Comparison of provision of maxillofacial emergency service during the two COVID-19 national lockdowns in the United Kingdom

We previously published a study on the provision of emergency maxillofacial services during the first UK COVID-19 pandemic national lockdown. We repeated the study during the second lockdown and now present our findings that highlight the main differences and learning issues as the services have evolved.     

The COVID-19 effect: number of patients presenting to The Mid Yorkshire Hospitals OMFS team with dental infections before and during The COVID-19 outbreak

This paper investigates the effect of the COVID-19 outbreak and closure of dental practices on the frequency and severity of dental infections presenting in our emergency department. We compared the mean number of daily emergency department referrals for dental abscesses in the two weeks prior to and following the Chief Dental Officer’s statement advising general dental practitioners to cease routine appointments, the mean number decreased from 1 to 0.37. In contrast, the severity and requirement for admission of these infections rose from 35% to 80%. This highlights the importance of the provision of local urgent dental centres during the COVID-19 outbreak in order to reduce pressure on secondary and tertiary care centres.     

Clinical endodontic management during the COVID-19 pandemic: a literature review and clinical recommendations

The spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in millions of confirmed cases and hundreds of thousands of deaths. Despite all efforts to contain the spread of the disease, the number of infections and deaths continue to rise, particularly in some regions. Given its presence in the salivary secretions of affected patients, and the presence of many reported asymptomatic cases that have tested positive for COVID-19, dental professionals, including Endodontists, are at high risk of becoming infected if they do not take appropriate precautions. As of today, there are no predictable treatments or approved vaccines that can protect the public and healthcare professionals from the virus; however, there is speculation that a vaccine might be available sometime in 2021. Until then, general dentists and Endodontist will need to be able to treat emergency patients in order to relieve pressure on emergency clinics in hospitals or local community hubs. In addition, as the pandemic continues, strategies to manage patients will need to evolve from a palliative to a more permanent/definitive treatment approach. In this article, an update on the treatment considerations for dental care in general is provided, as well as a discussion on the available endodontic guidelines reported in the literature. Recommendations on clinical management of endodontic emergencies are proposed.     

Modifications of emergency dental clinic protocols to combat COVID-19 transmission

During the COVID-19 pandemic, incidence rates for dental diseases will continue unabated. However, the intent to prevent the spread of this lethal respiratory disease will likely lead to reduced treatment access due to restrictions on population movements. These changes have the potential to increase dental-related emergency department visits and subsequently contribute to greater viral transmission. Moreover, dentists experience unique challenges with preventing transmission due to frequent aerosol-producing procedures. This paper presents reviews and protocols implemented by directors and residents at the Dental College of Georgia to manage a dental emergency clinic during the COVID-19 pandemic. The methods presented include committee-based prioritization of dental patients, a multilayered screening process, team rotations with social and temporal spacing, and modified treatment room protocols. These efforts aid in the reduction of viral transmission, conservation of personal protective equipment, and expand provider availability. These protocols transcend a university and hospital-based models and are applicable to private and corporate models.     

Impact of the COVID-19 lockdown on the epidemiology of maxillofacial trauma activity: a French multicentre comparative study

The coronavirus disease 2019 (COVID-19) outbreak has had a major impact on medical and surgical activities. A decline in facial trauma incidence was noticed during the lockdown period. The aim of this study was to evaluate the decline in maxillofacial trauma in France during this particular period. A retrospective multicentre comparative study was initiated in 13 major French public hospital centres. The incidence of facial trauma requiring surgery during the first month of lockdown was compared to that during equivalent periods in 2018 and 2019. Differences in the types of trauma were also analysed. Thirteen maxillofacial departments participated in the study. A significant decline in maxillofacial trauma volumes was observed when compared to equivalent periods in 2018 and 2019 (106 patients compared to 318 and 296 patients, respectively), with an average reduction of 65.5% (P = 0.00087). The proportion of trauma due to sports and leisure was reduced when compared to reports in the literature. As a consequence, in the context of a pandemic, the material and human resources related to this activity could be reallocated to the management of other pathologies that cannot be postponed.     

Provision of Emergency Maxillofacial Service During the COVID-19 Pandemic : A Collaborative Five Centre UK Study

The global pandemic of Coronavirus disease (COVID-19) represents one of the greatest challenges to healthcare systems, and has forced medical specialties to rapidly adapt their approaches to patient care. Oral and Maxillofacial Surgery is considered particularly at risk of disease transmission due to aerosol generation during surgical interventions, patient proximity and operating environment. On day 2 (26th March, 2020) of when severe restrictions in population movement were instigated in the United Kingdom, we began a study to prospectively monitor the presentation and management of maxillofacial emergencies at five hospital trusts. Data was collected onto an online live database fed through a smartphone application.Of the total 529 patients over six weeks, 395 attended for face-to-face consultations and 134 patients received remote consultations via telephone or video link. There were 255 trauma related cases, 221 infection and 48 cases of postoperative complications. Most trauma cases were minor soft tissue injury related to slip, trip or fall at home. There were 44 cases of facial fractures with a tendency for conservative treatment. 19 cases were related to domestic violence or self-harm. Of the 216 dental related emergencies, 68% could have been managed in the primary care setting. A quarter of all emergency patients were satisfactorily managed by remote consultations.There was a significant change in the provision of emergency maxillofacial service during the pandemic lockdown. We discuss the study findings as well as the potential implications in relation to planning for possible further COVID- 19 spikes and future pandemics.     

The impact of the COVID-19 pandemic on spinal surgery

The impact of the coronavirus disease (COVID-19) pandemic on healthcare services around the world has been unprecedented. Surgical specialities, in particular, had to respond rapidly and adapt to continue to meet the needs of their patients in this ever-evolving and uncertain situation. With the cancellation of elective surgery and outpatient clinics, the majority of work carried out by spinal surgeons was obliterated. It was imperative emergency spinal care continued throughout the pandemic, with the creation of guidelines to assist spinal surgeons manage patients appropriately. Alongside assisting on the frontline, spinal surgeons had to triage referrals to ensure urgent care was still provided, undertake outpatient clinics virtually and ensure educational opportunities were available for colleagues. Paediatric spinal surgery was affected by the pandemic; although the virus did not significantly impact children to the same extent, a notable consequence of the lockdown restrictions was a reduction in GP referrals into the specialist service. In the event of any future pandemics, national spinal organizations have created guidelines to assist in the prioritization and care of spinal pathologies. While a ‘return to normality’ is a long way off, the impact of the past year will undoubtedly change spinal surgeons and their practice forever.     

Role of respirators in controlling the spread of novel coronavirus (COVID-19) amongst dental healthcare providers: a review

During the ongoing COVID-19 pandemic, healthcare professionals are at the forefront of managing the highly infectious coronavirus. As the most common route of transmission is via aerosols and droplet inhalation, it is critical for healthcare workers to have the correct personal protective equipment (PPE) including gowns, masks and goggles. Surgical masks are not effective in preventing the influenza and SARS, so they are unlikely to be able to resist contaminated aerosols from entering the respiratory system. Therefore, it is vital to use respirators which have been proven to offer better protection against droplets, aerosols and fluid penetration and which form a tight seal around the mouth and nose. Various types of respirators are used in healthcare settings, such as half-mask filtering facepiece respirators (FFRs) and powered air-purifying respirators (PAPRs). The most commonly used FFR is the N95 disposable respirator, which is tight fitting and has a 95% or above particle filtering efficiency for a median particle size of 0.3 µm. This review discusses respirators, their purpose, types, clinical efficiency and proper donning and doffing techniques.     

COVID-19疫情期间口腔本科生线上学习决策TAN贝叶斯网络模型分析

目的: 探讨地方高校口腔医学本科生在COVID-19疫情期间线上学习的应对与决策规律。方法: 针对丽水学院2016—2018级口腔本科生,分别在线上课程开课之前和开课4周后进行2次问卷调查。利用SPSS Modeler 18.0对资料进行整理、审核和内部一致性分析,构建TAN贝叶斯网络模型（tree augmented naive Bayesian network）,并使用总体正确率、受试者工作特征曲线(ROC曲线)和ROC曲线下面积（AUC值）等指标评价模型的优劣。结果: 2次调查收集个案数分别为422个和382个,Cronbach α系数分别为0.91和0.82。所构建的TAN贝叶斯网络模型分析显示,是否预习线上资料的决策中,最重要的变量是期待开学,其次是网络资料的有效性;在线上课程是否达到线下课程标准的评价变量中,讲课节奏（视频直播或录播中）、线上资料任务点多少、线上资料框架条理3个变量的重要性显著高于其他变量。2个模型的总体预测正确率分别为89.42%和87.82%,AUC值分别为0.75和0.93。结论: 疫情期间,教师应充分认识到地方高校口腔医学本科生的教育期待。教学中首先要精心组织内容全面、结构条理清晰、生动且难度适中的线上资料,辅以节奏适中、语音和画面质量均上乘的线上直播或视频录播,再结合多渠道师生交互,真正做到“停课不停学”。     

Clinical activities suspended: How the COVID-19 affected the self-confidence of Italian dental students

Introduction

COVID-19 emergency caused several effects on the dental educational system, especially affecting courses including practical activities. The study aims to evaluate the impact of the suspension of dental clinical activities on the Italian dental students' self-confidence. Furthermore, the other purpose of the research is to find an integrative didactics solution to improve the clinical training of dentistry during the COVID-19 pandemic.

Materials and Methods

A questionnaire was administered to evaluate the impact of the suspension of clinical activities on dental students' self-confidence. A 67-questions survey tested the students' self-confidence in several dental disciplines (Conservative Dentistry, Endodontics, Oral Surgery and Dental Emergency). The study reached a sample of 193 dental students and the answers from 9 different Italian dental schools were analysed.

Results

The degree of students' self-confidence for all the dental disciplines investigated was found statistically different between the periods before and after the interruption of clinical activities. The students proposed, as a potential solution to improve their practice during the COVID-19 pandemic, to combinate the use of a video tutorials and dental simulators.

Conclusion

The interruption of the training in clinical practice significantly affected the educational career and the self-confidence of students. An alternative teaching method involving the use of video tutorials as support in teaching clinical procedures deserves to be considered.     

新型冠状病毒肺炎疫情期间口腔门诊管理与感染防控对策

2019年12月以来,湖北省武汉市新型冠状病毒肺炎（COVID-19,简称新冠肺炎）疫情爆发,并快速向全国各地及境外蔓延,严重威胁人民生命健康。口腔诊疗因具有医护患距离近、操作时间长,并且常规使用高速涡轮快速手机、超声波洁牙机等产生大量飞沫和气溶胶设备的特点,存在较高的院内扩散和医院感染风险。为有效地阻断医院内新型冠状病毒的传播,控制疫情的扩散,结合口腔诊疗特点,本文提出了新冠肺炎疫情期间口腔门诊管理及防控对策,并希望对后疫情期即将恢复正常诊疗活动的医院感染防控提供参考。     

Impact of COVID-19 epidemic on maxillofacial surgery in Italy

Maxillofacial departments in 23 surgical units in Italy have been increasingly involved in facing the COVID-19 emergency. Elective surgeries have been progressively postponed to free up beds and offer human and material resources to those infected. We compiled an inventory of 32 questions to evaluate the impact of the SARS-COV2 epidemic on maxillofacial surgery in 23 selected Italian maxillofacial departments. The questionnaire focused on three different aspects: the variation of the workload, showing both a reduction of the number of team members (-16% among specialists, -11% among residents) due to reallocation or contamination and a consistent reduction of elective activities (the number of outpatient visits cancelled during the first month of the COVID-19 epidemic was about 10 000 all over Italy), while only tumour surgery and trauma surgery has been widely guaranteed; the screening procedures on patients and physicians (22% of maxillofacial units found infected surgeons, which is 4% of all maxillofacial surgeons); and the availability of Personal Protective Equipment, is only considered to be partial in 48% of Maxillofacial departments.This emergency has forced those of us in the Italian health system to change the way we work, but only time will prove if these changes have been effective.     

The impact of the COVID-19 pandemic on orofacial pain practice: Perceptions from a convenience sample of orofacial pain practitioners

BackgroundCOVID-19 has had a substantial impact on people’s lives. Increasing evidence indicates that patients with chronic pain particularly are being affected; however, few articles have examined how the pandemic has affected the care or clinical presentation of patients with orofacial pain. The aim of this study was to describe COVID-19–related changes in referral patterns and numbers, in patient demographics, in patients’ seeking treatment for problems, and in administrative procedures in 3 orofacial pain clinical settings.MethodsPractitioners participating in the American Academy of Orofacial Pain webinar titled “Practicing Orofacial Pain, Headache, and Sleep Care During the COVID-19 Pandemic” completed a voluntary anonymous online survey. Survey respondents completed general questions related to their orofacial pain practices and about perceptions of their patients’ symptoms. For statistical analysis, the authors calculated frequencies and used analysis of variance for continuous variables or Likert scale variables and the χ² test for dichotomous or categorical variables. Statistical significance was set at P value of .05 or below.ResultsPractitioners noted an increase in new patients with orofacial pain. Of the participants, 33% indicated the onset of their patients’ pain was often or extremely often related to COVID-19. The 5 most common symptoms that providers felt were aggravated in their patients were masticatory muscle myalgia, anxiety, tension-type headache, bruxism, and insomnia or fragmented sleep.ConclusionThe COVID-19 pandemic has resulted in a marked increase in the number of patients seeking consultation for orofacial pain and associated symptoms.Practical ImplicationsBecause of the COVID-19 pandemic, orofacial pain practitioners have noticed an increase in orofacial pain symptoms across practice settings.     

Asymptomatic or mildly symptomatic COVID-19 patients with craniomaxillofacial injuries have an increased risk of surgical site infection

The aim of this paper was to evaluate the association between ‘asymptomatic or mildly symptomatic’ severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (AS/MS-COVID) and surgical site infection (SSI) after repair of craniomaxillofacial injury (CMFI). Using a case-control study design with a match ratio of 1:4, we enrolled a cohort of AS/MS-COVID cases with immediately treated CMFI during a one-year period. The main predictor variable was SARS-CoV-2 infection (yes/no), and the outcome of interest was SSI (yes/no). The other variables were demographic, clinical, and operative. Appropriate statistics were computed, and p<0.05 was considered statistically significant. The study group comprised 257 cases (28.8% female; 13.2% aged ≥ 60 years; 10.5% with fractures; 39.7% with involvement of nasal/oral/orbital tissue [viral reservoir organs, VROs]; 81.3% with blunt trauma; 19.1% developed an SSI [vs 6.8% in the control group]) with a mean (SD) age of 39.8 (16.6) years (range 19–87). There was a significant relation between SARS-CoV-2 infection and SSI events (p<0.0001; odds ratio 3.22; 95% confidence interval 2.17 to 4.78). On subgroup analysis, SSIs significantly increased with age ≥ 60 years, presence and treatment of fracture, contact with VROs, and prolonged antibiotic use (PAU). However, multivariate logistic regression analysis confirmed a positive effect only from old age, contact with VROs, and PAU (relative risk = 1.56, 2.52, and 2.03, respectively; r = 0.49; p = 0.0001). There was a significant 2.8-fold increase in SSIs among AS/MS-COVID cases, especially in those aged ≥ 60 years, or those with injuries to VROs, or both, who therefore required PAU.