Impact of cancelled General Anaesthetic dental extraction appointments on children due to the COVID-19 pandemic.

BACKGROUND: COVID-19 has resulted in the cancellation of general anaesthetic procedures including dental extractions (GAX) for children in the UK, exacerbating existing inequalities. There is robust evidence that children from deprived and some ethnic backgrounds are at greater risk of caries and are, therefore, more likely to be affected by cancellations. AIM: To identify the impact of, and possible mitigations for, cancelled general anaesthetic procedures on children in the South East of England. DESIGN: Data were collected from service providers on the number of children who had their appointments cancelled during the first lockdown. Paediatric dentists and clinical leads contributed views on the likely impact of these cancellations on the affected children. RESULTS: 1,456 children had their appointments cancelled in the six weeks between 20th March and 30th June 2020. The key themes identified from providers included lengthening waiting lists, challenges of swab testing and self-isolation and the need to re-orientate dental services to increase prevention. CONCLUSION: COVID-19 has exacerbated existing health inequalities within our communities. Different parts of the NHS must work together to ensure that all children have access to services to treat and improve oral health.

Clinical effectiveness of inhalation conscious sedation with nitrous oxide and oxygen for dental treatment in uncooperative paediatric patients during COVID-19 outbreak.

AIM: The aim of this study was to evaluate the features of inhalation conscious sedation for urgent dental treatments in uncooperative paediatric patients during COVID-19 outbreak. MATERIALS AND METHODS: Forty-two uncooperative patients, attending primary and secondary schools, were submitted to emergency dental treatments with inhalation conscious sedation using nitrous oxide and oxygen during COVID-19 pandemic. Collected data included: number of working sessions, success/failure, adverse events, side effects, number of teeth treated; type of dental procedure. Parents filled in an e-mailed questionnaire on post-discharge children status to evaluate: pain; crying; fever; vomiting; headache; drowsiness; excitability; irritability; ability to eat; need for drugs. RESULTS: One working session was carried out in 29 patients, 2 working sessions were carried out in 6 patients and 3 working sessions were carried out in 7 patients. Success rate was 87.1%. In relation to success, there was no statistically significant difference between males and females, healthy and disabled patients, respectively; while there was a statistically significant difference between patients attending primary and secondary schools (p=0.023). No adverse events occurred. The most frequent side effect was nausea. In relation to side effects, there was no statistically significant difference between males and females, healthy and disabled patients, patients attending primary and secondary schools, respectively. In relation to e-mailed questionnaires on post-discharge children status, 29.6% of the patients had pain, 22.2% vomited, 14.8% had headache, 18.5% experienced drowsiness, 29.6% failed to eating normally, 35.2% needed to take drugs. None of the patients cried, had a fever, exhibited irritability and excitability. CONCLUSION: Inhalation conscious sedation is a safe, practical and effective procedure with minimal side effects to perform emergency dental treatments in uncooperative paediatric patients during COVID-19 outbreak.

Inhalation Sedation During the COVID-19 Outbreak: An Expert Opinion.

BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the pathogen that causes coronavirus disease-2019 (COVID-19), is thought to be transmitted via droplets and aerosols, and was detected in saliva of infected individuals. These droplets from the upper airway may infect the inhalation sedation mask and tubing. The authors determined the adequate measures needed to prevent the transmission of COVID-19 by nitrous-oxide (N2O) system during inhalation sedation in dentistry and provided evidence on mask and tubing sterilization. Additional measures to protect patients and healthcare workers from COVID-19 that may be transmitted by the inhalation sedation system are discussed. The authors recommend minimal use of a N2O system during inhalation sedation in dentistry. In case of need, the practitioners should have more than one scavenger kit and nasal masks for each N2O/O2 mixer. Biologic barriers should be mounted between the scavenger's tubing and the central evacuation system. Strict cleansing and sterilization should be performed for all parts of the N2O system. The use a disposable scavenger system and nasal mask should be considered as a viable option.

Infection Control in Dental Anesthesiology: A Time for Preliminary Reconsideration of Current Practices.

Relegated to clinical afterthought, the topic of infection control has never taken center stage in our modern dental sedation and anesthesiology practices. Surgical and procedural masks, gloves, gowns, protective eyewear, and appropriate surgical attire have remained de rigueur in both fashion and custom for decades. However, the emergence of certain seminal events throughout health care history has driven mandated changes when practitioners, staff, patients, and the surrounding communities were exposed or put at risk of exposure to infectious disease. Hepatitis, human immunodeficiency virus, and now the global COVID-19 pandemic involving the novel coronavirus SARS-CoV-2, have forced us into rethinking our current practices. This review article will contextualize previous epidemics and their influence on infection control in dental settings, and it will explore the rapid evolution of current modifications to personal protective equipment and infection mitigation practices specific to sedation and anesthesia in dentistry.

Aerosol-Generating Procedures and Simulated Cough in Dental Anesthesia.

Dental professionals are at an increased risk for exposure to the severe acute respiratory syndrome coronavirus 2 with aerosol-generating procedures (AGPs), and dental anesthesia practices have additional risks due to airway management procedures. The purpose of this pilot study was to examine the extent of splatter on dental personnel that may occur with AGPs and coughing in a dental anesthesia practice. A Dentoform model was fitted into a dental mannequin and coated with Glo Germ to detect splatter during simulated dental AGPs produced with use of a high-speed handpiece, an ultrasonic scaler, and an air-water syringe, all in conjunction with high-volume suction. A simulated cough was also created using a ventilator programmed to expel Glo Germ within the velocity and volume parameters of a natural cough with dental personnel in their customary positions. A UV light was used after each procedure to systematically evaluate the deposition of Glo Germ splatter on each person. After AGPs were performed, splatter was noted on the face, body, arms, and legs of the dentist and dental assistant. The simulated cough produced more extensive splatter than AGPs; additional Glo Germ was seen on the shoes, the crown of the head, and the back of the dental personnel. Therefore, it is recommended that full personal protective equipment consistent with AGPs be used and changed between patients to reduce the risk of contamination and infection for dental personnel and patients.