Long-Term Complications of Coronavirus Disease 2019; What the Oral Surgeon Needs To Know.

ABSTRACT: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 manifests mainly as respiratory symptoms. Extrapulmonary manifestations have also been detected and several vital organs may sustain irreversible or long-standing damage. These extrapulmonary manifestations can be detected in cardiovascular, hepatic, renal, and hematologic systems. Maxillofacial surgeons may encounter patients who have recovered from COVID-19 but are still suffering long-term morbidities as a result of this incompletely understood infection. Consequently, they have to be aware of the various systemic complications that may be encountered in these patients as they may interfere with their treatment plan or may necessitate certain modifications and precautions.In this report the authors present the long-standing systemic complications of COVID-19 reported so far, and discuss their implications within the context of maxillofacial surgery with regards to the modifications and precautions in the process of treatment planning.Graphical abstract shows the long-term complications of COVID-19 that may complicate maxillofacial surgical procedures.

Long-term adverse events of three COVID-19 vaccines as reported by vaccinated physicians and dentists, a study from Jordan and Saudi Arabia.

Assessment of safety of COVID-19 vaccines is an ongoing process. This study aims to explore long-term adverse events reported by physicians and dentists who received at least two COVID-19 vaccine doses. A group of physicians and dentists were invited to complete a validated questionnaire that was composed of items on: socio-demographics, medical history, administered vaccines, and long-term adverse events (LTAE). Data of a total of 498 practitioners were included. Age ranged from 22 to 71 years (mean age= 35.75 ± 11.74) with a female majority (N = 348, 69.9%). The most frequently administered vaccines were Pfizer-BioNtech, Sinopharm and AstraZeneca vaccines. A total of 80 (16.0%) participants reported LTAEs which were mainly fatigue, menstrual disturbances, myalgia, arthralgia, dizziness, and headache (N = 32, 15, 8, 6, 4, and 4, respectively). There was no statistically significant association between LTAEs and: age, gender, or medical history (P > .05). The collective symptoms of fatigue, myalgia, arthralgia, dizziness, and headache were significantly associated with Sinopharm vaccine (P = .04). This was further confirmed by general linear multivariate model analysis. Less than 20% of COVID-19 vaccine recipients may complain of LTAEs that are mostly fatigue-related. It seems that factors such as age, gender, and medical status play a negligible role in development of these AEs. On the other hand, Sinopharm vaccine showed the highest significant association with these AEs followed by AstraZeneca vaccine.

Denture Stomatitis Revisited: A Summary of Systematic Reviews in the Past Decade and Two Case Reports of Papillary Hyperplasia of Unusual Locations.

OBJECTIVES: Denture stomatitis is a mucosal condition associated with complete and partial removable dentures. This paper presents a short review of the literature on this topic with more emphasis on the treatment protocols of denture stomatitis as studied in recent systematic reviews. METHODS: A general review of the literature was carried out in the first part of this paper, and then the most recent systematic reviews on the treatment protocols of denture stomatitis were summarized. RESULTS: Fifteen systematic reviews were collected and classified into six main treatment protocols. CONCLUSIONS: Dentist knowledge of up-to-date treatment options of denture stomatitis will assist comprehensive treatment planning. However, the newer methods of denture disinfection need further studies before recommendation.

Side Effects Reported by Jordanian Healthcare Workers Who Received COVID-19 Vaccines.

Background Distribution of COVID-19 vaccines has been surrounded by suspicions and rumors making it necessary to provide the public with accurate reports from trustworthy experts such as healthcare professionals. Methods We distributed a questionnaire in Jordan among physicians, dentists and nurses who received a COVID-19 vaccine to explore the side effects (SE) they encountered after the first or the second dose of one of three vaccines namely: AstraZeneca Vaxzevria (AZ), Pfizer-BioNTeck (PB), and SinoPharm (SP) vaccines. Results A total of 409 professionals participated. Approximately 18% and 31% of participants reported no SE after the first dose and second dose, respectively. The remainder had mostly local side effects related to injection site (74%). Systemic side effects in the form of fatigue (52%), myalgia (44%), headache (42%), and fever (35%) prevailed mainly after the first dose. These were significantly associated with AZ vaccine, and age ≤ 45 years (p = 0.000 and 0.01, respectively). No serious SE were reported. Conclusions We can conclude that SE of COVID-19 vaccines distributed in Jordan are within the common range known so far for these vaccines. Further studies are needed to include larger sample size and longer follow-up period to monitor possible serious and long-term SE of the vaccines.

What the dental practitioner needs to know about pharmaco-therapeutic modalities of COVID-19 treatment: A review.

BACKGROUND/PURPOSE: Several pharmacotherapeutic methods have been used for the treatment of COVID-19 with varying degrees of success. No definitive treatment or vaccine has been officially approved to-date. This review aimed to highlight COVID-19 pharmacotherapeutic agents that are relevant to dental practice in terms of their clinical indications in COVID-19 and dental practice, as well as their adverse effects as they impact the dental patient. MATERIAL AND METHODS: Systematic search was performed using the following keywords combinations: Pharmacotherapy AND COVID-19 OR Pharmacotherapy AND SARS-CoV-2 OR Treatment AND COVID-19. Studies were categorized according to the type of pharmacotherapy used. Pharmacotherapeutic agents were extracted and only those relevant to dental practice were included for review. RESULTS: For analysis, a total of 79 clinical trials research articles were included that included COVID-19 pharmacotherapeutic agents relevant to dental practice. Those were analgesics (paracetamol; non-steroidal anti-inflammatory agents); antibiotics (azithromycin, doxycycline, metronidazole); antivirals (penciclovir); and immunomodulatory agents (hydroxychloroquine, corticosteroids). While some COVID-19 drugs are less relevant to dental practice, as antivirals and hydroxychloroquine, their association with long-term adverse effects requires adequate knowledge among dental practitioners. CONCLUSION: Many of COVID-19 pharmacotherapeutic agents are used to treat oral diseases particularly orofacial pain and inflammatory conditions. Furthermore, some of these drugs may induce adverse effects that complicate dental treatment. Thorough knowledge of COVID-19 therapy and its dental implications is essential for dental practitioners, and is expected to contribute to a better understanding and effective utilization of these therapeutic agents.

Influence of gender on career expectations of oral and maxillofacial surgeons.

OBJECTIVES: This study aimed to explore gender differences on career satisfaction among oral and maxillofacial surgeons (OMFS) and to compare their views on female gender representation in leadership and mentorship positions. METHODS: A questionnaire was distributed among a sample of female and male OMFS surgeons in Egypt, Jordan and Saudi Arabia. Data were statistically analyzed to calculate significant differences between gender groups. RESULTS: A total of 110 (70 males and 40 females) or (18.7%) of a total of 587 (OMFS) surgeons in the three countries participated. Respondents had a mean age of: 39.2 ± 9.0 years (range = 25-60 years). Significantly more males (60) than females (24) indicated satisfaction with their careers (P = 0.008), and significantly more males (66) than females (23) thought that OMFS is the right specialty for them (P < 0.001). Also significantly more males (31) than females (9) indicated OMFS should be solely practiced by males (P = 0.025). On the other hand, significantly more females (20) than males (7) thought that females possess certain qualities that make them more suitable for OMFS (P < 0.001); and more females (27) than males (32) believed that females are under-represented in OMFS (P = 0.031). Significantly more females (25) than males (27) believed that female OMFS surgeons tend to be single or to get divorced (P = 0.018). Males and females were in agreement that females are under-represented in leadership and mentorship positions (P = 0.561). CONCLUSIONS: Females OMFS surgeons are less satisfied with their career than their male peers. It seems that female surgeons are under-represented in the profession especially as leaders and mentors. Socially, more female OMFS surgeons than males tend to be single and this may be correlated with the surgical career.

Utilization of Teledentistry in Antimicrobial Prescribing and Diagnosis of Infectious Diseases during COVID-19 Lockdown.

OBJECTIVES: This study aimed to analyze Jordanian dentists' inquiries on oral infections and antimicrobial prescribing using dental professional WhatsApp groups during coronavirus disease lockdown period. MATERIALS AND METHODS: Three professional WhatsApp groups of Jordanian dentists were reviewed and analyzed for inquiries posted during the period from January to May 2020. Inquiries were sent from patients to their dentists who posted these inquiries to the professional WhatsApp dental groups for consultation and professional advice. All queries regarding oral infections and antimicrobial prescribing were extracted and analyzed. RESULTS: Three WhatsApp professional groups with a total numbers of members of 750 dentists who posted queries about their patients were included in this study. Dentist members posted queries about their patients to these professional WhatsApp groups. There was a total of 32 inquiries regarding oral lesions and 11 consultations regarding prescribing and dental management of medically compromised patients giving a total of 43 consultations. Among which there were 19 inquiries on oral infections and 9 inquiries on antimicrobial prescribing giving a total of 28 consultations. Most common inquiries were on bacterial infections (localized dentoalveolar abscess, pericoronitis, cellulitis, and lymphoid hyperplasia of the tongue), viral herpetic infections, and Candida infections (erythematous and pseudomembranous candidiasis). CONCLUSIONS: Many dental practitioners cannot distinguish the correct diagnostic features of oral infections particularly viral and fungal infections. Continuing education should be considered to focus on clinical manifestations of various oral infections. Further, educational activities that focus on variations in treatment protocols for various infections should be introduced particularly those that concern indications for antimicrobial prescribing.

COVID-19: Present and Future Challenges for Dental Practice.

COVID-19 was declared a pandemic by the World Health Organization, with a high fatality rate that may reach 8%. The disease is caused by SARS-CoV-2 which is one of the coronaviruses. Realizing the severity of outcomes associated with this disease and its high rate of transmission, dentists were instructed by regulatory authorities, such as the American Dental Association, to stop providing treatment to dental patients except those who have emergency complaints. This was mainly for protection of dental healthcare personnel, their families, contacts, and their patients from the transmission of virus, and also to preserve the much-needed supplies of personal protective equipment (PPE). Dentists at all times should competently follow cross-infection control protocols, but particularly during this critical time, they should do their best to decide on the emergency cases that are indicated for dental treatment. Dentists should also be updated on how this pandemic is related to their profession in order to be well oriented and prepared. This overview will address several issues concerned with the COVID-19 pandemic that directly relate to dental practice in terms of prevention, treatment, and orofacial clinical manifestations.

Factors Influencing Global Variations in COVID-19 Cases and Fatalities; A Review.

Since the first cases of the novel corona virus disease (COVID-19) were diagnosed in China, outcomes associated with this infection in terms of total numbers of cases and deaths have varied widely between countries. While some countries had minimal rates of infections and deaths, other countries were hit hard by the pandemic. Countries with highest numbers of cases continued to change over time, but at the time of submission of this article they are: USA, Brazil, Russia, UK, India, Spain, Italy, Peru and Chile. This is in contrary to many countries in the Middle East, Far East, and Africa, which had lower cases or deaths/cases rates. This raised many questions pertaining to this variation. This overview explores the potential factors that contribute to spread, transmission and outcomes of the COVID-19 infection. It also uses an evidence-based approach in reviewing the available most recent literature that tackled the various factors that modify the populations' response to COVID-19, namely, factors pertaining to population characteristics, environmental and geographic factors.

Use of natural remedies to treat oral diseases among female patients in Al Madinah, western Saudi Arabia.

Background The study aimed to investigate natural remedies use (NRU) for oral diseases among female patients. Methods Dental patients attending the female section of Taibah University Dental Hospital were invited to complete an online questionnaire which explored demographic data, and pattern of NRU for oral diseases. Results A total of 540 patients participated in the survey. A total of 232 patients (43%) used natural remedies to treat oral diseases. The most commonly cited reasons for NRU were financial reasons (n=79, 34.1%). The practice had a statistically significant association with older participants (p=0.003), and those working as employees (p=0.031). Most of the natural remedies used (n=17) were herbal, with cloves (71.1%) and miswak (26.7%) being the most frequently reported. Acute dental pain (n=157, 67.7%) and halitosis (n= 51, 22%) were the most frequently cited oral conditions associated with NRU. A percentage of 87.1% of patients using natural remedies (n=202) perceived improvement of symptoms upon use of natural remedies, however, 2.2% (n=5) reported complications. Conclusions Substantial proportion of patients use natural remedies to treat their oral disease. Patients were mostly satisfied with natural remedies in terms of effectiveness and lack of complications.

Antibiotic Prescribing for Oro-Facial Infections in the Paediatric Outpatient: A Review.

There are many reports on the complications associated with antibiotics abuse during the treatment of paediatric patients, particularly those related to antimicrobial resistance. The dental profession is no exception; there is growing evidence that dental practitioners are misusing antibiotics in the treatment of their paediatric patients. This review is directed to dental practitioners who provide oral healthcare to children. It is also directed to medical practitioners, particularly those working in emergency departments and encountering children with acute orofacial infections. A systematic search of literature was conducted to explore the clinical indications and recommended antibiotic regimens for orofacial infections in paediatric outpatients. The main indications included cellulitis, aggressive periodontitis, necrotizing ulcerative gingivitis, and pericoronitis. Amoxicillin was found to be the most commonly recommended antibiotic for short durations of 3⁻5 days, with metronidazole or azithromycin being the alternative antibiotics in penicillin-sensitive patients.

Oral Healthcare Services Delivered During COVID-19 Lockdown: A Report from Eastern Mediterranean Region

ABSTRACT Objective: To describe oral healthcare services administered during the lockdown in the Eastern Mediterranean region and to investigate the role of socio-professional characteristics of dental practitioners or their self-reported COVID-19 infection. Material and Methods: A questionnaire was distributed to dental practitioners in all healthcare sectors in Jordan, Egypt, and Saudi Arabia. Results: There was a total of 335 participants, with the majority being females (N=225, 67.2%) and general practitioners (N=202, 60.3%). Cellulitis was the most common emergency encountered (N=108). The most common urgent procedures were for pulpitis, abscesses, and pericoronitis (N=191, 130, and 95, respectively). Country-specific significant associations were pulpitis in Egypt and Jordan, broken symptomatic teeth in Jordan, and biopsy in Egypt (p<0.05). The Ministry of Health was significantly associated with the management of dental infections, avulsion, and orthodontic emergencies, while university hospitals were significantly associated with advanced restorative procedures (p<0.05). Male practitioners performed significantly more procedures, particularly surgical emergencies (p<0.05). Conclusion: Dental infections were the most common complaints among dental patients during lockdown. Countryand sector-specific dental procedures are detected. Male gender seems to play a determinant role in performing a higher number of procedures, particularly for surgical emergencies (AU).

Factors affecting oral health determinants in female university students: a cross-sectional survey in Saudi Arabia.

Objective This study aims at investigating factors affecting oral health patterns, attitudes and health risk behaviors among female university students. Methods An online questionnaire was distributed to female university students in Al Madinah in the western region of Saudi Arabia. Students were requested to answer questions on demographic data, oral hygiene practices, dental attendance, smoking history, practice of sports and body weight and height. Results Two hundred and fourteen students participated with age range of 18-31 years (mean = 21.64 ± 1.72 years). Oral hygiene habits were reported by a percentage of 97.2%, 34.6%, 30.8% and 19.2% who used a tooth brush, dental floss, mouthwash, and a miswak (a teeth cleaning twig made from the Salvadora persica tree), respectively. The only factor that was significantly associated with a good oral hygiene level was a university major of non-healthcare specialties (p = 0.009). Conclusion It is concluded that female university students use various oral hygiene methods, however, dental attendance is poor and a number of health risk factors are noticed like smoking, lack of practicing sport and unhealthy body mass index (BMI).

Why do Women avoid Dental Visits During Pregnancy? A Cross- Sectional Survey in Al Madinah, Western Saudi Arabia

Objective: To investigate why women avoid dental visits during pregnancy and to explore the possible association between this attitude and relevant socio-demographic factors. Material and Methods: An online questionnaire was distributed to pregnant women during their routine visits to antenatal clinics in Al Madinah, Saudi Arabia. The questionnaire explored socio-demographic factors of age, education, employment status and nationality. It also explored misconceptions/ reasons for avoiding dental visits during pregnancy. Results: A total of 360 pregnant women participated, and their mean age was 30.08 years (range=18-52 years, SD=5.96). The most commonly cited misconception/reason for avoiding dental visits was "local anesthesia is not safe during pregnancy", followed by "transportation is difficult" and lastly, "dental treatment is not safe during pregnancy", (43.6%, 37.5%, 18.9%, respectively). Illiterate participants were statistically significantly associated with the misconception of "unsafe dental treatment during pregnancy" (p=0.002), whereas school-level and unemployed participants were statistically significantly associated with the misconception of "unsafe local anesthesia during pregnancy" (p=0.02, p=0.036 respectively). Conclusion: Pregnant women avoid dental visits mainly due to the misconception that local anesthesia is not safe during pregnancy. Difficult transportation seems to be another important deterrent in preventing pregnant women to visit dentists in this geographic area. Changing the misconceptions should be the starting point in addressing this public health problem and this should involve the three parties involved: pregnant women, oral healthcare providers and obstetric care providers.

Assessing Expectant Mothers' Knowledge and Beliefs about Oral Healthcare During Infancy and Pregnancy: A Cross Sectional Survey in Saudi Arabia

Objective: To evaluate expectant mothers' knowledge and beliefs on oral healthcare of infants. It also aimed at exploring their knowledge on oral health care during pregnancy and the possible relationship between oral health and adverse pregnancy outcomes. Material and Methods: A cross-sectional, questionnaire-based survey was conducted among expectant mothers attending antenatal clinics in Al Madinah, Saudi Arabia in summer, 2017. Questions collected data on sociodemographic characteristics of the study sample as well as basic knowledge on oral healthcare during pregnancy and infancy. There were also questions on knowledge about adverse pregnancy outcomes that may be associated with poor oral health. Results: A convenient sample of 360 pregnant women participated in the study. A percentage of 79.7% showed a good level of knowledge in oral healthcare of infants while a percentage of 8.9% only showed a good level of knowledge in oral healthcare during pregnancy and pregnancy outcomes. Education level and employment status were significantly associated the good level of knowledge in oral healthcare of infants (p=0.000, and 0.002 respectively). Conclusion: Most of expectant mothers, particularly educated and employed ones, have good knowledge on oral healthcare of infants, however, the majority lacked sufficient knowledge on pregnancy outcomes and oral healthcare during pregnancy.