Paediatric dental care during and post-COVID-19 era: Changes and challenges ahead

BackgroundCOVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus is transmitted through respiratory droplets and by physical contact from contaminated surfaces to the mucosa. Its route of transmission has caused a significant challenge in medical and dental healthcare.ObjectiveThis article aims to review the literature and information available on the provision of paediatric dental treatment during and post-pandemic and to provide specific recommendations on the safe provision of paediatric dental care.ResultsChildren infected by SARS-CoV-2 have no or milder COVID-19 symptoms and are potential vectors in spreading the disease. Routine dental treatment is suspended in many countries because of the increased risk of cross-infection in dental practices. Only emergency dental care is provided for urgent conditions. It is necessary to gradually reinstate regular dental care to paediatric patients and maintain their good oral health. To control the disease transmission and maintain the oral health of the population, minimally intervention techniques that minimise or eliminate aerosol generation, plus comprehensive oral health preventive measures should be practised to safeguard safety at dental practices in this unprecedented time.ConclusionsRobust infection control guidelines should be implemented in dental clinics to minimise the risk of infection and to ensure the safety of patients and staff during the pandemic. Three levels of preventive care should be practised to prevent oral diseases and improve children's oral health in this COVID-19 era. Treatment should be prioritized to patients in urgent needs and aerosol-generating procedures should be minimized.     

The shortened dental arch concept and its implications for oral health care

The minimum number of teeth needed to satisfy functional demands has been the subject of several studies. However, since functional demands--and consequently the number of teeth needed--can vary from individual to individual, this minimum number cannot be defined exactly. In general, occlusion of a complete dental arch is preferable. However, this goal might be neither attainable, for general, dental or financial reasons, nor necessary. Many studies demonstrate that shortened dental arches comprising the anterior and premolar regions can meet the requirements of a functional dentition. Consequently, when priorities have to be set, restorative therapy should be aimed at preserving the most strategic parts of the dental arch: the anterior and premolar regions. This also implies that in cases of a shortened dental arch, the prompt replacement of absent posterior molars by free-end removable partial dentures leads to overtreatment and discomfort. The shortened dental arch concept is based on circumstantial evidence: it does not contradict current theories of occlusion and fits well with a problem-solving approach. The concept offers some important advantages and may be considered a strategy to reduce the need for complex restorative treatment in the posterior regions of the mouth.     

Hepatitis B prevalence and infection control among dental health care workers in a community in South Korea

OBJECTIVES: The objectives of this study were to investigate the prevalence of hepatitis B vaccine and use of infection control procedures by dental health care workers in Taegu, South Korea. METHODS: Information was obtained with a mailed questionnaire sent to 300 private dental practices. Surveys were received from 177 dentists, 104 dental hygienists, and 46 dental assistants. All dental health care workers were asked to donate a blood sample for analysis of hepatitis B surface antigen (HBsAg) and antibody (anti-HBs). RESULTS: Vaccination against hepatitis B virus was reported by 63 percent of the respondents. About 40 percent of all participants answered that they were anti-HBs positive, while another 43 percent did not know their status. About 89 percent of dentists reported that they wore a mask with all patients, while hygienists (13.6%) and assistants (13.0%) were less likely to do so. Reported use of gloves (4.5%) and protective eyewear (14%) with all patients was extremely low in every group. Among the 56 dentists who were tested for HBV markers, 23 did not receive the vaccine against hepatitis B, and 13 percent (3 of 23) were positive for HBsAg as carriers. CONCLUSIONS: About 37 percent (120 of 327) of dental health care workers surveyed in this study in Korea did not receive the vaccine against HBV infection. Basic barrier techniques to prevent cross-contamination were not being used consistently. Nationwide guidelines for barrier techniques and hepatitis vaccinations should be developed and disseminated to dental personnel.     

Developing and deploying a new member of the dental team: a pediatric oral health therapist

There are inadequate numbers of dentists able and willing to treat America's children, specifically children from low income and minority populations. This has led to the well-publicized disparities in oral health among children. In the early part of the 20th century New Zealand faced a significant problem with oral disease among its children and introduced a School Dental Service, staffed by allied dental professionals with two years' training in caring for the teeth of children, "school dental nurses." A significant number of countries have adopted the model. This article reviews the history of attempts to develop such an approach in the United States. It advocates for the development and deployment of pediatric oral health therapists as a means of addressing the disparities problem that exists in America with such individuals being trained in children's dentistry in a two-year academic program. The article asserts that adding a pediatric oral health therapist to the dental team is one way in which the profession of dentistry can fulfill its moral obligation to care for the oral health of America's children and ensure that all children are treated justly. Recently, the American Association of Public Health Dentistry promulgated a strategic plan that endorsed such an approach.     

Continuing dental education: evaluation of the effectiveness of a disinfection and decontamination course

Aim: To evaluate a disinfection and decontamination dental postgraduate course run by the Wales Dental Postgraduate Deanery between 2008 and 2010. Methods: Pre‐ and post‐course multiple choice questionnaires were completed by 1177 course attendees. Mean scores before and after participation on the training course were compared and analysed. Results: Mean pre‐course score was 45.3%, rising to 87.0% in the post‐course assessment, reflecting an improvement of 41.8%. Prior to training, 30.7% achieved a satisfactory score of 13/20 (65%) compared to 98.3% on completion of training. Dental technicians were found to score significantly lower than other occupation groups both before and after course attendance. Decade of graduation had no effect on results. Theoretical microbiology was the question area which showed least improvement. Conclusion: Attending the disinfection and decontamination course significantly improved participants’ knowledge. Theoretical microbiology, as a topic area, may be targeted for improvements in future courses to improve results further.     

Integration of oral health into primary health care: the role of dental hygienists and the WHO stewardship

Abstract:  Interest in addressing the unmet oral health needs of the citizens of the world has manifested itself, lately, in noteworthy expressions of commitment. Oral health is integrated with general health and support for community programmes offering 'essential oral health' within primary health care (PHC) is increasing. The WHO Global Goals for Oral Health 2020 has assumed a more directed public health orientation, and the Global Oral Health Programme has its focus on modifiable oral risk behaviours. Last, but not the least, opportunities are being created, under the 'stewardship' of the World Health Organization (WHO), for the expansion of oral disease prevention and health promotion knowledge and practices in communities. A review of the literature on community-oriented oral health primary care reveals one dominant and disease-oriented practice model with dental practitioners being the principal and exclusive actors. One alternative to this biomedical model of care that may be better suited to translate health promotion principles into action at community levels is the practice that involves hygienists serving as primary oral health care providers. The WHO 'stewardship' should include the support of dental hygiene practice within PHC, many legislative restrictions and regulatory barriers would be relaxed, thus enabling dental hygienists to respond to the WHO's call for community-based demonstration projects. With their focus on preventive oral care, hygienists are 'best poised' to help accelerate the integration of oral health with primary care, particularly in the light of the compelling evidence confirming the cost-effectiveness of the care delivered by intermediate providers.     

Coronavirus disease (COVID‐19): Characteristics in children and considerations for dentists providing their care

The emergence of the novel virus severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) causing coronavirus disease (COVID‐19) has led to a global pandemic and one of the most significant challenges to the healthcare profession. Dental practices are focal points for cross‐infection, and care must be taken to minimise the risk of infection to, from, or between dental care professionals and patients. The COVID‐19 epidemiological and clinical characteristics are still being collated but children's symptoms seem to be milder than those that adults experience. It is unknown whether certain groups, for example children with comorbidities, might be at a higher risk of more severe illness. Emerging data on disease spread in children, affected by COVID‐19, have not been presented in detail. The purpose of this article was to report current data on the paediatric population affected with COVID‐19 and highlight considerations for dentists providing care for children during this pandemic. All members of the dental team have a professional responsibility to keep themselves informed of current guidance and be vigilant in updating themselves as recommendations are changing so quickly.     

Compliance with infection prevention and control in oral health‐care facilities: a global perspective

Many publications are available on the topic of compliance with infection prevention and control in oral health‐care facilities all over the world. The approaches of developing and developed countries show wide variation, but the principles of infection prevention and control are the same globally. This study is a systematic review and global perspective of the available literature on infection prevention and control in oral health‐care facilities. Nine focus areas on compliance with infection‐control measures were investigated: knowledge of infectious occupational hazards; personal hygiene and care of hands; correct application of personal protective equipment; use of environmental barriers and disposable items; sterilisation (recirculation) of instruments and handpieces; disinfection (surfaces) and housekeeping; management of waste disposal; quality control of dental unit waterlines, biofilms and water; and some special considerations. Various international studies from developed countries have reported highly scientific evidence‐based information. In developed countries, the resources for infection prevention and control are freely available, which is not the case in developing countries. The studies in developing countries also indicate serious shortcomings with regard to infection prevention and control knowledge and education in oral health‐care facilities. This review highlights the fact that availability of resources will always be a challenge, but more so in developing countries. This presents unique challenges and the opportunity for innovative thinking to promote infection prevention and control.     

Prevention and rehabilitation of musculoskeletal disorders in oral health care professionals: A systematic review

BackgroundThe authors’ objective in this systematic review was to describe the evidence for preventive and rehabilitative interventions for musculoskeletal disorders in oral health care.Types of Studies ReviewedThe authors conducted systematic search, screening, and eligibility processes to identify experimental, quasiexperimental, observational, and survey research studies in which the investigators either directly evaluated or predicted the effects of preventive or rehabilitative interventions on the reduction of musculoskeletal symptoms in oral health care professionals.ResultsThe authors identified and screened 3,571 unique abstracts, assessed 256 full-text articles for eligibility, and included 34 articles in the review. Investigators in 17 experimental studies described the results of preventive or rehabilitation interventions and in 17 survey research studies predicted or correlated preventive or protective techniques to a reduction in musculoskeletal symptoms. The primary techniques evaluated in the studies included equipment modification, ergonomic training, and physical exercise.Conclusions and Practical ImplicationsThe evidence suggests that magnification loupes and indirect-vision techniques have a positive effect on the reduction of musculoskeletal symptoms. In terms of evaluating intervention efficacy, other techniques have mixed evidence or are limited by low-level study design.     

Recommendations for a safe restart of elective aerosol-generating oral surgery procedures following the COVID-19 pandemic outbreak: An Italian multicenter study

Among healthcare workers, oral and maxillofacial surgeons are some of the most exposed to coronavirus disease (COVID-19). The aim of this retrospective study was to develop suggestions for continuing the work of oral and maxillofacial surgeons using a safe protocol for elective and urgent aerosol-generating procedures that could prevent the onset of new clusters.Based on the results obtained and a guidelines review of those Asian countries that had promptly managed the current pandemic, the following safety protocol was developed:     

Long COVID and oral health care considerations

BackgroundPeople who have recovered from the initial severe acute respiratory syndrome coronavirus 2 infection are at risk of developing long COVID, a prolonged suite of signs and symptoms that may interfere with daily life and the ability to undergo routine oral health care.MethodsThe available literature on long COVID was reviewed and compiled to produce a review of the syndrome as currently understood. Articles were evaluated with a focus on how long COVID may affect the provision of oral health care and on ways in which treatment may need to be modified to best care for this vulnerable patient population.ResultsLong COVID includes a wide variety of symptoms, such as fatigue, shortness of breath, chest pain, risk of developing thromboembolism, and neurologic and psychiatric complications. These symptoms may arise at various times and in a wide range of patients, and they may necessitate modification of routine oral health care interventions.ConclusionsRecommendations for the treatment of affected people in an oral health care setting are presented, including a thorough evaluation of the patient history and current status, understanding of how related symptoms may affect oral health care interventions, and which modifications to treatment are needed to provide safe and appropriate care.Practical ImplicationsOral health care professionals must be aware of long COVID, an increasingly prevalent condition with a widely variable presentation and impact. Oral health care professionals should be prepared to treat these patients safely in an outpatient oral health setting.     

Household expenditure in dental health care: national estimations in Mexico for 2000, 2002, and 2004

OBJECTIVE: To estimate the expenditure on dental care of Mexican households, analyze their trends, and determine the factors associated with the decision to spend and the amount of money spent in 2000, 2002, and 2004. MATERIAL AND METHODS: Using the National Survey of Household Income and Expenditure for 2000, 2002, and 2004, the national dental health care expenditure was calculated. To facilitate comparability across years, all expenditure was converted to pesos of 2004, using the National Consumer Price Index (11.201 pesos per USD). Proportion of households incurring catastrophic expenditures was also estimated. To evaluate the association between environmental, household, and individual characteristics with the amount of dental health care expenditure, the Heckman regression model was used to control for self-selection bias. RESULTS: More than 6,467 million pesos (MP) were spent in 2000 (8.5 percent of all households had some expenditure), over 3,925 MP in 2002 (4 percent households), and above 5,136 MP in 2004 (5 percent households), with an average expenditure of $806, $1,000, and $987 pesos, respectively. Prevalence of catastrophic expenditure because of dental health care was 0.8 percent in 2000 compared to 0.01 and 1.8 percent in 2002 and 2004, respectively. The Heckman model showed that municipal development, stratum, and age of the head of household significantly influenced the amount spent on dental care in all 3 years. Household capacity to pay and wealth index had a positive and statistically significant association in the 3 years with the preceding decision to spend. CONCLUSIONS: Variables associated with the amount of expenditure and the decision of spending support the existence of inequities in health care financing in the Mexican population.     

Effects of the new fixed-subsidy system for prosthetic dental care in Germany: results of descriptive research

OBJECTIVE: To detail how provision of prosthetic treatments altered in Germany following changes in legislation on 1 January 2005, enacted as part of the health system modernisation law (GMG). This legislation directs health insurance companies to fix subsidies on dental prostheses based on diagnostic findings. The goal of the reform is to ensure that insured persons can select any medically recognised form of prosthetic treatment without losing their right to a health insurance subsidy. AIM: To show subsequent effects on provision of prosthetic treatments. METHOD: The four largest substitute health insurance funds each collected the billing data from 300 medical and costs projections and/or from the submitted bills in June 2005, allowing access and analysis of a randomised sample (n = 1,200), which in turn made usable assertions possible. RESULTS: Under the fixed-subsidy system the co-payment from the insured person has risen as soon as the area of Standard Prosthetic Care is left and dental prostheses treatment is provided from the categories care of a similar or different kind. The costs of dental prostheses in the new fixed-subsidy system are composed of approx. 39% dentists' fee and 61% dental materials. Only a small proportion of insured persons capitalise on these changes; in fact only 1.2% of the subsidy is for surgically implanted prostheses in the new fixed-subsidy system. CONCLUSIONS: The current fixed-subsidy system results in substantially higher co-payments for the insured, as soon as Standard Prosthetic Care is left and care of a similar or different kind is provided. This raises the question as to whether the marginalisation of contractual care to fund the additional costs resulting from surgically implanted prostheses was necessary.     

Evaluating quality of dental care among patients with diabetes: Adaptation and testing of a dental quality measure in electronic health records

Background

Patients with diabetes are at increased risk of developing oral complications, and annual dental examinations are an endorsed preventive strategy. The authors evaluated the feasibility and validity of implementing an automated electronic health record (EHR)–based dental quality measure to determine whether patients with diabetes received such evaluations.