The emergence of the novel 2019 coronavirus disease (COVID-19) pandemic has led to a significant challenge to healthcare professionals. Among all the healthcare providers, dental clinical setup is exposed to the generation of potentially hazardous aerosols which could be a point of cross-contamination. Dentists catering to pediatric patients need to take special precautions, as they have milder symptoms or could be asymptomatic and hence potential vectors for the transfer of infection. One needs to change the perspective to manage the oral health of children as a child\'s oral health presents specific problems that could be time-bound and hence need to be treated accordingly. These problems can be managed on one hand by preventive methods, and on the other by implementing specific protocols relating to the conditions that represent an emergency, or those situations that fall into the category of elective dental procedures. This article highlights the routes of transmission in a dental practice and focuses on the categorization of treatment for children based on treatment needs. It proposes a restructuring of the treatment protocol and hence shifting to minimal invasive or non-aerosol-generating procedures (AGP). These techniques are also proposed to be used even after the end of the current emergency period to minimize the aerosol splatter.
Clinical significance: The article highlights the protocol that needs to be followed after treatment categorization during and after COVID-19 pandemic.
Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus–infected pneumonia. N Engl J Med 2020(13). DOI: 10.1056/NEJMoa2001316.
Huang C, Wang Y, Li X, et al. Clinical features of patients with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395(10223):497–506. DOI: 10.1016/S0140-6736(20)30183-5.
Tagarro A, Epalza C, Santos M, et al. Screening and severity of coronavirus disease 2019 (COVID-19) in children in Madrid, Spain. 2020. JAMA Pediatr 2020. e201346.
To KK-W, Tsang OT-Y, Yip CC-Y, et al. Consistent detection of 2019 novel coronavirus in saliva. Clin Infect Diseases 2020;71(15):841–843. DOI: 10.1093/cid/ciaa149.
Lai CC, Shih TP, Ko WC, et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): the epidemic and the challenges. Int J Antimicrob Agents 2020;55(3):105924. DOI: 10.1016/j.ijantimicag.2020.105924.
Bai Y, Yao L, Wei T, et al. Presumed asymptomatic carrier transmission of COVID-19. J Am Med Assoc 2020; 323(14):1406–1407. DOI: 10.1001/jama.2020.2565.
Mallineni SK, Innes NP, Raggio DP, et al. Coronavirus disease (COVID 19): characteristics in children and considerations for dentists providing their care. Int J Paediatr Dent 2020;30(3):245–250. DOI: 10.1111/ipd.12653.
de Wit E, van Doremalen N, Falzarano D, et al. SARS and MERS: recent insights into emerging coronaviruses. Nat Rev Microbiol 2016;14(8):523–534. DOI: 10.1038/nrmicro.2016.81.
Liu L, Wei Q, Alvarez X, et al. Epithelial cells lining salivary gland ducts are early target cells of severe acute respiratory syndrome coronavirus infection in the upper respiratory tracts of rhesus macaques. J Virol 2011;85(8):4025–4030. DOI: 10.1128/JVI.02292-10.
Chen J. Pathogenicity and transmissibility of 2019-nCoV—a quick overview and comparison with other emerging viruses. Microb Infect 2020;22(2):69–71. DOI: 10.1016/j.micinf.2020.01.004.
Peng X, Xu X, Li Y, et al. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci 2020;12(1):9. DOI: 10.1038/s41368-020-0075-9.
Wei J, Li Y. Airborne spread of infectious agents in the indoor environment. Am J Infect Control 2016;44(9 Suppl):S102–S108. DOI: 10.1016/j.ajic.2016.06.003.
Cleveland JL, Gray SK, Harte JA, et al. Transmission of blood-borne pathogens in US dental health care settings: 2016 update. J Am Dent Assoc (1939) 2016;147:729–738.
Kampf G, Todt D, Pfaender S, et al. Persistence of coronaviruses on inanimate surfaces and its inactivation with biocidal agents. J Hosp Infect 2020;104(3):246–251. DOI: 10.1016/j.jhin.2020.01.022.
Otter JA, Donskey C, Yezli S, et al. Transmission of SARS and MERS coronaviruses and influenza virus in healthcare settings: the possible role of dry surface contamination. J Hosp Infect 2016;92(3):235–250. DOI: 10.1016/j.jhin.2015.08.027.
Guo H, Zhou Y, Liu X, et al. The impact of the COVID-19 epidemic on the utilization of emergency dental services. J Dent Sci, 2020;15(4):564–567. DOI: 10.1016/j.jds.2020.02.002.
Wheeler SQ, Greenberg ME, Mahlmeister L, et al. Safety of clinical and non-clinical decision makers in telephone triage: a narrative review. J Telemed Telecare 2015;21(6):305–322. DOI: 10.1177/1357633X15571650.
Fox C, Newton JT. A controlled trial of the impact of exposure to positive images of dentistry on anticipatory dental fear in children. Community Dent Oral Epidemiol 2006;34(6):455–459. DOI: 10.1111/j.1600-0528.2006.00303.x.
Chitguppi R. A simple, inexpensive yet effective screening method to detect asymptomatic COVID patients entering dental clinics. 2020. pp. 1–8.
American Academy of Pediatric Dentistry. Special issue: proceedings of the conference on behavior management for the pediatric dental patient. Pediatr Dent 2004;26(2):110–183.
Boyce TW. The lifelong effects of early childhood adversity and toxic stress. Pediatr Dent 2014;36(2):102–107.
Long N. The changing nature of parenting in America. Pediatr Dent 2004;26(2):121–124.
Wright GZ, Stigers JI. Nonpharmacologic management of children's behaviors. In: Dean JA, Avery DR, McDonald RE, ed. McDonald and Avery's dentistry for the child and adolescent. 9th ed., Maryland Heights, Mo: Mosby-Elsevier; 2011. pp. 27–40.
Townsend JA. Behavior guidance in the pediatric patient. In: Casamassimo PS, Fields HW Jr, McTigue DJ, et al., ed. Pediatric dentistry — Infancy through adolescence. 5th ed., St Louis, Mo: Elsevier-Saunders Co; 2013. pp. 352–370.
National Health Commission of the People's Republic of China. Guideline for the Diagnosis and Treatment of Novel Coronavirus Pneumonia (5th edition). 2020. Available online: http://www.nhc.gov.cn/xcs/zhengcwj/202002/3b09b894ac9b4204a79db5b8912d4440.shtml.
Saloranta A, Forss H, Walsh T, et al. Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database Syst Rev 2017;7(7):CD001830. DOI: 10.1002/14651858.CD001830. pub5.
Ma X, Lin X, Zhong T, et al. Evaluation of the efficacy of casein phosphopeptide-amorphous calcium phosphate on remineralization of white spot lesions in vitro and clinical research: a systematic review and meta-analysis. BMC Oral Health 2019;19(1):295–306. DOI: 10.1186/s12903-019-0977-0.
Rosenblatt A, Stamford TC, Niederman R. Silver diamine fluoride: a caries “silver-fluoride bullet”. J Dent Res 2009;88(2):116–125. DOI: 10.1177/0022034508329406.
Besinis A, De Peralta T, Handy RD. The antibacterial effects of silver, titanium dioxide and silica dioxide nanoparticles compared to the dental disinfectant chlorhexidine on Streptococcus mutans using a suite of bioassays. Nanotoxicology 2014;8(1):1–16. DOI: 10.3109/17435390.2012.742935.
Hernández-Sierra JF, Salas-López EK, Martínez-Gutiérrez F, et al. Bactericidal capacity of silver nanoparticles associated with Gantrez S-97 on Streptococcus mutans. J Clin Pediatr Dent 2010;35(2):183–185. DOI: 10.17796/jcpd.35.2.c61l421mj0655lgm.
Saliba MSA, Coelho OAC, Coelho LD, et al. Clinical and microbiological analysis of mechanical and chemomechanical methods of caries removal in deciduoud teeth. Oral Health Prev Dent 2019;17(3):283–288.
Souza RCC, Costa PS, Costa LR. Dental sedation precautions and recommendations during the COVID-19 pandemic. Rev Bras Odontol 2020;77:e1788. DOI: 10.18363/rbo.v77.2020.e1887.