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.     

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.     

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-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.     

The impact of COVID-19 lockdown on maintenance of children's dental health: A questionnaire-based survey

BackgroundThe COVID-19 pandemic has been associated with several changes in maintenance of children's dental health. The aim of this study was to evaluate the extent of these changes.MethodsParents were asked to respond anonymously to a questionnaire regarding alterations in their children's oral habits, such as frequency of eating and drinking, toothbrushing, signs of stress, and receiving oral health care during the lockdown period. The participants were reached either during their visit to the clinics or via the social media groups of the authors.ResultsThere were 308 parents of children aged 1 through 18 years who responded to the questionnaires. The authors found associations between increased frequency of eating and drinking, decreased frequency of toothbrushing, and postponing oral health care. Among the children, 11% experienced more frequent oral signs of stress, such as temporomandibular disorder and aphthous stomatitis, during the lockdown. Although children from all age groups ate and drank more frequently between meals, younger children received a diagnosis of carious lesions more often during the lockdown (P = .015).ConclusionsDuring the lockdown, many children changed their eating, drinking, and toothbrushing habits and, thus, increased their risk of developing caries.Practical ImplicationsDuring pandemic-associated re-care visits or recall visits, it is imperative to conduct a detailed interview regarding changes in oral health habits. In children at high risk, dentists recommended more diagnostic and preventive measures to prevent deterioration of their oral health. Moreover, dentists should put more emphasis on motivational interviewing to help children resume healthier routines after the lockdown.     

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.     

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.     

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.     

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.     

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.     

COVID-19 among dentists in the United States: A 6-month longitudinal report of accumulative prevalence and incidence

BackgroundIn 2020, the Centers for Disease Control and Prevention and the American Dental Association released COVID-19 infection control interim guidance for US dentists, advising the use of optimal personal protection equipment during aerosol-generating procedures. The aim of this longitudinal study was to determine the cumulative prevalence and incidence rates of COVID-19 among dentists and to assess their level of engagement in specific infection control practices.MethodsUS dentists were invited to participate in a monthly web-based survey from June through November 2020. Approximately one-third of initial respondents (n = 785) participated in all 6 surveys, and they were asked about COVID-19 testing received, symptoms experienced, and infection prevention procedures followed in their primary practice.ResultsOver a 6-month period, the cumulative COVID-19 infection prevalence rate was 2.6%, representing 57 dentists who ever received a diagnosis of COVID-19. The incidence rates ranged from 0.2% through 1.1% each month. The proportion of dentists tested for COVID-19 increased over time, as did the rate of dentists performing aerosol-generating procedures. Enhanced infection prevention and control strategies in the dental practice were reported by nearly every participant monthly, and rates of personal protection equipment optimization, such as changing masks after each patient, dropped over time.ConclusionsUS dentists continue to show a high level of adherence to enhanced infection control procedures in response to the ongoing pandemic, resulting in low rates of cumulative prevalence of COVID-19. Dentists are showing adherence to a strict protocol for enhanced infection control, which should help protect their patients, their dental team members, and themselves.Practical ImplicationsCOVID-19 infections among practicing dentists will likely remain low if dentists continue to adhere to guidance.     

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.     

Multifaceted impact of COVID-19 on dental practice: American dental care professionals prepared and ready during unprecedented challenges

BackgroundThe purpose of this study was to evaluate the multifaceted impact of the COVID-19 pandemic on dental practices and their readiness to resume dental practice during arduous circumstances.MethodsThe authors distributed an observational survey study approved by The University of Texas Health Science Center at San Antonio Institutional Review Board to dental care practitioners and their office staff members using Qualtrics XM software. The survey was completed anonymously. The authors analyzed the data using R statistical computing software, χ² test, and Wilcoxon rank sum test.ResultsNearly all participants (98%) felt prepared to resume dental practice and were confident of the safety precautions (96%). Only 21% of dentists felt the COVID-19 pandemic changed their dental treatment protocols, with at least two-thirds agreeing that precautions would influence their efficiency adversely. Although most participants were satisfied with the resources their dental practice provided for support during the pandemic (95%), most were concerned about the impact on their general health and safety (77%) and to their dental practice (90%), found working during the pandemic difficult (≈ 60%), and agreed there are challenges and long-term impacts on the dental profession (> 75%).ConclusionsDental care professionals, although affected by the COVID-19 pandemic and at high risk of developing COVID-19, were prepared to resume dental practice during most challenging circumstances.Practical ImplicationsThe pandemic has affected dental care practitioners substantially; thus, there is need to formulate psychological interventions and safety precautions to mitigate its impact. Further research should evaluate the long-term effects on dentistry and oral health and interceptive measures for better communication and programming around future challenges.     

Frequency and pattern of outpatient dental visits during the COVID-19 pandemic at hospital and community clinics

BackgroundThe authors aimed to measure the frequency of dental visits before and during the COVID-19 pandemic and to evaluate whether dental visits can be predicted from demographic characteristics, socioeconomic status, oral problem diagnoses, and dental service providers.MethodsParticipants for this retrospective study were patients visiting dental care providers at hospital- and community-based outpatient clinics in Alberta, Canada. Data were retrieved from electronic databases from March 12, 2020, through September 30, 2020, and from the same period for 2018 and 2019. The COVID-19 lockdown was declared for March 12 through May 14, 2020. Data were analyzed using analysis of variance test and multiple logistic regression at α = 0.05.ResultsFrom a total of 14,319 dental visits, 5,671, 5,036, and 3,612 visits occurred in 2018, 2019, and 2020, respectively. The mean (standard deviation) frequency of daily visits was 36.69 (15.64), 32.09 (15.51), and 24.24 (14.78), respectively. Despite the overall decrease, the frequency of visits for infections, salivary problems, and temporomandibular disorders increased during the COVID-19 pandemic in 2020. Dental visits during the pandemic were associated with more complicated oral diagnoses and dental services as well as higher economic status.ConclusionsDuring the COVID-19 pandemic, the frequency of dental visits decreased specifically during lockdown. Patients with complicated problems requiring urgent treatments mainly visited dental clinics. Reduced access to care was observed primarily among socially disadvantaged groups.Practical ImplicationsAlthough guidelines and related recommendations have been effective in restoring the compromised dental system during the COVID-19 pandemic, additional modifications are needed to promote in-person visits to improve the oral health status of patients.     

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.     

Biofilm on and structural damage of rotary cutting instruments after 5 cycles of clinical use and processing

BackgroundRotary cutting instruments (RCIs) are sterilized routinely. The authors aimed to analyze the structural integrity, presence of dirt, and microbial contamination of RCIs used in clinical practice after processing.MethodsEighty-four RCIs (42 carbide burs, 42 diamond burs) were divided into baseline, control, and test groups. The RCIs were evaluated by means of scanning electron microscopy and microbiological analysis. Evaluation criteria included presence of structural damage, dirt, biofilm, and isolated cells and their phenotypic profile.ResultsThe carbide burs from all groups and diamond burs from the test groups had structural damage. Dirt was observed in the baseline and test groups. Three bacterial species were isolated from 4 RCIs (9.52%). An isolated cell was observed from 1 carbide bur. Biofilm was observed on 3 RCIs (7.14%).ConclusionsRCIs should not be subjected to multiple uses; after the first clinical use they accumulate structural damage and dirt that hampers the cleaning step, causing failure in the sterilization process.Practical ImplicationsThe presence of microorganisms and structural damage on the RCIs confirmed that they are not amenable to processing, a fact that characterizes them as a single-use health care product.     

Association of MMP9, MMP13 and MMP20 genes polymorphism with dental caries: A meta-analysis

ObjectivesGenetic factors can be involved in dental caries as the most common chronic oral diseases. The association between polymorphism of MMP9, MMP13 and MMP20 genes with tooth decay has been studied but contradictory outcomes have been indicated. Thus, a meta-analysis was done to get comprehensive outcomes in this path.Materials and methodsAll articles in English by March 2022 were searched with correlated keywords from known database as PubMed, Scopus, Embase and Web of Science, and the articles were selected in several stages based on exclusion and inclusion criteria. Comprehensive meta-analysis software v.2.0 was used for Meta-analysis.ResultsFinally, 11 related articles were selected for meta-analysis. According to the results, MMP9 and MMP20 polymorphisms were not related with increased susceptibility to caries in the studied models, but in the case of MMP13, a significant association was observed between gene polymorphism and caries risk.ConclusionThe results about MMP13 gene polymorphism showed that guanine G allele and GG genotype have a protective role and decrease the risk of dental caries. It should be noted that, these conclusions could be promoted by studies contain large sample sizes. Finding the genetic factors influencing tooth decay can help increase our current knowledge of caries pathology, predict its occurrence, and target genes at the molecular level to prevent it.