Clinical Dental Hygienists' Experience Returning to Work After Closure of Dental Offices Due to COVID-19: A qualitative study.

Purpose: The impact of the COVID-19 pandemic on healthcare providers includes physical, psychological, financial, and childcare issues. The purpose of this qualitative study was to explore the experiences of dental hygienists returning to clinical practice after the March 2020 closure due to the COVID-19 pandemic.Methods: A qualitative phenomenological research design was used with virtual focus groups. Clinical dental hygienists who had worked a minimum of 3 days a week prior to dental practice closures in March 2020 and had returned to work in May 2020 were invited to participate through purposive sampling on dental hygiene social media sites. Demographic data was collected prior to a one-hour focus group session. Two investigators independently analyzed and coded the data using a qualitative data analysis software program. The themes identified were used to generate a description of the major findings.Results: Data saturation was achieved with (n=35) participants for a total of 13 focus groups. Most participants were female (89%), and the average age was 40 years. The following major themes were identified: physical issues; emotional; adherence to infection control protocols; fear of contracting/transmitting COVID-19; financial stress; our career was marginalized; and let's get back and make money.Conclusion: Dental hygienists experienced similar physical and mental health stressors as other health care professionals upon returning to work during the COVID-19 pandemic, however dental hygienists also reported feeling marginalized and undervalued. Results from this study suggest that dental hygienists need both personal and workplace support to manage the issues resulting from the COVID-19 pandemic in order to retain them in the workforce.

COVID-19 Surface Persistence: A Recent Data Summary and Its Importance for Medical and Dental Settings.

Recently, due to the coronavirus pandemic, many guidelines and anti-contagion strategies continue to report unclear information about the persistence of coronavirus disease 2019 (COVID-19) in the environment. This certainly generates insecurity and fear in people, with an important psychological component that is not to be underestimated at this stage of the pandemic. The purpose of this article is to highlight all the sources currently present in the literature concerning the persistence of the different coronaviruses in the environment as well as in medical and dental settings. As this was a current study, there are still not many sources in the literature, and scientific strategies are moving towards therapy and diagnosis, rather than knowing the characteristics of the virus. Such an article could be an aid to summarize virus features and formulate new guidelines and anti-spread strategies.

COVID-19 Pandemic and Periodontal Practice: The Immunological, Clinical, and Economic Points of View.

The recent global health problem, COVID-19, has had far-reaching impacts on lifestyles. Although many effective WHO-approved vaccines have been produced that have reduced the spread and severity of the disease, it appears to persist in humans for a long time and possibly forever as everyday it turns out to have new mutations. COVID-19 involves the lungs and other organs primarily through cytokine storms, which have been implicated in many other inflammatory disorders, including periodontal diseases. COVID-19 is in a close association with dental and periodontal practice from two respects: first, repeated mandatory lockdowns have reduced patient referrals to dentists and limited the dental and periodontal procedures to emergency treatments, whereas it is important to recognize the oral manifestations of COVID-19 as well as the influence of oral and periodontal disease on the severity of COVID-19. Second, dentistry is one of the high-risk professions in terms of close contact with unmasked individuals, necessitating redefining the principles of infection control. The pressures of the economic recession on patients as well as dentists add to the difficulty of resuming elective dental services. Therefore, this study is divided into two parts corresponding to what mentioned above: the first part examines the clinical and immunological associations between COVID-19 and periodontal and oral diseases, and the second part delineates the measures needed to control the disease transmission in dental clinics as well as the economic impact of the pandemic era on dental services.

Analysis of the reliability of patient COVID-19 screening data compared against their actual test data.

OBJECTIVES: This study aimed to evaluate the truthfulness of patients about their pre-appointment COVID-19 screening tests at a dental clinic. METHODS: A total of 613 patients were recruited for the study from the dental clinic at the Faculty of Dentistry, Najran University, Saudi Arabia. The data collection was done in three parts from the patients who visited the hospital to receive dental treatment. The first part included the socio-demographic characteristics of the patients and the COVID-19 swab tests performed within the past 14 days. The second part was the clinical examination, and the third part was a confirmation of the swab test taken by the patient by checking the Hesen website using the patient ID. After data collection, statistical analysis was carried out using SPSS 26.0. Descriptive analysis was done and expressed as mean, standard deviation, frequency, and percentage (%). A cross-tabulation, also described as a contingency table, was used to identify trends and patterns across data and explain the correlation between different variables. RESULTS: It was seen from the status of the swab test within 14 days of the patient's arrival at the hospital for the dental treatment that 18 (2.9%) patients lied about the pre-treatment swab test within 14 days, and 595 (97.1%) were truthful. The observed and expected counts showed across genders and diagnosis a statistically significant difference (p < 0.001), and there was no significant difference seen across different age groups (p = 0.064) of the patients. CONCLUSIONS: Dental healthcare workers are worried and assume a high risk of COVID-19 infection as the patients are not truthful about the pre-treatment COVID-19 swab test. Routine rapid tests on patients and the healthcare staff are a feasible option for lowering overall risks.

In Situ Measurement of Airborne Particle Concentration in a Real Dental Office: Implications for Disease Transmission.

Aerosols generated during dental procedures are one of the most significant routes for infection transmission and are particularly relevant now in the context of COVID-19 pandemic. This study aimed to assess the effectiveness of an indoor air purifier on dental aerosol dispersion in dental offices. The spread and removal of aerosol particles generated from a specific dental operation in a dental office are quantified for a single dental activity in the area near the generation and corner of the office. The effects of the air purifier, door condition, and particle sizes on the spread and removal of particles were investigated. The results show that, in the worst-case scenario, it takes 95 min for 0.5-µm particles to settle and that it takes a shorter time for the larger particles. The air purifier expedited the removal time at least 6.3 times faster than the case with no air purifier in the generation zone. Our results also indicate that particles may be transported from the source to the rest of the room even when the particle concentrations in the generation zone dropped back to the background. Therefore, it is inaccurate to conclude that indoor purifiers help reduce the transmission of COVID-19. Dental offices still need other methods to reduce the transmission of viruses.

Stopping the COVID-19 pandemic in dental offices: A review of SARS-CoV-2 transmission and cross-infection prevention.

Due to the essential role of dentists in stopping the COVID-19 pandemic, the purpose of this review is to help dentists to detect any weaknesses in their disinfection and cross-contamination prevention protocols, and to triage dental treatments to meet the needs of patients during the pandemic. We used PRISMA to identify peer-reviewed publications which supplemented guidance from the center for disease control about infection control and guidelines for dentists. Dentists must triage dental treatments to meet the needs of patients during the pandemic. The ongoing pandemic has changed the practice of dentistry forever, the changes make it more cumbersome, time-consuming, and costly due to the possible pathways of transmission and mitigation steps needed to prevent the spread of COVID-19. Dental chairside rapid tests for SARS-CoV-2 are urgently needed. Until then, dentists need to screen patients for COVID-19 even though 75% of people with COVID-19 have no symptoms. Despite the widespread anxiety and fear of the devastating health effects of COVID-19, only 61% of dentists have implemented a change to their treatment protocols. As an urgent matter of public health, all dentists must identify the additional steps they can take to prevent the spread of COVID-19. The most effective steps to stop the pandemic in dental offices are to; vaccinate all dentists, staff, and patients; triage dental treatments for patients, separate vulnerable patients, separate COVID-19 patients, prevent cross-contamination, disinfect areas touched by patients, maintain social distancing, and change personal protective equipment between patients.

2020 trends in dental office visits during the COVID-19 pandemic.

BACKGROUND: COVID-19 has created barriers to the delivery of health care services, including dental care. This study sought to quantify the change in dental visits in 2020 compared with 2019. METHODS: This retrospective, observational study examined the percentage change in weekly visits to dental offices by state (inclusive of the District of Columbia), nationally, and by county-level COVID-19 incidence using geographic information from the mobile applications of 45 million smartphones during 2019 and 2020. RESULTS: From March through August 2020, weekly visits to dental offices were 33% lower, on average, than in 2019. Weekly visits were 34% lower, on average, in counties with the highest COVID-19 rates. The greatest decline was observed during the week of April 12, 2020, when there were 66% fewer weekly visits to dental offices. The 5 states (inclusive of the District of Columbia) with the greatest declines in weekly visits from 2019 through 2020, ranging from declines of 38% through 53%, were California, Connecticut, District of Columbia, Massachusetts, and New Jersey. CONCLUSIONS: Weekly visits to US dental offices declined drastically during the early phases of the COVID-19 pandemic. Although rates of weekly visits rebounded substantially by June 2020, rates remain about 20% lower than the prior year as of August 2020. These findings highlight the economic challenges faced by dentists owing to the pandemic. PRACTICAL IMPLICATIONS: States exhibited widespread variation in rates of declining visits during the pandemic, suggesting that dental practices may need to consider different approaches to reopening and encouraging patients to return depending on location.

Electrolyzed Water Generated On-Site as a Promising Disinfectant in the Dental Office During the COVID-19 Pandemic.

Electrolyzed water is a safe, broad-spectrum bactericidal and viricidal agent, which can be used as a potent and effective alternative disinfectant in case of supply shortages. This report describes the on-site production of slightly acidic electrolyzed water (EW) from diluted salt solution and vinegar at a dental office using a portable EW generator unit. Such measures can ensure the safe continuity of important dental service provision for our patients during the coronavirus disease 2019 (CoVID-19) pandemic.

Testing for COVID-19 in dental offices: Mechanism of action, application, and interpretation of laboratory and point-of-care screening tests.

BACKGROUND: The dental office potentially possesses all transmission risk factors for severe acute respiratory syndrome coronavirus 2. Anticipating the future widespread use of COVID-19 testing in dental offices, the authors wrote this article as a proactive effort to provide dental health care providers with current and necessary information surrounding the topic. METHODS: The authors consulted all relevant and current guidelines from the Centers for Disease Control and Prevention and the US Food and Drug Administration, as well as online resources and review articles. RESULTS: Routine COVID-19 screening and triage protocols are unable to detect all infected people. With the advancements in diagnostic tools and techniques, COVID-19 testing at home or in the dental office may provide dentists with the ability to evaluate the disease status of their patients. At-home or point-of-care (POC) tests, providing results within minutes of being administered, would allow for appropriate measures and rapid decisions about dental patients' care process. In this review, the authors provide information about available laboratory and POC COVID-19 screening methods and identify and elaborate on the options available for use by dentists as well as the regulatory requirements of test administration. CONCLUSIONS: Dentists need to be familiar with COVID-19 POC testing options. In addition to contributing to public health, such tests may deliver rapid, accurate, and actionable results to clinical and infection control teams to enhance the safe patient flow in dental practices. PRACTICAL IMPLICATIONS: Oral health care must continue to offer safety in this or any future pandemics. Testing for severe acute respiratory syndrome coronavirus 2 at the POC offers a control mechanism contributing to and enhancing the real and perceived safety of care in the dental office setting.

Reopening Dental Offices for Routine Care Amid the COVID-19 Pandemic: Report From Palestine.

OBJECTIVES: This study reports on the readiness of Palestinian dentists to reopen their practices for routine care during the current coronavirus disease 2019 (COVID-19) pandemic. METHODS: A cross-sectional study targeted dentists in the West Bank area of Palestine using an online survey during the first 2 weeks of May 2020. Questions mainly asked about dentists' perception of the risks of COVID-19, readiness to reopen their clinics for routine care, and the level of confidence in dealing with patients suspected of having COVID-19. RESULTS: A total of 488 dentists completed the survey. Almost 60% believed that they were not ready to reopen their practices. Almost 13% had "no confidence" in dealing with patients with COVID-19, while 64% had "little to moderate" confidence. Confidence was correlated negatively with increased fear of becoming infected (ρ = -0.317, P < .0001) and positively with years of practice (ρ = 1.7, P < .0001). Dentists who received updated training on infection control or on COVID-19 reported higher levels of confidence (χ2 = 53.8, P < .0001, χ2 = 26.8, P < .0001, respectively). Although 88% preferred not to treat patients with COVID-19, 40% were willing to provide care to them. Almost 75% reported that they were already facing financial hardships and could not survive financially until the end of the current month. CONCLUSIONS: Ethical and financial reasons were the main drivers for dentists in this sample to reopen their practices for routine care. Data from this study highlights the fragility of private dental practice in emergency situations. Ethical, health, and financial challenges that emerged during COVID-19 require dentists to adapt and be better prepared to face future crises.

COVID-19 Guidelines to Protect Healthcare Workers at Hospitals and Dental Professionals at Dental Office.

BACKGROUND: Coronavirus disease 2019 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2. This study aimed to address the preventive procedures to protect healthcare workers at hospital to avoid COVID-19, and infection control procedures to protect dental professionals in dental office. METHODS: We conducted a search of published articles from PubMed, google scholar databases using key words such as COVID-19, healthcare worker, infection control, and dental practice. Relevant articles were identified and reviewed. Most published papers were clinical reports and case studies. We have selected some of the current published papers written in English in 2020. RESULTS: Infection control procedures to protect health workers at hospitals, and dental professionals at dental office were summurised and presented. Infection control procedures for healthcare workers at hospitals include Personal protective equipment, Korea filter (KF)94 respirator, goggles, face protector, disposable waterproof long-arm gown, and gloves, and others. Extra-protection procedures should be taken with old and vulnerable healthcare workers. Dental professionals should evaluate patients in advance before starting dental treatment. Aerosols generating procedures should be avoided and personal protective equipment should be used. Dental treatment should be restricted to emergency cases only. CONCLUSION: Old medical staff should be in safer distance to avoid infection, but young physicians and nurses should work at frontline as their immunity is better than their colleagues at old age. Screening patients and measurement of the body temperature are essential measures before dental treatment.

COVID-19 Management in Clinical Dental Care Part III: Patients and the Dental Office.

The coronavirus 2019 (COVID-19) pandemic dramatically changed all aspects of life. In the context of clinical dental care, a significant number of new recommendations have been implemented to comply with public health policies, ensuring the safety of dental care professionals, staff, and patients and preventing further spread of the virus. This article is the third in a series of 3 on the management of COVID-19 in clinical dental care and presents a set of recommendations and standards to be implemented in the context of the COVID-19 pandemic. These include remote contact with all patients for triage and guidance before scheduling a clinical visit to know if they have COVID symptoms or are positive for COVID, if they belong to a risk group, and if there is a suggestion that aerosol-generating procedures (AGPs) will be required during their visit. It also reviews additional precautionary measures in the waiting room and reception area, where the environment is reorganised to protect patients and clinical staff, avoiding situations that could result in cross contamination. The dental office operates under a strict set of guidelines, namely, use of personal protective equipment by professionals, contact with patients, a strategy to avoid aerosol-generating procedures, as well as disinfection procedures for the dental office before, during, and after each patient visit. The implementation of these protocols to mitigate cross infection and spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the dental office will help improve safety and restore the confidence required to provide dental care to patients during the COVID-19 pandemic.

Incidence of COVID-19 Virus Transmission in Three Dental Offices: A 6-Month Retrospective Study.

The World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020. SARS CoV-2, the virus that causes COVID-19, has shown the ability to become aerosolized with a potential airborne route of transmission. Dentists and dental hygienists are listed as two of the occupations in a nonhospital setting with the greatest risk of contracting the SARS-CoV-2 virus, as routine dental procedures involve aerosol generation. In a statement on interim guidance, WHO recommended that all routine dental procedures be delayed until COVID-19 transmission rates decrease from community transmission to cluster cases and until the risk of transmission in a dental office can be studied and evaluated. This prospective study involves 2,810 patients treated over a 6-month period (March 15 to September 15, 2020) in three different dental offices by two dentists and three hygienists during and shortly after the height of the pandemic in New York. By utilizing screening questionnaires, performing enhanced infection control, and having appropriate personal protective equipment, these dental offices were able to record no transmission of COVID-19 to the dental healthcare workers or patients during the study. In addition, 69% of the patients treated in these dental offices were recorded as having one or more high-risk comorbidities related to COVID-19 severity.

Air disinfection procedures in the dental office during the COVID-19 pandemic.

The outbreak of coronavirus disease 2019 (COVID-19) generated a huge pressure on health care systems worldwide and exposed their lack of preparation for a major health crisis. In the times of a respiratory disease pandemic, members of the dental profession, due to having a direct contact with the patients' oral cavity, body fluids and airborne pathogens, are exposed to a great occupational hazard of becoming infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The authors carried out a systematic literature search using the main online databases (PubMed, Google Scholar, MEDLINE, UpToDate, Embase, and Web of Science) with the following keywords: "COVID-19," "2019-nCoV," "coronavirus," "SARS-CoV-2," "dental COVID-19," "dentistry COVID-19," "occupational hazards dentistry," "ventilation," "air disinfection," "airborne transmission," "hydrogen peroxide disinfection," "UV disinfection," "ozone disinfection," "plasma disinfection," and "TiO2 disinfection." They included publications focused on COVID-19 features, occupational hazards for dental staff during COVID-19 pandemic, and methods of air disinfection. They found that due to the work environment conditions, if appropriate measures of infection control are not being implemented, dental offices and dental staff can become a dangerous source of COVID-19 transmission. That is why the work safety protocols in dentistry have to be revised and additional methods of decontamination implemented. The authors specifically advise on the utilization of wildly accepted methods like ultraviolet germicidal irradiation with additional disinfection systems, which have not been introduced in dentistry yet, like vaporized hydrogen peroxide, non-thermal plasma and air filters with photocatalytic disinfection properties. Due to its toxicity, ozone is not the first-choice method for air decontamination of enclosed clinical settings. Med Pr. 2021;72(1):39-48.

Reducing the Risk of COVID-19 Transmission in Dental Offices: A Review.

The COVID-19 epidemic has become a major public health challenge around the world. According to the World Health Organization (WHO), as of August 2020 there are more than 833,556 dead and over 24,587,513 people infected around the world. This pandemic has adversely affected many professions around the globe, including dentistry. COVID-19, caused by the Corona virus family, is transmitted mainly by direct contact with an infected person or through the spread of aerosol and droplets. Dentistry by nature is considered to be one of the most vulnerable professions with regards to the high risk of transmission between the dentist, dental team, and patients; therefore, a protocol for infection control and the prevention and spreading of the COVID-19 virus in dental settings is urgently needed. This article reviews essential knowledge about this virus and its transmission and recommends preventive methods based on existing scientific research and recommendations to prevent the spread of this virus in dental offices and clinics.

Alternative Methods of Sterilization in Dental Practices Against COVID-19.

SARS-CoV-2, and several other microorganisms, may be present in nasopharyngeal and salivary secretions in patients treated in dental practices, so an appropriate clinical behavior is required in order to avoid the dangerous spread of infections. COVID-19 could also be spread when patients touches a contaminated surface with infected droplets and then touch their nose, mouth, or eyes. It is time to consider a dental practice quite similar to a hospital surgery room, where particular attention should be addressed to problems related to the spreading of infections due to air and surface contamination. The effectiveness of conventional cleaning and disinfection procedures may be limited by several factors; first of all, human operator dependence seems to be the weak aspect of all procedures. The improvement of these conventional methods requires the modification of human behavior, which is difficult to achieve and sustain. As alternative sterilization methods, there are some that do not depend on the operator, because they are based on devices that perform the entire procedure on their own, with minimal human intervention. In conclusion, continued efforts to improve the traditional manual disinfection of surfaces are needed, so dentists should consider combining the use of proper disinfectants and no-touch decontamination technologies to improve sterilization procedures.

The Impact of COVID-19 Related Lockdown on Dental Practice in Central Italy-Outcomes of A Survey.

The COVID-19 pandemic has affected lives and professions worldwide. We aimed to determine the behavior of dentists during the lockdown in Central Italy through an online survey. We demonstrated that the most frequent of urgencies, not otherwise manageable through telemedicine, was dental pulp inflammation. Although a statistically significant increase in the use of some of the personal protective equipment (PPE) from pre to during lockdown was shown, dentists were afraid of being infected during the dental procedures. Moreover, we showed that digital dentistry, telemedicine, use of the rubber dam, distancing of the appointments and further structural changes at the dental office are necessary to reduce the contagion among dentists and patients. No significant differences were shown between gender.

Hypochlorous Acid: A Review.

The surgeon needs to have an inexpensive, available, nontoxic, and practical disinfectant that is effective in sanitizing against the COVID-19 (Coronavirus Disease 2019) virus. The purpose of this article was to review the evidence for using hypochlorous acid in the office setting on a daily basis. The method used to assemble recommendations was a review of the literature including evidence for this solution when used in different locations and industries other than the oral-maxillofacial clinic facility. The results indicate that this material can be used with a high predictability for disinfecting against the COVID-19 (Coronavirus Disease 2019) virus.