COVID-19 transmission risk and protective protocols in dentistry: a systematic review

Abstract

Background Among several potential transmission sources in the spreading of the COVID-19, dental services have received a high volume of attention. Several reports, papers, guidelines, and suggestions have been released on how this infection could be transmitted through dental services and what should be done. This study aimed to review the guidelines in order to develop a practical feasibility protocol for the re-opening of dental clinics and the reorientation of dental services. Methods This study systematically reviewed the published literature and the guidelines of international health care institutions on dentistry and COVID-19. We searched Pubmed, Web of Science, and SCOPUS electronic databases using MESH terms. The recommendations identified were tested with a convenience sample of experienced practitioners, and a practical step-by-step protocol is presented in this paper. Results To the date this paper was drafted, 38 articles were found, of which 9 satisfied our inclusion criteria. As all the nine studies were proposed in a general consensus, any elective non-emergency dental care for patients with suspected or known COVID-19 should be postponed for at least 2 weeks during the COVID-19 pandemic. Only urgent treatment of dental diseases can be performed during the COVID-19 outbreak taking into consideration pharmacological management as the first line and contagion-reduced minimally invasive emergency treatment as the secondary and final management. Conclusions While the currently available evidence has not demonstrated a clear and direct relationship between dental treatment or surgery and the possibility of the transmission of COVID-19, there is clearly the potential for transmission. Therefore, following the protective protocols in the COVID-19 crisis is of utmost importance in a dental setting.

Impact of COVID-19 pandemic on oral health procedures provided by the Brazilian public health system

“…It would also help to avoid nosocomial infections due to admission for elective procedures. Although such recommendations have been made by several studies ( 13 , 14 , 15 , 16 ) and from governmental agencies in different countries, ( 4 , 17 ) the Brazilian government delayed adopting the WHO determinations for self-isolation, border closures, limitations on non-essential elective services in the public health system, and extensive testing for all suspected cases. As of DATE, the spread of COVID-19 in Brazil has killed more than 215,000 and infected more than 8 million Brazilians.…”

“…Although the available evidence has not demonstrated a clear and direct relationship between dental treatment and transmission of COVID-19, there is clearly the potential for transmission since some dental procedures generate aerosols containing salivary droplets, which is how SARS-CoV-2 is transmitted ( 13 , 16 ). However, the suspension of non-urgent elective procedures may be seen as a relevant side effect of the measures adopted to reduce COVID-19 contamination, since the reduction of such treatments might result in significant oral health deterioration.…”

Dentists’ Working Conditions during the First COVID-19 Pandemic Lockdown: An Online Survey

“…The number of patients simultaneously present in the office was reduced as far as possible, and sufficient distance had to be ensured, for example a one meter distance between seats in the waiting area. Magazines and demonstration models in the waiting room were removed as their proper disinfection could not be guaranteed [ 6 , 14 , 15 ].…”

“…Reduction of aerosol-producing actions like ultrasonic scaling, restorative procedures or bracket/attachment removal with high speed handpieces decreases the risk of air-borne transmission [ 14 ]. If aerosol generating procedures cannot be avoided, high-volume salivary ejectors are necessary [ 15 ]. The use of rubber dams reduces aerosolized particles by 70% [ 19 ].…”

Mothers’ Knowledge, Attitudes, and Fears About Dental Visits During the COVID-19 Pandemic

“…A study on COVID-19 infection in the dental setting reported nine confirmed cases among the dental team in the School and Hospital of Stomatology, Wuhan University, Wuhan, China. [ 31 ] It was suggested in a systematic review of 9 studies that assessed the transmission of COVID-19 in the dental clinic that there is a potential for transmission, through saliva, bodily fluids, aerosols, contaminated instruments, and surfaces[ 32 ] Nonetheless, one cannot underestimate infection control measures being second nature to most dentists, who routinely wear gloves and a mask, often with eye protection, when treating patients. [ 33 ]…”