Estimating COVID-19 prevalence and infection control practices among US dentists

BackgroundUnderstanding the risks associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission during oral health care delivery and assessing mitigation strategies for dental offices are critical to improving patient safety and access to oral health care.MethodsThe authors invited licensed US dentists practicing primarily in private practice or public health to participate in a web-based survey in June 2020. Dentists from every US state (n = 2,195) answered questions about COVID-19–associated symptoms, SARS-CoV-2 infection, mental and physical health conditions, and infection control procedures used in their primary dental practices.ResultsMost of the dentists (82.2%) were asymptomatic for 1 month before administration of the survey; 16.6% reported being tested for SARS-CoV-2; and 3.7%, 2.7%, and 0% tested positive via respiratory, blood, and salivary samples, respectively. Among those not tested, 0.3% received a probable COVID-19 diagnosis from a physician. In all, 20 of the 2,195 respondents had been infected with SARS-CoV-2; weighted according to age and location to approximate all US dentists, 0.9% (95% confidence interval, 0.5 to 1.5) had confirmed or probable COVID-19. Dentists reported symptoms of depression (8.6%) and anxiety (19.5%). Enhanced infection control procedures were implemented in 99.7% of dentists’ primary practices, most commonly disinfection, COVID-19 screening, social distancing, and wearing face masks. Most practicing dentists (72.8%) used personal protective equipment according to interim guidance from the Centers for Disease Control and Prevention.ConclusionsCOVID-19 prevalence and testing positivity rates were low among practicing US dentists. This indicates that the current infection control recommendations may be sufficient to prevent infection in dental settings.Practical ImplicationsDentists have enhanced their infection control practices in response to COVID-19 and may benefit from greater availability of personal protective equipment. ClinicalTrials.gov: NCT04423770.     

COVID-2019 fundamentals

BackgroundA novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified at the end of 2019. The disease caused by SARS-CoV-2 was named COVID-19. The main purpose of this review was to provide an overview of SARS-CoV-2.MethodsThe authors searched the MEDLINE database for clinical studies related to virus characteristics, pathogenesis, diagnosis, transmission mechanisms, and treatment options.ResultsAs of January 27, 2021, the number of infected people and deaths associated with COVID-19 worldwide were approximately 100 million and 2 million, respectively. The manifestations of COVID-19 are variable, and the severity is affected by age and preexisting medical conditions. Children and adolescents are usually asymptomatic or have mild symptoms. Older adults, in comparison, may experience severe illness and have disproportionally elevated mortality. Among those who survive, some may experience enduring deficits. The viral load is particularly elevated in saliva and oropharynx, which constitute potential sources of infection. The diagnosis of the disease may be confounded by factors related to the replicating cycle of the virus, viral load, and sensitivity of the diagnostic method used. As of January 2021, COVID-19 has no cure but can be prevented. Its treatment is based on supportive care along with antiviral medications and monoclonal antibodies. In severe cases with multiorgan involvement, mechanical ventilation, dialysis, and hemodynamic support may be necessary.ConclusionsCOVID-19 is a transmittable disease with a variable course. A substantial number of patients, particularly children, remain asymptomatic. Important advances have been made in the development of new treatments. However, the mortality in vulnerable populations remains elevated.Practical ImplicationsThe elevated viral load in the oral cavity and pharynx suggests that oral health care professionals could get infected through occupational exposure. Providers should understand the variables that influence the yield of diagnostic studies because false-negative results can occur.     

Impact of SARS-CoV-2 on saliva: TNF-⍺, IL-6, IL-10, lactoferrin,lysozyme, IgG,IgA, and IgM

ObjectivesUnderstanding the role of certain salivary components, such as TNF-?, IL-6, IL-10, lactoferrin, lysozyme, IgG, IgA, and IgM, in airway defense during the ongoing SARS-CoV-2 pandemic is essential. The salivary immune barrier of patients with COVID-19 may play a role in their prognosis. The present study aims to evaluate the impact of SARS-CoV-2 on saliva composition.MethodsA longitudinal study was carried out with male and female firefighters aged 24–48 years. The study sample (n = 34) was divided into 3 groups: asymptomatic volunteers with a negative polymerase chain reaction (PCR) test for SARS-CoV-2 (group 1, Control, n = 21); patients with symptoms of COVID-19 of less than 7 days’ duration and a diagnosis of SARS-CoV-2 infection by PCR (group 2, COVID-19, n = 13); and recovered patients from group 2 who were free of COVID-19 symptoms for at least 2 months (group 3, post-COVID-19 recovery, n = 13). All groups underwent real-time PCR to detect the presence of SARS-CoV-2, as well as analysis of the salivary concentrations of TNF-?, IL-6, IL-10, lactoferrin, lysozyme, IgG, IgA, and IgM by the ELISA method.ResultsLactoferrin concentrations were significantly decreased in the infected group (COVID-19) when compared to those not infected by SARS-CoV-2 (control) (p = 0.032). IgA concentrations were decreased in the COVID-19 and post-COVID-19 groups compared to the control group (p = 0.005 and p = 0.016, respectively). Comparison of the COVID-19 and post-COVID-19 groups also revealed an increase in IgM concentrations during acute SARS-CoV-2 infection (p = 0.010).ConclusionSARS-CoV-2 alters the composition of the salivary immune barrier.     

Testing for COVID-19 in dental offices: Mechanism of action,application, and interpretation of laboratory and point-of-care screening tests

BackgroundThe dental office potentially possesses all transmission risk factors for severe acute respiratory syndrome coronavirus 2. Anticipating the future widespread use of COVID-19 testing in dental offices, the authors wrote this article as a proactive effort to provide dental health care providers with current and necessary information surrounding the topic.MethodsThe authors consulted all relevant and current guidelines from the Centers for Disease Control and Prevention and the US Food and Drug Administration, as well as online resources and review articles.ResultsRoutine COVID-19 screening and triage protocols are unable to detect all infected people. With the advancements in diagnostic tools and techniques, COVID-19 testing at home or in the dental office may provide dentists with the ability to evaluate the disease status of their patients. At-home or point-of-care (POC) tests, providing results within minutes of being administered, would allow for appropriate measures and rapid decisions about dental patients' care process. In this review, the authors provide information about available laboratory and POC COVID-19 screening methods and identify and elaborate on the options available for use by dentists as well as the regulatory requirements of test administration.ConclusionsDentists need to be familiar with COVID-19 POC testing options. In addition to contributing to public health, such tests may deliver rapid, accurate, and actionable results to clinical and infection control teams to enhance the safe patient flow in dental practices.Practical ImplicationsOral health care must continue to offer safety in this or any future pandemics. Testing for severe acute respiratory syndrome coronavirus 2 at the POC offers a control mechanism contributing to and enhancing the real and perceived safety of care in the dental office setting.     

Pandemics past,present, and future: Their impact on oral health care

BackgroundPandemics have significantly modified our societal behaviour over the millennia, and the COVID-19 pandemic is no exception.Types of Articles ReviewedIn this article, the authors review the history of pandemics, the probable reasons for their emergence, and the COVID-19 pandemic due to the severe acute respiratory syndrome virus 2 (SARS-CoV-2) and its variants, as well as its possible impact on dentistry during the postpandemic period.ResultsThere are multiple reasons why catastrophic pandemics occur due to new infectious organisms that cross the species barrier from animals to humans. These include, population explosion, mass migration, and prolonged survival of debilitated and susceptible cohorts on various immunosuppressants. Coupled with global warming and the resultant loss of habitats, such vicissitudes of humans and nature lead to microbes evolving and mutating at an exponential pace, paving the way for pandemics. The contemporary epidemics and pandemics beginning with the HIV pandemic have modulated dentistry beyond recognition, now with assiduous and robust infection control measures in place.Conclusions and Practical ImplicationsBecause COVID-19 may become an endemic disease, particularly due to emerging SARS-CoV-2 variants the dental community should adopt modified infection control measures, teledentistry, and point-of-care diagnostics, among other measures. It is likely, that clinical ecosystems in future would be rendered even safer by predicting how pathogens evolve and priming the human immune system for the next wave of microbial combatants through vaccines produced using deep mutational scanning in which artificial intelligence and machine learning can predict the next variants even before their arrival.     

Saliva diagnostics: Salivaomics,saliva exosomics,and saliva liquid biopsy

BackgroundEach day, humans produce approximately 0.5 through 1.5 liters of saliva, a biofluid that is rich in biological omic constituents. Our lack of understanding how omic biomarkers migrate from diseased tissue to the saliva has impeded the clinical translation of saliva testing. Although such biomarkers must be conveyed via the vascular and lymphatic systems to the salivary glands, the molecular mechanisms that underlie this transport remain unclear. Although COVID-19 highlighted the need for rapid and reliable testing for infectious diseases, it represents only one of the many health conditions that potentially can be diagnosed using a saliva sample.Types of Studies ReviewedThe authors discuss salivaomics, saliva exosomics, and the mechanisms on which saliva diagnostics are based and introduce a novel electrochemical sensing technology that may be exploited for saliva liquid biopsy.ResultsThe utility of saliva for screening for lung cancer is under investigation. Saliva testing may be used to stratify patients, monitor treatment response, and detect disease recurrence. The authors also highlight the landscapes of saliva-based SARS-CoV-2 testing and ultrashort cell-free DNA and outline how these fields are likely to evolve in the near future.Practical ImplicationsBreakthroughs in the study of saliva research, therefore, will facilitate clinical deployment of saliva-based testing.     

Is hydrogen peroxide an effective mouthwash for reducing the viral load of SARS-CoV-2 in dental clinics?

BackgroundPrevious studies have demonstrated that SARS-CoV-2 is mainly transmitted by inhalation of aerosols and can remain viable in the air for hours. Viruses can spread in dental settings and put professionals and patients at high risk of infection due to proximity and aerosol-generating procedures, and poor air ventilation.ObjectivesThe aim of this study was to investigate the effects of a 1% hydrogen peroxide (H₂O₂) mouth rinse on reducing the intraoral SARS-CoV-2 load.MethodsPortable air cleaners with HEPA filters exposed for 3 months were analysed to test for virus presence in a waiting room (where patients wore a face mask but did not undergo mouth rinsing) and three treatment rooms (where patients wore no mask but carried out mouth rinsing). As CO₂ is co-exhaled with aerosols containing SARS-CoV-2 by COVID-19 infected people, we also measured CO₂ as a proxy of infection risk indoors. Specific primer and probe RT-PCR were applied to detect viral genomes of the SARS-CoV-2 virus in the filters. Specifically, we amplified the nucleocapsid gene (Nuclv) of SARS-CoV-2.ResultsCO₂ levels ranged from 860 to 907 ppm, thus indicating low ventilation and the risk of COVID-19 transmission. However, we only found viral load in filters from the waiting room and not from the treatment rooms. The results revealed the efficiency of 1-minute mouth rinsing with 1% H₂O₂ since patients rinsed their mouths immediately after removing their mask in the treatment rooms.ConclusionsOur findings suggest that dental clinics would be safer and more COVID-19 free by implementing mouth rinsing 1 min with 1% H₂O₂ immediately after the patients arrive at the clinic.     

The incidence of COVID-19 among dentists practicing in the community in Canada: A prospective cohort study over a 6-month period

BackgroundOral health care settings carry a potentially high risk of causing cross-infection between dentists and patients and among dental staff members due to close contact and use of aerosol-generating procedures. The authors aimed to estimate COVID-19 incidence rates among Canadian dentists over a 6-month period.MethodsThe authors conducted a prospective cohort study of 644 licensed dentists across Canada from July 29, 2020, through February 12, 2021. An online questionnaire, adapted from the World Health Organization’s Unity Studies protocols for assessment of COVID-19 risk among health care workers, was used to collect data on self-reported severe acute respiratory syndrome coronavirus 2 infections every 4 weeks. A bayesian Poisson model was used to estimate the incidence rate and corresponding 95% credible intervals (CIs).ResultsMedian age of participants was 47 years; most participants were women (56.4%) and general practitioners (90.8%). Median follow-up time was 188 days. Six participants reported COVID-19 infections during the study period, giving an incidence rate of 5.10 per 100,000 person-days (95% CI, 1.86 to 9.91 per 100,000 person-days). The incidence proportion was estimated to be 1,084 per 100,000 dentists (95% CI, 438 to 2,011 per 100,000 dentists) and 1,864 per 100,000 people (95% CI, 1,859 to 1,868 per 100,000 people) in the Canadian population during the same period.ConclusionsThe low infection rate observed among Canadian dentists from July 29, 2020, through February 12, 2021, should be reassuring to the dental and general community.Practical ImplicationsAlthough the infection rates were low among Canadian dentists, it is important to continue to collect disease surveillance data.     

Severe acute respiratory syndrome coronavirus 2 infection in asymptomatic pediatric dental patients

BackgroundChildren with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are typically asymptomatic but contagious. The authors investigated the positivity rate of asymptomatic SARS-CoV-2 infection in pediatric dental patients.MethodsThe authors reviewed consecutive charts of children younger than 18 years scheduled for elective dental procedures from April 1, 2020, through August 1, 2020. All patients were screened for signs and symptoms of SARS-CoV-2 infection. Asymptomatic patients scheduled for dental procedures underwent polymerase chain reaction (PCR) testing for SARS-CoV-2. Sociodemographic characteristics were abstracted, and positivity rates were calculated. Variables for patients who were SARS-CoV-2 positive and SARS-CoV-2 negative were compared using Fisher exact and Mann-Whitney U tests.ResultsThe sample size was 921. The median age was 6 years, and 50.9% were boys. The overall SARS-CoV-2 positivity rate was 2.3%. Age, insurance status, medical history, and dental diagnosis were comparable in patients who were SARS-CoV-2 positive and SARS-CoV-2 negative. Positivity rates were statistically higher for Hispanic or Latinx patients than other groups (P = .038).ConclusionsAlthough the yield of testing was low, the systematic evaluation of asymptomatic pediatric dental cases via PCR resulted in the identification of SARS-CoV-2 carriers who could have been infectious. In this study, Hispanics or Latinx had a higher positivity rate than other demographic groups.Practical ImplicationsPCR testing for SARS-CoV-2 of asymptomatic patients in pediatric dentistry adds value to the use of screening questionnaires for the identification of infected people who could be contagious.     

The effect of mouthrinses on severe acute respiratory syndrome coronavirus 2 viral load: A systematic review

BackgroundConsidering that the oral cavity is a major entryway and reservoir for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the aim of the authors was to perform a systematic review of in vivo and in vitro studies to assess the effectiveness of mouthrinses on SARS-CoV-2 viral load.Types of Studies ReviewedThe authors searched PubMed, Web of Science, Scopus, MedRxiv, and bioRxiv databases, including in vitro and in vivo studies assessing the virucidal effect of mouthrinses on SARS-CoV-2 or surrogates. From a total of 1,622 articles retrieved, the authors included 39 in this systematic review.ResultsPovidone-iodine was the most studied mouthrinse (14 in vitro and 9 in vivo studies), frequently showing significant reductions in viral load in in vitro assays. Similarly, cetylpyridinium chloride also showed good results, although it was evaluated in fewer studies. Chlorhexidine gluconate and hydrogen peroxide showed conflicting results on SARS-CoV-2 load reduction in both in vitro and in vivo studies.Practical ImplicationsPovidone-iodine–based mouthrinses appear to be the best option as an oral prerinse in the dental context for SARS-CoV-2 viral load reduction. Although the results of primary studies are relevant, there is a need for more in vivo studies on mouthrinses, in particular, randomized controlled clinical trials, to better understand their effect on SARS-CoV-2 viral load and infection prevention.     

COVID-19 vaccine acceptance and hesitancy among dental and medical students

BackgroundDental students (DS) and medical students (MS) are exposed to COVID-19. It is important to achieve high COVID-19 vaccination coverage rates in both of these groups. The authors developed a survey to assess COVID-19 vaccine hesitancy among MS and DS.MethodsThe authors conducted the study at 3 US dental schools and 1 US medical school using an online survey that assessed previous immunization behavior, attitudes about and perceptions of COVID-19 vaccines, and personal experience with COVID-19.ResultsA total of 248 DS and 167 MS completed the survey. Forty-five percent of DS and 23% of MS were hesitant about receiving the COVID-19 vaccine. Results of bivariate analyses found that MS were 2.7 times more likely than DS to receive the vaccine (odds ratio, 2.74; 95% CI, 1.76 to 4.31; P = .0001). Although DS were more likely than MS (P < .05) to have had COVID-19 and to personally know someone who had COVID-19, MS were more likely to agree with mandates and trust information about the vaccines. In multivariable analyses, after controlling for demographic variables, experience with COVID-19, and personal vaccination behaviors, being a MS or DS was no longer predictive of willingness to get the vaccine.ConclusionsThese results highlight the need for profession-specific curricula designed to enhance student knowledge about the vaccines and vaccine counseling skills.Practical ImplicationsThe American Dental Association supports dentists administering vaccines, including the COVID-19 vaccines. Dentists and DS should be willing to receive the vaccines themselves. Education about the vaccines is needed to improve uptake.     

Oral manifestations of COVID-2019–related multisystem inflammatory syndrome in children: a review of 47 pediatric patients

BackgroundAlthough much is still unknown about the full effects of COVID-19, literature from the early stages of the COVID-19 pandemic (spring and summer 2020) supports a postviral immunologic reaction resulting in a multisystem inflammatory syndrome in children (MIS-C). The purpose of this study was to report the rates of documented oral and oropharyngeal manifestations among these patients and to determine the association of these findings with other MIS-C symptoms.MethodsThe authors conducted a retrospective review of pediatric patients with COVID-19 who were admitted to the Morgan Stanley Children’s Hospital of NewYork-Presbyterian. Patients fulfilling the Centers for Disease Control and Prevention criteria for MIS-C were included in this study. The documented signs, symptoms, and laboratory values were collected and compared with the presence of oral or oropharyngeal findings.ResultsThe mean (standard deviation) age of MIS-C patients was 9.0 (5.0) years (range, 1.3-20.0 years), and there was no obvious sex difference (51.1% male, 48.9% female). With respect to oral findings, 23 patients (48.9%) had red or swollen lips, whereas only 5 (10.6%) had a strawberry tongue. Oral or oropharyngeal findings were associated significantly with the presence of systemic rash (P = .04) and conjunctivitis (P = .02).ConclusionsThe presence of oral or oropharyngeal changes may be an early indicator of MIS-C and should be considered suggestive of MIS-C in the setting of COVID-19 infection.Practical ImplicationsDental care providers may play an integral role both in the early detection of oral manifestations of MIS-C and in the identification of oral lesions in hospitalized patients with confirmed MIS-C.     

Dysgeusia: A review in the context of COVID-19

BackgroundTaste disorders in general, and dysgeusia in particular, are relatively common disorders that may be a sign of a more complex acute or chronic medical condition. During the COVID-19 pandemic, taste disorders have found their way into the realm of general as well as specialty dentistry, with significance in screening for patients who potentially may have the virus.Types of Studies ReviewedThe authors searched electronic databases (PubMed, Embase, Web of Science, Google Scholar) for studies focused on dysgeusia, ageusia, and other taste disorders and their relationship to local and systemic causes.ResultsThe authors found pertinent literature explaining the normal physiology of taste sensation, proposals for suggested new tastes, presence of gustatory receptors in remote tissues of the body, and etiology and pathophysiology of taste disorders, in addition to the valuable knowledge gained about gustatory disorders in the context of COVID-19. Along with olfactory disorders, taste disorders are one of the earliest suggestive symptoms of COVID-19 infection.ConclusionsGustatory disorders are the result of local or systemic etiology or both. Newer taste sensations, such as calcium and fat tastes, have been discovered, as well as taste receptors that are remote from the oropharyngeal area. Literature published during the COVID-19 pandemic to date reinforces the significance of early detection of potential patients with COVID-19 by means of screening for recent-onset taste disorders.Practical ImplicationsTimely screening and identification of potential gustatory disorders are paramount for the dental care practitioner to aid in the early diagnosis of COVID-19 and other serious systemic disorders.     

US dental health care workers’ mental health during the COVID-19 pandemic

BackgroundThis study was designed to assess the prevalence of anxiety and depression symptoms and understand factors influencing mental health among dental health care workers (DHCWs) during the COVID-19 pandemic.MethodsBeginning in June 2020, 8,902 DHCWs participated monthly in an anonymous longitudinal, web-based survey (response rate, 6.7%). The Patient Health Questionnaire-4 was used to estimate rates of anxiety and depression symptoms. Changes in mental health over time and differences by demographic and practice characteristics, COVID-19 community transmission level, and COVID-19 vaccination status were tested using χ² tests and multilevel multivariable logistic regression.ResultsAnxiety symptom rates peaked in November 2020 (28% of dental hygienists, 17% of dentists) and declined to 12% for both professions in May 2021. Depression symptom rates were highest in December 2020 (17% of dental hygienists, 10% of dentists) and declined to 8% in May 2021. Controlling for gender, age, race or ethnicity, and COVID-19 community transmission level, the authors found that dentists had significantly lower odds of anxiety symptoms (adjusted odds ratio [aOR], 0.82; 95% CI, 0.70 to 0.95) and depression symptoms (aOR, 0.79; 95% CI, 0.67 to 0.93) than dental hygienists. Compared with vaccinated respondents, those who were unvaccinated but planning on getting vaccinated had significantly higher rates of anxiety (aOR, 1.71; 95% CI, 1.20 to 2.44) and depression (aOR, 1.57; 95% CI, 1.07 to 2.29) symptoms.ConclusionsDHCWs’ mental health fluctuated during the pandemic. Anxiety and depression in DHCWs were associated with demographic and professional characteristics as well as perceived risk of COVID-19.Practical ImplicationsMental health support should be made available for DHCWs.This clinical trial was registered at ClinicalTrials.gov. The registration numbers are NCT04423770 and NCT04542915.     

COVID-19 vaccine hesitancy and reasons for or against adherence among dentists

BackgroundCOVID-19 has spread widely among health care workers. Oral health care workers have an increased risk of being infected owing to dental practice characteristics. New, effective vaccines against COVID-19 have been approved for use. The authors aim was to evaluate intentions to be vaccinated against COVID-19 in a population of dentists and identify factors associated with their intentions.MethodsThe authors conducted an anonymous online survey among 761 dentists enrolled at the Board of Physicians and Dentists of the District of Monza Brianza, Monza, Italy. The authors collected data on demographic characteristics, influenza vaccine uptake, COVID-19 history, vaccine attitudes, and specific reasons for their intentions to be vaccinated against COVID-19 or not.ResultsOverall, 421 dentists completed the survey. More than 82% of the participants declared their intention to be vaccinated against COVID-19. The multivariate logistic regression model reported a positive association with receiving the influenza vaccine in the 2020-2021 influenza season (odds ratio, 5.15; 95% CI, 2.14 to 12.39) and a negative association with receiving a diagnosis of COVID-19 previously (odds ratio, 0.32; 95% CI, 0.15 to 0.66). The participants’ main reason for supporting vaccination was to protect their family and friends (87%) and their main reason for opposing vaccination was the lack of information (39%).ConclusionsIt is fundamental to consider vaccine hesitancy in health care workers and address it properly because they must provide recommendations to patients and promote adherence to vaccination programs.Practical ImplicationsThe vaccination of dental practitioners should be prioritized owing to the high risk related to dental practice.     

Willingness and ability of oral health care workers to work during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic continues to disrupt dental practice in the United States. Oral health care workers play an integral role in societal health, yet little is known about their willingness and ability to work during a pandemic.MethodsOral health care workers completed a survey distributed on dental-specific Facebook groups during an 8-week period (May 1-June 30, 2020) about their willingness and ability to work during the COVID-19 pandemic, barriers to working, and willingness to receive a COVID-19 vaccine.ResultsFour hundred and fifty-nine surveys were returned. Only 53% of dentists, 33% of dental hygienists, 29% of dental assistants, and 48% of nonclinical staff members would be able to work a normal shift during the pandemic, and even fewer (50%, 18%, 17%, and 38%, respectively) would be willing to work a normal shift. Barriers included caring for family, a second job, and personal obligations, and these were faced by dental assistants and hygienists. Dentists were more likely than hygienists (P < .001), assistants (P < .001), and nonclinical staff members (P = .014) to receive a COVID-19 vaccine.ConclusionsOral health care workers have a decreased ability and willingness to report to work during a pandemic, and dentists are significantly more able and willing to work than hygienists and assistants. Dentists are more likely than staff to receive a COVID-19 vaccine.Practical ImplicationsThe results of this study may help inform future initiatives of dental workforce readiness during a pandemic. Dentists should be prepared to discuss alterations to standard operating procedures to allay staff members’ fears and improve retention rates during pandemics, allowing for improved access to oral health care.     

Antiviral effect of mouthwashes against SARS-COV-2: A systematic review

ObjectiveThis systematic review aimed to evaluate the antiviral effect of mouthwashes against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).Material and methodsAn electronic search was performed on PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ProQuest, and Google Scholar, and was complemented by a manual search. Both clinical and in vitro studies that focused on the antiviral effect of mouthwashes against SARS-CoV-2 were included. Risk of bias assessment was performed only on the clinical studies using the RoB-2 and ROBINS-I tools.ResultsA total of 907 records were found; after initial selection by title and abstract, 33 full-text articles were selected to be evaluated for eligibility. Finally, a total of 27 studies were included for the qualitative synthesis, including 16 in vitro studies and 11 clinical trials. Antiviral effects were evaluated separately for the in vitro and clinical studies. In vitro studies included mouthwashes containing hydrogen peroxide, chlorhexidine digluconate, povidone-iodine, essential oils, cetylpyridinium chloride, and other compounds; in vivo studies included mouthwashes containing hydrogen peroxide, chlorhexidine digluconate, povidone-iodine, cetylpyridinium chloride, essential oils, chlorine dioxide, β-cyclodextrin-citrox, and sorbitol with xylitol. Povidone-iodine, cetylpyridinium chloride, and essential oils were effective in vitro, while hydrogen peroxide, chlorhexidine digluconate, povidone-iodine, cetylpyridinium chloride, β-cyclodextrin-citrox, and sorbitol with xylitol were effective in vivo. Unclear or high risk of bias was found for almost all clinical studies, and only one study presented with a low risk of bias. No further quantitative analysis was performed.ConclusionAlthough povidone-iodine, cetylpyridinium chloride, and essential oils may be an alternative to reduce the viral load in vitro and in vivo, more studies are needed to determine the real antiviral effect of these different mouthwashes against SARS-CoV-2.This work was not funded. The protocol was registered in PROSPERO (identification number: CRD42021236134).     

Caregiver acceptance of an anticipated COVID-19 vaccination

BackgroundThe world is hopeful a vaccine will help mitigate the COVID-19 pandemic. The authors conducted a hospital-based study using a questionnaire to examine parental acceptance of an anticipated COVID-19 vaccination.MethodsA 41-item questionnaire using the Health Belief Model was administered to caregivers of children receiving oral health care in a dental clinic in an urban pediatric teaching hospital. Demographic, health-seeking, and health-behavior questions were assessed.ResultsA total of 39.2% of caregivers would not allow their child to receive a COVID-19 vaccination. Whereas 27.8% of caregivers agreed that if their physician recommends a COVID-19 vaccination, they will allow their child to receive it, 52.2% said that a health care professional could influence this decision.ConclusionsDentists, intimately aware of the suggested risks of aerosol-generating procedures, can play a critical role in educating the public about the importance of accepting a COVID-19 vaccine.Practical ImplicationsDentists are in a unique position to discuss and advocate for vaccine acceptance. If a COVID-19 vaccine is not widely accepted, risks associated with performing aerosol-generating procedures will remain.