Precise Control of Digital Dental Unit to Reduce Aerosol and Splatter Production: New Challenges for Future Epidemics (preprint)

Background During dental procedures, critical parameters, such as cooling condition, speed of the rotary dental turbine (handpiece), and distance and angle from pollution sources, were evaluated for transmission risk of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), simulated by spiking in a plasmid encoding a modified viral spike protein, HexaPro (S6P), in droplets and aerosols.Methods To simulate routine operation in dental clinics, dental procedures were conducted on a dental manikin within a digital dental unit, incorporating different dental handpiece speeds and cooling conditions. The tooth model was immersed in Coomassie brilliant blue dye and was pre-coated with 100 µL water spiked-in with S6P-encoding plasmid. Furthermore, the manikin was surrounded by filter papers and Petri dishes positioned at different distances and angles. Subsequently, the filter papers and Petri dishes were collected to evaluate the aerosol splash points and the viral load of S6P-encoding plasmid in aerosols and splatters generated during the dental procedure.Results Aerosol splashing generated a localized pollution area extended up to 60 cm, with heightened contamination risks concentrated within a 30 cm radius. Significant differences in aerosol splash points and viral load by different turbine handpiece speeds under any cooling condition (P < 0.05) were detected. The highest level of aerosol splash points and viral load were observed when the handpiece speed was set at 40,000 rpm. Conversely, the lowest level of aerosol splash point and viral load were found at a handpiece speed of 10,000 rpm. Moreover, the aerosol splash points with higher viral load were more prominent in the positions of the operator and assistant compared to other positions. Additionally, the position of the operator exhibited the highest viral load among all positions.Conclusions To minimize the spread of aerosol and virus in clinics, dentists are supposed to adopt the minimal viable speed of a dental handpiece with limited cooling water during dental procedures. In addition, comprehensive personal protective equipment is necessary for both dental providers and dental assistants.

Management of odontogenic infections and sepsis: an update.

The management of odontogenic infections has improved over recent decades, but further improvements are still required. The ongoing education of GDPs and their dental teams on this issue continues to be important, especially during the current COVID-19 pandemic, where remote triage poses additional difficulties and challenges.Odontogenic infections can lead to sepsis, a potentially life-threatening condition caused by the body's immune system responding in an abnormal way. This can lead to tissue damage, organ failure and death. A patient with non-odontogenic-related infection could also present with sepsis at a dental practice. Early recognition and prompt management of sepsis improves outcomes. GDPs and their dental teams should be trained in the recognition and management of sepsis. Age-specific sepsis decision support tools have been developed by the UK Sepsis Trust to help dental staff recognise and manage patients with suspected sepsis.The aim of this article is to provide an update on the management of odontogenic infections and sepsis.

Psychological status of TMD patients, orthodontic patients and the general population during the COVID-19 pandemic.

Confronting the outbreak of COVID-19, this cross-sectional study was aimed to assess psychological status of temporomandibular disorders (TMD) patients, orthodontic patients and the general population in China during the pandemic. An online anonymous questionnaire was developed in Chinese, including the individual background information, the perception of the epidemic, and level of anxiety and depression through Kessler Psychological Distress Scale (K10). The respondents were divided into ORTHO group, TMD group and Control group. Descriptive analysis and multiple linear regression modelling were performed. In total, 1241 valid questionnaires were collected, covering 587 orthodontic patients and 220 TMD patients. It is shown that the overall mental health is not quite optimistic during the COVID-19 pandemic with the mean score of K10 being 18.65. TMD patients have higher level of anxiety and depression than orthodontic patients as well as the general population. Younger age, female gender, having close contact with individuals from Hubei province, higher self-rated infection possibility, concern about psychological barriers and distrust are negatively affecting patients' psychological status. Mental health care should be emphasized when hospitals and clinics reopen after the COVID-19 pandemic, especially to patients with these relevant characteristics.

Using A New Endodontic Tooth Model as an Alternative in Clinical Education Course During the Covid-19 Pandemic (preprint)

Background The COVID-19 pandemic massively impacts endodontic teaching and a dramatically reduced number of patients is registered in clinical courses. This could be countered with suitable training aids. Based on treatment errors made by students in the last five years of endodontic courses at RWTH Aachen University (Germany), a new artificial root canal treatment model (DRSK RCT) was developed. The model was aimed to be radiopaque and to simulate the tactile feel during instrumentation in a realistic manner. Unlike already existing 3D-printed tooth replicas, the RCT has anatomical root canals with a narrow lumen with its width matching an ISO size 6 endodontic file. Methodology 35 fourth-year students and seven dental demonstrators performed endodontic treatments on both the DRSK RCT and extracted teeth. Students and demonstrators answered a questionnaire on a scale ranging from 1 to 7 (poor to high) for different items (part 1). After the first study, changes in the materials and root canal anatomy were applied to the model. Then, the whole study was repeated and evaluated (part 2). Finally, it was evaluated whether the models could replace patient treatment during the Covid-19 pandemic. Results Ratings by students and dental instructors (5.1 ± 0.4 and 5.3 ± 1.5 [mean ± SD], respectively) in the first study increased after modifications of the DRSK RCT (5.5 ± 0.5 and 6.2 ± 0.8, respectively). Radiographs of the models were excellently assessable. The properties of the DRSK RCT were found to be realistic, thus allowing students to perform a satisfactory simulation of root canal treatment and being rated sufficient in substituting patient treatment during COVID-19 pandemic. Conclusion The analysis suggests that the DRSK RCT has the ability to improve endodontic technique and education. Visible root canals enable students to observe the treatment process. All steps of a regular root canal treatment can be simulated. Further studies are needed to investigate the outcome of treating the first patient after practicing on the DRSK RCT.

Late presentation of 'Lemierre's syndrome': how a delay in seeking healthcare and reduced access to routine services resulted in widely disseminated Fusobacterium necrophorum infection during the global COVID-19 pandemic.

The SARS-CoV-2 outbreak has disrupted the delivery of routine healthcare services on a global scale. With many regions suspending the provision of non-essential healthcare services, there is a risk that patients with common treatable illnesses do not receive prompt treatment, leading to more serious and complex presentations at a later date. Lemierre's syndrome is a potentially life-threatening and under-recognised sequela of an oropharyngeal or dental infection. It is characterised by septic embolisation of the gram-negative bacillus Fusobacterium necrophorum to a variety of different organs, most commonly to the lungs. Thrombophlebitis of the internal jugular vein is frequently identified. We describe an atypical case of Lemierre's syndrome involving the brain, liver and lungs following a dental infection in a young male who delayed seeking dental or medical attention due to a lack of routine services and concerns about the SARS-CoV-2 outbreak.