Dental Health Services Response to COVID-19 in Norway. Lina Stangvaltaite-Mouhat, Marte-Mari Uhlen, Rasa Skudutyte-Rysstad, Ewa Alicja Szyszko Hovden, Maziar Shabestari, and Vibeke Elise Ansteinsson

 Abstract:

We aimed to investigate the management of urgent dental care, the perception of risk and workplace preparedness among dental staff in Norway during the COVID-19 pandemic. An electronic questionnaire regarding the strictest confinement period in Norway (13 March–17 April 2020) was distributed to dental staff. Among the 1237 respondents, 727 (59%) treated patients, of whom 170 (14%) worked in clinics designated to treat patients suspected or confirmed to have COVID-19. Out of them 88% (143) received training and 64% (103) simulation in additional infection prevention procedures, while 27 (24%) respondents reported deviation. In total, 1051 (85%) respondents perceived that dental staff had a high risk of being infected, 1039 (84%) that their workplace handled the current situation well, 767 (62%) that their workplace had adequate infection control equipment and 507 (41%) agreed that their workplace is well equipped to handle an escalation. Before an appointment, 1182 (96%) respondents always/often inquired per phone information if a patient experienced symptoms of COVID-19, and 1104 (89%) asked about a history of travel to affected areas. Twice as many patients on average per week were treated by phone than in a clinic. A lower proportion of dental staff in high incidence counties applied additional infection prevention measures compared to low and medium incidence counties. To conclude, urgent dental health care was managed relatively well in Norway. Additional training of the dental staff in adequate infection prevention and step-by-step procedures may be needed. These results may be used to improve the dental health service’s response to future outbreaks.

Dental Health Services Response to COVID-19 in Norway

International Journal of Environmental Research and Public Health, August, 2020

 

The effect of temperature on persistence of SARS-CoV-2 on common surfaces. Shane Riddell, Sarah Goldie, Andrew Hill, Debbie Eagles & Trevor W. Drew

WHO: Coronavirus disease (COVID-19) technical guidance: Maintaining Essential Health Services and Systems

Folkehelseinstituttet (FHI): Råd til tannhelsetjenesten under covid-19-pandemien

Saliva or Nasopharyngeal Swab Specimens for Detection of SARS-CoV-2

Helsedirektoratet: Koronavirus – beslutninger og anbefalinger. Kapittel 5 Kommunehelsetjenesten og tannhelsetjenesten

Coronavirus Disease 19 (COVID-19): Implications for Clinical Dental Care. Amber Ather, Biraj Patel, Nikita B Ruparel, Anibal Diogenes, Kenneth M Hargreaves

The recent spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated Coronavirus disease (COVID-19), has gripped the entire international community and has caused widespread public health concerns. Despite global efforts to contain the disease spread, the outbreak is still on a rise owing to the community spread pattern of this infection. This is a zoonotic infection that, similar to other coronavirus infections, is believed to have been originated in bats and pangolins, and later transmitted to humans. Once in the human body, this Corona virus (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 soon 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.

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

 

Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected

Author: WHO
Abstract
This is the first edition of guidance on infection prevention and control (IPC) strategies for use when infection with a novel coronavirus (2019-nCoV) is suspected. It has been adapted from WHO’s Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection,1 based on current knowledge of the situation in China and other countries where cases were identified and experiences with severe acute respiratory syndrome (SARS)-CoV and MERS-CoV. This guidance is intended for healthcare workers (HCWs), healthcare managers and IPC teams at the facility level but it is also relevant for the national and district/provincial level. Full guidelines are available from WHO.

 

Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected
 

Possible aerosol transmission of COVID-19 and special precautions in dentistry. Zi-yu Ge, Lu-ming Yang, Jia-jia Xia, Xiao-hui Fu & Yan-zhen Zhang

Abstract
Since its emergence in December 2019, corona virus disease 2019 (COVID-19) has impacted several countries, affecting more than 90 thousand patients and making it a global public threat. The routes of transmission are direct contact, and droplet and possible aerosol transmissions. Due to the unique nature of dentistry, most dental procedures generate significant amounts of droplets and aerosols, posing potential risks of infection transmission. Understanding the significance of aerosol transmission and its implications in dentistry can facilitate the identification and correction of negligence in daily dental practice. In addition to the standard precautions, some special precautions that should be implemented during an outbreak have been raised in this review.

Possible aerosol transmission of COVID-19 and special precautions in dentistry
 

Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1

Coronavirus Disease 2019 (COVID-19): Emerging and Future Challenges for Dental and Oral Medicine. L. Meng, F. Hua, and Z. Bian

 Abstract
The epidemic of coronavirus disease 2019 (COVID-19), originating in Wuhan, China, has become a major public health challenge for not only China but also countries around the world. The World Health Organization announced that the outbreaks of the novel coronavirus have constituted a public health emergency of international concern. As of February 26, 2020, COVID-19 has been recognized in 34 countries, with a total of 80,239 laboratory-confirmed cases and 2,700 deaths. Infection control measures are necessary to prevent the virus from further spreading and to help control the epidemic situation. Due to the characteristics of dental settings, the risk of cross infection can be high between patients and dental practitioners. For dental practices and hospitals in areas that are (potentially) affected with COVID-19, strict and effective infection control protocols are urgently needed. This article, based on our experience and relevant guidelines and research, introduces essential knowledge about COVID-19 and nosocomial infection in dental settings and provides recommended management protocols for dental practitioners and students in (potentially) affected areas.

Coronavirus Disease 2019 (COVID-19): Emerging and Future Challenges for Dental and Oral Medicine
 

The impact of the COVID-19 epidemic on the utilization of emergency dental services. Huaqiu Guoa †YinZhoub †Xiaoqiang Liuc Jianguo Tanc

Abstract
Background/Purpose

To assess how the current COVID-19 epidemic influenced peoples' utilization of emergency dental services in Beijing, China.
Methods
The first-visit patients seeking emergency dental services before or at the beginning of the COVID-19 epidemic were retrieved. Their demographic characteristics and the reasons for visiting were recorded and analysed.
Results
There were 2,537 patients involved in this study. Thirty-eight percent fewer patients visited the dental urgency at the beginning of the COVID-19 epidemic than before. The distribution of dental problems has changed significantly. The proportion of dental and oral infection raised from 51.0% of pre-COVID-19 to 71.9% during COVID-19, and dental trauma decreased from 14.2% to 10.5%. Meanwhile, the non-urgency cases reduced to three-tenths of pre-COVID-19.
Conclusion
Within the limitation of this study, the COVID-19 epidemic had a strong influence on the utilization of emergency dental services.

The impact of the COVID-19 epidemic on the utilization of emergency dental services
 

Coronavirus COVID-19 impacts to dentistry and potential salivary diagnosis. Robinson Sabino-Silva & Ana Carolina Gomes Jardim & Walter L. Siqueira

Summary
A novel coronavirus (COVID-19) is associated with humanto-human transmission. The COVID-19 was recently identified in saliva of infected patients. In this point-of-view article, we discuss the potential of transmission via the saliva of this virus. The COVID-19 transmission via contact with droplets and aerosols generated during dental clinical procedures is expected. There is a need to increase investigations to the detection of COVID-19 in oral fluids and its impact on the transmission of this virus, which is crucial to improve effective strategies for prevention, especially for dentists and healthcare professionals that perform aerosol-generating procedures. Saliva can have a pivotal role in the human-to-human transmission, and non-invasive salivary diagnostics may provide a convenient and cost-effective point-of-care platform for the fast and early detection of COVID-19 infection.

Coronavirus COVID-19 impacts to dentistry and potential salivary diagnosis
 

What Constitutes a Dental Emergency?

The ADA recognizes that state governments and state dental associations may be best positioned to recommend to the dentists in their regions the amount of time to keep their offices closed to all but emergency care. This is fluid situation and those closest to the issue may best understand the local challenges being faced.

What Constitutes a Dental Emergency?

Transmission routes of 2019-nCoV and controls in dental practice. Xian Peng, Xin Xu, Yuqing Li, Lei Cheng, Xuedong Zhou and Biao Ren

Abstract
A novel β-coronavirus (2019-nCoV) caused severe and even fetal pneumonia explored in a seafood market of Wuhan city, Hubei province, China, and rapidly spread to other provinces of China and other countries. The 2019-nCoV was different from SARS-CoV, but shared the same host receptor the human angiotensin-converting enzyme 2 (ACE2). The natural host of 2019-nCoV may be the bat Rhinolophus affinis as 2019-nCoV showed 96.2% of whole-genome identity to BatCoV RaTG13. The person-to-person transmission routes of 2019-nCoV included direct transmission, such as cough, sneeze, droplet inhalation transmission, and contact transmission, such as the contact with oral, nasal, and eye mucous membranes. 2019-nCoV can also be transmitted through the saliva, and the fetal–oral routes may also be a potential person-to-person transmission route. The participants in dental practice expose to tremendous risk of 2019-nCoV infection due to the face-to-face communication and the exposure to saliva, blood, and other body fluids, and the handling of sharp instruments. Dental professionals play great roles in preventing the transmission of 2019-nCoV. Here we recommend the infection control measures during dental practice to block the person-to-person transmission routes in dental clinics and hospitals.

Transmission routes of 2019-nCoV and controls in dental practice

Guidance for health workers

Aerosolgenererende prosedyrer i helsetjenesten, og covid-19. FHI

Funnene i denne hurtigoversikten baserer seg på raske søk i PubMed og Embase. Én forsker har gått gjennom søketreff, valgt ut og oppsummert resultatene. Ettersom det har vært viktig å få fram forskningsresultatene raskt, har vi valgt denne framgangsmåten, selv om det innebærer risiko for at vi kan ha oversett viktig dokumentasjon og kan ha gjort feilvurderinger underveis

Aerosolgenererende prosedyrer i helsetjenesten, og covid-19 

Dentists' awareness, perception, and attitude regarding COVID-19 and infection control: A cross-sectional study among Jordanian dentists. Khader Y, Al Nsour M, Al-Batayneh OB, Saadeh R, Bashier H, Alfaqih M, Al-Azzam S, AlShurman BA

Background: Despite the availability of prevention guidelines and recommendations on infection control, many dental practices lack the minimum requirements of infection control.
Objective: This study aimed to assess the level of awareness, perception, and attitude regarding COVID-19 and infection control among Jordanian dentists
Methods: The study population consisted of dentists who work in private clinics, hospitals, and health centers in Jordan. An online questionnaire was sent to a sample of Jordanian dentists in March 2020. The questionnaire comprised a series of questions about dentists’ demographic characteristics, their awareness of incubation period, the symptoms of the disease, mode of transmission of the COVID-19, and infection control measures for preventing COVID-19, and their attitude toward treating patients with COVID-19. Results RESULTS This study included a total of 368 dentists aged from 22 to 73 year with a mean (SD) of 32.9 (10.6) year. A total of 112 (30.4%) had completed a master or residency program in dentistry, 195 (53.0%) had received training in infection control in dentistry, and 28 (7.6%) had attended training or received lectures regarding COVID-19. A total of 162 (44.0%) dentists reported that the incubation period is 7-14 days. The majority of dentists were aware of COVID-19 symptoms and ways of how to identify patients at risk of having COVID-19, were able to correctly report known modes of transmission and were aware of measures for preventing COVID-19 transmission in dental clinics. A total of 275 (74.7%) believed that it is necessary to ask patients to set far from each other, wear masks while in the waiting room, and wash hands before getting in the dental chair to decrease disease transmission. Conclusion CONCLUSIONS Jordanian dentists were aware of COVID-19 symptoms, mode of transmission, infection control and measures in dental clinic. However, dentists had limited comprehension of the extra precautionary measures that protect the dental staff and other patients from COVID-19. National and international guidelines should be sent by the regional and national dental associations to all registered dentists during crisis, including this COVID -19 pandemic, to make sure that dentists are well informed and aware of the best practices and recommended disease management approaches.

Dentists' awareness, perception, and attitude regarding COVID-19 and infection control: A cross-sectional study among Jordanian dentists

 

Coronavirus Disease (COVID-19): Characteristics in children and considerations for Dentists providing their care. Mallineni SK, Innes NP, Raggio DP, Araujo MP, Robertson MD, Jayaraman J.

Health services provision of 48 public tertiary dental hospitals during the COVID-19 epidemic in China. Yang Y, Zhou Y, Liu X, Tan J.

Abstract
Objectives
To assess the status of health services provision of public tertiary dental hospitals during the COVID-19 epidemic in China and to evaluate the regional difference of telehealth.
Materials and methods: The health services provision of public tertiary dental hospitals in China mainland during the COVID-19 epidemic was inquired. The status of non-emergency dental services, emergency dental services, and online professional consultation and the hospitals’ geographical distribution were recorded and analyzed.
Results: All the 48 public tertiary dental hospitals suspended general non-emergency dental treatment while providing emergency dental services only. Ninety percent of them notified the change of dental services online, and 69% of them offered free online professional consultations. The penetration rate of online technology was significantly higher in the eastern region than that of the central and western regions.
Conclusions: There was a significant change in the health service provision of Chinese public tertiary dental hospitals during the COVID-19 epidemic and wider use of telehealth in the eastern region.
Clinical relevance: This report demonstrated that dental health services were significantly affected by the COVID-19 epidemic in China, which might lead to a long-time impact on dental care in the future.

Health services provision of 48 public tertiary dental hospitals during the COVID-19 epidemic in China

COVID-19 outbreak and its monetary implications for dental practices, hospitals and healthcare workers. Farooq I, Ali S.

Postgrad Med J. 2020 Apr 3. pii: postgradmedj-2020-137781. doi: 10.1136/postgradmedj-2020-137781. [Epub ahead of print]

Abstract The novel COVID-19 came under limelight few months back (December 2019) and has recently been declared a pandemic by WHO. It has resulted in serious financial implications being faced by dental practices, hospitals and healthcare workers. Dental practice currently is restricted to provision of emergency dental care whereas, many hospitals have also cancelled elective procedures to save finances for COVID-19 treatment which is expensive and unpredictable. In addition, healthcare workers are also facing financial challenges in this difficult time. Competent authorities should step in to help dental practices, hospitals and healthcare workers in order to ensure the provision of all types of healthcareefficiently in these testing times and beyond.

COVID-19 outbreak and its monetary implications for dental practices, hospitals and healthcare workers

 

Spread of SARS-CoV-2 in the Icelandic Population. Daniel F. Gudbjartsson, Ph.D., Agnar Helgason, Ph.D., Hakon Jonsson, Ph.D., Olafur T. Magnusson, Ph.D., Pall Melsted, Ph.D., Gudmundur L. Norddahl, Ph.D., Jona Saemundsdottir, B.Sc., Asgeir Sigurdsson,

Background: During the current worldwide pandemic, coronavirus disease 2019 (Covid-19) was first diagnosed in Iceland at the end of February. However, data are limited on how SARS-CoV-2, the virus that causes Covid-19, enters and spreads in a population.

Methods: We targeted testing to persons living in Iceland who were at high risk for infection (mainly those who were symptomatic, had recently traveled to high-risk countries, or had contact with infected persons). We also carried out population screening using two strategies: issuing an open invitation to 10,797 persons and sending random invitations to 2283 persons. We sequenced SARS-CoV-2 from 643 samples.

Results: As of April 4, a total of 1221 of 9199 persons (13.3%) who were recruited for targeted testing had positive results for infection with SARS-CoV-2. Of those tested in the general population, 87 (0.8%) in the open-invitation screening and 13 (0.6%) in the random-population screening tested positive for the virus. In total, 6% of the population was screened. Most persons in the targeted-testing group who received positive tests early in the study had recently traveled internationally, in contrast to those who tested positive later in the study. Children under 10 years of age were less likely to receive a positive result than were persons 10 years of age or older, with percentages of 6.7% and 13.7%, respectively, for targeted testing; in the population screening, no child under 10 years of age had a positive result, as compared with 0.8% of those 10 years of age or older. Fewer females than males received positive results both in targeted testing (11.0% vs. 16.7%) and in population screening (0.6% vs. 0.9%). The haplotypes of the sequenced SARS-CoV-2 viruses were diverse and changed over time. The percentage of infected participants that was determined through population screening remained stable for the 20-day duration of screening.

Spread of SARS-CoV-2 in the Icelandic Population

 

Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19). A Review. James M Sanders, Marguerite L Monogue, Tomasz Z Jodlowski, James B Cutrell

Abstract
Importance: The pandemic of coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents an unprecedented challenge to identify effective drugs for prevention and treatment. Given the rapid pace of scientific discovery and clinical data generated by the large number of people rapidly infected by SARS-CoV-2, clinicians need accurate evidence regarding effective medical treatments for this infection.

Observations: No proven effective therapies for this virus currently exist. The rapidly expanding knowledge regarding SARS-CoV-2 virology provides a significant number of potential drug targets. The most promising therapy is remdesivir. Remdesivir has potent in vitro activity against SARS-CoV-2, but it is not US Food and Drug Administration approved and currently is being tested in ongoing randomized trials. Oseltamivir has not been shown to have efficacy, and corticosteroids are currently not recommended. Current clinical evidence does not support stopping angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in patients with COVID-19

Conclusions and Relevance: The COVID-19 pandemic represents the greatest global public health crisis of this generation and, potentially, since the pandemic influenza outbreak of 1918. The speed and volume of clinical trials launched to investigate potential therapies for COVID-19 highlight both the need and capability to produce high-quality evidence even in the middle of a pandemic. No therapies have been shown effective to date.

Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19). A Review.

 

Coronavirus Disease 2019 (COVID-19): Emerging and Future Challenges for Dental and Oral Medicine. L Meng, F Hua, Z Bian

Abstract
The epidemic of coronavirus disease 2019 (COVID-19), originating in Wuhan, China, has become a major public health challenge for not only China but also countries around the world. The World Health Organization announced that the outbreaks of the novel coronavirus have constituted a public health emergency of international concern. As of February 26, 2020, COVID-19 has been recognized in 34 countries, with a total of 80,239 laboratory-confirmed cases and 2,700 deaths. Infection control measures are necessary to prevent the virus from further spreading and to help control the epidemic situation. Due to the characteristics of dental settings, the risk of cross infection can be high between patients and dental practitioners.

For dental practices and hospitals in areas that are (potentially) affected with COVID-19, strict and effective infection control protocols are urgently needed. This article, based on our experience and relevant guidelines and research, introduces essential knowledge about COVID-19 and nosocomial infection in dental settings and provides recommended management protocols for dental practitioners and students in (potentially) affected areas.

Keywords: dental education; dental practice management; dental public health; infection control; transmission; virology.

Coronavirus Disease 2019 (COVID-19): Emerging and Future Challenges for Dental and Oral Medicine

Recommendations for the re-opening of dental services: a rapid review of international sources