Aim: The aim of this review is to discuss the implications of COVID-19 on various aspects of dental care. Background: The COVID-19 pandemic had suspended dental practice globally for over 3 months. While dental practice is being resumed cautiously, standard infection control protocols that were traditionally overlooked are now being strictly implemented. Post-COVID-19, dental care is expected to see a drastic change in the way it is practiced. Review results: With a view on the natural history and disease dynamics of COVID-19, this review reports various aspects of dental care, viz., patient triaging, engineering and work practice controls, and administrative, financial, and ethical aspects of dental care during and after COVID-19 pandemic. Current evidence-based recommendations with regard to infection-control practices are discussed. A call for universal oral health care with suggestions regarding integration of medical and health care is also proposed. Conclusion: COVID-19 is expected to be a watershed moment in the field of dentistry. While we expect to see positive changes in safe delivery of dental care, an increase in cost of availing care is imminent. Clinical significance: The practice of dentistry and dental infection control has undergone dimensional changes due to bloodborne infectious diseases such as hepatitis B virus infections and human immunodeficiency virus epidemic. Due to these pandemics, many regulatory organizations have provided safety recommendations and guidelines that impact the dental practice. Currently, we are faced with a highly infective disease with a high mortality rate among people with comorbidities and of predominantly droplet transmission and no concrete safety recommendations and guidelines. This manuscript addresses multiple issues, gaps, and pragmatic solutions in controlling transmission of SARS-CoV-2 in dental settings, during and after the pandemic.
Fehr AR, Perlman S. Coronaviruses: an overview of their replication and pathogenesis. Coronaviruses 2015;1282:1–23. DOI: 10.1007/978-1-4939-2438-7_1.
Shereen MA, Khan S, Kazmi A, et al. COVID-19 infection: origin, transmission, and characteristics of human coronaviruses. J Adv Res 2020;24:91–98. DOI: 10.1016/j.jare.2020.03.005.
International Committee on Taxonomy of Viruses (ICTV) [Internet]. [cited 2020 Jun 24]. Available from: https://talk.ictvonline.org/.
Cui J, Li F, Shi Z-L. Origin and evolution of pathogenic coronaviruses. Nat Rev Microbiol 2019;17(3):181–192. DOI: 10.1038/s41579-018-0118-9.
John Hopkins University and Medicine. COVID-19 Map - Johns Hopkins Coronavirus Resource Center [Internet]. [cited 2020 Jun 24]. Available from: https://coronavirus.jhu.edu/map.html.
Giacomelli A, Pezzati L, Conti F, et al. Self-reported olfactory and taste disorders in patients with severe acute respiratory coronavirus 2 infection: a cross-sectional study. Clin Infect Dis [Internet]. 2020. Available from: https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa330/5811989.
Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382(18):1708–1720. DOI: 10.1056/NEJMoa2002032.
Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19) – Symptoms [Internet]. Centers for Disease Control and Prevention. 2020 [cited 2020 Jun 24]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms. html.
Oren O, Kopecky SL, Gluckman TJ, et al. Coronavirus disease 2019 (COVID-19): epidemiology, clinical spectrum and implications for the cardiovascular clinician [Internet]. Am Coll Cardiol 2020. Available from: http%3a%2f%2fwww.acc.org%2flatest-in-cardiology%2farticles%2f2020%2f04%2f06%2f11%2f08%2fcovid-19-epidemiology-clinical-spectrum-and-implications-for-the-cv-clinician.
Lauer SA, Grantz KH, Bi Q, et al. The Incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application. Ann Intern Med 2020;172(9):577–582. DOI: 10.7326/M20-0504.
Sanche S, Lin YT, Xu C, et al. High contagiousness and rapid spread of severe acute respiratory syndrome coronavirus 2. Emerg Infect Dis [Internet] 2020;26(7). DOI: 10.3201/eid2607.200282Available from: https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article.
Viceconte G, Petrosillo N. COVID-19 R0: magic number or conundrum? Infect Dis Rep [Internet] 2020;12(1). DOI: 10.4081/idr.2020.8516Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073717/.
Zhang S, Diao M, Yu W, et al. Estimation of the reproductive number of novel coronavirus (COVID-19) and the probable outbreak size on the Diamond Princess cruise ship: a data-driven analysis. Int J Infect Dis 2020;93:201–204. DOI: 10.1016/j.ijid.2020.02.033.
Centers for Disease Control and Prevention. Guidance for Dental Settings. Interim Infection Prevention and Control Guidance for Dental Settings during the COVID-19 response [Internet]. Centers for Disease Control and Prevention. 2020 [cited 2020 Jun 24]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html.
Centers for Disease Control and Prevention. Screening Clients for COVID-19 at Homeless Shelters or Encampments [Internet]. Centers for Disease Control and Prevention. 2020 [cited 2020 Jun 24]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/community/homeless-shelters/screening-clients-respiratory-infection-symptoms.html.
Ather A, Patel B, Ruparel NB, et al. Coronavirus disease 19 (COVID-19): implications for clinical sental care. J Endod. 2020;46(5):584–595. DOI: 10.1016/j.joen.2020.03.008.
American Dental Association. ADA releases interim guidance on minimizing COVID-19 transmission risk when treating dental emergencies [Internet]. 2020 [cited 2020 Jun 24]. Available from: https://www.ada.org/en/publications/ada-news/2020-archive/april/ada-releases-interim-guidance-on-minimizing-covid-19-transmission-risk-when-treating-emergencies.
Centers for Disease Control and Prevention. CDC Releases Interim Reopening Guidance for Dental Settings [Internet]. 2020 [cited 2020 Jun 24]. Available from: https://www.cdc.gov/oralhealth/infectioncontrol/statement-COVID.html.
University of Memphis. Pandemic Risk Medium. Protecting Employees in Work Places Classified at Medium Exposure Risk for Pandemic Influenza. University of Memphis, Office of Environmental Health and Safety. [Internet]. 2019 [cited 2020 Jun 24]. Available from: https://www.memphis.edu/ehs/programs/pandemicriskmedium.php.
Long RH, Ward TD, Pruett ME, et al. Modifications of emergency dental clinic protocols to combat COVID-19 transmission. Spec Care Dentist 2020;40(3):219–226. DOI: 10.1111/scd.12472.
American Dental Association. ADA develops guidance on dental emergency, nonemergency care [Internet]. 2020 [cited 2020 Jun 24]. Available from: https://www.ada.org/en/publications/ada-news/2020-archive/march/ada-develops-guidance-on-dental-emergency-nonemergency-care.
United States Department of Labor. Hospital eTool: Healthcare Wide Hazards - (Lack of) Universal Precautions [Internet]. [cited 2020 Jun 24]. Available from: https://www.osha.gov/SLTC/etools/hospital/hazards/univprec/univ.html.
Xu R, Cui B, Duan X, et al. Saliva: potential diagnostic value and transmission of 2019-nCoV. Int J Oral Sci 2020;12(1):1–6. DOI: 10.1038/s41368-020-0080-z.
United States Department of Labor. COVID-19 - Control and Prevention | Dentistry Workers and Employers | Occupational Safety and Health Administration [Internet]. [cited 2020 Jun 24]. Available from: https://www.osha.gov/SLTC/covid-19/dentistry.html.
Zemouri C, de Soet H, Crielaard W, et al. A scoping review on bio-aerosols in healthcare and the dental environment. PloS ONE. 2017;12(5):e0178007. DOI: 10.1371/journal.pone.0178007.
Samaranayake LP, Peiris M. Severe acute respiratory syndrome and dentistry: a retrospective view. J Am Dent Assoc 2004;135(9):1292–1302. DOI: 10.14219/jada.archive.2004.0405.
World Health Organization. Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations [Internet]. 2020 [cited 2020 Jun 24]. Available from: https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations.
Escombe AR, Oeser CC, Gilman RH, et al. Natural ventilation for the prevention of airborne contagion. PloS Med. 2007;4(2):e68. DOI: 10.1371/journal.pmed.0040068.
van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and aurface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med 2020;382(16):1564–1567. DOI: 10.1056/NEJMc2004973.
Kohn WG, Collins AS, Cleveland JL, et al. Guidelines for infection control in dental health care settings - 2003. Morb Mortal Wkly Rep. 2003;52(RR-17):1–61.
Coronavirus: Two NHS medics on ventilators after contracting COVID-19 from patients. Sky News [Internet]. 2020 Mar 22 [cited 2020 Jun 24]; Available from: https://news.sky.com/story/coronavirus-two-nhs-medics-on-ventilators-after-contracting-covid-19-from-patients-11961531.
OMFS and ENT surgeons issue new COVID-19 PPE guidance. Br Dent J 2020;228(8):571. DOI: 10.1038/s41415-020-1552-4.
Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet Lond Engl. 2020;395(10229):1033–1034. DOI: 10.1016/S0140-6736(20) 30628-0.
Chang D, Xu H, Rebaza A, et al. Protecting health-care workers from subclinical coronavirus infection. Lancet Respir Med 2020;8(3):e13. DOI: 10.1016/S2213-2600(20)30066-7.
Patel ZM, Fernandez-Miranda J, Hwang PH, et al. Letter: precautions for endoscopic transnasal skull base surgery during the COVID-19 pandemic. Neurosurgery. 2020;87(1):E66–E67. DOI: 10.1093/neuros/nyaa125.
Centers for Disease Control and Prevention. Using Antibody Tests for COVID-19 [Internet]. Centers for Disease Control and Prevention. 2020 [cited 2020 Jun 24]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/antibody-tests.html.
APS2000 3-in-1 Air Protection System | Air Protection System (APS) | Products | Air Rover, Inc [Internet]. [cited 2020 Jun 24]. Available from: https://www.airrover.com/products/air-protection-system/aps2000?utm_term=hospital%20grade%20air%20purifier&utm_campaign=APS2000&utm_source=adwords&utm_medium=ppc&hsa_acc=7331579621&hsa_cam=9944652438&hsa_grp=104549714070&hsa_ad=432760829693&hsa_src=g&hsa_tgt=kwd-304699403476&hsa_kw=hospital%20grade%20air%20purifier&hsa_mt=b&hsa_net=adwords&hsa_ver=3&gclid=Cj0KCQjwuJz3BRDTARIsAMg-HxXNwSZrTAA1-wALjwrKrxNj7nTCRTvhdOyZrLF3Zdg_a5hAbHW3P14aAgr3EALw_wcB.
Welch D, Buonanno M, Grilj V, et al. Far-UVC light: a new tool to control the spread of airborne-mediated microbial diseases. Sci Rep. 2018;8(1):2752. DOI: 10.1038/s41598-018-21058-w.
US EPA O. What is a HEPA filter? [Internet]. US EPA. 2019 [cited 2020 Jun 24]. Available from: https://www.epa.gov/indoor-air-quality-iaq/what-hepa-filter-1.
World Health Organization. Review of preparations used for hand hygiene [Internet]. WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care. World Health Organization; 2009 [cited 2020 Jun 24]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK144041/.
PUR·ONE | EvaClean [Internet]. [cited 2020 Jun 24]. Available from: https://evaclean.com/products/purone.
DolfinPods™ [Internet]. Toppen Health. [cited 2020 Jun 24]. Available from: https://toppenhealth.com/pro/dolfinpods/.
OPTIM 1 [Internet]. SciCan (US). [cited 2020 Jun 24]. Available from: https://www.scican.com/us/products/cleaners-disinfectants/optim-1/.
US EPA O. Selected EPA-Registered Disinfectants [Internet]. US EPA. 2015 [cited 2020 Jun 24]. Available from: https://www.epa.gov/pesticide-registration/selected-epa-registered-disinfectants.
Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. Healthcare Respiratory Protection Resources [Internet]. 2019 [cited 2020 Jun 24]. Available from: https://www.cdc.gov/niosh/npptl/hospresptoolkit/default.html.
Centers for Disease Control and Prevention. Considerations for Optimizing the Supply of Powered Air-Purifying Respirators (PAPRs) [Internet]. Centers for Disease Control and Prevention. 2020 [cited 2020 Jun 24]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/powered-air-purifying-respirators-strategy.html.
Mizumoto K, Kagaya K, Zarebski A, et al. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Eurosurveillance [Internet]. 2020;25(10):Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7078829/.
American Dental Association. ADA Principles of Ethics and Code of Professional Conduct [Internet]. [cited 2020 Jun 24]. Available from: https://www.ada.org/en/about-the-ada/principles-of-ethics-code-of-professional-conduct.
Gillon R. Medical ethics: four principles plus attention to scope. BMJ. 1994;309(6948):184. DOI: 10.1136/bmj.309.6948.184.
Ethics | Internet Encyclopedia of Philosophy [Internet]. [cited 2020 Jun 24]. Available from: https://www.iep.utm.edu/ethics/#SSH2c.i.
World Health Organization. Oral health [Internet]. 2020 [cited 2020 Jun 24]. Available from: https://www.who.int/news-room/fact-sheets/detail/oral-health.
Okunseri C, Zbin S, Zheng C, et al. Emergency department visits and dental procedures: mission of mercy, 2013–2016. Clin Cosmet Investig Dent 2019;11:157–162. DOI: 10.2147/CCIDE.S207266.
Wall T, Majority of Dental-Related Emergency Department Visits Lack Urgency and Can Be Diverted to Dental Offices 9.
Janakiram C, Chalmers NI, Fontelo P, et al. Sex and race or ethnicity disparities in opioid prescriptions for dental diagnoses among patients receiving medicaid. J Am Dent Assoc 2018;149(4):246–255. DOI: 10.1016/j.adaj.2018.02.010.
Nazir MA, AlGhamdi L, AlKadi M, et al. The burden of diabetes, its oral complications and their prevention and management. Open Access Maced J Med Sci 2018;6(8):1545–1553. DOI: 10.3889/oamjms. 2018.294.
D'Aiuto F, Gkranias N, Bhowruth D, et al. Systemic effects of periodontitis treatment in patients with type 2 diabetes: a 12 month, single-centre, investigator-masked, randomised trial. Lancet Diabetes Endocrinol 2018;6(12):954–965. DOI: 10.1016/S2213-8587(18)30038-X.
NCD Alliance. Accelerating Action on Oral Health and NCDs: Achieving an integrated response. FDI World Dental Federation;.
Marley-320. COVID-19 Benefits - From the Office of DCY [Internet]. Oral Health Group. 2020 [cited 2020 Jun 24]. Available from: https://www.oralhealthgroup.com/news/covid-19-benefits-from-the-office-of-dcy-1003951146/.
Farooq I, Ali S. COVID-19 outbreak and its monetary implications for dental practices, hospitals and healthcare workers. Postgrad Med J 2020. DOI: 10.1136/postgradmedj-2020-137781.
Ministry of Micro, Small & Medium Enterprises, Govt. of India. Initiatives by Ministry of MSME on Covid-19 relief [Internet]. 2020 [cited 2020 Jun 24]. Available from: https://msme.gov.in/initiatives-ministry-msme-covid-19-relief.
Fisher J, Selikowitz H-S, Mathur M, et al. Strengthening oral health for universal health coverage. Lancet Lond Engl. 2018;392(10151): 899–901. DOI: 10.1016/S0140-6736(18)31707-0.
Levels of integration – Medical Dental Integration Toolkit [Internet]. [cited 2020 Jun 24]. Available from: http://medicaldentalintegration.org/what-is-this-toolkit/levels-of-integration/.
Skinner D. From healthcare to health: an update of Norman Daniels's approach to justice. Int J Health Policy Manag 2014;2(3):151–153. DOI: 10.15171/ijhpm.2014.31.