Challenges in providing special care dentistry during COVID-19 pandemic: a survey of public dental care services in Italy.

BACKGROUND: The aim of this paper was to assess COVID-19 pandemic impact over the public health care services (HCS) involved in special care dentistry (SCD). METHODS: Customized questionnaire was sent to 45 HCS involved in SCD. Healthcare personnel (HP) on duty, safety of HCS, time of suspension and reduction of routine dental practice in special needs patients (SNP), kind of SNP mostly penalized during pre-COVID period/T1, lockdown (phase 1/T2) and post pandemic reopening (phase 2/T3) were analyzed by statistical means (P<0.05). RESULTS: 21 questionnaires were returned. A significant decrease of median number of HP during T2 was observed. Prevalence of COVID-19 infection among HP was not significantly different between T2 vs. T3. Medical surveillance of HP during T2 was significantly lower than during T3. Patients with lack of cooperation were the most disadvantaged during both phases dental procedures were significantly lower between T1 and T2 and between T1 and T3 as well. Patients with lack of cooperation and/or living in residential care homes were the most disadvantaged in relation to access to dental care during both phases. CONCLUSIONS: COVID-19 pandemic determined significant restrictions in daily access to routine oral care resulting in reduction of preventive evaluations and decline of oral health in a population which is already at a higher risk of oral pathologies. Our data reveal that reduction of dental procedures, healthcare professionals and days of suspension of clinical activity were still considerable also in T3 with respect to T1 and in some cases not significantly different from T2.

Dentistry during COVID-19: patients' knowledge and satisfaction toward health protocols COVID-19 during dental treatment.

BACKGROUND: Coronavirus disease 2019 (COVID-19) as an infectious disease primarily spreading through droplet infection in dental treatment. Patient satisfaction is an indicator of healthcare quality service. Quality of healthcare service and patient satisfaction has been affected by the COVID­19 pandemic. This study aims to assess the knowledge and satisfaction toward health protocols COVID-19 during dental treatment among dental patients. METHODS: An institutional-based cross-sectional study was conducted on 270 dental patients using a self­designed questionnaire consisting of knowledge and satisfaction about health protocols COVID-19 during dental treatment through a random sampling technique. Data were imported to SPSS version 21 for analysis. Descriptive and analytical statistics were used to identify the factors associated with their knowledge and satisfaction. A p value < 0.05 was considered statistical significance. RESULTS: Totally, 270 dental patients with mean age of 37.6 ± 6.7 years participated in the study. The mean knowledge score was 36.7 ± 3.5, as considerable number of participants were unaware about the risk associated with dental treatment as well as restrictions imposed on dental procedures. About 18% of participants experienced one or other form of dental complaints during the lockdown period. The overall level of patient satisfaction was 44.6%. CONCLUSION: It can be concluded that, public knowledge is to be improved about risk of virus transmission that can be related with dental treatment and also people should be encouraged to use virtual facilities, such as teledentistry, so that no dental emergencies is left untreated during the pandemic time. In addition, the level of satisfaction was in a medium level for dental patients in the study area. Specifically, we deduced from the results that social/physical distancing measures are one of the mechanisms to decrease the fear of exposure to the COVID-19.

[Dental care during SARS-CoV-2 pandemic]. / SARS-CoV-2 en atención odontológica: vías de transmisión y sus consideraciones en la práctica clínica.

We analyze the transmission routes, possible viral reservoirs in the oral cavity and considerations about dental care of SARS-CoV-2 virus infection. We also analyze the protocols required before and after a dental procedure, aiming to increase the awareness of dentists about the importance of virus spread prevention among health care workers and patients. The evaluation of symptoms associated with SARS- CoV-2 such as fever, fatigue, dry cough, myalgia, dyspnea, and the inquiry about possible contacts with infected people is of utmost importance. The tongue and oral mucosa are important viral reservoirs and the transmission of the virus occurs primarily by saliva droplets. Therefore, elective dental care should be postponed, attending only dental emergencies during this period, incorporating the use of protective personal equipment (PPE) and using manual instruments to prevent the production of aerosols.

The utilization of rapid serological tests in COVID-19 diagnostics - a high risk of false-negative results in outpatient care, with particular emphasis on dental treatment.

In order to mitigate the spread of COVID-19, in the early stages of the pandemic outbreak, postponing elective procedures was recommended all around the world. Outpatient care and dental care were limited to telephone advice and emergency services. Dental staff is particularly vulnerable to SARS-CoV-2 contraction, because of the inevitable contact with patients' body fluids during aerosol-generating procedures. The implementation of diagnostic tests among ambulatory patients could improve the occupational safety among outpatient care personnel. The aim of this review was to introduce information regarding COVID-19 diagnostics with a particular focus on the methods which can be utilized in an outpatient and dental care setting. An online PubMed database review of articles on COVID-19 diagnostics, published on February 12-May 15, 2020, was conducted. Reverse transcription polymerase chain reaction is the gold standard in COVID-19 diagnostics, which determines if a person has an active infection. Unfortunately, its utilization in outpatient care is limited. Serological enzyme-linked immunosorbent assays identify people who were infected, including those who have had an asymptomatic infection, but they do not give sufficient information about the acute infection. Rapid serological assays developed to facilitate testing outside of laboratories, especially in dental offices, are not recommended by the World Health Organization to be used outside research settings, and they should not constitute the basis for clinical decision-making because of frequent false-negative results which may consequently contribute to personnel infections. Out of all available COVID-19 diagnostic methods, rapid serological assays seemed to be a method of choice in outpatient medical care. Unfortunately, their results turned out to be unreliable. The best methods to ensure the occupational safety of medical staff and to avoid cross-infections in outpatient care facilities include a thorough epidemiological interview, temperature measurement to rule out patients with an active infection, and the implementation of strict infection control procedures. Med Pr. 2021;72(2):155-62.

[Dental recommendations in the COVID-19 pandemic: A narrative review]. / Recomendaciones odontológicas en la pandemia COVID-19: revisión narrativa.

INTRODUCTION: COVID-19 is a world public health problem due to its morbidity and mortality, especially in at-risk groups. The dental environment has a high risk of viral transmission; accordingly, this study aimed to identify recommendations based on the best available evidence for dental care during this pandemic. METHODS: We performed a search for scientific evidence published since 2002 to March 23th 2020 in electronic databases (MEDLINE/PubMed, EMBASE, Cochrane, and Epistemonikos) and the web pages of the American Dental Association, Centers for Disease Control and Prevention Oral Health, the Ministry of Health in Chile and scientific societies. RESULTS: We included nine published studies. The recommendations were the following: unrestricted use of personal protection elements, use of extraoral radiographic techniques, use of mouth rinses with 1% hydrogen peroxide or 0.2% iodine povidone, a four-hand technique with ongoing aspiration and the use of absorbable sutures. Furthermore, there is a consensus that non-urgent treatments should be postponed during periods of community transmission. CONCLUSIONS: Dental practitioners are exposed to a high risk of cross-infection, meaning they must implement recommendations based on the best available evidence to preserve the health of team members and the population they are caring for.

INTRODUCCIÓN: La enfermedad por coronavirus-19 (COVID-19) es un problema mundial de salud pública debido a su morbimortalidad, especialmente en grupos de riesgo. El entorno odontológico tiene un alto riesgo de transmisión viral, por ello el objetivo de este estudio fue identificar recomendaciones para la atención odontológica durante esta pandemia. MÉTODOS: Se realizó una búsqueda de evidencia científica publicada desde 2002 hasta el 23 de marzo de 2020 en bases de datos electrónicas (MEDLINE/PubMed, EMBASE, Cochrane y Epistemonikos) y en las páginas electrónicas de la Asociación Dental Americana, de Centers for Disease Control and Prevention Oral Health, del Ministerio de Salud de Chile y de sociedades científicas. RESULTADOS: Se incluyeron nueve artículos publicados, en los cuales se recomienda el uso irrestricto de elementos de protección personal, preferir técnicas radiográficas extraorales, uso de enjuagues bucales con peróxido de hidrógeno al 1% o povidona yodada al 0,2%, técnica a cuatro manos con aspiración constante y uso de suturas reabsorbibles. Además, existe consenso respecto a que durante los periodos de transmisión comunitaria se deben posponer los tratamientos odontológicos no urgentes. CONCLUSIONES: Debido al alto riesgo de infección cruzada que presentan los equipos odontológicos, deben implementarse recomendaciones basadas en la mejor evidencia disponible, con el fin de preservar la salud de los miembros del equipo y de la población a su cuidado.

Exposure Risks and Preventive Strategies Considered in Dental Care Settings to Combat Coronavirus Disease (COVID-19).

In recent times, numerous scientific articles have been published on the risks of exposure to infectious microorganisms in dental care settings. The main mode of transmission of such infectious organisms is primarily through bioaerosols generated during routine dental procedures which put both dental care providers and their patients at an increased risk of exposure. Other frequent modes of infection transmission often reported include cross contamination and inadequate adoption of infection control protocols. The main objective of this article is to highlight the findings of those studies that have reported on the routes and modes of transmission of infectious organisms in dental settings, to report possibilities of cross contamination in dental care settings, and also to report any breach in adherence to infection control protocols in dental care settings. We also intend to emphasize on standard infection control protocols and strategies that need to be considered in dental care settings during disease outbreaks like coronavirus disease (COVID-19).

Infection Control in Dental Practice During the COVID-19 Pandemic.

COVID-19 is the disease supported by SARS-CoV-2 infection, which causes a severe form of pneumonia. Due to the pathophysiological characteristics of the COVID-19 syndrome, the particular transmissibility of SARS-CoV-2, and the high globalization of our era, the epidemic emergency from China has spread rapidly all over the world. Human-to-human transmission seems to occur mainly through close contact with symptomatic people affected by COVID-19, and the main way of contagion is via the inhalation of respiratory droplets, for example when patients talk, sneeze or cough. The ability of the virus to survive outside living organisms, in aerosol or on fomites has also been recognized. The dental practitioners are particularly exposed to a high risk of SARS-CoV-2 infection because they cannot always respect the interpersonal distance of more than a meter and are exposed to saliva, blood, and other body fluids during surgical procedures. Moreover, many dental surgeries can generate aerosol, and the risk of airborne infection is to be considered higher. The aim of this paper is to provide practical advice for dentists based on the recent literature, which may be useful in reducing the risk of spreading COVID-19 during clinical practice.

Coronavirus disease (COVID-19): Characteristics in children and considerations for dentists providing their care.

The emergence of the novel virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease (COVID-19) has led to a global pandemic and one of the most significant challenges to the healthcare profession. Dental practices are focal points for cross-infection, and care must be taken to minimise the risk of infection to, from, or between dental care professionals and patients. The COVID-19 epidemiological and clinical characteristics are still being collated but children's symptoms seem to be milder than those that adults experience. It is unknown whether certain groups, for example children with comorbidities, might be at a higher risk of more severe illness. Emerging data on disease spread in children, affected by COVID-19, have not been presented in detail. The purpose of this article was to report current data on the paediatric population affected with COVID-19 and highlight considerations for dentists providing care for children during this pandemic. All members of the dental team have a professional responsibility to keep themselves informed of current guidance and be vigilant in updating themselves as recommendations are changing so quickly.

COVID-19 Transmission in Dental Practice: Brief Review of Preventive Measures in Italy.

The outbreak and diffusion of SARS-CoV-2, responsible for the coronavirus disease (COVID-19), has caused an emergency in the health system worldwide. After a first development in Wuhan, China, the virus spread in other countries, with Italy registering the second highest number of cases in Europe on the 7th of April 2020 (135,586 in total). The World Health Organization declared the pandemic diffusion of COVID-19, and restrictive measures to limit contagion have been taken in several countries. The virus has a predominantly respiratory transmission through aerosol and droplets. The importance of infection control is therefore crucial in limiting the effects of virus diffusion. We aim to discuss the risks related to dental practice and current recommendations for dental practitioners. A literature search was performed to retrieve articles on the management of COVID-19 diffusion in dental practice. The documented clinical experience, the measures of professional prevention, and the actual Italian situation were reported and described. Four articles were retrieved from the literature search. Among the eligible articles, 3 reported measures to contrast COVID-19 diffusion. The infection management protocols suggested were reviewed. Finally, recommendations based on the Italian experience in terms of patient triage, patients' entrance into the practice, dental treatment, and after-treatment management are reported and discussed. COVID-19 is a major emergency worldwide, which should not be underestimated. Due to the rapidly evolving situation, further assessment of the implications of COVID-19 outbreak in dental practice is needed.

[Prevention and control of novel coronavirus infection in department of stomatology].

During a short period of time, the COVID-19, a respiratory disease caused by a novel coronavirus and first reported by the end of the year 2019 in China, has spread rapidly to many countries and regions outside China. The number of confirmed cases and deaths continued to rise. World Health Organization announced that the outbreaks of the novel coronavirus infection have constituted a Public Health Emergency of International Concern. Efficient infection control can prevent the virus from further spreading, which may make the pandemic situation under control. Due to the specialty of oral healthcare settings, the risk of cross infection is severe among patients and oral healthcare workers. It's urgent to implement more strict and efficient infection control protocols. This article, based on existing guidelines and published researches pertinent to dental infection-control principles and practices, mainly discusses epidemiological characteristics of COVID-19 and the features of nosocomial infection in oral healthcare settings, and furthermore provides recommendations on patient's evaluation, and infection control protocols in departments of stomatology under current circumstance.

Health services provision of 48 public tertiary dental hospitals during the COVID-19 epidemic in China.

OBJECTIVES: To assess the status of health services provision of public tertiary dental hospitals during the COVID-19 epidemic in China and to evaluate the regional difference of telehealth. MATERIALS AND METHODS: The health services provision of public tertiary dental hospitals in China mainland during the COVID-19 epidemic was inquired. The status of non-emergency dental services, emergency dental services, and online professional consultation and the hospitals' geographical distribution were recorded and analyzed. RESULTS: All the 48 public tertiary dental hospitals suspended general non-emergency dental treatment while providing emergency dental services only. Ninety percent of them notified the change of dental services online, and 69% of them offered free online professional consultations. The penetration rate of online technology was significantly higher in the eastern region than that of the central and western regions. CONCLUSIONS: There was a significant change in the health service provision of Chinese public tertiary dental hospitals during the COVID-19 epidemic and wider use of telehealth in the eastern region. CLINICAL RELEVANCE: This report demonstrated that dental health services were significantly affected by the COVID-19 epidemic in China, which might lead to a long-time impact on dental care in the future.

COVID-19 Outbreak: An Overview on Dentistry.

Coronavirus disease 2019, also called COVID-19, is the latest infectious disease to rapidly develop worldwide [...].

Transmission routes of 2019-nCoV and controls in dental practice.

A novel ß-coronavirus (2019-nCoV) caused severe and even fetal pneumonia explored in a seafood market of Wuhan city, Hubei province, China, and rapidly spread to other provinces of China and other countries. The 2019-nCoV was different from SARS-CoV, but shared the same host receptor the human angiotensin-converting enzyme 2 (ACE2). The natural host of 2019-nCoV may be the bat Rhinolophus affinis as 2019-nCoV showed 96.2% of whole-genome identity to BatCoV RaTG13. The person-to-person transmission routes of 2019-nCoV included direct transmission, such as cough, sneeze, droplet inhalation transmission, and contact transmission, such as the contact with oral, nasal, and eye mucous membranes. 2019-nCoV can also be transmitted through the saliva, and the fetal-oral routes may also be a potential person-to-person transmission route. The participants in dental practice expose to tremendous risk of 2019-nCoV infection due to the face-to-face communication and the exposure to saliva, blood, and other body fluids, and the handling of sharp instruments. Dental professionals play great roles in preventing the transmission of 2019-nCoV. Here we recommend the infection control measures during dental practice to block the person-to-person transmission routes in dental clinics and hospitals.

Coronavirus Disease 2019 (COVID-19): Emerging and Future Challenges for Dental and Oral Medicine.

The epidemic of coronavirus disease 2019 (COVID-19), originating in Wuhan, China, has become a major public health challenge for not only China but also countries around the world. The World Health Organization announced that the outbreaks of the novel coronavirus have constituted a public health emergency of international concern. As of February 26, 2020, COVID-19 has been recognized in 34 countries, with a total of 80,239 laboratory-confirmed cases and 2,700 deaths. Infection control measures are necessary to prevent the virus from further spreading and to help control the epidemic situation. Due to the characteristics of dental settings, the risk of cross infection can be high between patients and dental practitioners. For dental practices and hospitals in areas that are (potentially) affected with COVID-19, strict and effective infection control protocols are urgently needed. This article, based on our experience and relevant guidelines and research, introduces essential knowledge about COVID-19 and nosocomial infection in dental settings and provides recommended management protocols for dental practitioners and students in (potentially) affected areas.