COVID-19 Dentistry-Related Aspects: A Literature Overview.

A new coronavirus (Sars-CoV-2) was detected in China at the end of 2019 and has since caused a worldwide pandemic. This virus is responsible for an acute respiratory syndrome (COVID-19), distinguished by a potentially lethal interstitial bilateral pneumonia. Because Sars-CoV-2 is highly infective through airborne contamination, the high infection risk in the dental environment is a serious problem for both professional practitioners and patients. This literature overview provides a description of the clinical aspects of COVID-19 and its transmission, while supplying valuable information regarding protection and prevention measures.

Psychological reactions to COVID-19 and epidemiological aspects of dental practitioners during lockdown in Italy.

BACKGROUND: Due to droplet production and exposure to saliva and blood, dental practitioners are at high risk of COVID-19 contagion during their routine procedures. The aim of this study was to investigate the behavior of Italian dentists and to analyze their reactions in relation to Sars-CoV-2 pandemic professional restrictive measures. METHODS: An online structured survey composed of 40 questions has been sent to dental practitioners all over Italy to investigate their behavior and to analyze their reactions in relation to Sars-CoV-2 pandemic restrictive measures introduced by the Italian national administrative order of 10 March 2020 (DM-10M20). RESULTS: 1109 dentists replied. To assess concerns and psychological responses the sample was divided into two groups based on the number of cases registered in their work area. In the first group were included all the responders working in the Italian regions that had more than 15,000 confirmed cases of COVID-19 as of April 29, 2020. The second group included responders working in the Italian regions that had less than 15,000 confirmed cases. The 45.2% of the respondents showed minimal anxiety, 34.5% showed mild anxiety, 13.9% showed moderate anxiety, while 6.4% showed a score indicative of a severe level of anxiety. CONCLUSIONS: The COVID-19-related emergency condition had a highly negative impact on dental practices in Italy. Those who completed the survey reported practice closure or reduction during the lockdown, and a high level of concern about the professional future for all dental practitioners. Concerns related to professional activity were accompanied by severe anxiety levels.

Epidemiological Aspects and Psychological Reactions to COVID-19 of Dental Practitioners in the Northern Italy Districts of Modena and Reggio Emilia.

The outbreak and diffusion of the Severe Acute Respiratory Syndrome-Coronavirus-2 (Sars-CoV-2) and COronaVIrus Disease 19 (COVID-19) have caused an emergency status in the health system, including in the dentistry environment. Italy registered the third highest number of COVID-19 cases in the world and the second highest in Europe. An anonymous online survey composed of 40 questions has been sent to dentists practicing in the area of Modena and Reggio Emilia, one of the areas in Italy most affected by COVID-19. The survey was aimed at highlighting the practical and emotional consequences of COVID-19 emergence on daily clinical practice. Specifically, it assessed dentists' behavioral responses, emotions and concerns following the Sars-CoV-2 pandemic restrictive measures introduced by the Italian national administrative order of 10 March 2020 (DM-10M20), as well as the dentists' perception of infection likelihood for themselves and patients. Furthermore, the psychological impact of COVID-19 was assessed by means of the Generalized Anxiety Disorder-7 test (GAD-7), that measures the presence and severity of anxiety symptoms. Using local dental associations (ANDI-Associazione Nazionale Dentisti Italiani, CAO-Commissione Albo Odontoiatri) lists, the survey was sent by email to all dentists in the district of Modena and Reggio Emilia (874 practitioners) and was completed by 356 of them (40%). All dental practitioners closed or reduced their activity to urgent procedures, 38.2% prior to and 61.8% after the DM-10M20. All reported a routinely use of the most common protective personal equipment (PPE), but also admitted that the use of PPE had to be modified during COVID-19 pandemic. A high percentage of patients canceled their previous appointments after the DM-10M20. Almost 85% of the dentists reported being worried of contracting the infection during clinical activity. The results of the GAD-7 (General Anxiety Disorder-7) evaluation showed that 9% of respondents reported a severe anxiety. To conclude, the COVID-19 emergency is having a highly negative impact on the activity of dentists practicing in the area of Modena and Reggio Emilia. All respondents reported practice closure or strong activity reduction. The perception of this negative impact was accompanied by feelings of concern (70.2%), anxiety (46.4%) and fear (42.4%). The majority of them (89.6%) reported concerns about their professional future and the hope for economic measures to help dental practitioners.

Drug-induced gingival enlargement: an overview.

The first documented case of drug-induced gingival enlargement was reported in 1939. Since that time, specific medications have been associated with this condition. Although the biologic mechanisms responsible for drug-mediated gingival enlargement remain unclear, a multifactorial etiology is considered to be responsible, with contributing factors including age, genetic predisposition, and local conditions. While the role of plaque remains to be completely elucidated, there is abundant clinical evidence demonstrating at least partial resolution of drug-induced gingival enlargement following improved plaque control. Variations in drug kinetics, gingival crevicular fluid concentrations, protein synthesis, and the presence of growth factors also might contribute to the mechanism of gingival overgrowth.

Treatment modalities for drug-induced gingival enlargement.

PURPOSE: This paper identifies 3 specific classifications of commonly prescribed medications that are known to cause gingival enlargement and describes surgical and non-surgical treatment therapies. Primary risks associated with drug-induced gingival enlargement, including increased dental decay and periodontal disease are also discussed. The precise bacterial etiology in gingival enlargement remains unclear, although sufficient evidence exists to support the role of good oral hygiene in decreasing the incidence and severity of gingival enlargement and improving overall gingival health. Etiology, treatment planning and coordination of care between physician, dentist or dental hygienist when indicated are important factors determining whether a surgical or non-surgical course of treatment should be considered.

Effect of local nifedipine administration on rat gingiva.

BACKGROUND: Nifedipine, a calcium channel-blocking agent, has been associated with gingival enlargement in humans. This enlargement has also been successfully established in animal models. Previous investigators have administered nifedipine through a systemic route, most commonly by oral intake. The aim of the present study was to measure the effects of nifedipine administered directly into rat gingival interproximal papillae. METHODS: Twenty-four adult female rats were assigned to three groups. Each animal received a series of three injections, one week apart; each injection was placed directly into the interdental papilla of the maxillary and mandibular central incisors. Group 1 (control) received only saline. Group 2 received a low (10 microg/ml) concentration of nifedipine, while Group 3 received a higher concentration (500 microg/ml). One week after the last series of injections, gingival specimens were harvested from the injection site and prepared for histological and immunocytochemical analyses. RESULTS: Specimens from Group 3 displayed a significantly greater number of ED2-positive cells compared to the other two groups. Specimens from Group 2 showed a significantly higher mean count of positive cells compared to Group 1. Collectively, our data suggest that repeated local injections of 10 microg/ml and 500 microg/ml nifedipine each elicit an inflammatory response in the gingival connective tissue. CONCLUSIONS: Immunocytochemical analysis revealed dose-dependent increases of resident tissue macrophages in rats receiving nifedipine (p<0.005). An increased inflammatory infiltrate also was observed via routine histology. Gross macroscopic changes consistent with gingival enlargement were not observed.