cord-006215-1ob719sh	2020	The obvious answer would be to emphasise the importance of ongoing ethical education in business and practice, but Tenbrunsel and Messick claim that this doesn''t go far enough. To combat the danger of ethical fading, then, it seems that we need to be constantly aware of the decisions we make, taking a mindfulness-like approach of maintaining a moment-by-moment awareness of our decision-making process. We''re making ethical-based decisions all the time without even realising it. James Sleigh, Publisher of the BDJ Portfolio, based at Springer Nature, commented: ''Springer Nature has been investigating alternatives to single-use polywrap for some time, but until now we weren''t satisfied that there was a solution that was both environmentally more beneficial and also economically viable. Postal distribution of BDJ In Practice (once a month with the BDJ) and the bound-in Evidence-Based Dentistry (four times a year) is included in the change.
cord-010856-3g0123lk	2020	Cross-pathway referral for these cancers allows both general medical practitioners (GMPs) and general dental practitioners (GDPs) to refer patients to be seen within two weeks by a specialist secondary care consultant in an oral maxillofacial cancer unit. To analyse whether the positively diagnosed cancer patients were being given their initial diagnosis within 28 days, in preparation for the new guidelines to be implemented in the NHS Long Term Plan (2020) 5. One hundred percent of the patients positively diagnosed with cancer would receive diagnosis within 28 days and subsequent treatment within 62 days in line with the current guidelines for the 2ww referral system for HNCs. The standard for diagnostic cancer yield/positive oncological transformation would be set at 3%, as appropriate for a screening test as set out by NHS England.
cord-011512-gw2sk90q	2020	Sir, the British Orthodontic Society (BOS) and the Oral Health Foundation have recently collaboratively launched a muchawaited campaign, Safe Brace Campaign, alerting the public to the dangers of direct to consumer orthodontics, also known as ''DIY Braces'' (www.safebrace.org). Sir, to determine the use and perceived benefit of webinars and online learning, a brief survey was sent to dentists across the UK; 50 responses were received from a mix of those working in general dental practice, hospital and community. 2 The calming and stress reducing effects of listening to music have been widely studied and this simple and cost-effective method of relaxation is something easily accessible to all members of the dental team. Sir, as a DCT3 in Oral Surgery I have seen several patients referred for removal of teeth under general anaesthetic (GA) due to dental anxiety. Experience of listening to music on patient anxiety during minor oral surgery procedures: a pilot study
cord-011520-qfbjars7	2020	key: cord-011520-qfbjars7 authors: nan title: Prescribing antibiotics for urgent dental care during the pandemic date: 2020-05-22 journal: Br Dent J DOI: 10.1038/s41415-020-1652-1 sha: doc_id: 11520 cord_uid: qfbjars7 nan We are in unprecedented times dealing with a global pandemic that is affecting the health and economics of our country and impacting personally on all of us. We recognise the difficulties for the dental profession in managing patients when there is sustained transmission of Urgent dental care systems in the context of coronavirus Prescribing antibiotics for urgent dental care during the pandemic
cord-011769-yjtwuaht	2020	'' 1 Throughout the COVID-19 crisis, those in control appear to have ignored this sage advice with both dental professionals and patients increasingly used as pawns in a political game. At a time when the profession feels under fire, this will only exacerbate the ill will towards those that govern us. Significant sectors of the profession have felt alienated throughout the COVID-19 crisis, with no support from the government or their leaders. The toolkit will help dental teams implement the changes needed to gear up to providing appropriate treatments at appropriate times. A recently published paper in the Korean Journal of Medical Science, ''Clinical significance of a high SARS-CoV-2 viral load in the saliva'' , demonstrates the in vivo activity of chlorhexidine as a mouthwash against viruses. Clinical significance of a high SARS-CoV-2 viral load in the saliva
cord-011771-vganve2b	2020	authors: Gallichan, N.; Heggie, C.; Lee, S.; Messahel, S.; Albadri, S. With GDPs reopening and reaching a ''new normal'' , the emergency management of TDIs and children in pain should be considered a priority in paediatric primary care triage to reduce the subsequent burden on tertiary services, which carries increased expense to the NHS. Sir, whilst there has been a significant decrease in attendance to Emergency Departments during the COVID-19 pandemic, 1 the Paediatric Emergency Department (PED) at Alder Hey Children''s Hospital has observed little change in the number of dental attendances. Firstly, the number of children attending the PED with traumatic dental injuries (TDIs) increased in the COVID-19 affected period. In addition, the   Fig. 1 Customised PPE for paediatric dentistry BRITISH DENTAL JOURNAL | VOLUME 228 NO.
cord-011773-vboa8xn9	2020	Sir, the last 18 months of DCT in Oral and Maxillofacial Surgery have highlighted challenges and complications presented by facial aesthetic treatments. The British Association of Aesthetic Plastic Surgeons warn that ''people who struggle with their psychological health can feel pressured to turn to "quick fix" procedures to improve their appearance'' and recommend pre-treatment psychological assessments. I am unaware of any dental schools teaching facial aesthetic treatments including dermal fillers as part of the undergraduate course. It is therefore somewhat unsettling that dentists can attend a one-day course before providing treatments such as ''nonsurgical rhinoplasty'' when they have likely had no training on this in their professional degree. It seems obvious that change is required in the regulations surrounding facial aesthetic procedures, particularly training of practitioners and steps to protect psychological health. It may be sensible to include such training within the BDS degree given the large proportion of dentists going on to provide these services.
cord-011775-2hg82nuy	2020	title: BDA updates its returning to work toolkit for members '' 1 Throughout the COVID-19 crisis, those in control appear to have ignored this sage advice with both dental professionals and patients increasingly used as pawns in a political game. At a time when the profession feels under fire, this will only exacerbate the ill will towards those that govern us. Significant sectors of the profession have felt alienated throughout the COVID-19 crisis, with no support from the government or their leaders. The toolkit will help dental teams implement the changes needed to gear up to providing appropriate treatments at appropriate times. A recently published paper in the Korean Journal of Medical Science, ''Clinical significance of a high SARS-CoV-2 viral load in the saliva'' , demonstrates the in vivo activity of chlorhexidine as a mouthwash against viruses. Clinical significance of a high SARS-CoV-2 viral load in the saliva
cord-011776-0qdxqu22	2020	'' 1 Throughout the COVID-19 crisis, those in control appear to have ignored this sage advice with both dental professionals and patients increasingly used as pawns in a political game. At a time when the profession feels under fire, this will only exacerbate the ill will towards those that govern us. Significant sectors of the profession have felt alienated throughout the COVID-19 crisis, with no support from the government or their leaders. The toolkit will help dental teams implement the changes needed to gear up to providing appropriate treatments at appropriate times. A recently published paper in the Korean Journal of Medical Science, ''Clinical significance of a high SARS-CoV-2 viral load in the saliva'' , demonstrates the in vivo activity of chlorhexidine as a mouthwash against viruses. Clinical significance of a high SARS-CoV-2 viral load in the saliva
cord-013116-n7auvqh3	2020	authors: Srinivas, A.; Moshkun, C.; Darcey, J. History revealed that the 17 had been removed four months prior to presentation due to similarly vague symptoms. He had already begun a course of antibiotics and was using chlorhexidine mouth rinses prescribed remotely via an urgent dental centre (UDC). The pain had reduced but there was still discomfort in the area and the patient reported it to feel sharp on his tongue. The patient contacted UDHM six weeks later with ongoing pain and a face-to-face review was arranged. In that time he had not been offered a face-to-face review but rather been given a further two courses of antibiotics after remote UDC consultations. Reflecting back over this patient''s history and clinical encounters there were signs that may have pointed towards a nonodontogenic diagnosis. Darcey, Manchester, UK https://doi.org/10.1038/s41415-020-2226-y missing a serious diagnosis or misdiagnosing.
cord-013311-r10f5yb0	2020	Sir, as a Past President of the BDA I am dismayed and bemused to read frequent reports in national newspapers decrying the number of children awaiting many months for tooth extractions in hospitals. Sir, in the current pandemic, the lack of equitable oral healthcare facilities, shortfall of dental healthcare providers, shortages of equipment/materials, and inadequate management of existing services is well known in developing countries. 1 It may not be possible for such countries to upgrade the dental surgeries in their tertiary care facilities to the suggested level of ventilation, filtration, and negative pressure, due to financial limitations. 4 To prevent the transmission of infection through aerosol in the dental setting the ''protection box'' is an innovative and economical solution for performing aerosol generating procedures. Sir, I would like to thank all my colleagues who have worked so diligently to up-skill and kindly help guide others through the current COVID-19 pandemic. Frugal solutions for the operating room during the COVID-19 pandemic
cord-014333-54ow0ckn	2020	The study shows most patients were managed successfully by the triaging nurse on the first call. The study has shown how a whole-team approach to triaging can work advice'' is within the scope of practice of the dental nurse but diagnosing is not. It is of concern that some patients were unable to contact their own dentist since the absence of an efficient out-of-hours on-call service is likely to elevate patient stress and potentially negatively impact on a patient''s pain threshold, particularly at the time of a pandemic when access to emergency dental care might be restricted. Dental Nurse triage of patients with dental emergencies Conference: IADR General Session and Exhibition Triaging of non-scheduled appointments in general dental practice: a clinical audit Evaluation of a dental nurse-led triage system in a private dental practice during the COVID-19 pandemic. Br Dent J 2020; 229: https://doi.org/10.1038/s41415-020-2177-3.
cord-014337-nnuvrb6o	2020	gdc-uk.org/news-blogs/news/detail/2020/09/01/ joint-statement-on-arrangements-for-dental-educationand-training-while-measures-are-in-place-to-control-thespread-of-covid-19-(version-2-dated-1-september-2020) (accessed November 2020). To evaluate the existing curricula and reorganise them by adopting the Commission on Dental Accreditation (CODA) compliance protocols on the interruption of education and distance education to allow for a continuation of the PGRs'' hands-on and didactic learning 2. Clinical case presentations through online sessions allowed continued PGRs'' feedback to enhance their presentation and treatment planning skills as well as surgical techniques 3. 1 report that sequencing data indicate high reads for Prevotella, Staphylococcus and Fusobacterium in patients severely infected with SARS-CoV-2. Despite facing changes in a teaching format, especially in clinical training, our approaches, including the use of online portals and modules, maintained and enhanced PGRs'' hands-on and didactic experiences. One way of ensuring best practice would be that the directions for use of each new batch of product are read carefully and then stored in a centrally placed file in the clinic, easily accessible to all members of the dental team.
cord-014344-pg6is6u5	2020	The Royal College of Surgeons of Edinburgh (RCSEd) has become the first surgical college in the UK to offer an app to its members in a bid to transform the way training and educational materials are accessed and shared. The app will be made available to the RCSEd''s 29,000 members around the world, giving them access to exclusive content and information on the latest developments in the surgical field. The launch coincides with the unveiling of the College''s new branding, which features Edinburgh Castle, to reflect its long history, and a unicorn, known for its association with healing. The full schedule of College courses, exams and events are now also accessible via an in-app calendar, enabling members to click, save and secure their spot for development opportunities. RCSEd launches app and brand refresh 580 BRITISH DENTAL JOURNAL | VOLUME 229 NO.
cord-026758-drhae7vy	2020	Regulations were introduced in 2018 to advise on the management and use of dental amalgam as a restorative material. Sir, it was with incredulity and disappointment I read the article entitled Why re-invent the wheel if you''ve run out of road? Many current dental procedures utilise some of the most cutting-edge and non-invasive techniques available today. All other services could then be delivered via private dental practices, eliminating the often confusing and litigious mixing of ''private'' and NHS dentistry. Over the past weeks we have seen many well-researched and practical standard operating procedures (SOPs) published by various dental associations, 3 corporate dental bodies, 4 and devolved government. 5 Even with the release of the CDO''s ''Prompt to Prepare'' and ''Resumption of Dental Services'' letters published on 28 May, why are we still waiting for detailed guidance, SOPs and strong leadership? Standard Operating Procedures for Portman Dental Care Practices
cord-026764-eag13h3p	2020	Several recent clinical studies have investigated hydroxychloroquine for COVID-19 patients but these have been at high risk of bias, hence the need for large randomised placebo-controlled clinical trials to determine the potential benefits and harms before any role can be recommended. Hydroxychloroquine is one such drug with hypothesised mechanisms of action and in vitro evidence supporting the inhibition of severe acute respiratory syndrome coronavirus 2. Treating paediatric patients in an Urgent Dental Care Centre at Newcastle Dental Hospital, we have worryingly seen a shocking proportion of children who have been prescribed age-inappropriate, suboptimal doses of antibiotics and subsequently referred for treatment as ''unresponsive to antibiotics'' . 4 The Centre for Evidence Based Medicine''s commentary on PPE in primary care concerns general medical practice. In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)
cord-026765-cw4rh1on	2020	authors: Dingle, M.; Irshad, H.; McKernon, S.; Taylor, K. dosing protocols as accurately as possible (to standardise the dosing), and we anticipate the that the product will be available mid-May, initially in a 5L presentation, primarily for dentists, while a nasal and throat spray will follow in late May primarily for pre-procedural use in the hospital setting. Sir, we write to inform your readers about techniques for non-surgical exodontia we have adapted to at Liverpool University Dental Hospital during the COVID-19 pandemic. As cases in our population grew the dental clinic went on an emergency only protocol and to date we have provided dental care to almost 500 patients and performed approximately over 100 dental emergency procedures. Sir, I would like to share my thoughts and experiences on how COVID-19 has affected me as a year 13 student, applying to university to study dentistry this September.
cord-029722-85h5060v	2020	It could be seen as a vehicle to herald what the CDO England has described as a ''COVID-19 legacy hallmarked by a determined revision of the current activitydriven clinical approach, optimising time with patients and delivered as an integrated oral health team.'' 3 Beyond the scope of the SOP document, there also appears to be an appetite for contract reform to support this ''revision'' going forwards. Seemingly, the raison d''être of the new standard operating procedures is not just to outline the detailed procedures for kick-starting dentistry, but also to support practices through transition and the shift towards a preventative and minimally invasive clinical approach that meets the current clinical challenges, and possibly then goes beyond. Seemingly, the raison d''être of the new standard operating procedures is not just to outline the detailed procedures for kick-starting dentistry, but also to support practices through transition and the shift towards a preventative and minimally invasive clinical approach that meets the current clinical challenges, and possibly then goes beyond.
cord-030556-usyvz5fj	2020	https://doi.org/10.1038/s41415-020-2006-8 themselves have often had little knowledge about the importance of optimising their dental health as part of their medical condition and some have not accessed dental care for many years. Sir, as a specialist registrar in training in special care dentistry I have been working in an urgent dental care (UDC) hub providing care for shielded, vulnerable and COVID positive patients in a rural county. Traditionally, closed book examinations such as multiple-choice questions, where learners are not permitted to have any supportive material with them, are the preferred format for UK dental courses. 1 In open-book examinations, learners have access to supportive material such as revision notes, books and online resources thereby testing the application of knowledge rather than its recall. With such an hypothesis in mind, it is recommended to postpone dental treatment of a recently recovered COVID-19 patient who still suffers from these persistent symptoms until complete resolution. Influence of open-and closed-book tests on medical students'' learning approaches
cord-032698-ev8gylpf	2020	Two recently published articles in your journal highlighted the utility of silver diamine fluoride (SDF) and potassium iodide (SDF/KI) application, and paediatric patients audit attending emergency care for irreversible pulpitis symptoms during the current coronavirus disease 19 (COVID-19) pandemic. 2 Thus, to limit bioaerosol risks, the contemporary treatment algorithm includes the use of pre-procedure oral rinse with 1% hydrogen peroxide or povidone-iodine 3 and the use of dental dam, as well as high-volume suction. potential dental team role in supporting the delivery of a flu vaccination programme. 1 In the United States, Minnesota and Illinois allow dentists to administer vaccines, but only to protect against the flu and only in adult patients. 2 In Scotland, NHS dental contractors (dentists and dental bodies corporate) can opt in to participate in the 2020/21 flu vaccination programme. Other members of the dental team will not be allowed to deliver vaccinations. https://doi.org/10.1038/s41415-020-2183-5 Authors must sign the letter, which may be edited for reasons of space.
cord-032703-wxlr7p1u	2020	Sir, photography can be used to accurately record the appearance of the oral cavity as well as following specific clinical conditions over time. Sir, you recently published an interesting research article regarding the career aspirations of female dental students and trainees. It is also important that dental institutions play an increasing role in educating their students regarding the career options available to them, including those that may allow them to continue working or continue specialty training pathways whilst affording them the flexibility that they may want. The results from this study showed that 63% of respondents, of which 70% were females, wanted to work part-time 15 years post-qualification. Sir, many clinical signs and syndromes in medicine are named eponymously after the person who supposedly originally described them. Use of the possessive is now much less common in American than European journals.
cord-255635-0pr9oae6	2020	on the antiseptic efficacy of povidone-iodine (PVP-I) against SARS-CoV-2; we aim to demonstrate the potential prophylactic capacity of the new generation of uncomplexed molecular iodine (I 2 ) mouthwashes. The number of antibiotics dispensed each month by community pharmacists in England relating to NHS dental prescription forms from January 2018 to May 2020 is given in Figure 1 . 2 Antibiotics may have been used: • As a ''quick fix'' to avoid the life-time impact of an unnecessary extraction, in anticipation that AGPs might soon be permissible in general dental practices • Because dentists felt pressured by some patients for antibiotics, irrespective of their efficacy or appropriateness for treating toothache • Because of difficulties diagnosing a patient''s condition remotely prompting a ''just in case'' approach through concerns of life-threatening deterioration without treatment • As some UDCs were requiring patients to have tried antibiotics before accepting referral for face-to-face care, highlighting system and process impact on antibiotic prescribing.
cord-270051-rs3cz9lq	2020	The number of antibiotics dispensed each month by community pharmacists in England relating to NHS dental prescription forms from January 2018 to May 2020 is given in Figure 1 . This is despite the significantly poorer access to dentistry (only around 7,500 patients were seen at designated urgent dental centres [UDCs] across England) compared to May when the capacity of these centres increased and saw over 27,000 patients. 2 Antibiotics may have been used: • As a ''quick fix'' to avoid the life-time impact of an unnecessary extraction, in anticipation that AGPs might soon be permissible in general dental practices • Because dentists felt pressured by some patients for antibiotics, irrespective of their efficacy or appropriateness for treating toothache • Because of difficulties diagnosing a patient''s condition remotely prompting a ''just in case'' approach through concerns of life-threatening deterioration without treatment Finally, the NHS may have seen an influx in patients who might otherwise receive care privately, resulting in an increase in NHS dental prescriptions as, anecdotally, not all practices were open for telephone triage during April and May 2020.
cord-270712-v6nnnzhm	2020	patients'' general medical practitioners (GMPs), funding restraints have resulted in NHS Clinical Commissioners advising against the routine prescription of high fluoride toothpaste in primary medical settings. For oncology patients without a regular GDP, or those who may have intermittent treatment in a tertiary dental centre, accessing prescriptions for high fluoride products may be particularly challenging during COVID-19. Sir, there are two reasons why the current guidelines pose an existential risk to dental practice: • The additional costs involved plus the required fallow periods make general practice dentistry unsustainable • The necessity to approach our patients while dressed like Darth Vader will raise perceived levels of fear and panic among them. It is important to reflect that we have always been an infection aware profession and have therefore often been at the forefront of infection control in the surgery for both our patients and the whole dental team.
cord-271612-dmgb3gta	2020	Dental professionals require a fit test to wear a certain type of personal protective equipment (PPE) the filtering facepiece class 3 (FFP3) mask. 8 As dental professionals, we perform aerosol generating procedures (AGPs), such as using the high-speed handpiece; 4 these produce airborne particles -FFP3 masks help to avoid their inhalation. Prior to wearing a FFP3 mask, you need to have passed the face fit test -if there is an inadequate seal, your protection can be undermined. If you do taste the aerosol, you have failed the test and the mask is deemed an inadequate fit for you; 11 you may be retested with a different type, size or model of a FFP3 mask. You should perform and pass a fit test before wearing a FFP3 mask. Moreover, it is important to know that every time you wear a FFP3 mask, you should perform a fit check; this should not substitute a fit test.
cord-273335-ogxq6vtc	2020	1 The MIOC team-delivery framework is based around four interlinked domains, applicable to any of the restorative disciplines, across all ages and patient groups (with suitable adaptions where necessary) ( Figure 1 Four years later, I was again delighted and honoured this time to coordinate, co-author and present the first MI-themed BDJ issue as its guest editor, commissioning a selection of high quality manuscripts from national and international renowned professionals and dear colleagues with an acknowledged expertise in MI dentistry. 7 '' Through such adversity comes the glimmer of opportunity to change and develop new strategies and mechanisms to deliver better oral health programmes'' that in 2020 this second MI-themed issue has been published, collating international experts'' outputs on how the accepted principles of MIOC/minimally invasive operative dentistry (MID) can be implemented in the broader world of ''real-life'' primary care dentistry, for the benefit of our patients long term.
cord-280944-uphs5gvl	2020	Sir, current guidance from the RCS Recommendations for paediatric dentistry during the COVID-19 pandemic is very clear: '' Access to general anaesthesia will be significantly reduced for the foreseeable future'' . Sir, prior to the COVID-19 pandemic, patients undergoing invasive procedures were subject to confirming their consent through written means, a process which is considered common within surgical fields. 1 The guidance issued by the FGDP on 1 June suggested a move towards provision of ''digital packs'' and it seems many standard operating procedures (SOPs) being issued by practices include the provision of digital information packs with consent forms to patients. With dental practices now resuming a limited level of practice and possibly experiencing the level of frustrations with lack of treatment provisions for anxious patients, oral sedation with Diazepam is an invaluable tool in enabling patients the access to care they require. Careful case selection is of course key to its successful use, and requires the triaging clinician to be thorough in ascertaining dental history and indication of sedation need.
cord-293180-f1ulk9ce	2004	Special management protocols and modified measures that regulate droplet and aerosol contamination in a dental setting have to be introduced and may include the reduction or avoidance of droplet/aerosol generation, the disinfection of the treatment field, application of rubber dam, pre-procedural antiseptic mouthrinse and the dilution and efficient removal of contaminated ambient air. In the first part of this two-part article an account of the epidemiology, virology, pathology and management of Severe Acute Respiratory Syndrome (SARS) was provided together with public health issues and general aspects of infection control. On the other hand smaller droplets (or aerosols, generally under 10 µm in size) or small-particle residue of evaporated droplets are usually airborne and are entrained in the air for a lengthy period • SARS is a highly infectious disease and dental personnel are likely to be at risk because of the nature of their profession, working in close proximity to the patient.
cord-299999-jra1yu6a	2020	However, a structure needs to be developed to account for the disruption in training COVID-19 has caused and facilitate the progression of the trainees without compromising the quality and integrity of the respected specialities. The New England Journal of Medicine case report of the first COVID-19 patient in the USA detected high SARS-CoV-2 viral load in their stool sample. At present, PDPs are not a routine part of the undergraduate curricula 3 and as such, newly qualified dentists will be faced with the new challenge of having to proactively plan their CPD to fulfil outstanding competencies from their current training course. Whilst CPD cycles are five years, the need to complete certain key foundation skills to ensure adequate competence and baseline knowledge to facilitate progression through postgraduate training pathways will result in trainees having to meet such objectives sooner. Urgent dental care for patients during the COVID-19 pandemic Approaches to the management of patients in oral and maxillofacial surgery during COVID-19 pandemic
cord-302379-jh6jxwyn	2020	A patient with non-odontogenic-related infection could also present with sepsis at a dental practice. Age-specific sepsis decision support tools have been developed by the UK Sepsis Trust to help dental staff recognise and manage patients with suspected sepsis. The aim of this article is to provide an update on the management of odontogenic infections and sepsis in the dental practice. A careful history, thorough clinical examinations and a high index of suspicion will enable the GDP to diagnose and appropriately manage patients presenting with odontogenic sepsis. The ''GDP sepsis decision support tool for primary dental care'' (Fig. 3) should be applied to all adults and young people aged 12 years and over with fever (or recent fever), symptoms presenting with a source of orofacial/dental infection (including post-operative infection) or have clinical observations outside normal limits. This stresses the importance for dental teams to be familiar with sepsis and the decision tools described here for safe management of such patients.
cord-307144-g8d1xkub	2016	Dental professionals should be aware of areas affected by emerging infections, the incubation period and the recent travel history of patients. Dental professionals should be aware of areas affected by emerging infections, the incubation period and the recent travel history of patients. Elective dental care for those returning from areas affected by emerging infections should be delayed until the incubation period for the infection is over. The implications for the dental team include: • Being aware of emerging infections • Being aware of incubation periods • Being aware of patients'' recent travel history • Delaying elective treatment of those from (or returning from) affected areas who may have been in contact with cases until the incubation period has passed to reduce risk of transmission • For urgent treatment of those who may have the disease or may have been in recent contact with cases, seeking advice from health protection colleagues before providing care and use of full protective equipment.
cord-309493-mp43qa7w	2020	Sir, patients with autism and other special care needs often rely on familiar surroundings, processes and faces when attending the dentist to reduce the sensory burden and anxiety of being in the dental environment. Sending photographs and advice of how layouts and processes may have changed within the practice and what to expect regarding PPE and infection control procedures ahead of their appointment to patients and carers could prove invaluable in maintaining both attendance for this potentially higher risk group, as well as talking through any new steps during their visit or procedure to maximise compliance. highlighted the potential of povidone iodine (PVP-I) mouthwash and nasal spray in reducing the risk of cross-infection of COVID-19 among the dentists and their assistants. Here, we demonstrate in vitro virucidal activity of an oral PVP-I product against SARS-CoV-2, the virus causing COVID-19. Send your letters to the Editor, British Dental Journal, 64 Wimpole Street, London, W1G 8YS.
cord-313084-l7odplqg	2020	The risk factors already identified for developing complications from a COVID-19 infection are age, gender and comorbidities such as diabetes, hypertension, obesity and cardiovascular disease. This paper investigates the potential link between SARS-CoV-2 and bacterial load, questioning whether bacteria may play a role in bacterial superinfections and complications such as pneumonia, acute respiratory distress syndrome and sepsis. 1 While COVID-19 has a viral origin, it is suspected that in severe cases, bacterial superinfections may contribute to causing complications such as pneumonia and acute respiratory distress syndrome (ARDS). 18 It is common for respiratory viral infections to predispose patients to bacterial superinfections, leading to increased disease severity and mortality; for example, during the influenza pandemic in 1918, where the primary cause of death was not from the virus itself but from bacterial superinfections. Bacteria present in patients with severe COVID-19 are associated with the oral cavity and improved oral hygiene may play a part in reducing the risk of complications.
cord-314492-483rn3aw	2020	It examined evidence on which type of full body PPE and which method of donning (putting on) or doffing (removing) are most effective, while having the least risk of contamination or infection for healthcare workers, as well as which training methods increase compliance with PPE protocols. The global COVID-19 pandemic, caused by the SARS-CoV-2 virus, 1 has highlighted the importance of personal protective equipment (PPE) for health and social care personnel. The global COVID-19 pandemic, caused by the SARS-CoV-2 virus, 1 has highlighted the importance of personal protective equipment (PPE) for health and social care personnel. 8 The evidence from this review is of great importance where there is a risk of highly infectious diseases, and even though COVID-19 is no longer considered to be a high consequence disease in the UK, 9 its findings remain relevant to the current pandemic 10 and continue to be updated.
cord-318136-2skr13gc	2020	title: Using National Early Warning Score (NEWS) 2 to help manage medical emergencies in the dental practice This can be helped by using the Royal College of Physicians'' (RCP''s) National Early Warning Score (NEWS) 2, widely used by the ambulance service and in hospitals it reliably detects deterioration in adults, triggering review, treatment and escalation of care. Using NEWS2 in the dental practice will help the dental team to effectively, confidently and safely manage medical emergencies, including sepsis, should they arise. The Royal College of Physicians'' (RCP''s) National Early Warning Score (NEWS) 2, 2 widely used in the healthcare setting both in the UK and abroad, reliably detects deterioration in adults, triggering review, treatment and escalation of care. The RCP hopes that NEWS2 will be validated for use in primary care, assisting triage and communication of acute-illness severity to ambulance and hospital services.
cord-320393-9bgxct3z	2020	Sir, we are writing to draw attention to some interesting research that questions the validity of the disulfiram-like reaction between metronidazole and alcohol. This reaction is the reason the British National Formulary 1 advises to avoid alcohol during and for 48 hours after taking metronidazole. 2 The disulfiram-like reaction of metronidazole and alcohol is said to be similar, and was traditionally explained by the same mechanism, although this now seems to be incorrect. In response to the COVID-19 pandemic, we undertook a rapid literature review on the effectiveness of rubber dam in reducing the risk of transmission of microbial pathogens during dental aerosol-generating procedures (AGPs). Six studies 1,2,3,4,5,6 produced a broad consensus that the use of rubber dam during dental AGPs is effective at reducing the spread of spatter by 33%, as well as reducing surface contamination with bacteria by 80-99% at a distance of up to one metre. Do ethanol and metronidazole interact to produce a disulfiram-like reaction?
cord-337904-q90ftaht	2020	5 A report by the UK Parliament''s House of Commons Health and Social Care Committee about the impact of the COVID-19 pandemic on NHS services states: ''patients have been remotely prescribed with antibiotics for their dental problems but have returned with pain or further swelling as the cause of their dental problem has not been properly addressed…this is contributing to an "overhang of oral healthcare"'' . The objectives of this study were twofold: to describe trends in overall dental antibiotic use across England between January 2018 and July 2020; and to compare trends in the rate of use between the seven NHS England regions, from when restrictions were first placed on face-toface dental care to the most up-to-date data available (April 2020 to July 2020). During the period of increased dental restrictions owing to COVID-19 (25 March-8 June 2020), all patients in England requiring urgent dental care were treated within the NHS.
cord-337955-4p6wbd0h	2020	The number of antibiotics dispensed each month by community pharmacists in England relating to NHS dental prescription forms from January 2018 to May 2020 is given in Figure 1 . 2 Antibiotics may have been used: • As a ''quick fix'' to avoid the life-time impact of an unnecessary extraction, in anticipation that AGPs might soon be permissible in general dental practices • Because dentists felt pressured by some patients for antibiotics, irrespective of their efficacy or appropriateness for treating toothache • Because of difficulties diagnosing a patient''s condition remotely prompting a ''just in case'' approach through concerns of life-threatening deterioration without treatment Finally, the NHS may have seen an influx in patients who might otherwise receive care privately, resulting in an increase in NHS dental prescriptions as, anecdotally, not all practices were open for telephone triage during April and May 2020. When this figure is combined with the average number of patients that we have seen each week, since lockdown was eased, and the local population, this enables us to quantify the risk of us seeing an undiagnosed COVID-19 patient in the practice.
cord-339147-9v3anfbo	2020	as the dental care of hospital in-patients has long been a concern of mine. A large part of my work included pre-operative assessment and treatment of cardiothoracic patients and dealing with dental emergencies when they arose not just at Guy''s but also at the associated hospitals and care homes in the Guy''s group. Informal seminars were also given to nurses about the importance of the oral health of patients in their care. 2 In this time of enormous pressure on the NHS utilising the expertise of the dental team would help relieve the stresses on the hard-pressed medical and nursing staff engaged currently in their battle against COVID-19 and in the long term improve patient care without adding to the burden on the already over-stretched doctors and nurses. Dental care pathways for adult inpatients in an acute hospital: a five-year service evaluation
cord-348403-3ahdes97	2020	Available at: https:// www.health.com/condition/infectious-diseases/ coronavirus/asymptomatic-vs-presymptomatic (accessed 12 July 2020). 1, 2 Mistrust of dentists is demonstrated in a study reporting that Black Minority Ethnicity (BME) participants in London believe that, because of their background, they received a poor service, were not respected, listened to or cared about by dentists compared to other non-BME patients. 3 More generally, within the NHS, ethnic minority patients at the Scottish First Minister''s briefings, if someone is tested today and the result comes back negative tomorrow, that only proves that they were negative today. A I want to stress the importance of acknowledging the structural and institutional racism in dentistry specifically and in society more generally. This is an ongoing issue and we need to not only act and speak up whenever we witness injustice but to engage more in the conversation about race and racism.
cord-348947-o6qpaa6a	2020	Sir, as a Past President of the BDA I am dismayed and bemused to read frequent reports in national newspapers decrying the number of children awaiting many months for tooth extractions in hospitals. J. Stuart Robson, York, UK https://doi.org/10.1038/s41415-020-2282-3 used a purpose built protection box during aerosol generating procedures (https://www. Sir, in the current pandemic, the lack of equitable oral healthcare facilities, shortfall of dental healthcare providers, shortages of equipment/materials, and inadequate management of existing services is well known in developing countries. 4 To prevent the transmission of infection through aerosol in the dental setting the ''protection box'' is an innovative and economical solution for performing aerosol generating procedures. Sir, I would like to thank all my colleagues who have worked so diligently to up-skill and kindly help guide others through the current COVID-19 pandemic.