Transmission risk and protective protocols for COVID-19 in dentistry: systematic review

Authors

  • Dr. Heba Alshammary Riyadh Elm University
  • Dr. Munther Abumismar Al Iman General Hospital

DOI:

https://doi.org/10.14419/ijdr.v9i1.31922

Published:

2022-03-20

Keywords:

COVID-19, Dental Clinics, Dental Practice Management, Dental Procedure, Infection Control.

Abstract

Background: According to WHO, the new COVID-19 cases are rising with 4.5 million new cases in the first week of April 2021 and over 76000 new deaths globally. The risk of COVID-19 transmission in dental settings has been a concern. Therefore, this study aims to assess the transmission risk in dentistry and review the infection-control measures followed in different dental clinics worldwide and their compliance with the standard country-based or international guidelines.

Methods: This study reviewed the published literature regarding the COVID-19 transmission-control guidelines followed by different dental care centers worldwide. We performed a comprehensive literature search in PubMed and Embase databases. The key guidelines were listed study-wise, divided into three parts: before entering the dental treatment, during the dental procedure, and after the dental procedure. A comparison study was conducted to assess the compliance with the country-based or internationally accepted recommendations given by WHO, ADA, CDC, etc., for dental practices in the COVID-19 pandemic.

Results: During the dental procedure, a rubber dam and high volume saliva ejectors are recommended to minimize aerosol diffusion; mouth rinsing with 1% hydrogen peroxide or 0.2% povidone-iodine is recommended for patients. After the treatment, proper disinfection of the surfaces and instruments must be followed; the reusable dental instruments should be sterilized. Different guidelines were followed in different dental settings depended on the geographical locations; however, the most commonly followed guidelines were provided by WHO, ADA, CDC, and NHS.

Conclusions: The available guidelines will contribute to the prevention of COVID-19 in dental settings. Although the dental clinics are adopting standard guidelines to prevent COVID-19 transmission, the joint efforts and cooperation of both patients and dental practitioners are needed to make it successful. Therefore, both parties should strictly adhere to their respective recommended guidelines and hand hygiene practice in dental settings.

References

[1] WHO declares COVID-19, a Pandemic. [Accessed on 15 Apr 2021]; Available from: https://pubmed.ncbi.nlm.nih.gov/32191675/

[2] Coronavirus disease (COVID-19): How is it transmitted?, [Accessed on 15th Apr 2021]; Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/coronavirus-disease-covid-19-how-is-it-transmitted

[3] Coronavirus disease (COVID-19), [Accessed on 15th Apr 2021]; Available from: https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19

[4] WHO Coronavirus (COVID-19) Dashboard ;[Accessed on 15th Apr 2021]; Available from: https://covid19.who.int/

[5] Harrel SK, Molinari J. Aerosols and splatter in dentistry: a brief review of the literature and infection control implications. JADA. 2004;135(4):429-437 https://doi.org/10.14219/jada.archive.2004.0207.

[6] The predicament of gag reflex and its management in dental practice during COVID-19 outbreak. [Accessed on 15th Apr 2021]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7274631/

[7] Coronavirus, [Accessed on 15th Apr 2021]; Available from: https://www.who.int/health-topics/coronavirus#tab=tab_1

[8] The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2) in Dentistry. Management of Biological Risk in Dental Practice , [Accessed on 15th Apr 2021]; Available from: https://doi.org/10.3390/ijerph17093067.

[9] Alessandra Amato et al. 2020 : Infection Control in Dental Practice During the COVID-19 Pandemic [Accessed on 7th Apr 2021]; Available from: https://www.mdpi.com/1660-4601/17/13/4769. https://doi.org/10.3390/ijerph17134769.

[10] Bruno César de Vasconcelos et al. 2020 :COVID-19: Perspectives for the management of dental care and education [Accessed on 7th Apr 2021]; Available from: https://doi.org/10.1590/1678-7757-2020-0358.

[11] Cameron Estrich et al. 2020 : Estimating COVID-19 prevalence and infection control practices among US dentists. [Accessed on 7th Apr 2021]; Available from: https://doi.org/10.1016/j.adaj.2020.09.005.

[12] Elmeng et al. 2020 :Coronavirus Disease 2019 (COVID-19): Emerging and Future Challenges for Dental and Oral Medicine [Accessed on 7th Apr 2021]; Available from: https://doi.org/10.1177/0022034520914246.

[13] GulsumDuruk et al. 2020 :Investigation of Turkish dentists’ clinical attitudes and behaviors towards the COVID-19 pandemic: a survey study [Accessed on 7th Apr 2021]; Available from: https://doi.org/10.1590/1807-3107bor-2020.vol34.0054.

[14] Khalifa S et al. 2020 :Pandemic preparedness of dentists against coronavirus disease: A Saudi Arabian experience [Accessed on 15th Apr 2021]; Available from: https://doi.org/10.1371/journal.pone.0237630.

[15] Dental Emergency Protocol During Covid-19 Pandemic [Accessed on 7th Apr 2021]; Available from: https://www.moh.gov.sa/Ministry/MediaCenter/Publications/Documents/MOH-Dental-emergency-guidline.pdf

[16] KhawerAyub et al. 2020 : Acute endodontic and dental trauma provision during the COVID-19 crisis ,[Accessed on 15th Apr 2021]; Available from: https://www.nature.com/articles/s41415-020-1920-0.pdf

[17] Kumar ChandarSrivastava et al. 2020 : Knowledge, attitudes and practices regarding COVID-19 among dental health care professionals: a crosssectional study in Saudi Arabia [Accessed on 15th Apr 2021]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7739093/pdf/10.1177_0300060520977593.pdf

[18] MatteoPeditto et al. 2020: Dentistry during the COVID-19 Epidemic: An Italian Workflow for the Management of Dental Practice ,[Accessed on 15th Apr 2021]; Available from: https://www.mdpi.com/1660-4601/17/9/3325. https://doi.org/10.3390/ijerph17093325.

[19] Mohamed Jamal et al. 2020 : Overview of transnational recommendations for COVID-19 transmission control in dental care settings ,[Accessed on 15th Apr 2021]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280672/pdf/ODI-9999-na.pdf

[20] Monika Tysiąc-Miśta et al. 2020: The Attitudes and Professional Approaches of Dental Practitioners during the COVID-19 Outbreak in Poland: A Cross-Sectional Survey, [Accessed on 15th Apr 2021]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370196/pdf/ijerph-17-04703.pdf. https://doi.org/10.3390/ijerph17134703.

[21] Muhammad Adeel Ahmed et al. 2020: Fear and Practice Modifications among Dentists to Combat Novel Coronavirus Disease (COVID-19) Outbreak, [Accessed on 15th Apr 2021]; Available from: https://www.mdpi.com/1660-4601/17/8/2821. https://doi.org/10.3390/ijerph17082821.

[22] Pedro H. et al. 2020: COVID-19: how to decrease the risk of infection in dental practice? [Accessed on 15th Apr 2021]; Available from: https://pubmed.ncbi.nlm.nih.gov/32407062/.

[23] R. Izetti et al. 2020 : COVID-19 Transmission in Dental Practice: Brief Review of Preventive Measures in Italy ,[Accessed on 15th Apr 2021]; Available from: https://doi.org/10.1177/0022034520920580.

[24] Roberto Lo Giudice et al. 2020: The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2) in Dentistry. Management of Biological Risk in Dental Practice , [Accessed on 15th Apr 2021]; Available from: https://www.mdpi.com/1660-4601/17/9/3067. https://doi.org/10.3390/ijerph17093067.

[25] SanjeevKhangar et al. 2020 : Exposure Risks and Preventive Strategies Considered in Dental Care Settings to Combat Coronavirus Disease (COVID-19) [Accessed on 15th Apr 2021]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7459178/pdf/10.1177_1937586720950746.pdf

[26] Amber Ather et al. 2020 : Coronavirus Disease 19 (COVID-19): Implications for Clinical Dental Care; [Accessed on 15th Apr 2021]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270628/pdf/main.pdf. https://doi.org/10.1016/j.joen.2020.03.008.

[27] C. Prati et al. 2020 :COVIDâ€19: its impact on dental schools in Italy, clinical problems in endodontic therapy and general considerations , [Accessed on 15th Apr 2021]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7262194/. https://doi.org/10.1111/iej.13291.

[28] Catherine MC Volgenant et al. 2020 : Infection control in dental health care during and after the SARS-CoV-2 outbreak ,[Accessed on 15th Apr 2021]; Available from: https://www.researchgate.net/publication/341296227_Infection_control_in_dental_health_care_during_and_after_the_SARS-CoV-2_outbreak https://doi.org/10.1111/odi.13408.

[29] FlavioFreitas et al. 2020: COVID-19: a new turning point for dental practice [Accessed on 15th Apr 2021]; Available from: https://www.researchgate.net/publication/341296227_Infection_control_in_dental_health_care_during_and_after_the_SARS-CoV-2_outbreak

[30] Khadijah et al. 2020 : Precautions and recommendations for orthodontic settings during the COVID-19 outbreak: A review [Accessed on 15th Apr 2021]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7218376/pdf/main.pdf

[31] Maryam Bagizadeh Et Al. 2020 : What dentists need to know about COVID-19 , [Accessed on 15th Apr 2021]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186204/pdf/main.pdf

[32] MehranFalahchai et al. 2020 : Dental care management during the COVID-19 outbreak [Accessed on 15th Apr 2021]; Available from: https://onlinelibrary.wiley.com/doi/10.1111/scd.12523

[33] Zi Yu Ge et al. 2020 : Possible aerosol transmission of COVID-19 and special precautions in dentistry [Accessed on 15th Apr 2021]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7089481/pdf/JZUSB21-0361.pdf

[34] Xian Peng et al. 2020 : Transmission routes of 2019-nCoV and controls in dental practice , [Accessed on 15th Apr 2021]; Available from: https://www.nature.com/articles/s41368-020-0075-9.pdf

[35] COVID-19 Infection Control Protocols and Procedures Webinar , [Accessed on 15th Apr 2021]; Available from: https://success.ada.org/en/practice-management/patients/digital-events/covid-19-infection-control-protocols-and-procedures-webinar

[36] Guidance for Dental Settings : [Accessed on 15th Apr 2021]; Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html#section-2

[37] Considerations for the provision of essential oral health services in the context of COVID-19 [Accessed on 15th Apr 2021]; Available from: https://www.who.int/publications/i/item/who-2019-nCoV-oral-health-2020.1

[38] COVID-19 guidance and standard operating procedure [Accessed on 15th Apr 2021]; Available from: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/06/C0581-covid-19-urgent-dental-care-sop-update-16-june-20-.pdf

[39] Guideline for the Diagnosis and Treatment of Novel Coronavirus Pneumonia
(the 5th edition) [Accessed on 15th Apr 2021]; Available from: http://www.nhc.gov.cn/yzygj/s7653p/202002/3b09b894ac9b4204a79db5b8912d4440.shtml

[40] the Guideline for the Prevention and Control of Novel Coronavirus Pneumonia in Medical Institutes (the 1st edition )[Accessed on 15th Apr 2021]; Available from: http://www.nhc.gov.cn/yzygj/s7659/202001/b91fdab7c304431eb082d67847d27e14.shtml

[41] The Guideline for the Use of Medical Protective Equipment in the Prevention
and Control of Novel Coronavirus Pneumonia [Accessed on 15th Apr 2021]; Available from: http://www.nhc.gov.cn/yzygj/s7659/202001/e71c5de925a64eafbe1ce790debab5c6.shtml

[42] Chinese Stomatological Association. [Guidelines of clinical dental care during the COVID-19 epidemic]. [Accessed on 15th Apr 2021]; Available from: http://www.cndent.com/archives/66974

[43] COVID-19 and professional dental practice. The Polish Dental Association Working Group recommendations for procedures in dental office during an increased epidemiological risk [Accessed on 15th Apr 2021]; Available from: https://www.researchgate.net/publication/340794869_COVID-19_and_professional_dental_practice_The_Polish_Dental_Association_Working_Group_recommendations_for_procedures_in_dental_office_during_an_increased_epidemiological_risk

[44] COVID-19 in Dental Care Settings , [Accessed on 15th Apr 2021]; Available from: https://www.publichealthontario.ca/-/media/documents/ncov/ipac/2020/07/covid-19-dental-care-settings.pdf?la=en

[45] Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. J Dent Res. 2020; 99(5):481–7. [Accessed on 15th Apr 2021]; Available from: https://doi.org/10.1177/0022034520914246.

[46] Shamszadeh S, Parhizkar A, Mardani M, Asgary S. Dental considerations after the outbreak of 2019 novel coronavirus disease: a review of literature. Arch Clin Infect Dis. 2020, 15:2. [Accessed on 15th Apr 2021]; Available from: https://doi.org/10.5812/archcid.103257.

[47] Dave M, Seoudi N, Coulthard P. Urgent dental care for patients during the COVID-19 pandemic. Lancet. 2020;395(10232):1257. [Accessed on 15th Apr 2021]; Available from: https://doi.org/10.1016/S0140-6736 (20)30806-0.

[48] Negahdaripour M. The battle against COVID-19: where do we stand
now? Iranian J Med Sci. 2020; 45(2):81. [Accessed on 15th Apr 2021]; Available from: https://doi.org/10.1016/S0140-6736(20)30806-0.

[49] Santacroce L, Passarelli PC, Passarelli G, Charitos IA, Rella E, D’Addona A. COVID-19 and Oral diseases: how can we manage hospitalized and quarantined patients while reducing risks? 2020. [Accessed on 15th Apr 2021]; Available from: https://doi.org/10.29333/ejgm/7945.

[50] Morteza Banakar et al. 2020: COVID-19 transmission risk and protective protocols in dentistry: a systematic review, [Accessed on 15th Apr 2021]; Available from: https://doi.org/10.1111/iej.13312.

[51] Morteza Banakar et al. 2020: COVID-19 transmission risk and protective protocols in dentistry: a systematic review, [Accessed on 15th Apr 2021]; Available from: https://doi.org/10.1111/iej.13312.

[52] KutterJS, Spronken MI, Fraaij PL, et al. Transmission routes of respiratory viruses among humans. CurrOpinVirol, 2018; 28:142-151. [Accessed on 15th Apr 2021]; Available from: https://doi.org/10.1016/j.coviro.2018.01.001.

[53] Otter JA, Yezli S, Salkeld JAG, et al. Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings. Am J Infect Control, 2013; 41(5):S6-S11. [Accessed on 15th Apr 2021]; Available from: https://doi.org/10.1016/j.ajic.2012.12.004.

[54] Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis, 2006; 6:130. [Accessed on 15th Apr 2021]; Available from: https://doi.org/10.1186/1471-2334-6-130.

[55] Farah RI. Effect of cooling water temperature on the temperature changes in pulp chamber and at handpiece head during high-speed tooth preparation. Restor Dent Endod, 2019; 44(1):e3. [Accessed on 15th Apr 2021]; Available from: https://doi.org/10.5395/rde.2019.44.e3.

[56] Grenier D. Quantitative analysis of bacterial aerosols in two different dental clinic environments. Appl Environ Microbiol, 1995; 61(8):3165-3168. [Accessed on 15th Apr 2021]; Available from: https://doi.org/10.1128/aem.61.8.3165-3168.1995.

[57] Jones RM, Brosseau LM. Aerosol transmission of infectious disease. J Occup Environ Med, 2015; 57(5):501-508. [Accessed on 15th Apr 2021]; Available from: https://doi.org/10.1097/JOM.0000000000000448.

[58] Chowell G, Abdirizak F, Lee S, et al. Transmission characteristics of MERS and SARS in the healthcare setting: a comparative study. BMC Med, 2015; 13:210. [Accessed on 15th Apr 2021]; Available from: https://doi.org/10.1186/s12916-015-0450-0.

[59] Xu H, Zhong L, Deng JX, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci, 2020; 12(1):1-5. [Accessed on 15th Apr 2021]; Available from: https://doi.org/10.1038/s41368-020-0074-x.

[60] Atkinson J, Chartier Y, Pessoa-Silva CL, et al., 2009. Natural Ventilation for Infection Control in Health-Care Settings. World Health Organization, Geneva, Switzerland

[61] RabenauHF, Kampf G, Cinatl J, et al. Efficacy of various disinfectants against SARS coronavirus. J Hosp Infect, 2005; 61(2):107-111. [Accessed on 15th Apr 2021]; Available from: https://doi.org/10.1016/j.jhin.2004.12.023.

[62] Fung ICH, Cairncross S. Effectiveness of handwashing in preventing SARS: a review. Trop Med Int Health, 2006, 11(11): 1749-1758. [Accessed on 15th Apr 2021]; Available from: https://doi.org/10.1111/j.1365-3156.2006.01734.x.

[63] Bentley CD, Burkhart NW, Crawford JJ. Evaluating spatter and aerosol contamination during dental procedures.J Am Dent Assoc, 1994; 125(5):579-584. https://doi.org/10.14219/jada.archive.1994.0093.

[64] Nejatidanesh F, Khosravi Z, Goroohi H, et al. Risk of contamination of different areas of dentist’s face during dental practices. Int J Prev Med, 2013; 4(5):611-615

[65] Lu CW, Liu XF, JiaZF. 2019-nCoV transmission through the ocular surface must not be ignored. Lancet, 2020, 395(10224):PE39. [Accessed on 15th Apr 2021]; Available from: https://doi.org/10.1016/S0140-6736(20)30313-5.

[66] Marui VC, Souto MLS, RovaiES, et al. Efficacy of preproceduralmouthrinses in the reduction of microorganisms in aerosol: a systematic review. J Am Dent Assoc, 2019; 150(12):1015-1026.e1. [Accessed on 15th Apr 2021]; Available from: https://doi.org/10.1016/j.adaj.2019.06.024.

[67] Harrel SK, Molinari J. Aerosols and splatter in dentistry: a brief review of the literature and infection control implications. J Am Dent Assoc, 2004, 135(4):429-437. [Accessed on 15th Apr 2021]; Available from: https://doi.org/10.14219/jada.archive.2004.0207.

[68] Cunningham, A. C., Goh, H. P., &Koh, D. Treatment of COVID- 19: Old tricks for new challenges. Critical Care, 2020, 24(1), 91. [Accessed on 15th Apr 2021]; Available from: https://doi.org/10.1186/s13054-020-2818-6.

View Full Article: