of the outer layer of the mask. Fewer droplets adhered in the middle layer than those in the outer layer. No droplets reached the inner layer. In conclusion, it is suggested that a surgical mask can prevent droplet infection when performing impacted M3 extraction. This study is expected to contribute to the study of infection control strategies during dental treatment in the future.

Impact of COVID-19 pandemic on the activities of Dental Clinic of University Hospital Center Zagreb

Aim:The aim of this study was to show the impact of the pandemic on changes in guidelines for clinical work and the number of patients of the Clinic of Dentistry, University Hospital Centre (UHC) Zagreb, in the period of normal work before the pandemic and in subsequent years. Methods: From the data base of the hospital information system of UHC Zagreb data were retrospectively collected on the total number of cases at the Clinic of Dentistry in each period and the total number of cases at individual departments, for the period from January 1 to November 11, in 2018, 2019, 2020 and 2021. Results: During the pandemic period the most significant decrease in the number of patients in majority of organizational units was evident in 2020 compared to 2018, when a decrease in the number of patients of 30.27% was recorded, while in 2021, compared to 2018, the number of patients decreased by 9.73 %. The Department of Oral Surgery and the Department of Orthodontics had an almost unchanged number of patients in 2020 compared to 2018, while in 2021, compared to 2018, there was an increase in the number of patients. Rebro Dental Clinic and One-day surgery also recorded an increase in the number of patients. At the time of the epidemiological recommendations on the introduction of cold drive, these units of the Dental Clinic also treated other, less urgent diagnoses that would lead to bad consequences if delayed. During the collective annual leave of all other organizational units of the Dental Clinic, these units take over the provision of all necessary services of the Dental Clinic. Conclusion: COVID-19 pandemic has led to a reduction in the number of patients at the level of the Dental Clinic. The inability to treat teeth in a timely manner resulted in increased need for extractions and an increase in the number of patients at the Department of Oral Surgery. In 2021 there was a greater or lesser increase in the number of patients in individual departments, which, however, in the observed period has not yet reached the numbers from 2018. In the coming months, a further increase in the number of patients and elective dental procedures is expected. © 2022 Hrvatski Lijecnicki Zbor. All rights reserved.

Hemofilia a Adquirida E a Precariedade Da Saude Bucal: A Dificuldade Do Manejo Hematologico E Odontologico

A hemofilia A adquirida (HAa) e uma coagulopatia autoimune rara, associada a deficiencia do fator de coagulacao VIII, diagnosticada em idosos, que apresenta altas taxas de morbidade e mortalidade. Os principais sintomas sao sangramentos recorrentes, espontaneos e prolongados em regioes subcutaneas e mucosas, alem de hematomas musculares. O prolongamento isolado do Tempo de Tromboplastina Parcial Ativada (TTPA) e o Tempo de Protrombina (TP) normal, acompanhados de sangramento anormal, sugerem aprofundar a investigacao diagnostica. Por ser um disturbio autoimune, o paciente desenvolve inibidores contra o fator de coagulacao VIII, tornando o tratamento ainda mais complexo, ja que a reposicao do fator de coagulacao deficiente pode sofrer ataque dos autoanticorpos envolvidos. Medicamentos antifibrinoliticos e imunossupressores sao opcoes terapeuticas complementares. Um homem de 71 anos, branco, com historico profissional na agricultura e construcao civil, foi encaminhado a equipe de Hematologia apresentando dor nas pernas, hemartrose no joelho e hematomas extensos nos membros superiores e inferiores, relatando inicio dos sintomas apos segunda dose vacinal para Sars-Cov-2. Com historico de hipertensao arterial, artrite reumatoide e hiperplasia prostatica benigna, encontrava-se em uso de sinvastatina, enalapril, prednisona, diclofenaco sodico, carisoprodol e doxazosina. Os exames laboratoriais demonstraram hemograma, RNI, TP e plaquetograma dentro dos limites de normalidade. Ja a dosagem de fator de coagulacao VIII foi de 3% e o TTPA de 69,5 segundos, levando ao diagnostico de HAa. Por queixa de dor dentaria, o paciente foi encaminhado a Odontologia. Ao exame fisico, observou-se edentulismo superior e uso de protese total, pseudomembrana removivel a raspagem no palato, compativel clinicamente com candidose pseudomembranosa, presenca de quatro dentes inferiores com mobilidade, acumulo de biofilme bacteriano e caries. Alem disso, apresentava pequena ulceracao em labio inferior, indolor, nao endurecida a palpacao, compativel clinicamente com queilite actinica. Para as manifestacoes estomatologicas, prescreveu-se dexpantenol labial, fator de protecao solar e nistatina suspensao oral (100.000UI) para bochecho durante 7 dias, ocasionando a melhora incompleta da lesao labial e resolucao completa da infeccao fungica. Apesar da conduta indicada ter sido a extracao de todos os dentes, o quadro hematologico instavel nao permitiu tais procedimentos, ja que agentes antifibrinoliticos foram considerados insuficientes para controlar a hemorragia e o uso de alfaeptacogue ativado nao foi liberado pelo Ministerio da Saude para realizacao das exodontias. Assim, optou-se pela prescricao de analgesicos e proservacao do caso, enquanto as condicoes hematologicas aguardavam estabilizacao. Esse fato limitou a acao da equipe multiprofissional, uma vez que os focos infecciosos dentarios podem ocasionar episodios de dor intensa e sangramentos espontaneos, agravando ainda mais a condicao geral. O caso demonstra a complexidade do manejo hematologico de um paciente com HAa, levando a dificuldade do tratamento odontologico, nao sendo possivel atender imediatamente as necessidades do paciente mesmo em condicoes onde a intervencao odontologica nao podia ser considerada eletiva. Copyright © 2022

Project Tooth Fairy - Addressing Paediatric Dental General Anaesthesia Waiting Lists in London

Aims Oral disease poses significant health, social and economic burden globally, often causing pain, infection, hospital admission and mortality. Dental caries (tooth decay) is amongst the most common health conditions despite being non-communicable and entirely preventable. The Global Burden of Disease Study estimated that greater than 530 million children suffer from caries in their primary dentition (WHO, 2020). Within the NHS, is it estimated that 25-30% of the overall paediatric waiting list consists of cases that require removal of grossly decayed teeth under general anaesthesia (GA) (figure 1). Between 2015 and 2016, the financial cost to the NHS of extractions amounted to 50.5M. Before the COVID-19 pandemic, there was an existing burden within London NHS trusts of children on waiting lists for exodontia under GA. This issue has been further compounded by the cessation of elective dental activity in primary and secondary care settings due to the pandemic. Project Tooth Fairy was thus conceived to manage the growing paediatric GA waiting list. Methods Project Tooth Fairy is a collaborative, pan-London initiative designed to address London's growing paediatric GA waiting list. The new facility will employ clinical and non-clinical staff in a passport-type scheme allowing clinicians from different units to deliver care centrally in a purpose-built unit. The initiative started in November 2021. The project will deliver paediatric extractions, comprehensive care and complex oral surgery under GA. It will also serve as a source of training for dental trainees and anaesthetic trainees. Results Early results demonstrate that Project Tooth Fairy has treated over 250 children over two months, working with staff from over six NHS trusts, most cases comprising paediatric dental extractions. In March 2021, the total number of children waiting for paediatric GA across 19 London hospitals was around 14,400. To tackle the existing (and future) paediatric GA waiting lists in London, Project Tooth Fairy aims to increase capacity to treat 290 children over six days each week across three procedure rooms. Demand and capacity analysis suggests that approximately 212 procedures would be required each week (not including the backlog resulting from the pandemic). The backlog has seen a 61% increase from approximately 2,500 children waiting in March 2020 to an estimated 4,000 today, with projections of 7,000 by the time capacity is restored for P4 category work across London. It is estimated that 72% of these children have waited longer than 30 weeks, with greater than 1000 children waiting more than 52 weeks - a 96% increase in 52 week-waits compared to pre-COVID figures. The initiative also provides a more cost-effective solution due to the collaborative approach between trusts and staffing with an estimated saving of approximately 850,000 over 17 months compared to a more traditional system using two modular theatres. Conclusion Project Tooth Fairy is a more cost-effective and collaborative approach to tackling spiralling waiting lists within individual trusts. Nonetheless, a conceptual shift is needed away from 'downstream' strategies and those addressing the 'upstream' underlying inequalities in oral health across the population to achieve a more sustainable healthcare system.

HYPOTENSION WITH ST ELEVATIONS.NOT A STEMI OR EVEN THE HEART

CASE: Mr. S is a 60 yo man with DM, HTN and HLD who presents to the urgent care (UC) clinic complaining of sore throat and phlegm in the throat. He is noted to have normal vital signs except for a BP of 75/47. Exam showed slight erythema of the oropharynx, normal cardiac and pulmonary exams. Initial treatment of fluid resuscitation is started for his presumed sepsis, thought secondary to presumed COVID-19 as this occurred during the Omicron surge. An EKG was performed showing anteriolateral ST elevations. The patient was transported emergently to the hospital. An immediate cardiac catheterization was performed which showed mild coronary artery disease, but no obstruction. At this time, COVID-19 PCR test returns negative. The patient is transfered to the MICU for further evaluation and treatment for hypotension/septic shock. At this time, a chest x-ray demonstrated subcutaneous gas in the soft tissues of the neck. CT imaging showed subcutaneous gas extending from the neck to the mediastinum. Patient was taken to the operating room and found to have significant pus in the neck and mediastinum. He was diagnosed with necrotizing mediastinitis requiring multiple surgical wash-outs and prolonged SICU stay. The source was a suspected dental extraction. His ST elevations were presumed to be secondary to a pericarditis effect from the mediasinitis. IMPACT/DISCUSSION: Overall, this case presents necrotizing mediastinitis which is a very unusual and rare presentation, however, it is a surgical emergency so internists need to be aware of this disease and its presentation. Additionally, this case identifies four important points. The first is to make a broad differential, specifically for hypotension. In the setting of a sore throat during the Omicron surge, it was easy to assume this was COVID-19 but thinking of other etiologies led to the EKG being performed. The second is the importance of the physical exam. After the CXR was seen, the patient was examined and noted to have subcutaneous gas which could have been noted at the initial UC visit but that piece of the exam was not performed as the focus was on the hypotension. Third, there is a differential for etiologies of ST elevation on EKG which include STEMI, pericarditis, early repolarization, etc. that should be considered while preparing for treatment of STEMI. Lastly, taking a extensive history, to include dental work, is important as there may be systemic effects of these experiences/treatments. CONCLUSION: -Make a broad differential for atypical patient presentations and physical exam findings -Review EKGs carefully and make a differential for those findings -Necrotizing mediastinitis is a rare presentation but life threatening and needs immediate surgical attention.

HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION PRESENTING WITH PROGRESSIVE RASH

CASE: A 25-year-old female with no medical history presented with progressive petechial rash at the chest, trunk, bilateral forearms, and thighs. Patient had the COVID-19 vaccine three weeks prior. However, denied recent travel or tick bites. No home medications nor recent hospitalizations, other than a tooth extraction a month earlier. On physical exam, the patient's vitals were unremarkable and had non-blanching petechial rash noted on her torso and bilateral extremities. Labs were significant of platelet count 1,000/mcL, hemoglobin 12.9 mg/dL, WBC 7.52 x103 /mcL, absolute lymphocytes 3.33x103 /mcL. Patient was administered two units of platelets followed by intravenous immunoglobulin (IVIG) and dexamethasone. No bleeding or hemodynamic instability was identified. Platelet count improved to 100,000/mcL over the next 24 hours. Further work-up revealed a positive HIV-1 antibody, absolute CD4 256 cells/mcL, viral load 27,300 copies/mcL. Once starting antiretroviral therapy (ART);bictegravir, emtricitabine, and tenofovir alafenamide, platelet count increased within a month to more than 200,000/mcL. IMPACT/DISCUSSION: Thrombocytopenia is defined as platelet count below 150,000/mcL. HIV-induced cytopenias are common, mainly neutropenia. However, sentinel events of thrombocytopenia are very rare in otherwise healthy individuals. A review of 5,290 HIV patients at the University of British Columbia from 1996 to 2012 revealed only 0.6% incidence of severe thrombocytopenia which they defined as platelet count <20,000/mcL. The exact pathophysiology is not clearly understood, but it is possible that antibodies against HIV cross-react with platelets or possible immune alteration. This is suggested by the prompt resolution of thrombocytopenia once ART is initiated. Immune thrombocytopenia (ITP) is a diagnosis of exclusion typically presenting with thrombocytopenia while other cell lines are normal. The greatest concern is when platelet counts drop less than 20,000/mcL due to fears of intracranial bleeding. Literature is not decisive in a correlation between platelet counts and risk of bleeding, yet it is suggested that circulating platelets are younger and more effective to maintain hematopoiesis in ITP when compared to other causes of thrombocytopenia. Treatment approach for ITP depends on the bleeding risk. In the presence of bleeding, urgent platelet transfusion, glucocorticoids, and IVIG are the mainstay of treatment. In absence of bleeding, individualized assessment of the condition is recommended to either monitor or treat. Platelet counts below 20,000-30,000/mcL require steroids or IVIG. In our case, she surprisingly presented only with minor petechial bleeding. Prompt initiation of ART, close monitoring of platelet response and CD4 count, as well as identifying resistant thrombocytopenia is indicated once patient is medically stable. CONCLUSION: Sole presentation of ITP due to HIV infection is rare. Risks of critical bleeding and further management are crucial to prevent fatal outcomes.

Assessment of dental emergency management at the Rothschild hospital during the first lockdown due to COVID-19 pandemic

Background and Aim: Many obstacles have risen during the lockdown period due to the COVID-19 pandemic, including the provision of urgent dental care. The Rothschild hospital had to establish a balance between providing a core service and limiting patient admission through a fair sorting system. This study aims to assess the efficacy of the dental emergency protocol implemented during the first lockdown. Methods: The protocol was applied for patients who arrived at the hospital between March 18 and May 11, 2020. First, they underwent a sorting diagnosis (A) based on self-reported symptoms. If deemed as urgent, they were oriented towards dental professionals, who performed an intraoral examination leading to a clinical diagnosis (B). Diagnoses (A and B) were categorized into four groups: infectious, prosthetic, traumatic, and other emergencies. The agreement between diagnoses A and B was tested (Cohen's Kappa score). Positive predictive value, negative predictive value, sensitivity and specificity among diagnostic categories were assessed to evaluate the performance and efficacy of the sorting diagnosis. Results: Out of 1651 dental visits, 1064 were included for this analysis. The most frequent reported symptom at the sorting diagnosis was pain (40%), whereas the most frequent clinical diagnosis was endodontic emergency (30%). Periodontal emergency concerned 6% of patients. Tooth extraction was required in 32% of cases;systemic antibiotics were prescribed for 49.2% of patients. Infectious emergency diagnosis had the higher sensitivity (94.2%), whereas prosthetic emergency diagnosis had the higher specificity (99.1%). The level of agreement was substantial (kappa > 0.6) for the majority of diagnoses. No Covid-19 contamination occurred. Conclusions: This study demonstrates that the implemented protocol during the first COVID-19 lockdown to manage dental emergencies was effective, establishing an appropriate patient orientation prior to clinical examination to minimize the risk of COVID-19 exposure whilst safeguarding professionals and patients.

Triage and urgent dental care for COVID-19 patients in the Hospital District of Helsinki and Uusimaa

Background and Aim: When COVID-19 pandemic broke out, there was a need to set up an urgent dental care (UDC) clinic where COVID-19 infected, suspected, exposed, or quarantined patients could be treated safely. The aim of this study is to report UDC clinic's triage and the patient-specific characteristics, reasons to seek for care and the given treatments from March to December 2020 at the UDC clinic in the Hospital District of Helsinki and Uusimaa (HUS), Finland. Methods: The triage and the treatment protocol were based on the existing scientific data. Questionnaire and assessment of the treatment needs were done by dental specialists as gatekeepers. Staff was educated to follow the treatment protocol, which aimed to avoid the transmission of SARS-CoV-2 while providing adequate treatment for the patients. Patient files were evaluated from HUS electronic data base. Modified Total Dental Index and the number of teeth were assessed from the panoramic tomography and used to determine the overall oral health of the patients. Results: There were 1114 consultations and 257 visits at the clinic. Most of the patients (63.2%) were generally healthy with a mean age of 35. The most common reason for seeking for care was toothache (78.6%). Respiratory symptoms were present in 63.4% and 6.8% of the patients had COVID-19 infection. The most frequent given treatment was tooth extraction (65.8%), mostly due to caries (66.5%). Periodontal problems were reason for 4.7% of the visits. Statistically significant differences between COVID-19 infected and other patients occurred in age (45 vs. 34 years-of-age, p = 0.009) and number of teeth (25 vs. 28, p = 0.031). No SARS-CoV-2 infection transmission chains were traced to the clinic. Conclusions: Triage worked well and patients were treated safely and effectively. Patient-specific characteristics revealed no new data on COVID-19 and visits were typical for UDC.

Dental Emergencies and Coronavirus Disease-2019: Scoping Review of the Literature and Single Centre Experience.

Understanding the impact of the COVID-19 pandemic on dental emergencies. A systematic review of the literature (PubMed/Scopus) searching for articles on COVID-19 and dental abscess and a retrospective cohort study with quantitative/qualitative data analysis of our hospital E.R. patients admitted for cervico-facial abscess of dental origin were performed. Thirteen studies could be included in the review, concerning characteristics/management of patients with dental emergencies in hospitals/private practices, generally with poor evidence. For the retrospective analysis, 232 consecutive patients were included (100 study vs. 132 control). The prevalence of dental emergencies (abscess) and relative complications (mediastinitis, exitus) increased. Dental care availability was limited, with strong heterogeneity amongst regions/nations. At-risk (aerosol-generating) procedures were generally avoided, and hospitalization length reduced. Comorbidity patients and males seem less likely to restore regular dentist attendance during the post-lockdown pandemic. Despite the poor scientific evidence, COVID-19 seems to have impacted dental emergencies through limited routine dental care availability and influence on physicians' and patients' behaviour.

Differences in Demand of Domestic and Foreign Patients in Hungary's Dental Tourism

Objectives: Our aim was to assess a dental service provider’s utilization by domestic and foreign patients, the changes of prices and the purchased hotel services in Hungary since the start of the Covid pandemic. Methods: The closed questions concerned sociodemographic factors and access to health and other services. Quantitative cross-sectional analysis and non-random sampling were used (N=1350). We used the data of 2019 as the starting date. Descriptive statistics (mean, absolute, and relative frequency) were used for data management and processed using Microsoft Excel. The use of services was grouped according to ordinal and nominal independent variables / explanatory variables (gender, age group, income group). Results: During the pandemic, besides the low number of Hungarian patients, the amount of Swiss, Belgian patients have decreased (-35%), while the number of northern Italian and Austrian patients have increased (39%). Examination of foreign patients have decreased by 67% in the assessed dental service provider. While 25% of Hungarian patients came for tooth extraction, 55% for implants, 30% for removable dentures, 30% for non-removable dentures, foreigners rather chose oral surgery (10%), implants (5%), removable ceramic (35%) and other dentures (30%). During the pandemic, the price of ceramic dentures rose by 11.9%, removable ceramic dentures by 9.6%, oral surgery and bone replacement by 3.6%. Hungary has a price difference of 31% between the average prices in the sample and those used in the European Union, 49% in the case of bone replacement and 51% in the case of minor oral surgery. Conclusions: Despite the border closure due to Covid, dental traffic has increased. This is because dentists accept status checks made by in other countries by a mutual agreement. Foreign insurance companies are offering increasingly favourable insurance terms. It is still worth coming to Hungary for dental treatment, considering the accommodation and travel costs.

News

The article presents the discussion on world news briefs. Topics include Royal College of Surgeons of England welcoming the plans for expanding water fluoridation schemes across England for improving children's oral health;and reduction in the number of children undergoing dental treatment under general anaesthesia.