key: cord-1017706-azlss3ay
authors: Carter, Annabelle
title: Can orthodontic care be safely delivered during the COVID-19 pandemic? Recommendations from a literature review
date: 2020-06-26
journal: Evid Based Dent
DOI: 10.1038/s41432-020-0103-9
sha: 28159e68e80d28a7dfb09dbc0f0bc3d782da5a0d
doc_id: 1017706
cord_uid: azlss3ay

Data sources Five electronic databases were searched: COVID-19 Open Research Dataset (CORD-19-2020); PubMed; MEDLINE; Scopus; and Google Scholar. Study selection Titles of articles and abstracts were identified during the electronic database searches and then screened for relevance. Publications up until the date of the literature search, 19th March 2020, were used. All articles with the appropriate topics pertaining to COVID-19, dentistry, orthodontics, and infection control were used irrespective of language. The author did not state whether they were selective about the study type or design of articles screened. References of these articles were also screened, via the 'snowballing technique', to obtain as much relevant literature as possible. Data extraction and synthesis Articles were reviewed by the cited author, and one research assistant. Data was extracted from each study by this author. The data obtained was combined and discussed narratively, in a qualitative manner. Due to the broad scope of studies included, it was not possible to conduct a meta-analysis. Results This literature review describes ways to reduce COVID-19 transmission in orthodontic practice. Overview of the literature discusses how the virus may be transmitted in the orthodontic setting: by human-human contact; saliva; aerosols; and use of orthodontic instruments. The literature review illustrates the need for optimum infection control and strict cleaning, detailing surface disinfection and sterilisation protocols. It highlights the need for optimal hand hygiene, use of high standard personal protective equipment, controlling aerosol use, appropriate ventilation, and treating emergency cases only. Conclusions While there are no known cases of COVID-19 cross-transmission within the dental setting currently reported, utmost vigilance is required by orthodontic professionals to reduce risk of transmission. The review reinforces crucial measures required to reduce infection, as outlined in the Results section above. While the virus is still emerging, knowledge is limited and as such it is difficult to provide robust and complete recommendations for best practice. Further studies to inform future practice are required.

The dental world is united in its battle against COVID-19 and its efforts to safely provide dental care during this health crisis. Crucially, the review included non-English language studies. This is particularly important given that the virus emerged earlier in certain countries. As such, practitioners in these countries were able to gain an earlier understanding of how to deal with COVID-19 (past the peak). The scientific quality and characteristics of the included studies were not assessed or reported. The author did not state how many articles were included, which would have been of interest. • Orthodontic dental teams will need to be aware of updates in infection control guidance, aerosol limitation and containment, as well as screening and limiting patient numbers to try to ensure safe working environments for the benefit of patients and dental professionals throughout the pandemic.

Precautions and recommendations for orthodontic settings during the Orthodontic treatment involves aerosol generating procedures throughout, 4 and when required use of rubber dam is not possible.

The author described a study that found COVID-19 was viable for three hours in aerosols. However, the author did not provide any practical recommendations regarding this. It would have been useful, for example, for the author to explain how long a surgery should be cleared post aerosol procedure until it is safe to reuse.

It is important to note that as this is a literature review and The guidance may not provide new information to the engaged practitioner as many of these are basic recommendations, which are published and already implemented in the international dental community whose restrictions are being lifted. 5 This review may have already been superseded by other papers, which offer more detailed practical points for practice re-openings. 5 

Precautions and recommendations for orthodontic settings during the COVID-19 outbreak: A review

Decontamination: Health Technical Memorandum 0105Decontamination in primary care dental practices

Transmission routes of 2019-nCoV and controls in dental practice

British Orthodontic Society. AGP and NON-AGP in Orthodontic Procedures. 2020. Available at

COVID-19 Transmission in Dental Practice: Brief Review of Preventive Measures in Italy

Recommendations for the re-opening of dental services: a rapid review of international sources Version 1.3. 2020

COVID-19 Recovery Guidance

FACTSHEETS/Phase%202/Planning%20for%20re-opening.pdf