Pragmatic Return to Effective Dental Infection Control through Triage and Testing (PREDICT): an observational, feasibility study to improve dental office safety.

BACKGROUND: During the COVID-19 pandemic, there was a substantial interruption of care, with patients and workers fearful to return to the dental office. As dental practice creates a highly aerosolized environment, the potential for spread of airborne illness is magnified. As a means to increase safety and mitigate risk, pre-visit testing for SARS-CoV-2 has the potential to minimize disease transmission in dental offices. The Pragmatic Return to Effective Dental Infection Control through Testing (PREDICT) Feasibility Study examined the logistics and impact of two different testing mechanisms (laboratory-based PCR viral testing and point-of-care antigen testing) in dental offices. METHODS: Dental healthcare workers (DHCWs) and patients in four dental offices within the National Dental Practice-based Research Network participated in this prospective study. In addition to electronic surveys, participants in two offices completed POC testing, while participants in two offices used lab-based PCR methods to detect SARS-CoV-2 infection. Analysis was limited to descriptive measures, with median and interquartile ranges reported for Likert scale responses and mean and standard deviation for continuous variables. RESULTS: Of the total 72 enrolled, 28 DHCWs and 41 patients completed the protocol. Two patients (4.9%) tested positive prior to their visit, while 2 DHCWs (12.5%) tested positive for SARS-CoV-2 infection at the start of the study. DHCWs and patients shared similar degree of concern (69% and 63%, respectively) for contracting COVID-19 from patients, while patients feared contracting COVID-19 from DHCWs less (49%). Descriptive statistics calculations revealed that saliva, tongue epithelial cells, and nasal swabs were the most desirable specimen collection method; both testing (LAB and POC) protocols took similar amounts of total time to complete; and DHCWs and patients reported feeling more comfortable when both groups were tested. CONCLUSIONS: While a larger-scale, network study is necessary for generalizability of results, this feasibility study suggests that SARS-CoV-2 testing can be effectively implemented into dental practice workflows and positively impact perception of safety for DHCWs and patients. As new virulent infectious diseases emerge, preparing dental personnel to employ an entire toolbox of risk mitigation strategies, including testing, may have the potential to decrease dental practice closure time, maintaining continuity of dental care services for patients. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05123742.

Desinfección y esterilización en odontología frente al COVID-19 / Disinfection and sterilization in dentistry against COVID-19 / Desinfecção e esterilização em odontologia contra a COVID-19

A partir de la declaración de la Organización Mundial de la Salud del comienzo de la pandemia COVID-19 causada por el virus SARS-CoV-2 en marzo de 2020, los profesionales de la salud se vieron expuestos a esta enfermedad altamente contagiosa y potencialmente mortal que generó múltiples desafíos a toda la comunidad científica. Provocando cambios de paradigmas en la atención de los pacientes y en el uso de las barreras de protección personal. A nivel mundial se crearon múltiples protocolos para la atención odontológica a medida que se iba desarrollando e investigando el comportamiento del virus. Esta revisión bibliográfica resume las indicaciones y recomendaciones basadas en las evidencias disponibles para disminuir las posibilidades de contaminación ante la exposición a este virus, incluyendo medidas a utilizar desde el ingreso del paciente, los métodos de protección personal, la descontaminación y esterilización del material, así como también la desinfección del área de trabajo. Aunque se ha hecho un gran esfuerzo por mejorar los procesos de bioseguridad a nivel científico tecnológico, hay evidencias de que el factor humano sigue siendo el eslabón más débil de esta cadena.

Since the declaration by the World Health Organization of the beginning of the COVID-19 pandemic caused by the SARS-CoV-2 virus in March 2020, health professionals were exposed to this highly contagious and potentially fatal disease that generated multiple challenges to the entire scientific community. It caused paradigm shifts in patient care and in the use of personal protective barriers. Multiple protocols for dental care were created worldwide as the behavior of the virus was developed and investigated. This bibliographic review summarizes the indications and recommendations based on the available evidence to reduce the possibilities of contamination when exposed to this virus, including measures to be used from patient admission, personal protection methods, decontamination and sterilization of material, as well as disinfection of the work area. Although a great effort has been made to improve biosafety processes at the scientific and technological level, there is evidence that the human factor continues to be the weakest link in this chain.

Desde a declaração pela Organização Mundial da Saúde do início da pandemia de COVID-19 causada pelo vírus SARS-CoV-2 em março de 2020, os profissionais de saúde foram expostos a essa doença altamente contagiosa e potencialmente fatal, que criou vários desafios para toda a comunidade científica. Ela causou mudanças de paradigma no atendimento ao paciente e no uso de barreiras de proteção individual. Em todo o mundo, vários protocolos para atendimento odontológico foram criados à medida que o comportamento do vírus foi desenvolvido e pesquisado. Esta revisão da literatura resume as indicações e recomendações baseadas em evidências para reduzir a probabilidade de contaminação por exposição a esse vírus, incluindo medidas a serem usadas desde a admissão do paciente, métodos de proteção individual, descontaminação e esterilização de equipamentos, bem como desinfecção da área de trabalho. Embora muitos esforços tenham sido feitos para melhorar os processos de biossegurança em nível científico e tecnológico, há evidências de que o fator humano continua sendo o elo mais fraco dessa cadeia.

Evaluating the microbial aerosol generated by dental instruments: addressing new challenges for oral healthcare in the hospital infection.

BACKGROUND: Using a rotary instrument or ultrasonic instrument for tooth preparation is a basic operation in the dental clinic that can produce a significant number of droplets and aerosols. The dental droplet and aerosol can lead to the transfer of harmful germs. The goal of this study was to analyze the properties of microbiological aerosol created by droplets and aerosol generated by three common tooth-preparation instruments. METHODS: Streptococcus mutans UA159 was used as the biological tracer to visualize the droplets and aerosols. The passive sampling method was used to map the three-dimensional spatial distribution and the six-stage Andersen microbial sampler (AMS) was used as the active sampling method to catch aerosol particles at a specific time. RESULTS: The aerosol concentration is related to instruments, three-dimensional spatial distribution, and dissipation time. Most aerosols were generated by air turbines. More microorganisms are concentrated at the 1.5 m plane. The majority of the post dental procedure contamination was detected within the 0-10-min period and it decreased rapidly within 30 min. CONCLUSION: This study is conducive to the proposal and improvement of relevant infection control measures in dental procedures and provides a basis for the assessment of measures, reducing the risk of nosocomial infection.

Effective use of an extraoral vacuum in preventing the dispersal of particulate matter from metal dental materials.

OBJECTIVES: When dentists adjust prostheses at the dental chairside, particulate matter (PM) from the dental material is dispersed. Little is known about the effective use of an extraoral vacuum (EOV) in preventing PM dispersal. This study aimed to evaluate the effective use of an EOV in preventing the dispersal of metal PM in dental offices. METHODS: The following experimental conditions were planned: the distance from the EOV to the metallic materials (50, 100, 150, and 200 mm), the horizontal angle between the long axis of the micromotor handpiece and EOV (0°, 45°, and 90°), and the operating time of the EOV (during grinding, during grinding and 1 min thereafter, during grinding and the preceding 1 min, 1 min before and after grinding, and during grinding). Carborundum and silicone points were used for grinding and PM dispersal. Diameters (0.3, 0.5, 1.0, and 3.0 µm) were measured using a laser particle counter. RESULTS: Depending on the instrument used to grind, there were undetectable PMs of different diameters (Carborundum point: 0.3 and 0.5 µm, Silicone point: 0.3 µm). PMNs were reduced as the distance from the EOV to metal materials decreased. Operating the EOV before grinding along the long axis of the micromotor handpiece was effective in reducing the PMNs. CONCLUSION: PMNs dispersed when grinding metals were effectively reduced by positioning the EOV closer to the grinding surface (within 150 mm) along the long axis of the micromotor handpiece and operating the EOV before grinding.

Contaminación microbiana durante la atención odontológica por la producción de aerosoles y salpicaduras / Microbial contamination during dental care due to aerosol and splash production

RESUMEN Objetivo: Analizar la contaminación microbiana durante la atención odontológica por la producción de aerosoles y salpicaduras. Metodología: De tipo documental, bibliográfica. La búsqueda se realizó a través de las bases de datos PubMed y Scopus. Considerando los lineamientos de la declaración PRISMA obteniendo un total de 221 artículos. Posteriormente se aplicaron los criterios de exclusión como de inclusión, obteniendo un total de 25 artículos. Resultados: La carga microbiana presente en el ambiente odontológico ha sido analizada de manera cuantitativa a través de las Unidades Formadoras de Colonias (UFC) en diferentes espacios y superficies de las clínicas dentales. En conclusión: La contaminación microbiológica asociada con la generación de aerosoles es una problemática que se experimenta en la consulta diaria, relacionándose principalmente con procedimientos asociados con equipos como las piezas de mano de alta velocidad, el equipo ultrasónico y la jeringa triple.

ABSTRACT Objective: To analyze microbial contamination during dental care due to the production of aerosols and splashes. Methodology: Documentary, bibliographic type. The search was carried out through the Pubmed and SCOPUS databases. Considering the guidelines of the PRISMA declaration, a total of 221 articles were obtained. Subsequently, the exclusion and inclusion criteria were applied, obtaining a total of 25 articles. Results: The microbial load present in the dental environment has been analyzed quantitatively through Colony Forming Units (CFU) in different spaces and surfaces of dental clinics. In conclusion: Microbiological contamination associated with the generation of aerosols is a problem that is experienced in the daily dental practice, mainly related to procedures associated with equipment such as high-speed handpieces, ultrasonic equipment and triple syringe.

Contaminación microbiana durante la atención odontológica por la producción de aerosoles y salpicaduras / Microbial contamination during dental care due to aerosol and splash production

Analizar la contaminación microbiana durante la atención odontológica por la producción de aerosoles y salpicaduras. Metodología: De tipo documental, bibliográfica. La búsqueda se realizó a través de la en las bases de datos Pubmed y SCOPUS. Considerando los lineamientos de la declaración PRISMA obteniendo un total de 221 artículos. Posteriormente se aplicó los criterios de exclusión como de inclusión, obteniendo un total de 25 artículos. Resultados: La carga microbiana presente en el ambiente odontológico ha sido analizada de manera cuantifica a través de Unidades Formadoras de Colonias (UFC) en diferentes espacios y superficies de las clínicas dentales. En conclusión: La contaminación microbiológica asociada con la generación de aerosoles es una problemática que se experimenta en la consulta diaria, relacionándose principalmente con procedimientos asociados con equipos como las piezas de mano de alta velocidad, el equipo ultrasónico y la jeringa triple.

To analyze microbial contamination during dental care due to the production of aerosols and splashes. Methodology: Documentary, bibliographic type. The search was carried out through the Pubmed and SCOPUS databases. Considering the guidelines of the PRISMA declaration, a total of 221 articles were obtained. Subsequently, the exclusion and inclusion criteria were applied, obtaining a total of 25 articles. Results: The microbial load present in the dental environment has been analyzed quantitatively through Colony Forming Units (CFU) in different spaces and surfaces of dental clinics. In conclusion: Microbiological contamination associated with the generation of aerosols is a problem that is experienced in the daily dental practice, mainly related to procedures associated with equipment such as high-speed handpieces, ultrasonic equipment and triple syringe.

Accidental ingestion of a dental object during a periodontal surgical procedure on an IV sedated patient: Case management.

INTRODUCTION: Foreign-body aspiration (FBA) and ingestion (FBI) are rare but serious events that occur in dental offices throughout the world every year. Such events can have significant medical, legal, and financial consequences for both the dental clinician and the patient. By presenting this case study, we aim to highlight the proper management and possible sequelae of such an event. METHODS AND RESULTS: A 72-year-old woman underwent a dental procedure with intravenous sedation. In the process of dental treatment, a dental bur was accidentally ingested. The patient was promptly referred to an urgent care clinic, where serial abdominal radiographs were taken over several days to track the course of the bur through the digestive system. The bur was successfully removed without complication. CONCLUSION: Prompt management and referral of dental FBA and FBI cases, followed by successful object retrieval, lead to uncomplicated resolution of the event. KEY POINTS: Why is this case new information? This case presents the proper management of the FBA and FBI, particularly for IV sedated patients who require immediate action to mitigate and prevent serious complications. What are the keys to the successful management of this case and how can the risk of FBA and FBI be mitigated? The use of throat packs or rubber dams helps prevent foreign body aspiration and ingestion. Attaching floss to appliances and objects when appliances are used intraorally. (Specifically, to implant guide pins and implant screwdrivers.) Thorough isolation of the oropharynx from the mouth using a barrier, such as a gauze pad or rubber dam, during bracket placement, orthodontic appliance adjustment, and screwing or cementing of implant crowns Short and extra short implants should be connected by ligature to the implant handpiece. What are the primary limitations to success in this case? Lack of a throat pack Failure to confirm connection of bur to handpiece Patient's anatomy (redundant colon) preventing natural expulsion of the bur.

Impact of DHCWs' Safety Perception on Vaccine Acceptance and Adoption of Risk Mitigation Strategies.

OBJECTIVES: To estimate the association between safety perception on vaccine acceptance and adoptions of risk mitigation strategies among dental health care workers (DHCWs). METHODS: A survey was emailed to DHCWs in the New Jersey area from December 2020 to January 2021. Perceived safety from regular SARS-CoV-2 testing of self, coworkers, and patients and its association with vaccine hesitancy and risk mitigation were ascertained. Risk Mitigation Strategy (RiMS) scores were computed from groupings of office measures: 1) physical distancing (reduced occupancy, traffic flow, donning of masks, minimal room crowding), 2) personal protective equipment (fitted for N95; donning N95 masks; use of face shields; coverings for head, body, and feet), and 3) environmental disinfection (suction, air filtration, ultraviolet, surface wiping). RESULTS: SARS-CoV-2 testing of dental professionals, coworkers, and patients were perceived to provide safety at 49%, 55%, and 68%, respectively. While dentists were least likely to feel safe with regular self-testing for SARS-CoV-2 (P < 0.001) as compared with hygienists and assistants, they were more willing than hygienists (P = 0.004; odds ratio, 1.79 [95% CI, 1.21 to 2.66]) and assistants (P < 0.001; odds ratio, 3.32 [95% CI, 1.93 to 5.71]) to receive the vaccine. RiMS scores ranged from 0 to 19 for 467 participants (mean [SD], 10.9 [2.9]). RiMS scores did not significantly differ among groups of DHCWs; however, mean RiMS scores were higher among those who received or planned to receive the COVID-19 vaccine than those with who did not (P = 0.004). DHCWs who felt safer with regular testing had greater RiMS scores than those who did not (11.0 vs. 10.3, P = 0.01). CONCLUSIONS: Understanding DHCWs' perception of risk and safety is crucial, as it likely influences attitudes toward testing and implementation of office risk mitigation policies. Clinical studies that correlate risk perception and RiMS with SARS-CoV-2 testing are needed to demonstrate the effectiveness of RiMS in dental care settings. KNOWLEDGE TRANSFER STATEMENT: Educators, clinicians, and policy makers can use the results of this study when improving attitudes toward testing and implementation of risk mitigation policies within dental offices, for current and future pandemics.

[Radiation dose permitted in dentistry patients. A review]. / Dosis de radiación permitida en pacientes odontológicos. Una revisión.

In dental practice, the use of imaging has increased over the years, generating an increase in the radiation dose for the dental patient. One factor under discussion is the amount of dose used in patients, men, women and children, at different stages of their life, due to the scientific evidence of the harmful effects of ionizing radiation. This review of the literature analyzed the characteristics of radiation and its effects in relation to the doses administered, and its equivalences in dental practice in panoramic periapical radiographs and cone beam tomographies. A search of the literature was carried out in the main information sources such as Medline (via PubMed), SEVIER, SCIELO, and LILACS, using the search terms with a date limitation of the last 10 years. The selected articles had to include information regarding the keywords used, including "Dental Offices, Radiation Dose, X-Rays, Ambulatory Care."

Manifestaciones orales de la viruela símica y recomendaciones para su prevención en la práctica odontológica / Oral manifestations of monkeypox and recommendations for its prevention in dental practice

El brote reciente de viruela símica ha despertado el interés de la comunidad internacional por su creciente número de contagiados en países no endémicos. Entre sus síntomas se encuentran la fiebre, dolor de cabeza, fatiga, dolor muscular, exantema y linfadenoma. La cavidad bucal es el lugar en el que suelen aparecer los primeros signos de la enfermedad. Por tanto, el objetivo de este trabajo fue establecer las principales manifestaciones orales de la viruela del mono y enumerar algunas recomendaciones de prevención. Para ello, se hizo una revisión bibliográfica entre 2012 y 2022 en la base de datos PubMed, usando las palabras clave, en inglés, monkeypox, oral manifestation y transmission. Se garantizó que, de los 14 documentos seleccionados, al menos el 80%, fueran publicaron en 2022. Las manifestaciones orales más frecuentes fueron: úlcera eritematosa, vesículas-ulcerosas y las asociadas a linfadenopatía (disfagia, odinofagia y faringitis). Entre las recomendaciones se encuentran: uso de mascarilla N95 y visores faciales, lavado constante de manos y espacios y atención de contagiados solo por eventos agudos (urgencias). Aunque no se ha confirmado, es posible que el Tecovirimat sea de ayuda en pacientes con sintomatología grave. Se concluye que es necesario que los odontólogos sepan distinguir los signos orales de la enfermedad para que contribuyan a cortar la cadena de contagio y deriven prontamente a los sospechosos para que se hagan las pruebas diagnósticas y las terapias medicamentosas de manera oportuna(AU)

The recent outbreak of monkeypox has aroused the interest of the international community due to its growing number of infections in non-endemic countries. Its symptoms include fever, headache, fatigue, muscle pain, rash, and lymphadenoma. The oral cavity is the place where the first signs of the disease usually appear. Therefore, the objective of this work was to establish the main oral manifestations of monkeypox and list some prevention recommendations. For this, a bibliographic review was carried out between 2012 and 2022 in the PubMed database, using the keywords, in English, monkeypox, oral manifestation and transmission. It was guaranteed that, of the 14 selected documents, at least 80% would be published in 2022. The most frequent oral manifestations were: erythematous ulcer, ulcer-vesicles and those associated with lymphadenopathy (dysphagia, odynophagia and pharyngitis). Among the recommendations are: use of N95 mask and face visors, constant washing of hands and spaces, and attention to those infected only due to acute events (emergencies). Although it has not been confirmed, it is possible that Tecovirimat is helpful in patients with severe symptoms. It is concluded that it is necessary for dentists to know how to distinguish the oral signs of the disease so that they contribute to breaking the chain of contagion and promptly refer suspects to diagnostic tests and drug therapies in a timely manner(AU)

Use and management of disinfectants by dentists in San Luis Potosi, Mexico, during the covid-19 pandemic / Uso y manejo de desinfectantes por odontólogos de San Luis Potosí, México durante la pandemia covid-19

Introduction: Chlorine, ethyl alcohol, and quaternary ammonium are disinfectants with antiviral activity against SARS-Cov2. However, there are no previous reports of their use and handling for cleaning and disinfection in dental offices. Objetive: To determine the use and management of disinfectants in critical and non-critical areas used by dentists in San Luis Potosí, Mexico, during the COVID-19 pandemic. Material and Methods: A validated cross-sectional survey was applied online to 100 dentists in San Luis Potosí between February and June 2021. Participants were informed about the handling of personal data according to the standard DOF regulations (DOF 07-05-2010). Results: A total of 100 dentists were included in the study, 63% female and 37% male, with a mean age of 26 years. The most widely used disinfectants during the pandemic in critical areas were Lysol® and 0.1% sodium hypochlorite in non-critical areas. Eighty-five percent of dentists know the adverse effects of inappropriate use of disinfectants, 72% did not have any sign or symptom associated with the use of disinfectants. The most used protection barrier was gloves (97%). Sixty-seven per cent of dentists disposed of disinfectant waste down the drain. Conclusion: Sodium hypochlorite and quaternary ammonium compounds and/or ethanol are used to clean non-critical and critical areas in dental offices. However, appropriate measures for their management are not adopted. It is necessary to implement educational strategies to improve the use and management of disinfectants in dental practice.

Introducción: Cloro, alcohol etílico y amonio cuaternario son desinfectantes que muestran actividad antiviral contra el SARS-Cov2, sin embargo, no existen reportes previos de su uso y manejo para la limpieza y desinfección en clínicas dentales. Objetivo: Determinar el uso y manejo de los desinfectantes en áreas críticas y no críticas empleados por los odontólogos en San Luis Potosí durante la COVID-19. Material y Métodos: Encuesta transversal validada y aplicada on-line a 100 odontólogos de San Luis Potosí durante febrero-junio 2021. Se informó a los participantes sobre el manejo de datos personales de acuerdo a la norma (DOF 05-07-2010). Resultados: Se incluyeron un total de 100 odontólogos, 63% del sexo femenino y 37% del sexo masculino, con una edad promedio de 26 años. Los desinfectantes más utilizados durante la pandemia en las áreas críticas fueron el Lysol® y el hipoclorito de sodio al 0.1% en áreas no críticas. El 85% de los odontólogos conocen los efectos adversos del uso inadecuado de los desinfectantes, 72% no tuvieron algún signo o síntoma asociado al uso de desinfectantes. La barrera de protección más utilizada fueron los guantes (97%). El 67% de los odontólogos eliminó los desechos de desinfectantes por la coladera. Conclusión: Para la limpieza de las áreas no críticas y críticas en las clínicas dentales se utilizan el hipoclorito de Sodio y compuestos de amonio cuaternario y/o etanol, sin embargo, no se utilizan las medidas adecuadas para su manejo. Es necesario implementar estrategias educativas para mejorar el uso y manejo de desinfectantes en la práctica dental.

The impact of the COVID-19 pandemic on dental practice in Brazil / O impacto da pandemia de COVID-19 na prática odontológica no Brasil

INTRODUCTION: Dentists are at high risk of contamination by COVID-19 due to the proximity to the patients' oral cavity and airways. OBJECTIVE: To elucidate thebehaviors and adversities experienced by dentists because of the COVID-19 pandemic. METHODS: This descriptive study invited 1.811 dentists affiliated with professional associations, dental cooperatives, and health insurance providers from São Paulo State, Brazil, in 2020 of which 473 agreed to participate. The data collection, using Google Forms, included the variables: sociodemographic conditions; characteristics of dental work; level of healthcare and sources of information about the pandemic; changes in the work process, financial impact with personal protective equipment (PPE) andbiosafety measures; and consequences of the pandemic in the professional practice. RESULTS: The 473 dentists (40.36±13.44 years), were mostly women (52.22%), had a specialty (55.60%), and were self-employed professionals (73.36%). It was observed that 78.01% of professionals had a reduction in their monthly income. The average ofpatients treated daily decreased by 35.48%. It was found that 30.44% of professionalshad difficulty with the use of PPE, 3.59% contracted COVID-19, and 53.03% decided to postpone the appointment if the patient with suspected or confirmed COVID-19 sought treatment, even in emergencies. The use of high-speed handpieces was reported by most professionals (n=428; 90.48%). CONCLUSION: Behaviors: dentists used PPE and assigned very high or high levels of precaution about COVID-19. Adversities: dentists reported an increase in operating costs, changes in the work process, a decrease in appointments, and a reduction in the monthly income.

INTRODUÇÃO: Os cirurgiões-dentistas apresentam alto risco de contaminação pelo COVID-19 devido à proximidade com a cavidade oral e vias aéreas dos pacientes. OBJETIVO: Elucidar os comportamentos e adversidades vivenciados por cirurgiões-dentistas devido à pandemia de COVID-19. MÉTODOS: A pesquisa descritiva envolveu 1.811 cirurgiões-dentistas de associações profissionais, cooperativas odontológicas e convênios do Estado de São Paulo, Brasil, em 2020, dos quais 473 concordaram em participar. A coleta de dados, por meio do Formulários Google, incluiu as variáveis: condições sociodemográficas; características do trabalho odontológico; nível de atenção e fontes de informação sobre a pandemia; mudanças no processo de trabalho, impacto financeiro com equipamentos de proteção individual (EPI) e medidas de biossegurança; e consequências da pandemia na prática profissional. RESULTADOS: Dos 473 dentistas (40,36±13,44 anos), a maioria era mulher (52,22%), especialista (55,60%) e trabalhava como autônomo (73,36%). Observou-se que 78,01% dos profissionais apresentaram redução na renda mensal. A média de pacientes atendidos diminuiu 35,48%. Constatou-se que 30,44% dos profissionais tiveram dificuldade com o uso de EPI, 3,59% contraíram COVID-19 e 53,03% postergaram o atendimento de paciente com suspeita ou confirmação de COVID-19, mesmo em emergências. O uso de peça de alta rotação foi relatado pela maioria dos profissionais (n=428; 90,48%). CONCLUSÃO: Como comportamentos: os dentistas usaram EPI e atribuíram níveis muito altos ou altos de cuidados sobre o COVID-19. Como adversidades: os dentistas relataram aumento nos custos operacionais, mudanças no processo de trabalho, diminuição no atendimento e redução na renda mensal.

Indoor Carbon Dioxide, Fine Particulate Matter and Total Volatile Organic Compounds in Private Healthcare and Elderly Care Facilities.

Poor indoor air quality can have adverse effects on human health, especially in susceptible populations. The aim of this study was to measure the concentrations of dioxide carbon (CO2), fine particulate matter (PM2.5) and total volatile organic compounds (TVOCs) in situ in private healthcare and elderly care facilities. These pollutants were continuously measured in two rooms of six private healthcare facilities (general practitioner's offices, dental offices and pharmacies) and four elderly care facilities (nursing homes) in two French urban areas during two seasons: summer and winter. The mean CO2 concentrations ranged from 764 ± 443 ppm in dental offices to 624 ± 198 ppm in elderly care facilities. The mean PM2.5 concentrations ranged from 13.4 ± 14.4 µg/m3 in dental offices to 5.7 ± 4.8 µg/m3 in general practitioner offices. The mean TVOC concentrations ranged from 700 ± 641 ppb in dental offices to 143 ± 239 ppb in general practitioner offices. Dental offices presented higher levels of indoor air pollutants, associated with the dental activities. Increasing the ventilation of these facilities by opening a window is probably an appropriate method for reducing pollutant concentrations and maintaining good indoor air quality.

Un enfoque digital para restaurar un diente anterior traumatizado durante la pandemia COVID-19: reporte del caso / A digital approach to restore a traumatized anterior tooth during the COVID-19 pandemic: A clinical report

Los profesionales de la salud oral tienen un mayor riesgo de infección con el nuevo coronavirus 2019 (COVID-19), debido a la comunicación cercana a la cavidad oral y la exposición a saliva, sangre y otros fluidos corporales. Los enfoques digitales pueden reducir el tiempo clínico y contribuir a limitar el riesgo de infección. El objetivo del presente trabajo es presentar un enfoque digital para restaurar un diente anterior traumatizado, durante la pandemia de COVID-19. Paciente sexo feminino de 28 años, con movilidad anormal de la pieza 1.1 y antecedente de traumatismo dental en la adolescencia. Se realizó una evaluación inicial para detectar signos y síntomas de una posible infección por COVID-19. Las imágenes de la tomografía computarizada mostraron fractura coronaria y presencia de reabsorción cervical externa en el incisivo central derecho. El plan de tratamiento consistió en la rehabilitación del diente fracturado a través de una restauración retenida con un poste de fibra de vidrio, usando un abordaje digital por medio de un escáner intraoral con diseño y fabricación asistido por computadora (CAD/CAM). Los enfoques digitales en odontología podrían contribuir a reducir el riesgo de infección por COVID-19 en pacientes y dentistas durante los tratamientos restauradores.

Dental professionals are at increased risk of infection with the new coronavirus 2019 (COVID-19) due to face-to-face communication and exposure to saliva, blood and other body fluids. Digital approaches can reduce clinical time and contribute to limiting the risk of infection. The objective of this work was to report a digital approach to restoring a traumatized anterior tooth during the COVID-19 pandemic. A 28-year-old female with abnormal mobility in the crown of an upper anterior tooth with history of dental trauma in the adolescence. An initial screening was performed to check for signs and symptoms of possible COVID-19 infection. Cone Beam Computed Tomography images showed a crown fracture and the presence of external cervical resorption in the right permanent central incisor. The treatment plan consisted of rehabilitation of the fractured tooth through a restoration retained with a fiberglass post with a digital approach using an intraoral scanner, and computer-aided design and fabrication - CAD/CAM. Digital approaches in dentistry including intraoral scanners and CAD/CAM could contribute to reducing the risk of COVID-19 infection in patients and dentists during restorative treatments.

Evaluation of the economic impact of COVID-19 on Brazilian private dental clinics: A cross-sectional study.

BACKGROUND: The changes in dental care in the face of the COVID-19 pandemic resulted in the need for greater financial investment by dentists in biosafety measures and increase in the costs of dental consultations. OBJECTIVE: To evaluate the economic impact of the COVID-19 pandemic on dental practices in private clinics in Brazil. METHODS: A cross-sectional study was carried out, using an online questionnaire indexed in Google Forms, and distributed among dentists. The data obtained were analyzed using the IBM SPSS 25.0 software, evaluating the factors associated with strong or very strong impact on the participants' income and the factors that motivated the dentists to look for a credit line. Multiple logistic regression models were constructed to identify the associated factors. Variables with p < 0.05 were considered statistically significant. RESULTS: Most participants were female, with a median age of 35 years. Dentists who are most concerned about their professional future (OR = 3.134; 95% CI: 1.804-5.445), who have longer office hours (OR = 2.056; 95% CI: 1.198-3.529), who had the greatest impact on the flow of patients (OR = 16.358; 95% CI: 9.408-28.443) and in need of investing in infrastructure (OR = 1.756; 95% CI: 1.014-3.041), had the greatest impact on monthly earnings. CONCLUSIONS: The pandemic and the new biosafety recommendations for care during this period had a negative impact on the income of Brazilian dental offices and increased the chance of seeking credit to alleviate the financial deficit.

Avaliação do nível de conhecimento de acadêmicos de Odontologia sobre emergências médicas / Knowledge level assessment of Dentistry undergraduate students about medical emergencies

Emergências médicas são imprevisíveis e o cirurgião-dentista deve estar preparado para reconhecer e atuar frente a esses casos. No entanto, parece existir uma insegurança diante de tais situações, provavelmente devido às dificuldades de diagnosticar e conduzir esses eventos. Assim, esse estudo se justifica pela necessidade de avaliar o conhecimento dos acadêmicos frente a emergências médicas. O objetivo dessa pesquisa foi avaliar o nível de conhecimento sobre emergências médicas de graduandos emOdontologia. Esta pesquisa de natureza quantitativa, descritiva e exploratória, foi realizada com acadêmicos do Curso de Odontologia da Faculdade de Odontologia da Universidade Federal de Juiz de Fora, do sexto ao décimo períodos. A coleta de dados foi realizada por meio da aplicação de um teste com nove questões objetivas sobre emergências médicas. Os dados foram analisados e os resultados expressos empercentagens, médias e desvios-padrão. Os resultados mostraram quede uma amostra de 100 estudantes, sendo 21% homens e 79% mulheres,99% têminteresse em participar de um curso de emergências médicas; 4% se julgampreparadospara atuar nestes casos,10% se consideramcapazesde fazer uma reanimação cardiopulmonare79% obtiveram pontuação considerada como insuficienteno teste. Concluiu-se que os alunos não se mostraram preparados para atuar em casos de emergências médicas (AU).

Medical emergencies are unpredictable and the dental surgeonmust be prepared to recognize and act uponthese cases. However, there seems to be insecurity beforesuch situations, probably due to difficulties in diagnosing and conducting these events. Thus, this study is justified by the need to assess the knowledge of dentalstudentsbeforemedical emergencies. The aimof this research was to evaluate theknowledge level of undergraduate dentistry students about medical emergencies. This quantitative, descriptive and exploratory research was performedwith students from the Dentistry Course at the Dentistry School of the Federal University of Juiz de Fora, from the sixth to the tenth course terms. Data collection was accomplishedthrough the application of a test with nine objective questions onmedical emergencies. The data were analysedand the results were expressed as percentages, means and standard deviations. The results showed that out of a sample of 100 students, 21% men and 79% women, 99% are interested in participating in a medical emergency course; 4% consider themselves prepared to act in these cases, 10% consider themselves capable of performing cardiopulmonary resuscitation and 79% obtained a score considered as insufficient in the test. It was concludedthat the students did not seem prepared to act in cases of medical emergencies (AU).

Microbiological Contamination of the Office Environment in Dental and Medical Practice.

The microbiological contamination of the environment in independent healthcare facilities such as dental and general practitioner offices was poorly studied. The aims of this study were to describe qualitatively and quantitatively the bacterial and fungal contamination in these healthcare facilities and to analyze the antibiotic resistance of bacterial pathogens identified. Microbiological samples were taken from the surfaces of waiting, consulting, and sterilization rooms and from the air of waiting room of ten dental and general practitioner offices. Six surface samples were collected in each sampled room using agar contact plates and swabs. Indoor air samples were collected in waiting rooms using a single-stage impactor. Bacteria and fungi were cultured, then counted and identified. Antibiograms were performed to test the antibiotic susceptibility of bacterial pathogens. On the surfaces, median concentrations of bacteria and fungi were 126 (range: 0-1280) and 26 (range: 0-188) CFU/100 cm2, respectively. In indoor air, those concentrations were 403 (range: 118-732) and 327 (range: 32-806) CFU/m3, respectively. The main micro-organisms identified were Gram-positive cocci and filamentous fungi, including six ubiquitous genera: Micrococcus, Staphylococcus, Cladosporium, Penicillium, Aspergillus, and Alternaria. Some antibiotic-resistant bacteria were identified in general practitioner offices (penicillin- and erythromycin-resistant Staphylococcus aureus), but none in dental offices. The dental and general practitioner offices present a poor microbiological contamination with rare pathogenic micro-organisms.

Is aromatherapy associated with patient's dental anxiety levels? A systematic review and meta-analysis.

The use of aromatherapy for the reduction of anxiety levels during dental treatment procedures has been well established in the literature; however, there is limited evidence regarding its efficacy. The present meta-analysis is an attempt to assess the association between the use of aromatherapy and anxiety levels among dental patients. A comprehensive search was conducted across Medline, Scopus, Web of Science, EBSCO host, Cochrane databases, and Google Scholar for studies evaluating aromatherapy and anxiety level among dental patients. PRISMA guidelines were followed for the meta-analysis. Randomized and cluster-randomized trials comparing aromatherapy with controls were included. The random-effects model was used to assess the mean differences in anxiety levels of patients visiting dental OPD. The significance value was set at P < 0.05. Six studies were identified that met the requirements for inclusion. Aromatherapy was significantly associated with reduction in patient anxiety levels during dental treatment (pooled mean difference: -3.36 [95% CI, -3.77 - -2.95, P = 0.00001). Low heterogeneity was noted between studies (I2 = 1%, P = 0.41) analyzed in the meta-analysis. High certainty of the evidence was obtained from the association between the use of aromatherapy and dental anxiety. This meta-analysis suggests that aromatherapy is effective in reducing dental anxiety. When used judiciously, the results of this work should encourage the use of aromatherapy to reduce patient anxiety levels during dental procedures.

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.

Herramientas digitales para la obtención de registros, posicionamiento y articulación virtual de modelos / Digital tools for obtaining records, positioning and virtual articulation of casts

La siguiente revisión bibliográfica busca describir las alternativas digitales disponibles para la obtención de registros, posicionamiento y articulación virtual de modelos junto con ejemplificar algunos softwares que permitan la implementación de estas tecnologías en su trabajo diario. Se realizó una búsqueda de literatura en las bases de datos: Pubmed, LILACS, SciELO y Cochrane Library. Finalmente, luego de ser filtrados los resultados, se utilizaron un total de 36 publicaciones. Existen diversas herramientas disponibles actualmente para digitalizar una gran cantidad de técnicas que solo hasta hace algunos años eran realizadas manualmente por un operador. Algunas de ellas, facilitan una inmersión paulatina al mundo virtual del odontólogo novato ya que carecen de altos costos y recur-sos. Se sugiere que los odontólogos implementen estas tecnologías en su trabajo habitual según cada caso particular.

The following literature review seeks to bring together the digital alternatives available for obtaining records, positioning and virtual articulation of models together with exemplifying some softwares to allow the implementation of these technologies in their daily workflow. A literature search was carried out in the following databases: Pubmed, LILACS, SciELO and Cochrane Library. Finally, after the results were filtered, a total of 36 publications were used. There are various tools currently available to digitize a large number of techniques that were only performed manually by an operator until a few years ago. Some of them facilitate a gradual immersion into the virtual world of the novice dentist since they lack high costs and resources. It is suggested that dentists implement these technologies into daily dental practice according to each particular case.