COVID-19 Management in Clinical Dental Care Part III: Patients and the Dental Office

The coronavirus 2019 (COVID-19) pandemic dramatically changed all aspects of life. In the context of clinical dental care, a significant number of new recommendations have been implemented to comply with public health policies, ensuring the safety of dental care professionals, staff, and patients and preventing further spread of the virus. This article is the third in a series of 3 on the management of COVID-19 in clinical dental care and presents a set of recommendations and standards to be implemented in the context of the COVID-19 pandemic. These include remote contact with all patients for triage and guidance before scheduling a clinical visit to know if they have COVID symptoms or are positive for COVID, if they belong to a risk group, and if there is a suggestion that aerosol-generating procedures (AGPs) will be required during their visit. It also reviews additional precautionary measures in the waiting room and reception area, where the environment is reorganised to protect patients and clinical staff, avoiding situations that could result in cross contamination. The dental office operates under a strict set of guidelines, namely, use of personal protective equipment by professionals, contact with patients, a strategy to avoid aerosol-generating procedures, as well as disinfection procedures for the dental office before, during, and after each patient visit. The implementation of these protocols to mitigate cross infection and spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the dental office will help improve safety and restore the confidence required to provide dental care to patients during the COVID-19 pandemic.     

Coronavirus Disease 19 (COVID-19): Implications for Clinical Dental Care

The recent spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated coronavirus disease has gripped the entire international community and caused widespread public health concerns. Despite global efforts to contain the disease spread, the outbreak is still on a rise because of the community spread pattern of this infection. This is a zoonotic infection, similar to other coronavirus infections, that is believed to have originated in bats and pangolins and later transmitted to humans. Once in the human body, this coronavirus (SARS-CoV-2) is abundantly present in nasopharyngeal and salivary secretions of affected patients, and its spread is predominantly thought to be respiratory droplet/contact in nature. Dental professionals, including endodontists, may encounter patients with suspected or confirmed SARS-CoV-2 infection and will have to act diligently not only to provide care but at the same time prevent nosocomial spread of infection. Thus, the aim of this article is to provide a brief overview of the epidemiology, symptoms, and routes of transmission of this novel infection. In addition, specific recommendations for dental practice are suggested for patient screening, infection control strategies, and patient management protocol.     

COVID-19 Management in Clinical Dental Care. Part I: Epidemiology,Public Health Implications,and Risk Assessment

Coronavirus disease 2019 (COVID-19), a viral disease declared a pandemic by the World Health Organization (WHO) in March 2020, has posed great changes to many sectors of society across the globe. Its virulence and rapid dissemination have forced the adoption of strict public health measures in most countries, which, collaterally, resulted in economic hardship.This article is the first in a series of 3 that aims to contextualise the clinical impact of COVID-19 for the dental profession. It presents the epidemiological conditions of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), namely, its modes of transmission, incubation, and transmissibility period, signs and symptoms, immunity, immunological tests, and risk management in dental care.Individuals in dental care settings are exposed to 3 potential sources of contamination with COVID-19: close interpersonal contacts (<1 m), contact with saliva, and aerosol-generating dental procedures. Thus, a risk management model is propsoed for the provision of dental care depending on the epidemiological setting, the patient's characteristics, and the type of procedures performed in the office environment.Although herd immunity seems difficult to achieve, a significant number of people has been infected throughout the first 9 months of the pandemic and vaccination has been implemented, which means that there will be a growing number of presumable “immune” individuals that might not require many precautions that differ from those before COVID-19.In conclusion, dental care professionals may manage their risk by following the proposed model, which considers the recommendations by local and international health authorities, thus providing a safe environment for both professionals and patients.     

Reopening Dental Offices for Routine Care Amid the COVID-19 Pandemic: Report From Palestine

ObjectivesThis study reports on the readiness of Palestinian dentists to reopen their practices for routine care during the current coronavirus disease 2019 (COVID-19) pandemic.MethodsA cross-sectional study targeted dentists in the West Bank area of Palestine using an online survey during the first 2 weeks of May 2020. Questions mainly asked about dentists’ perception of the risks of COVID-19, readiness to reopen their clinics for routine care, and the level of confidence in dealing with patients suspected of having COVID-19.ResultsA total of 488 dentists completed the survey. Almost 60% believed that they were not ready to reopen their practices. Almost 13% had “no confidence” in dealing with patients with COVID-19, while 64% had “little to moderate” confidence. Confidence was correlated negatively with increased fear of becoming infected (ρ = -0.317, P < .0001) and positively with years of practice (ρ = 1.7, P < .0001). Dentists who received updated training on infection control or on COVID-19 reported higher levels of confidence (χ² = 53.8, P < .0001, χ² = 26.8, P < .0001, respectively). Although 88% preferred not to treat patients with COVID-19, 40% were willing to provide care to them. Almost 75% reported that they were already facing financial hardships and could not survive financially until the end of the current month.ConclusionsEthical and financial reasons were the main drivers for dentists in this sample to reopen their practices for routine care. Data from this study highlights the fragility of private dental practice in emergency situations. Ethical, health, and financial challenges that emerged during COVID-19 require dentists to adapt and be better prepared to face future crises.     

Rapid response: activity from a hospital based Urgent Dental Care Centre during the COVID-19 pandemic

On 23rd March, the UK Government announced a nationwide lockdown in response to the COVID-19 pandemic, resulting in the unequivocal and absolute cessation of all elective dental treatment. With much conflicting evidence on best practice to deliver safe treatment comprising of emergency dento-alveolar surgery, this paper describes the protocols which were undertaken to successfully set up a novel Urgent Dental Care Centre (UDCC) service within a short timeframe. We present patient data from referral through to treatment for the entire ten-week period of operation. A UDCC was established at Queen Mary’s Hospital, Sidcup within 10 days of this announcement. Through an iterative process with minor stakeholders and in collaboration with our Local Dental Committee, a comprehensive urgent dental service was established. Our UDCC received 1,311 referrals within a 10-week period, with 884 patients being accepted for treatment. The majority of treatment delivered in this emergency setting was surgical dento-alveolar procedures (84%). Sixteen per cent of patients attended for trauma, first stage restorative treatment for teeth and postoperative complications. Both aerosol and non-aerosol generating procedures were available to patients. Preventing acute hospital admissions relies on the ability to provide safe dento-alveolar surgery. Our results advocate that our unique UDCC is efficient and provides appropriate patient access and outcomes for those most in need of urgent dental treatment in the face of a pandemic.     

Psychological Impact of the COVID-19 Pandemic on Emergency Dental Care Providers on the Front Lines in China

Coronavirus disease 2019 (COVID-19) is an infectious disease that emerged at the end of 2019. On 30 January 2020, the World Health Organization (WHO) classified it as a pandemic. To examine the psychological effects on dental care providers in China in the midst of the COVID-19 outbreak and factors closely associated with those effects, we conducted a cross-sectional study online with 4 widely used self-administered questionnaires: the Patient Health Questionnaire-9, the General Anxiety Disorder-7, the Perceived Stress Scale-10, and the Acute Stress Disorder Scale. Univariate and multivariate analyses were performed to evaluate the variables that potentially affected the mental health of emergency dental care providers. As a result, 969 out of 1035 questionnaires were included in the analysis, with 642 respondents reporting more than 1 symptom (66.3%). The symptom of perceived stress was reported by the largest proportion of the respondents (66.2%, n = 641), and anxiety the least (7.1%, n = 69). After adjustment for confounders, it was found that dental practitioners with preexisting physical health conditions were at higher risk of depression (odds ratio [OR], 1.972; 95% CI, 1.128-3.448; P = .017), and perceived stress (odds ratio, 2.397 95% CI, 1.283-4.478; P = .006). Additionally, feelings of fear, helplessness, or terror resulting from the possibility of contracting COVID-19 were significantly associated with the prevalence of all the 4 psychological symptoms observed (P < .05). In the present study, we found that dental care providers suffered psychological depression, stress, anxiety, and posttraumatic stress disorder (PTSD) during COVID-19, which indicates the importance of psychological support at times of major epidemic outbreaks.Chinese Clinical Trial Registry number: ChiCTR2000031538.     

Dental materials: 1979 literature review Part II

This paper, which is presented in two parts, reviews the work on dental materials published in 1979. Included in Part II are sections on impression materials, model, die and investment materials, waxes, acrylic resins, denture base polymers, soft lining materials and tissue conditioners, cast and wrought dental alloys, ceramics, implants and, finally, corrosion. Part I included sections on dental biomechanics, fissure sealants, cements, amalgam, composite filling materials, endodontic materials and microleakage.     

Dental materials: 1977 literature review Part II

This paper, which is presented in two parts, reviews the work on dental materials published in 1977. Included in Part I were sections on amalgam, casting alloys, denture base polymers, composite filling materials, tissue conditioners and soft lining materials and fissure sealants. A review of the literature relating to impression materials, dental ceramics, model and die materials, cements, dental implants and dental biomechanics is presented in Part II.     

Validating the standard for the National Board Dental Examination Part II

As part of the overall exam validation process, the Joint Commission on National Dental Examinations periodically reviews and validates the pass/fail standard for the National Board Dental Examination (NBDE), Parts I and II. The most recent standard-setting activities for NBDE Part II used the Objective Standard Setting method. This report describes the process used to set the pass/fail standard for the 2009 exam. The failure rate on the NBDE Part II increased from 5.3 percent in 2008 to 13.7 percent in 2009 and then decreased to 10 percent in 2010. This article describes the Objective Standard Setting method and presents the estimated probabilities of classification errors based on the beta binomial mathematical model. The results show that the probability of correct classifications of candidate performance is very high (0.97) and that probabilities of false negative and false positive errors are very small (.03 and <0.001, respectively). The low probability of classification errors supports the conclusion that the pass/fail score on the NBDE Part II is a valid guide for making decisions about candidates for dental licensure.     

Clinical Response to COVID-19 and Utilization of an Emergency Dental Clinic in an Academic Institution

IntroductionThe spread of coronavirus disease 2019 (COVID-19) in the spring of 2020 resulted in the temporary suspension of elective dental procedures and clinical dental education in academic institutions. This study describes the use of the Tufts University School of Dental Medicine emergency dental clinic during the peak surge in COVID-19 cases in Massachusetts, highlighting the number of endodontic emergencies.MethodsAggregate data from clinical encounters and call records to an emergency triage phone line from March 30 through May 8, 2020, were used to describe the characteristics of dental emergencies, clinical encounters, and procedures performed.ResultsA total of 466 patient interactions occurred during this period, resulting in 199 patients advised by phone and 267 clinical encounters. The most common dental emergencies were severe dental pain from pulpal inflammation (27.7% of clinical encounters) followed by a surgical postoperative visit (13.1%). The most frequent procedures were extractions (13.9% of clinical encounters) and surgical follow-up (13.5%); 50.2% of the clinical encounters were categorized as aerosol generating, and 86.1% of encounters would have required treatment in a hospital emergency department if dental care was not available. There were no known transmissions of severe acute respiratory syndrome coronavirus-2 among clinic providers, patients, or staff during this period.ConclusionsThese results highlight the importance of endodontic diagnosis and treatment in the provision of emergency dental care during a pandemic and demonstrate that dental treatment can be provided in a manner that minimizes the risk of viral transmission, maintaining continuity of care for a large patient population.