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CC BY-NC-ND 4.0 · Eur J Dent 2020; 14(S 01): S165-S170
DOI: 10.1055/s-0040-1718641
Review Article

COVID-19 Pandemic: Oral Health Challenges and Recommendations

Fathima Fazrina Farook
1   Department of Preventive Dental Science, College of Dentistry, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
2   King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
,
Mohamed Nizam Mohamed Nuzaim
3   Department of Obstetrics and Gynecology, University of Malaya, Kuala Lumpur, Malaysia
,
Khansa Taha Ababneh
1   Department of Preventive Dental Science, College of Dentistry, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
2   King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
,
Abdulsalam Alshammari
1   Department of Preventive Dental Science, College of Dentistry, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
2   King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
,
Lubna Alkadi
1   Department of Preventive Dental Science, College of Dentistry, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
2   King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
› Author Affiliations Funding None.
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Abstract

The aim of this article is to shed light on coronavirus disease 2019 (COVID-19) and its oral effects and risk of nosocomial transmission to update the knowledge of dental health care workers. A thorough literature search of the PubMed/Embase/Web of Science/Cochrane central database was conducted to identify the impact of COVID-19 on oral health. We reviewed the recommendations on the recent guidelines set by the Centers for Disease Control and Prevention infection control practices for dentistry, American Dental Association, and the World Health Organization. According to the available evidence, COVID-19 may have a negative impact on the oral health due to the infection itself and due to various other consequences such as therapeutic measures, xerostomia, and other complications of the COVID-19. In light of the above facts, dentists should be wary of the disease, its identification, mode of spread and impacts on the oral health. The dental personnel have been identified as at the highest risk of getting COVID-19 due to cross infection from contact with their patients and aerosols generated in routine dental procedures. As such, they should be aware of the modifications that need to be made to the practice to prevent transmission of the disease. It is evident that COVID-19 has a negative impact on the oral health and at the same time a significant transmission risk to the dental personnel and patients who visit the clinic. If the recommendations issued by the regulatory authorities are meticulously followed, the risk of disease transmission can be lessened.

Keywords

coronavirus - SARS-CoV-2 - COVID-19 - oral health - recommendations - guidelines - dental practice


Publication History

Article published online:
24 November 2020

© 2020. European Journal of Dentistry. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Spagnuolo G, De Vito D, Rengo S, Tatullo M. COVID-19 outbreak: an overview on dentistry. Int J Environ Res Public Health 2020; 17 (06) E2094
    CrossrefPubMedSearch in Google Scholar
  • 2 Merad M, Martin JC. Pathological inflammation in patients with COVID-19: a key role for monocytes and macrophages. Nat Rev Immunol 2020; 20 (06) 1-8
    CrossrefPubMedSearch in Google Scholar
  • 3 Chan JF, Yuan S, Kok KH. et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020; 395 (10223) 514-523
    CrossrefPubMedSearch in Google Scholar
  • 4 Del Rio C, Malani PN. COVID-19-New Insights on a Rapidly Changing Epidemic. Jama 2020; 323 (14) 1339-1340
    CrossrefPubMedSearch in Google Scholar
  • 5 Wu YC, Chen CS, Chan YJ. The outbreak of COVID-19: an overview. J Chin Med Assoc 2020; 83 (03) 217-220
    CrossrefPubMedSearch in Google Scholar
  • 6 Ghinai I, McPherson TD, Hunter JC. et al. Illinois COVID-19 Investigation Team. First known person-to-person transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the USA. Lancet 2020; 395 (10230) 1137-1144
    CrossrefPubMedSearch in Google Scholar
  • 7 World Health Organization. Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations: scientific brief, 27 March 2020. World Health Organization; 2020
  • 8 Holshue ML, DeBolt C, Lindquist S. et al. Washington State 2019-nCoV Case Investigation Team. First case of 2019 novel coronavirus in the United States. N Engl J Med 2020; 382 (10) 929-936
    CrossrefPubMedSearch in Google Scholar
  • 9 Zhang W, Du R-H, Li B. et al. Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes. Emerg Microbes Infect 2020; 9 (01) 386-389
    CrossrefPubMedSearch in Google Scholar
  • 10 Sabino-Silva R, Jardim ACG, Siqueira WL. Coronavirus COVID-19 impacts to dentistry and potential salivary diagnosis. Clin Oral Investig 2020; 24 (04) 1619-1621
    CrossrefPubMedSearch in Google Scholar
  • 11 Wang Q, Qi J, Yuan Y. et al. Bat origins of MERS-CoV supported by bat coronavirus HKU4 usage of human receptor CD26. Cell Host Microbe 2014; 16 (03) 328-337
    CrossrefPubMedSearch in Google Scholar
  • 12 Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol 2004; 203 (02) 631-637
    CrossrefPubMedSearch in Google Scholar
  • 13 Xu H, Zhong L, Deng J. et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci 2020; 12 (01) 8
    CrossrefPubMedSearch in Google Scholar
  • 14 Hamid H, Khurshid Z, Adanir N, Zafar MS, Zohaib S. COVID-19 pandemic and role of human saliva as a testing biofluid in point-of-care technology 2020. Eur J Dent 2020;14(suppl S1):S123–S129 doi:10.1055/s-0040-1713020
  • 15 Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, evaluation and treatment coronavirus (COVID-19). In: Statpearls [internet]. Treasure Island (FL): StatPearls Publishing; 2020
    Search in Google Scholar
  • 16 Alsaad KO, Hajeer AH, Al Balwi M. et al. Histopathology of Middle East respiratory syndrome coronovirus (MERS-CoV) infection - clinicopathological and ultrastructural study. Histopathology 2018; 72 (03) 516-524
    CrossrefPubMedSearch in Google Scholar
  • 17 Alsaad KO, Arabi YM, Hajeer AH. Spectrum of histopathological findings in coronavirus disease-19, Middle East respiratory syndrome and severe acute respiratory syndrome. Ann Thorac Med 2020; 15 (02) 52-53
    CrossrefPubMedSearch in Google Scholar
  • 18 World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance, 13 March 2020. World Health Organization; 2020
  • 19 Casadevall A, Pirofski LA. The convalescent sera option for containing COVID-19. J Clin Invest 2020; 130 (04) 1545-1548
    CrossrefPubMedSearch in Google Scholar
  • 20 Wang D, Hu B, Hu C. et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323 (11) 1061-1069
    CrossrefPubMedSearch in Google Scholar
  • 21 Schwendicke F, Krois J, Gomez J. Impact of SARS-CoV2 (Covid-19) on dental practices: Economic analysis. J Dent 2020; 99: 103387
    CrossrefPubMedSearch in Google Scholar
  • 22 Nasseh K, Vujicic M. Modeling the impact of COVID-19 on US dental spending. Health Policy Institute Research Brief. American Dental Association. April 2020
  • 23 Patel N. Impact on dental economics and dental healthcare utilization in COVID-19: An exploratory study. J Adv Oral Res 2020; 11 (02) 128-136
    CrossrefSearch in Google Scholar
  • 24 Mattos FF, Pordeus IA. COVID-19: a new turning point for dental practice. Braz Oral Res 2020; 34: e085
    CrossrefPubMedSearch in Google Scholar
  • 25 Gamio L. The workers who face the greatest coronavirus risk. New York Times. 2020
  • 26 Parihar AV, Sahoo R, Parihar S. Dental practice in Covid times-an overview. Indian J Prev Soc Med 2020; 51 (02) 48-60
    Search in Google Scholar
  • 27 CDC. Corona virus disease 2019 (COVID-2019): Dental settings. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html. Accessed August 28, 2020
  • 28 CDC. Interim Infection Prevention and Control Guidance for Dental Settings During the Coronavirus Disease 2019 (COVID-19) Pandemic. Available at : https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html. Accessed August 4, 2020.
  • 29 ADA. Interim Guidance for Minimizing Risk of COVID-19 Transmission. Available at: https://www.ada.org/en/publications/ada-news/2020-archive/april/ada-releases-interim-guidance on-minimizing-covid-19-transmission-risk-when-treating-emergencies. Accessed April, 2020
  • 30 WHO. Advice on the use of masks in the community, during home care and in healthcare settings in the context of the novel coronavirus(COVID-19) outbreak. 2020. Available at: https://www.who.int/publications/i/item/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak. Accessed June 2020
  • 31 World Health Organization. August 3 AA. Considerations for the provision of essential oral health services in the context of COVID-19. Interim guidance. Available at: https://appswhoint/iris/bitstream/handle/10665/333625/WHO-2019-nCoV-Oral_health-20201-engpdf. Accessed August 3, 2020
  • 32 Wu C, Chen X, Cai Y. et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med 2020; 180 (07) 934-943
    CrossrefPubMedSearch in Google Scholar
  • 33 Niklander S, Veas L, Barrera C, Fuentes F, Chiappini G, Marshall M. Risk factors, hyposalivation and impact of xerostomia on oral health-related quality of life. Braz Oral Res 2017; 31: e14
    CrossrefPubMedSearch in Google Scholar
  • 34 Lechien JR, Chiesa-Estomba CM, De Siati DR. et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol 2020; 277 (08) 2251-2261
    CrossrefPubMedSearch in Google Scholar
  • 35 Netland J, Meyerholz DK, Moore S, Cassell M, Perlman S. Severe acute respiratory syndrome coronavirus infection causes neuronal death in the absence of encephalitis in mice transgenic for human ACE2. J Virol 2008; 82 (15) 7264-7275
    CrossrefPubMedSearch in Google Scholar
  • 36 Li YC, Bai WZ, Hashikawa T. Response to commentary on “The neuroinvasive potential of SARS-CoV-2 may play a role in the respiratory failure of COVID-19 patients.”. J Med Virol 2020; 92 (07) 707-709
    CrossrefPubMedSearch in Google Scholar
  • 37 Soares CD, de Carvalho RA, de Carvalho KA, de Carvalho MGF, de Almeida OP. Letter to editor: oral lesions in a patient with Covid-19. Med Oral Patol Oral Cir Bucal 2020; 25 (04) e563-e564
    PubMedSearch in Google Scholar
  • 38 Petrescu N, Lucaciu O, Roman A. Oral mucosa lesions in COVID-19 [published online ahead of print, 2020 Jun 19]. Oral Dis 2020;10.1111/odi.13499 doi:10.1111/odi.13499
  • 39 Chaux-Bodard A-G, Deneuve S, Desoutter A. Oral manifestation of Covid-19 as an inaugural symptom?. Journal of Oral Medicine and Oral Surgery. 2020; 26 (02) 18
    CrossrefSearch in Google Scholar
  • 40 Martín Carreras-Presas C, Amaro Sánchez J, López-Sánchez AF, Jané-Salas E, Somacarrera Pérez ML. Oral vesiculobullous lesions associated with SARS-CoV-2 infection [published online ahead of print, 2020 May 5]. Oral Dis 2020;10.1111/odi.13382 doi:10.1111/odi.13382
  • 41 Al-Khatib A. Oral manifestations in COVID-19 patients [published online ahead of print, 2020 Jun 10]. Oral Dis 2020;10.1111/odi.13477 doi:10.1111/odi.13477
  • 42 Maciel PP, Júnior HM, Martelli DRB. et al. COVID-19 pandemic: oral repercussions and its possible impact on oral health. Pesqui Bras Odontopediatria Clin Integr 2020; 20: 138
    Search in Google Scholar
  • 43 Chiotos K, Bassiri H, Behrens EM, et al. Multisystem inflammatory syndrome in children during the coronavirus 2019 pandemic: A case series. J Pediatric Infect Dis Soc 2020;9(3):393-398 doi:10.1093/jpids/piaa069
  • 44 Haberman R, Axelrad J, Chen A. et al. Covid-19 in immune-mediated inflammatory diseases—case series from New York. N Engl J Med 2020; 383 (01) 85-88
    CrossrefPubMedSearch in Google Scholar
  • 45 Dziedzic A, Wojtyczka R. The impact of coronavirus infectious disease 19 (COVID-19) on oral health [published online ahead of print, 2020 Apr 18]. Oral Dis 2020;10.1111/odi.13359 doi:10.1111/odi.13359
  • 46 Ramadan DE, Hariyani N, Indrawati R, Ridwan RD, Diyatri I. Cytokines and chemokines in periodontitis. Eur J Dent 2020; 14 (03) 483-495
    Thieme ConnectPubMedSearch in Google Scholar
  • 47 Duan L, Zhu G. Psychological interventions for people affected by the COVID-19 epidemic. Lancet Psychiatry 2020; 7 (04) 300-302
    CrossrefPubMedSearch in Google Scholar
  • 48 Pfefferbaum B, North CS. Mental health and the Covid-19 pandemic. N Engl J Med 2020; 383 (06) 510-512
    CrossrefPubMedSearch in Google Scholar
  • 49 Kisely S, Sawyer E, Siskind D, Lalloo R. The oral health of people with anxiety and depressive disorders - a systematic review and meta-analysis. J Affect Disord 2016; 200: 119-132
    CrossrefPubMedSearch in Google Scholar
  • 50 Castro MM, Ferreira RO, Fagundes NCF, Almeida APCPSC, Maia LC, Lima RR. Association between psychological stress and periodontitis: a Systematic Review. Eur J Dent 2020; 14 (01) 171-179
    Thieme ConnectPubMedSearch in Google Scholar
  • 51 Fentoglu O, Bozkurt FY. The bi-directional relationship between periodontal disease and hyperlipidemia. Eur J Dent 2008; 2 (02) 142-146
    Thieme ConnectPubMedSearch in Google Scholar
  • 52 Dai R, Lam OL, Lo EC, Li LS, Wen Y, McGrath C. A systematic review and meta-analysis of clinical, microbiological, and behavioural aspects of oral health among patients with stroke. J Dent 2015; 43 (02) 171-180
    CrossrefPubMedSearch in Google Scholar
  • 53 Yoshida M, Murakami T, Yoshimura O, Akagawa Y. The evaluation of oral health in stroke patients. Gerodontology 2012; 29 (02) e489-e493
    CrossrefPubMedSearch in Google Scholar
  • 54 Leira Y, Seoane J, Blanco M. et al. Association between periodontitis and ischemic stroke: a systematic review and meta-analysis. Eur J Epidemiol 2017; 32 (01) 43-53
    CrossrefPubMedSearch in Google Scholar
  • 55 Lafon A, Pereira B, Dufour T. et al. Periodontal disease and stroke: a meta-analysis of cohort studies. Eur J Neurol 2014; 21 (09) 1155-1161, e66–e67
    CrossrefPubMedSearch in Google Scholar
  • 56 Farook FF, Ng KT, Nuzaim MN, Koh WJ, Teoh WY. Association of periodontal disease and polycystic ovarian syndrome: a systematic review and meta-analysis with trial sequential analysis. Open Dent J 2019; 13 (01) 478-487
    CrossrefSearch in Google Scholar
  • 57 Mawardi HH, Elbadawi LS, Sonis ST. Current understanding of the relationship between periodontal and systemic diseases. Saudi Med J 2015; 36 (02) 150-158
    CrossrefPubMedSearch in Google Scholar
  • 58 Preshaw PM, Alba AL, Herrera D. et al. Periodontitis and diabetes: a two-way relationship. Diabetologia 2012; 55 (01) 21-31
    CrossrefPubMedSearch in Google Scholar
  • 59 Mitjà O, Clotet B. Use of antiviral drugs to reduce COVID-19 transmission. Lancet Glob Health 2020; 8 (05) e639-e640
    CrossrefPubMedSearch in Google Scholar
  • 60 Dong L, Hu S, Gao J. Discovering drugs to treat coronavirus disease 2019 (COVID-19). Drug Discov Ther 2020; 14 (01) 58-60
    CrossrefPubMedSearch in Google Scholar
  • 61 Smith RG, Burtner AP. Oral side-effects of the most frequently prescribed drugs. Spec Care Dentist 1994; 14 (03) 96-102
    CrossrefPubMedSearch in Google Scholar
  • 62 Suryana K. Lichenoid reaction caused by antihistamines and corticosteroids. J Asthma Allergy 2020; 13: 205-211
    CrossrefPubMedSearch in Google Scholar
  • 63 Abdollahi M, Radfar M. A review of drug-induced oral reactions. J Contemp Dent Pract 2003; 4 (01) 10-31
    CrossrefPubMedSearch in Google Scholar
  • 64 Deng X, Yu X, Pei J. Regulation of interferon production as a potential strategy for COVID-19 treatment. arXiv (2020):arXiv:2003.00751
  • 65 Kupferschmidt K, Cohen J. Race to find COVID-19 treatments accelerates. Science 2020; 367 (6485) 1412-1413
    CrossrefPubMedSearch in Google Scholar
  • 66 Pejčić AV. Stevens-Johnson syndrome and toxic epidermal necrolysis associated with the use of macrolide antibiotics: A review of published cases [published online ahead of print, 2020 Aug 17]. Int J Dermatol 2020;10.1111/ijd.15144 doi:10.1111/ijd.15144
  • 67 Pankhurst WC. Basic Guide to Infection Prevention and Control in Dentistry. Wiley-Blackwell. 2009: 33-47
    Search in Google Scholar
  • 68 Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci 2020; 12 (01) 9
    CrossrefPubMedSearch in Google Scholar
  • 69 Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. J Dent Res 2020; 99 (05) 481-487
    CrossrefPubMedSearch in Google Scholar
  • 70 Barbeau J, ten Bokum L, Gauthier C, Prévost AP. Cross-contamination potential of saliva ejectors used in dentistry. J Hosp Infect 1998; 40 (04) 303-311
    CrossrefPubMedSearch in Google Scholar