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in category dentistry and oral medicine

94 results found. For more information, click each entry to expand.

1: Efficacy of commercial mouth-rinses on SARS-CoV-2 viral load in saliva: Randomized Control Trial in Singapore
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Posted 18 Sep 2020

Efficacy of commercial mouth-rinses on SARS-CoV-2 viral load in saliva: Randomized Control Trial in Singapore
5,274 downloads medRxiv dentistry and oral medicine

Chaminda Jayampath Seneviratne, Preethi Balan, Karrie Ko Kwan Ki, Nadeeka S. Udawatte, Deborah Lai, Dorothy Ng Hui Lin, Indumathi Venkatachalam, Jay Lim Kheng Sit, Ling Moi Lin, Lynette Oon, Bee Tin Goh, Jean Sim Xiang Ying

The presence of high SARS-coronavirus 2 (SARS-CoV-2) titres in saliva may result in transmission of the virus and increase the risk of COVID-19 infection. This is particularly important as significant amounts of aerosols are generated during dental procedures, posing risk to dental care personnel and patients. Thus, reducing the titres of SARS-CoV-2 in the saliva of infected patients could be one of the key approaches to reduce the risk of COVID-19 transmission during dental procedures. In this randomised control trial, the efficacy of three commercial mouth-rinse viz. povidone-iodine (PI), chlorhexidine gluconate (CHX) and cetylpyridinium chloride (CPC), in reducing the salivary SARS-CoV-2 viral load in COVID-19 positive patients were compared with water. A total of 36 COVID-19 positive patients were recruited, of which 16 patients were randomly assigned to four groups: PI group (n=4), CHX group (n=6), CPC group (n=4) and water as control group (n=2). Saliva samples were collected from all patients at baseline and at 5 min, 3 h and 6 h post-application of mouth-rinses/water. The samples were subjected to SARS-CoV-2 RT-PCR analysis. The fold change of Ct values were significantly increased in CPC group at 5 minutes and 6 h time points (p<0.05), while it showed significant increase at 6 h timepoint for PI group (p<0.01). Considering Ct values as an indirect method of arbitrarily quantifying the viral load, it can be postulated that CPC mouth-rinse can decrease the salivary SARS-CoV-2 levels within 5 minutes of use, compared to water rinsing. The effect of decreasing salivary load with CPC and PI mouth-rinsing was observed to be sustained at 6 h time point. Within the limitation of the current study, it can be concluded that use of CPC and PI formulated commercial mouth-rinses, with its sustained effect on reducing salivary SARS-CoV-2 level, may be useful as a pre-procedural rinse to help reduce the transmission of COVID-19.

2: Saliva as a Candidate for COVID-19 Diagnostic Testing: A Meta-Analysis
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Posted 27 May 2020

Saliva as a Candidate for COVID-19 Diagnostic Testing: A Meta-Analysis
3,895 downloads medRxiv dentistry and oral medicine

Laszlo Mark Czumbel, Szabolcs Kiss, Nelli Farkas, Ivan Mandel, Anita Emoke Hegyi, Akos Karoly Nagy, Zsolt Lohinai, Zsolt Szakacs, Peter Hegyi, Martin C. Steward, Gabor Varga

Objectives: Our aim was to conduct a meta-analysis on the reliability and consistency of SARS-CoV-2 viral RNA detection in saliva specimens. Methods: We reported our meta-analysis according to the Cochrane Handbook. We searched the Cochrane Library, Embase, Pubmed, Scopus, Web of Science and clinical trial registries for eligible studies published between 1 January and 25 April 2020. The number of positive tests and total number of conducted tests were collected as raw data. The proportion of positive tests in the pooled data were calculated by score confidence interval estimation with the Freeman-Tukey transformation. Heterogeneity was assessed using the I2 measure and the Chi2 test. Results: The systematic search revealed 96 records after removal of duplicates. 26 records were included for qualitative analysis and 5 records for quantitative synthesis. We found 91% (95%CI = 80%-99%) sensitivity for saliva tests and 98% (95%CI 89%-100%) sensitivity for nasopharyngeal swab (NPS) tests in previously confirmed COVID-19 infected patients, with moderate heterogeneity among studies. Additionally, we identified 18 registered, ongoing clinical trials on saliva-based tests for detection of the virus. Conclusion: Saliva tests offer a promising alternative to NPS for COVID-19 diagnosis. However, further diagnostic accuracy studies are needed to improve their specificity and sensitivity.

3: COVID-19 challenges to dentistry in the new pandemic epicenter: Brazil
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Posted 14 Jun 2020

COVID-19 challenges to dentistry in the new pandemic epicenter: Brazil
2,673 downloads medRxiv dentistry and oral medicine

Rafael R Moraes, Marcos B Correa, Ana B Queiroz, Ândrea Daneris, João P Lopes, Tatiana Pereira-Cenci, Otávio P D'Avila, Maximiliano S Cenci, Giana S Lima, Flavio Fernando Demarco

A nationwide survey of dentists was carried out in Brazil, a new pandemic epicenter, to analyze how dental coverage has been affected (public versus private networks), changes in routine and burdens, and how the local prevalence of COVID-19 affects dental professionals. Dentists were recruited via email and an Instagram campaign. Responses to an online questionnaire were collected May 15-24, 2020. COVID-19 case/death counts in the state where respondents work was used to test associations between contextual status and decreases in weekly appointments, fear of contracting COVID-19 at work, and current work status (alpha=0.05). Over 10 days, 3,122 responses were received, with region, gender, and age distributions similar to those of dentists in Brazil. Work status was affected for 94% of dentists, with less developed regions being more impacted. The impact on routine was high or very high for 84%, leading to varied changes to clinic infrastructure, personal protective equipment use, patient screening, and increased costs. COVID-19 patients had been seen by 5.3% of respondents, and 90% reported fearing contracting COVID-19 at work. Multilevel statistics showed that greater case and death rates (1000 cases or 100 deaths per million inhabitants) in one's state increased the odds of being fearful of contracting the disease (by 18% and 25%). For each additional 1000 cases or 100 deaths, the odds of currently not working or treating emergencies increased by 36% and 58%. The reduction in patients seen weekly per dentist was greater in public (38.7+/-18.6) than in private clinics (22.5+/-17.8). This study provides early evidence of three major impacts of the pandemic on dentistry in Brazil: increasing inequalities due to coverage differences between public and private networks; adoption of new clinical routines, which are associated with an economic burden; and associations of regional COVID-19 incidence and mortality with fear of contracting the disease at work.

4: Perceived Stress and Psychological (Dis)Stress among Indian Endodontists During COVID19 Pandemic Lock down
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Posted 10 May 2020

Perceived Stress and Psychological (Dis)Stress among Indian Endodontists During COVID19 Pandemic Lock down
1,827 downloads medRxiv dentistry and oral medicine

Anil Kumar Ramachandran Nair, Karumaran Savarimalai Chellaswamy, Deepthi Kattula, Rooban Thavarajah, Anusa Arunachalam Mohandoss

Background: The novel 2019 coronavirus(COVID-19) spreads by respiratory and aerosols. COVID19 driven pandemic causes panic, fear and stress among all strata of society. Like all other medical professions, dentists, particularly endodontists, who are highly exposed to aerosols would be exposed to stress. The aim of this study was to assess the (dis)stress among Indian endodontists and the factors that could influence the (dis)stress. Methods: From 8th April to 16th April 2020, we conducted an online survey in closed endodontic social media using snowball sampling technique, collecting basic demographic data, practice setting and relevant data. Psychological stress and perceived distress were collected through COVID-19 Peri-traumatic Distress Index (CPDI) and Perceived stress scale (PSS). Multinomial regression analysis was performed to estimate relative risk rate and P[&le;]0.05 was considered significant. Results: This study had 586 Indian endodontists completing this survey across India. Of these, 311(53.07%) were males, 325(55%) in the age group of 25-35 years, 64%in urban areas, 13.14% in solo-practice and a fourth of them were residents. Female endodontists had high perceived stress (RRR=2.46,P=0.01) as compared to males, as measured by PSS. Younger endodontists<25 years(RRR=9.75;P=0.002) and 25-35years (RRR=4.60;P=0.004) as compared with >45 years age-group had more distress. Exclusive consultants had RRR= 2.90, P=0.02, for mild-to-moderate distress as compared to normal. Factors driving this phenomenon are considered. Conclusions: During the lock down due to COVID-19, 1-in-2 Indian endodontists had distress, as measured by CPDI and 4-in-5 of them had perceived stress, as indicated by PSS. Our model identified certain factors driving the (dis)stress, which would help policy framers to initiate appropriate response.

5: A Systematic Review of Droplet and Aerosol Generation in Dentistry
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Posted 01 Sep 2020

A Systematic Review of Droplet and Aerosol Generation in Dentistry
1,814 downloads medRxiv dentistry and oral medicine

Nicola Innes, Ilona Johnson, Waraf Al-Yaseen, Rebecca Harris, Rhiannon Jones, Sukriti KC, Scott McGregor, Mark Robertson, William Wade, Jennifer Gallagher

Introduction: Against the COVID-19 pandemic backdrop and potential disease transmission risk by dental procedures that can generate aerosol and droplets. Objectives: This review aimed to identify which clinical dental procedures do generate droplets and aerosols with subsequent contamination, and for these, characterise their pattern, spread and settle. Materials and Method: Six databases were searched and citation chasing undertaken (to 11/08/20). Screening stages were undertaken in duplicate, independently, by two researchers. Data extraction was performed by one reviewer and verified by another. Results: Eighty-three studies met the inclusion criteria and covered: Ultrasonic scaling (USS, n=44), high speed air-rotor (HSAR, n=31); oral surgery (n=11), slow-speed handpiece (n=4); air-water (triple) syringe (n=4), air-polishing (n=4), prophylaxis (n=2) and hand-scaling (n=2). Although no studies investigated respiratory viruses, those on bacteria, blood splatter and aerosol showed activities using powered devices produced the greatest contamination. Contamination was found for all activities, and at the furthest points studied. The operator torso operator arm, and patient body were especially affected. Heterogeneity precluded significant inter-study comparisons but intra-study comparisons allowed construction of a proposed hierarchy of procedure contamination risk: higher risk (USS, HSAR, air-water syringe [air only or air/water together], air polishing, extractions using motorised hand-pieces); moderate (slow-speed handpieces, prophylaxis with pumice, extractions) and lower (air-water syringe [water only] and hand scaling. Conclusion: Significant gaps in the evidence, low sensitivity of measures and variable quality limit firm conclusions around contamination for different procedures. However, a hierarchy of contamination from procedures can be proposed for challenge/verification by future research which should consider standardised methodologies to facilitate research synthesis. Clinical significance (49 words): This manuscript addresses uncertainty around aerosol generating procedures (AGPs) in dentistry. Findings indicate a continuum of procedure-related aerosol generation rather than the current binary AGP or non-AGP perspective. This informs discussion around AGPs and direct future research to help support knowledge and decision making around COVID-19 and dental procedures.

6: Fuzzy logic assisted COVID 19 safety assessment of dental care
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Posted 22 Jun 2020

Fuzzy logic assisted COVID 19 safety assessment of dental care
1,391 downloads medRxiv dentistry and oral medicine

Andrio Adwibowo

Uncertainty is significant when assessing a risk of certain health care facility conditions especially the facility that prone to the COVID 19 risk. One solution to deal with an uncertainty in health situation assessment is through fuzzy inference system. For that reason, this study aims to develop fuzzy assisted system to assess the safety of dental care related to the sets of patient and environmental conditions. The fuzzy system allows assessment based on the patient body temperature, travel history, dental care ventilation rate, and disinfection frequency. The fuzzy system incorporates several steps including fuzzification, fuzzy regulation, and defuzzification. As a result of this study, the fuzzy system is able to assess and identify the risk of dental care according to the patient health status and hygiene conditions of dental care as well. To conclude, fuzzy system used in this study has offered the advantage of assessing at any situation as for patient and environmental factor predicts the safety of dental care.

7: Ventilation rate assessment by carbon dioxide levels in dental treatment rooms
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Posted 08 Feb 2021

Ventilation rate assessment by carbon dioxide levels in dental treatment rooms
1,278 downloads medRxiv dentistry and oral medicine

Qirong Huang, Tamer Marzouk, Razvan Cirligeanu, Hans Malmstrom, Eli Eliav, Yanfang Ren

Objectives: The purpose of the present study was to monitor and evaluate CO2 levels in dental operatories using a consumer-grade CO2 sensor and determine the utility and accuracy of various methods using CO2 levels to assess ventilation rate in dental clinics. We aim to find a practical tool for dental practitioners to conveniently and accurately monitor CO2 levels and assess the ventilation rates in their office in order to devise a pragmatic and effective strategy for ventilation improvement in their work environment. Methods: Mechanical ventilation rate in air change per hour (ACHVENT) of 10 dental operatories was first measured with an air velocity sensor and air flow balancing hood. CO2 levels were measured in these rooms to analyze the effects of ventilation rate and number of persons in the room on CO2 accumulation. Ventilation rates were estimated using natural steady state CO2 levels during dental treatments and experimental CO2 concentration decays by dry ice or mixing baking soda and vinegar. We compared the differences and assessed the correlations between ACHVENT and ventilation rates estimated by steady states CO2 model with low (0.3 L/min, ACHSS30) or high (0.46 L/min, ACHSS46) CO2 generation rates, by CO2 decay constants using dry ice (ACHDI) or baking soda (ACHBV), and by time needed to remove 63% of excess CO2 generated by dry ice (ACHDI63%) or baking soda (ACHBV63%). Results: ACHVENT varied from 3.9 to 35.0 with a mean of 13.2 ({+/-}10.6) in the 10 dental operatories. CO2 accumulation occurred in rooms with low ventilation (ACHVENT [&le;]6) and more persons (n>3) but not in those with higher ventilation and less persons. ACHSS30 and ACHSS46 correlated well with ACHVENT (r=0.83, p=0.003), but ACHSS30 was more accurate for rooms with low ACHVENT. Ventilation rates could be reliably estimated using CO2 released from dry ice or baking soda. ACHVENT was highly correlated with ACHDI (r=0.99), ACHBV(r=0.98), ACHDI63%(r=0.98), and ACHBV63% (r=0.98). There were no statistically significant differences between ACHVENT and ACHDI63% or ACHBV63%. Conclusions: Dental operatories with low ventilation rates and overcrowding facilitate CO2 accumulations. Ventilation rates could be reliably calculated by observing the changes in CO2 levels after a simple mixing of household baking soda and vinegar in dental settings. Time needed to remove 63% of excess CO2 generated by baking soda could be used to accurately assess the ventilation rates using a consumer-grade CO2 sensor and a basic calculator.

8: Effectiveness of the Covid-19 vaccines in preventing infection in dental practitioners: results of a cross-sectional questionnaire based survey
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Posted 30 May 2021

Effectiveness of the Covid-19 vaccines in preventing infection in dental practitioners: results of a cross-sectional questionnaire based survey
1,180 downloads medRxiv dentistry and oral medicine

Sanjeev Kumar, Susmita Saxena, Mansi Atri, Sunil Kumar Chamola

India started its vaccination program at the beginning of 2021, the main beneficiaries being health workers and frontline workers including police, paramilitary forces, sanitation workers, and disaster management volunteers in the first phase. By the time, the second wave of Covid-19 impacted India, approximately 14 million healthcare and frontline workers, including dentists had been vaccinated. AimTo study the effectiveness of vaccination on a subset of high-risk healthcare workers i.e. dentists in preventing Covid-19 during the second wave of the pandemic. Study designA questionnaire based pan-India online survey was carried out to record the Covid-related experiences of dentists prior to and after vaccination. ResultDuring the second wave, 9.18% (n=364) respondents became positive in spite of the vaccine, while 14.69%(n=78) became positive in the unvaccinated group. A chi-square test of independence was performed to examine the relation between vaccination and the Covid positivity rate in all age groups. The relation between these variables was highly significant, [X2 (1, N = 4493) = 15.9809, p=.000064]. ConclusionOur pan-India online survey inferred that vaccination has a definitive role to play in reducing the positivity rate amongst dentists during the second wave of the pandemic across all age groups.

9: Brazilian dental students and COVID-19: a survey on knowledge and perceptions
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Posted 30 Jul 2020

Brazilian dental students and COVID-19: a survey on knowledge and perceptions
1,018 downloads medRxiv dentistry and oral medicine

Maria Gerusa Brito Aragao, Francisco Isaac Fernandes Gomes, Leticia Pinho Maia Paixao de Melo, Silmara Aparecida Milori Corona

This study evaluated the knowledge and perception of Brazilian dental students about COVID-19 and the undergraduate clinical practice during the outbreak by a self-administered web-based questionnaire. A social network campaign on Instagram was raised to approach the reach population. The survey covered demographic and academic profile, general knowledge, preventive measures, and perception about the COVID-19. Descriptive statistics were used to identify frequencies and distributions of variables, which were compared by type of institution and current year of enrollment using Chi-square or Fishers exact tests (alpha=0.05). A total of 833 valid responses were received over 10 days. Students were able to identify the incubation period, main symptoms, and contagious routes of the disease but struggled in recognizing the name of the virus responsible for the pandemics. Hand washing before and after a dental appointment with a patient (97.7%) followed by use of barriers to protect mucosa (97.2%) were the more frequently recognized measures to prevent COVID-19 spread in the dental office. As for the perception of COVID-19, 73.2% of the dental students perceive the disease as severe, while only 11.1% of them think that COVID-19 is severe only for people presenting risk factors. Dental students knowledge and perception were associated with the type of institution and year of enrollment. In summary, the dental students demonstrated an acceptable general knowledge about COVID-19, but dental schools will need to address gaps in knowledge and control measures and perceptions to ensure a safer return to practical activities.

10: Prevalence and risk/protective indicators of peri-implant diseases: a university-representative cross-sectional study
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Posted 05 Jun 2020

Prevalence and risk/protective indicators of peri-implant diseases: a university-representative cross-sectional study
921 downloads medRxiv dentistry and oral medicine

Mario Romandini, Cristina Lima, Ignacio Pedrinaci, Ana Araoz, Maria Costanza Soldini, Mariano Sanz

Aim. To evaluate the prevalence of peri-implant diseases and to identify risk/protective indicators of peri-implantitis. Materials and Methods. 240 randomly selected patients from a university clinic database were invited to participate. Those who accepted, once data from their medical and dental history was collected, were examined clinically and radiographically to assess the prevalence of peri-implant health and diseases. A multilevel multivariate logistic regression analysis was carried out to identify those factors associated either positively (risk) or negatively (protective) with peri-implantitis defined as BoP/SoP and bone levels [&ge;]2 mm. Results. 99 patients with a total of 458 dental implants were analyzed. The prevalence of pre-periimplantitis and of peri-implantitis were respectively 56.6% and 31.3% at patient-level, while 27.9% and 31.7% at implant-level. The following factors were identified as risk indicators for peri-implantitis: smoking (OR=3.59; 95%CI:1.52-8.45), moderate/severe periodontitis (OR=2.77; 95%CI:1.20-6.36), <16 remaining teeth (OR=2.23; 95%CI:1.05-4.73), plaque (OR=3.49; 95%CI:1.13-10.75), implant malposition (too vestibular: OR=2.85; 95%CI:1.17-6.93), implant brand (Nobel vs. Straumann: OR=4.41;95% CI:1.76-11.09), restoration type (bridge: OR=2.47; 95%CI:1.19-5.12), and trauma as reason of tooth loss (OR=6.51;95% CI:1.45-29.26). Conversely, the following factors were identified as protective indicators: interproximal flossing/brushing (OR=0.27; 95%CI:0.11-0.68), proton pump inhibitors (OR=0.08; 95%CI:0.01-0.90) and anticoagulants (OR=0.08; 95%CI:0.01-0.56). Conclusions. Peri-implant diseases are highly prevalent among patients with dental implants in this university-based population. Several factors were identified as risk- and protective-indicators of peri-implantitis.

11: A clinical observational analysis of aerosol emissions from dental procedures.
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Posted 12 Jun 2021

A clinical observational analysis of aerosol emissions from dental procedures.
919 downloads medRxiv dentistry and oral medicine

Tom Dudding, Sadiyah Sheikh, Florence K.A. Gregson, Jennifer Haworth, Simon Haworth, Barry Main, Andrew Shrimpton, Fergus Hamilton, Tony Ireland, Nick Maskell, Jonathan Reid, Bryan R Bzdek, Mark Gormley

There remains uncertainty as to which dental procedures constitute aerosol generating procedures. We aimed to quantify aerosol concentration produced during different dental procedures. Where aerosol was detected, we assessed whether the aerosol size distribution from patient procedures was explained by the non-salivary contaminated instrument source, using phantom head controls. This study obtained ethical approval within the AERATOR grant. Patients were recruited consecutively, and written consent was obtained. Both an optical and an aerodynamic particle sizer were used to measure aerosol, attached to a 3D-printed polylactide funnel 22cm from the patients face. A range of periodontal, oral surgery and orthodontic procedures were captured using time-stamped protocols. High-fidelity phantom head control experiments for each procedure were performed, under the same conditions. Aerosol was measured for each procedure. Where aerosol was detected, phantom head control and patient procedure aerosol size distributions were compared, with the assumption that if the distributions were the same, aerosol detected from the patient could be explained by the instrument source. 41 patients underwent fifteen different dental procedures. For nine procedures, no aerosol was detected. Where aerosol was detected, the percentage of procedure time that aerosol was observed above background ranged from 12.7% for ultrasonic scaling to 42.9% for 3-in-1 air + water syringe. For ultrasonic scaling, 3-in-1 syringe use and surgical drilling, the aerosol size distribution matched the non-salivary contaminated instrument source. High and slow speed drilling produced aerosol from patient procedures which appear to have different size distributions from a phantom head control and so may pose a greater risk of (potentially infected) salivary contamination. Ultrasonic scaling does not appear to generate additional aerosol above that of the instrument itself and therefore does not increase the risk to dental teams, relative to the risk from being in close proximity to the patient.

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Posted 05 May 2020

865 downloads medRxiv dentistry and oral medicine

Kidambi Sneha, Ajmera Jhansi Rani, Rampalli Viswa Chandra

Aim: A force of 400g at 2700 RPM results in an optimum leucocyte and platelet-rich fibrin (L-PRF). Most of centrifuges with varying characteristics generate a g-force in excess of 700g at 2700 RPM. In this context, the study explores the effect of the original centrifugation protocol and a modified protocol tailor-made to lower the RPM to generate a g-force of ~400g on platelet concentration, clot size and growth factors release in L-PRF prepared in two different commercially available centrifuges. Materials and Methods: 25 subjects each were assigned to the following groups; R1 and R2 where L-PRF was obtained from two laboratory swing-out centrifuges (Remi 8C(R) & C854(R), Mumbai, India) respectively. PRF was obtained from each subject within a group using two protocols; Original (O) protocol: conforming to the original centrifugation cycle (2700 RPM for 12 min) and Modified (M) protocol. Clot size, growth factor estimation and platelet counts were measured at 20, 40 and 60 mins from all the L-PRF clots. Results: At the third time period (40-60min), there were no significant differences in clot sizes with the original protocol (p=0.09), but a highly significant difference was noticed with the modified protocol in both the centrifuges (p=0.001). Our results showed an increased concentration of VEGF and EGF with modified protocol than with original protocol with both the centrifuges (p=0.001). By the end of second and third time periods, more platelet concentration was observed with modified protocol than with the original protocol in both the centrifuges (p=0.001) Conclusion: This study infers that the centrifuge type and RCF can affect the quality and quantity of cells and growth factors and an optimum relationship between g-force and RPM should be maintained in order to obtain L-PRF with adequate cell viability and optimum growth factor release.

13: The first 6 weeks: setting up a UK urgent dental care centre during the COVID-19 pandemic.
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Posted 11 May 2020

The first 6 weeks: setting up a UK urgent dental care centre during the COVID-19 pandemic.
842 downloads medRxiv dentistry and oral medicine

Emily Carter, Charlotte Currie, Abisola Asuni, Rachel Goldsmith, Grace Toon, Catherine Horridge, Sarah Simpson, Christopher Donnell, Mark Greenwood, Graham Walton, Ben Cole, Justin Durham, Richard Holliday

Introduction: The COVID-19 pandemic has posed many challenges, including provision of urgent dental care. This paper presents a prospective service evaluation during establishment of urgent dental care in the North-East of England over a six-week period. Aim: To monitor patient volumes, demographics and outcomes at the North-East urgent dental care service and confirm appropriate care pathways. Main Outcome Methods: Data were collected on key characteristics of patients accessing urgent care from 23rd March to 3rd May 2020. Analysis was with descriptive statistics. Results: There were 1746 patient triages, (1595 telephone and 151 face-to-face) resulting in 1322 clinical consultations. The most common diagnoses were: symptomatic irreversible pulpitis or apical periodontitis. 65% of clinical consultations resulted in extractions, 0.5% an aerosol generating procedure. Patients travelled 25km on average to access care, however this reduced as more urgent care centres were established. The majority of patients were asymptomatic of COVID-19 and to our knowledge no staff acquired infection due to occupational exposure. Conclusion: The urgent dental care centre effectively managed urgent and emergency dental care, with appropriate patient pathways established over the 6-week period. Dental preparedness for future pandemic crisis could be improved and informed by this data.

14: Paediatric Dentistry and the coronavirus (COVID-19) response in the North East of England and North Cumbria
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Posted 05 Jun 2020

Paediatric Dentistry and the coronavirus (COVID-19) response in the North East of England and North Cumbria
770 downloads medRxiv dentistry and oral medicine

Sarah Simpsons, Oliver Sumner, Richard Holliday, Charlotte C Currie, Virginia Hind, Nicola Lush, Lucy Burbridge, Ben Cole

Introduction: Coronavirus (COVID-19) has dramatically changed the landscape of dentistry including Paediatric Dentistry. This paper explores paediatric patient data within a wider service evaluation completed within an Urgent Dental Care Centre in the North East of England and North Cumbria over a 6-week period. Aim: To assess demand for the service, patient demographics and inform paediatric urgent dental care pathways. Main outcome methods: Data collected included key characteristics of paediatric patients accessing Paediatric Dental Services from 23rd March to 3rd May 2020. Descriptive statistics were used for analysis. Results: There were 369 consultations (207 telephone, 124 face-to-face and 38 Out of Hours consultations). The mean age of children accessing the service was 7 years old. 7% of those attending face-to-face visits were reattenders. The most common diagnoses were irreversible pulpitis and dental trauma. 49% of face-to-face consultations resulted in extractions, 28% with General Anaesthetic, and 21% with Local Anaesthetic. Conclusion: Management of dental emergencies provided by the Urgent Dental Care Centre for paediatric patients has largely been effective and confirmed the efficacy of patient pathways established.

15: Evaluating aerosol and splatter during orthodontic debonding: implications for the COVID-19 pandemic
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Posted 22 Aug 2020

Evaluating aerosol and splatter during orthodontic debonding: implications for the COVID-19 pandemic
767 downloads medRxiv dentistry and oral medicine

Hayley Llandro, James R Allison, Charlotte Currie, David Edwards, Charlotte Bowes, Justin Durham, Nicholas Jakubovics, Nadia Rostami, Richard Holliday

Introduction: Dental procedures often produce splatter and aerosol which have potential to spread pathogens such as SARS-CoV-2. Mixed guidance exists on the aerosol generating potential of orthodontic procedures. The aim of this study was to evaluate aerosol and/or splatter contamination during an orthodontic debonding procedure. Material and Methods: Fluorescein dye was introduced into the oral cavity of a mannequin. Orthodontic debonding was carried out in triplicate with filter papers placed in the immediate environment. Composite bonding cement was removed using a slow-speed handpiece with dental suction. A positive control condition included a high-speed air-turbine crown preparation. Samples were analysed using digital image analysis and spectrofluorometric analysis. Results: Contamination across the 8-metre experimental rig was 3% of the positive control on spectrofluorometric analysis and 0% on image analysis. There was contamination of the operator, assistant, and mannequin, representing 8%, 25%, and 28% of the positive control spectrofluorometric measurements, respectively. Discussion: Orthodontic debonding produces splatter within the immediate locality of the patient. Widespread aerosol generation was not observed. Conclusions: Orthodontic debonding procedures are low risk for aerosol generation, but localised splatter is likely. This highlights the importance of personal protective equipment for the operator, assistant, and patient.

16: Email vs. Instagram recruitment strategies for online survey research
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Posted 03 Sep 2020

Email vs. Instagram recruitment strategies for online survey research
726 downloads medRxiv dentistry and oral medicine

Rafael R Moraes, Marcos B Correa, Ândrea Daneris, Ana B Queiroz, João P Lopes, Giana S Lima, Maximiliano S Cenci, Otávio P D'Avila, Claudio M Pannuti, Tatiana Pereira-Cenci, Flavio Fernando Demarco

In this study, we describe and evaluate a method for reaching a target population (i.e., dentists practicing in Brazil) to engage in survey research using traditional e-mail invites compared with recruitment campaigns created on Instagram. A pre-tested questionnaire was used and participants were recruited for 10 days via a source list of email addresses and two discrete Instagram organic open campaigns. A total of 3,122 responses were collected: 509 participants were recruited by email (2.1% response rate) and 2,613 by the two Instagram campaigns (20.7% and 11.7% conversion rates), respectively. Response/min collection rates in the first 24 h ranged between 0.23 (email) and 1.09 (first campaign). In total, 98.8% of all responses were received in the first 48 h for the different recruitment strategies. There were significant differences for all demographic variables (p<0.001) between email and Instagram respondents, except for sex (p=0.373). Instagram respondents were slightly older, had more professional experience (years in practice), and a higher graduate education level than email respondents. Moreover, most email and Instagram respondents worked in the public sector and private practice, respectively. Although both strategies could collect responses from all Brazilian regions, email responses were slightly better distributed across the five territorial areas compared to Instagram. In conclusion, this study provides evidence that survey recruitment of a large sample using Instagram is feasible. However, using Instagram to engage participants is challenging and has limitations that warrant further investigation. Combination of email and Instagram recruitment led to a more diverse population and improved response rates.

17: SARS-CoV-2 positivity in asymptomatic-screened dental patients
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Posted 01 Jan 2021

SARS-CoV-2 positivity in asymptomatic-screened dental patients
701 downloads medRxiv dentistry and oral medicine

DI Conway, S Culshaw, M Edwards, C Clark, C Watling, Chris Robertson, R Braid, E O’Keefe, N McGoldrick, J Burns, S Provan, H VanSteenhouse, J Hay, R Gunson, Dental COVID-19 Surveillance Survey Group

Enhanced community surveillance is a key pillar of the public health response to COVID-19. Asymptomatic carriage of SARS-CoV-2 is a potentially significant source of transmission, yet remains relatively poorly understood. Disruption of dental services continues with significantly reduced capacity. Ongoing precautions include pre- and/or at appointment COVID-19 symptom screening and use of enhanced personal protective equipment (PPE). This study aimed to investigate SARS-CoV-2 infection in dental patients to inform community surveillance and improve understanding of risks in the dental setting. Thirty-one dental care centres across Scotland invited asymptomatic screened patients over 5-years-old to participate. Following verbal consent and completion of sociodemographic and symptom history questionnaire, trained dental teams took a combined oropharyngeal and nasal swab sample using standardised VTM-containing testkits. Samples were processed by the Lighthouse Lab and patients informed of their results by SMS/e-mail with appropriate self-isolation guidance in the event of a positive test. Over a 13-week period (from 3August to 31October2020) n=4,032 patients, largely representative of the population, were tested. Of these n=22 (0.5%; 95%CI 0.5%, 0.8%) tested positive for SARS-CoV-2. The positivity rate increased over the period, commensurate with uptick in community prevalence identified across all national testing monitoring data streams. All positive cases were successfully followed up by the national contact tracing program. To the best of our knowledge this is the first report of a COVID-19 testing survey in asymptomatic-screened patients presenting in a dental setting. The positivity rate in this patient group reflects the underlying prevalence in community at the time. These data are a salient reminder, particularly when community infection levels are rising, of the importance of appropriate ongoing Infection Prevention Control and PPE vigilance, which is relevant as healthcare team fatigue increases as the pandemic continues. Dental settings are a valuable location for public health surveillance.

18: Detection of cross-reactive IgA in saliva against SARS-CoV-2 Spike1 subunit
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Posted 01 Apr 2021

Detection of cross-reactive IgA in saliva against SARS-CoV-2 Spike1 subunit
661 downloads medRxiv dentistry and oral medicine

Keiichi Tsukinoki, Tatsuo Yamamoto, Keisuke Handa, Mariko Iwamiya, Juri Saruta, Satoshi Ino, Takashi Sakurai

Abundant secretory IgA (sIgA) in mucus, breast milk, and saliva provides immunity that prevents infection of mucosal surfaces. sIgA in pre-pandemic breast milk samples have been reported to cross-react with SARS-CoV-2, but whether it also occurs in saliva and, if so, whether it cross-reacts with SARS-CoV-2, has remained unknown. We aimed to clarify whether sIgA in saliva cross-reacts with SARS-CoV-2 spike 1 subunit in individuals who have not been infected with this virus. The study included 137 (male, n = 101; female, n = 36; mean age, 38.7 [24-65] years) of dentists and doctors in the Kanagawa Dental University Hospital. Saliva and blood samples were analyzed by PCR and immunochromatography for IgG and IgM, respectively. We then identified patients with saliva samples that were confirmed as PCR- and IgM-negative for COVID-19. Proportions of SARS-CoV-2 cross-reactive IgA-positive individuals were determined by enzyme-linked immunosorbent assay using a biotin-labeled spike S1-mFc recombinant protein covering the receptor-binding domain of SARS-CoV-2. The proportion of SARS-CoV-2 cross-reactive IgA-positive individuals was 46.7%, and this correlated negatively with age (r = -0.218, p = 0.01). The proportion of IgA-positive individuals [&le;] 50 y was significantly lower than that of patients aged [&ge;] 49 y (p = 0.008). sIgA was purified from the saliva of all patients, and the salivary sIgA was found to suppress the binding of SARS-CoV-2 spike protein to the ACE-2 receptor. We found SARS-CoV-2 cross-reactive sIgA in the saliva of some participants who had never been infected with the virus, suggesting that sIgA helps prevent SARS-CoV-2 infection.

19: Fallow time determination in dentistry using aerosol measurement.
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Posted 27 Jan 2021

Fallow time determination in dentistry using aerosol measurement.
660 downloads medRxiv dentistry and oral medicine

Shakeel Shahdad, Annika Hindocha, Tulsi Patel, Neil Cagney, Jens-Dominik Mueller, Amine Koched, Noha Seoudi, Claire Morgan, Padhraig Fleming, Ahmed Din

Aim: To calculate fallow time (FT) required following dental aerosol generating procedures (AGPs) in both a dental hospital (mechanically ventilated) and primary care (non-mechanically ventilated). Secondary outcomes were to identify spread and persistence of aerosol in open clinics compared to closed surgeries (mechanically ventilated environment), and identify if extra-oral scavenging (EOS) reduces production of aerosol and FT. Methods: In vitro simulation of fast handpiece (FHP) cavity preparations using a manikin was conducted in a mechanically and non-mechanically ventilated environment using Optical Particle Sizer and NanoScan at baseline, during the procedure and fallow period. Results: AGPs carried out in the non-mechanically, non-ventilated environment failed to achieve baseline particle levels after one hour. In contrast, when windows were opened after AGP, there was an immediate reduction in all particle sizes. In mechanically ventilated environments the baseline levels of particles were very low and particle count returned to baseline within 10 minutes following AGP. There was no detectable difference between particles in mechanically ventilated open bays and closed surgeries. The effect of the EOS was greater in non-mechanically ventilated environment on reducing the particle count; additionally, it also reduced the spikes in particle counts in mechanically ventilated environments. Conclusion: High-efficiency particulate air filtered mechanical ventilation along with mitigating factors (high-volume suction) resulted in reduction of FT (10 minutes). Non-ventilated rooms failed to reach baseline level even after one hour of FT. There was no difference in particle counts in open bay or closed surgeries in mechanically ventilated settings. The use of an EOS device can reduce the particulate spikes during procedures in both mechanical and non-mechanical environments. This study confirms that AGPs are not recommended in dental surgeries where no ventilation is possible. No difference was demonstrated in FT required in open bays and closed surgeries in mechanically ventilated settings. Clinical significance: AGPs should not be carried out in surgeries where ventilation is not possible. Mechanical ventilation for AGPs should be gold standard; where not available or practical then the use of natural ventilation with EOS helps reduce FT. AGPs can be carried out in open bay environment with a minimum of 6 air changes per hour of mechanical ventilation. Four-handed dentistry with high-volume suction and saliva ejector are essential mitigating factors during AGPs.

20: Oral ulcers of COVID-19 patients: a scoping review protocol
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Posted 26 Jan 2021

Oral ulcers of COVID-19 patients: a scoping review protocol
650 downloads medRxiv dentistry and oral medicine

Abanoub Riad, Julien Issa, Veronika Chuchmova, Esraa Gomaa, Andrea Pokorna, Jitka Klugarova, Miloslav Klugar

Objective: This scoping review aims to systematically identify the types, characteristics, and possible pathophysiologic etiologies of the oral ulcers that emerge in COVID-19 patients. Introduction: The oral cavity is a vulnerable niche for the most diverse microbial ecosystem in the human body; therefore, it presents a wide array of mucocutaneous complications that could indicate various acute and chronic conditions. The COVID-19-related oral conditions, including oral ulcers, had been widely debated as direct manifestations or indirect complications of the SARS-CoV-2 infection. According to a preliminary search of PROSPERO, MEDLINE, the Cochrane Database of Systematic Reviews and the JBI Evidence Synthesis, there is no published nor registered scoping review concerned with the oral ulcers of COVID-19 patients. Inclusion criteria: The review will include studies included COVID-19 patients whose infection had been confirmed by RT-PCR testing regardless of infection severity and clinical course. Only the studies that reported COVID-19 patients with oral ulcers. Methods: A three-phase search strategy will be carried out: an initial limited search, a full electronic search, and hand search using the reference lists of all included records. The main bibliographic databases of published literature will include MEDLINE (PubMed), Cochrane COVID-19 Study Register, EMBASE via Ovid, and Scopus. All identified records will be managed using EndNote 9.2, and the titles and abstracts will be screened against the inclusion criteria before the full text of all potentially relevant studies will be examined. The data will be presented in tabular form, rating maps, and narrative summary.

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