key: cord-022960-u4s23x1r
authors: Pihlstrom, Bruce Lee
title: Selections from the current literature
date: 2020-04-17
journal: J Am Dent Assoc
DOI: 10.1016/j.aime.2020.04.020
sha: 
doc_id: 22960
cord_uid: u4s23x1r

nan

Background. Although many people have mild symptoms when infected by the novel coronavirus 2019-nCoV, it can cause serious and fatal pneumonia, particularly among the elderly and those having pre-existing medical conditions. This article reviewed the possible ways 2019-nCOV is spread and methods to control its transmission in dental clinics.

In the context of the novel coronavirus pandemic, the authors reviewed relevant literature about the virus and made recommendations for controlling its transmission in dental offices.

Results. The authors noted that that 2019-nCoV is commonly spread by direct transmission via coughing, sneezing, droplet inhalation and by contact transmission with mucous membranes of the mouth, nose and eyes. They also noted that early evidence indicates that 2019-nCoV might be transmitted directly or indirectly through prolonged high viral loads in the sputum of convalescent patients and by contact with asymptomatic patients. 1 They also indicated that there are reports suggesting that 2019-nCoV can be transmitted by aerosols produced during medical July 2020 JSCAN 2 procedures. 2 In light of these reports, the authors noted that dental patients and personnel can be exposed to this virus because of face-to-face communication with patients, frequent exposure to saliva, blood, and aerosols, and by handling sharp instruments. They outlined how the virus may be spread in the dental office by airborne droplets and particles from patient breathing and coughing as well as from aerosols containing saliva and blood that are generated by high-speed dental handpieces and ultrasonic scalers. They also noted that the virus could be spread by direct or indirect contact with human fluids, patient materials, contaminated dental instruments, and environmental surfaces. This is especially important since it is known that coronavirus can persist on surfaces such as metal, glass, or plastic for days. [3] [4] Because of the likelihood of 2019-nCoV transmission in the dental office, the authors made several recommendations to help mitigate the spread of the virus in this setting. These include identifying patients who are suspected of having acute symptoms of the new coronavirus infectious disease (COVID-19) by using various screening questions and taking their temperature. They emphasized the need for practicing strict hand hygiene, wearing appropriate personal protective equipment, use of a rubber dam to minimize saliva and blood contaminated aerosol and splatter, avoiding use of high speed handpieces where possible, hand scaling, and four-handed dentistry to provide high volume evacuation of aerosols and fluids. The authors recommended using handpieces with anti-retraction valves because they have been shown to significantly reduce the backflow of oral bacteria and hepatitis B virus into dental units. 5 They also emphasized the need for strict adherence to cleaning and disinfection of the dental office including door handles, chairs, desks and other areas that may be exposed to the virus as well as appropriate management of medical / dental waste.

Why is this study important? This is an important article because during the coronavirus pandemic, it is critical to prevent cross-infection of dental patients and personnel in the dental office. As stated by the U.S. Centers for Disease Control (CDC), the disease is thought to spread mainly through close contact from personto-person in respiratory droplets from someone who is infected. 6 Moreover, while people who are infected often have symptoms, some people without symptoms may be able to spread the virus. 6 Therefore, it is critical that all dental personnel follow strict infection control procedures to limit the spread of this virus. It is important to note that as of this writing, the U.S. CDC has issued infection control guidance for outpatient ambulatory care facilities 7 Why is this study important? Although this was a small, preliminary study it is important because it showed that the novel coronavirus that is causing a worldwide pandemic may be consistently detected in saliva that is self-collected by patients. The results of this study need to be confirmed among a wider and more Results. The researchers reported that SARS-CoV-2 virus has one of the hardest outer shells among all coronaviruses and that this is consistent with the concept that a virus must have a hard shell to survive in harsh environments. They noted that because of its hard-shell structure, SARS-CoV-2 would be more resistant to digestive enzymes in saliva, mucous and other body fluids.

Why is this study important? This is an important study because as the authors noted, it may explain why this virus appears to persist in the environment and is more transmissible than other coronaviruses. It may also explain why this virus is able to remain active for a long period of time and requires few viral particles to infect someone. 

The authors reviewed the current information about the coronavirus epidemic and recommendations for controlling its spread that were available at the time the article was published.

Results. The authors noted that while the epidemiologic and clinical characteristics of COVID-19 are still being studied, there is evidence that children's symptoms appear to be milder than those of adults. However, they also noted that it is unknown if children with various comorbidities, might be at a higher risk for severe illness. They explained that because the coronavirus pandemic disease has a fairly long incubation period of up to 14 days, and because children can be asymptomatic or have mild, non-specific symptoms, all children and parents should be considered to be carriers of the virus unless proven otherwise. This is especially important because many dental procedures generate aerosols and because the virus can persist on surfaces for several days. The authors stated that during the current pandemic, treatment should only be provided when local, regional and national July 2020 JSCAN 9 guidelines are followed as much as possible and, in the dental professional's opinion, the care is safe for the child, caregiver and dental provider. 

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Persistence of coronaviruses on inanimate surfaces and its inactivation with biocidal agents

Transmission of SARS and MERS coronaviruses and influenza virus in healthcare settings: the possible role of dry surface contamination

Risk of hepatitis B virus transmission via dental handpieces and evaluation of an anti-suction device for prevention of transmission

How the Virus Spreads

Interim Additional Guidance for Outpatient and Ambulatory Care Settings: Responding to Community Transmission of COVID-19 in the United States

COVID-19)

Consistent detection of 2019 novel coronavirus in saliva