Implementing Mitigation Strategies in Early Care and Education Settings for Prevention of SARS-CoV-2 Transmission - Eight States, September-October 2020.

The Head Start program, including Head Start for children aged 3-5 years and Early Head Start for infants, toddlers, and pregnant women, promotes early learning and healthy development among children aged 0-5 years whose families meet the annually adjusted Federal Poverty Guidelines* throughout the United States.† These programs are funded by grants administered by the U.S. Department of Health and Human Services' Administration for Children and Families (ACF). In March 2020, Congress passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act,§ which appropriated $750 million for Head Start, equating to approximately $875 in CARES Act funds per enrolled child. In response to the coronavirus disease 2019 (COVID-19) pandemic, most states required all schools (K-12) to close or transition to virtual learning. The Office of Head Start gave its local programs that remained open the flexibility to use CARES Act funds to implement CDC-recommended guidance (1) and other ancillary measures to provide in-person services in the early phases of community transmission of SARS-CoV-2, the virus that causes COVID-19, in April and May 2020, when many similar programs remained closed. Guidance included information on masks, other personal protective equipment, physical setup, supplies necessary for maintaining healthy environments and operations, and the need for additional staff members to ensure small class sizes. Head Start programs successfully implemented CDC-recommended mitigation strategies and supported other practices that helped to prevent SARS-CoV-2 transmission among children and staff members. CDC conducted a mixed-methods analysis to document these approaches and inform implementation of mitigation strategies in other child care settings. Implementing and monitoring adherence to recommended mitigation strategies reduces risk for COVID-19 transmission in child care settings. These approaches could be applied to other early care and education settings that remain open for in-person learning and potentially reduce SARS-CoV-2 transmission.

Three Dimensional-Printed Gingivectomy and Tooth Reduction Guides Prior Ceramic Restorations: A Case Report.

Computer-aided design and computer-aided manufacturing (CAD/CAM) dentistry have significantly changed workflows in recent years. Restorations and devices can now be digitally designed and 3D-printed for dental care purposes. This clinical case report provides straightforward protocols for the digital design and 3D manufacture of gingivectomy and tooth preparation guides. These types of guides improved the gingival architecture of the anterior teeth and provided controllable tooth preparations prior to labial ceramic veneers. Thoughtful clinical evaluation started with listening to the patient's chief complaint and extra- and intra-oral evaluations. Then a digital wax-up was performed, followed by an intra-oral mock-up, to evaluate the shape of the proposed restorations. After patient acceptance, the clinical procedure started with the gingivectomy and tooth preparation. Hand-crafted porcelain veneers were bonded under rubber dam isolation to avoid any contamination and maximize the bonding protocol. The esthetic and functional demands were fully satisfied. Predictable outcomes can be obtained whenever a meticulous evaluation and execution of all the steps are performed. Three dimensional printing technology allows the fabrication of devices such as gingivectomy and tooth reduction guides that help accomplish the desired results.

Retrofitting technique for a crown or abutment following coronal fracture.

The fracture of tooth structure and/or restorative material within a crown or fixed partial denture abutment poses a restorative challenge. Depending upon the severity of the fracture and health of the tooth or teeth involved, the restoration often can be re-cemented, restoring the tooth to a serviceable condition. This article describes a technique that provides a safe and efficient means of restoring the fractured tooth, thereby overcoming a major obstacle to the conventional recementation process. An application of the technique also is described.

Accessing and restoring root caries: a case report.

Adequate access to root caries can be problematic. The inability to view, isolate, and access the entire lesion may result in residual caries, poor adaptation of the restoration, and defective margins. Minor periodontal procedures, ranging from a mini-flap involving only one tooth, to conventional flap surgery can provide increased visibility and access to these troublesome areas. Through utilization of this technique, excellent preparations and restorations can be achieved. Restorative materials with a high potential for fluoride release as well as uptake should be highly considered in cases of root caries. The selection of a conventional or resin-modified glass ionomer provides several advantages. Most notably are the ability of these restoratives to chemically bond to tooth structure, and to provide significant fluoride release and uptake. These properties are not present in amalgam, composites, or compomers. Additionally, the material itself is relatively easy to use and provides an effective zone of caries inhibition around the margins of the restoration. Glass ionomers are not as sensitive to moisture as conventional resin composites or compomers, and, as a result, may provide a better bond to tooth structure and margination in areas where moisture control is troublesome. Finally, the polymerization shrinkage of these materials is not as great as resin composites, which should also improve marginal integrity. Clinical studies have demonstrated longevity of ten years or greater as well as success in xerostomic patients. Management of xerostomic patients should be directed toward finding satisfactory methods to relieve dryness. Some prescription medications are available, but should only be recommended after consultation with the primary care physician. Oral moisturizers are also available as are saliva substitutes. Caution should be used when recommending saliva substitutes due to the fact that some commercial products have been demonstrated to have a pH below the demineralization point of enamel. Products of this nature should be avoided. In the last few decades, the age of the patient population has increased and individuals have a greater tendency to maintain their natural dentition throughout their entire life. Gingival recession and subsequent root exposure has become more prevalent in the adult population. Additionally, the use of prescription medications that impact the flow and consistency of saliva is widespread. As a result of these phenomena, it has been predicted that root caries will become more prevalent. When preventive measures prove to be ineffective and restorations must be placed, access, visibility, and appropriate material selection are paramount. A combined minor periodontal surgery and restorative procedure is relatively simple, and when done properly, can provide excellent and affordable dentistry in these problematic areas.

Gastroesophageal reflux disease: a dental concern.

Oral chemical erosion can be caused by several factors. The most significant and most frequent is gastroesophageal reflux disease (GERD). Asymptomatic patients with GERD often are unaware that they may have a potential life-threatening condition. The dental profession is in a position to identify the subtle oral signs of the disease and has the obligation to be alert to the signs of gastroesophageal reflux, making appropriate referrals when necessary. The purpose of this article is to raise awareness concerning earlier detection of the subtleties of chemical erosion, particularly from GERD. A severe case of asymptomatic chemical erosion caused by GERD is presented.