30 May 2021

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COVID-19 AND DENTISTRY: A NEW CHALLENGE

Authors:Ugo Consolo, Davide Bencivenni, Vittorio Checchi, Pierantonio Bellini

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A new virus has been identified in China between the end of 2019 and the beginning of 2020. In few months, this coronavirus spread quickly all around the world, leading to an acute respiratory syndrome often asymptomatic but potentially lethal. This new coronavirus, named 2019-nCoV, belongs to a pathogen family named Coronaviridae and presents a genomic sequence overlapped to SARS-CoV and MERS-CoV. Epidemiological and genetic studies performed on Chinese infected subjects led to the hypothesis that this pandemic originated from a transmission between animal and humans, followed by a contagion between humans. 2019-nCoV transmission potential is extremely high and infection pathways are different. This virus appears highly infective through droplets originated by cough, sneeze or exhalation of infected patients, but also through direct contact of hands or other body parts with contaminated surfaces. Incubation period seems to vary from three to fourteen days but some cases with a longer incubation period had been reported. Also patients in the incubation phase or asymptomatic subjects are considered potential virus carriers. Since the contagion window seems to be open already in the early phase of infection and seems to include also asymptomatic subjects, the difficulty in restricting the infection transmission is evident. Symptomatic patients mostly present fever, asthenia and dry cough, weather dyspnoea affects more severe subjects. In the worst cases, a severe involvement of respiratory functions leads to hospitalization. Form a clinical point of view, 2019-nCoV infection shows a bilateral interstitial pneumonia, radiographically evident as a bilateral opacity with no lobar involvement. In this environment, the high infection risk of dental professionals is undeniable.

Materials and methods.
This dossier is a literature review on this topic, since current published articles have been selected and valuable indications are given to the dentist. COVID-19 features, transmission and clinical aspects are given to the reader, as well as prevention and protections aspects in dentistry.

Conclusions.
Telephonic triage, an accurate anamnesis and a careful hand hygiene of both patients and operators are considered essential preliminary aspects to be considered. Moreover, big attention has to be placed on antimicrobial agents for personal hygiene effective on coronaviruses and on disinfectant agents for instruments and surfaces. Various methods for environment sanification are reported, through air changing and purification. For the most practical aspects instead, expedients suggested are the use of rubber dams, high-speed ejectors and anti-retraction handpieces. Very important is also the selection of the most adequate personal protection devices for airways and ocular protection. Differences between surgical masks and respirators are illustrated, highlighting indications towards 2019-nCoV. Also indications and information are provided about eye protection devices. These aspects play an important role mostly in this historical period featured by the coronavirus diffusion.

Clinical significance.
This contribution highlights the risks of coronavirus contamination in dental environments and provides practical indications on preventive and protective systems that can be implemented in daily clinical practice.