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| REVIEW ARTICLE |
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| Year : 2021 | Volume
: 8
| Issue : 1 | Page : 59-64 |
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COVID-19 outbreak: A renaissance in dentistry
Neha Singh, Vivek Gupta, Santosh Kumar Verma, Priyanka Kumari
Department of Periodontology and Oral Implantology, Dental Institute, RIMS, Ranchi, Jharkhand, India
| Date of Submission | 02-Jul-2020 |
| Date of Decision | 03-Jul-2020 |
| Date of Acceptance | 27-Jul-2020 |
| Date of Web Publication | 25-Feb-2021 |
Correspondence Address:
Santosh Kumar Verma
Department of Periodontology and Oral Implantology, Dental Institute, RIMS, Ranchi, Jharkhand
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdrr.jdrr_72_20
The novel coronavirus which originated from the city of Wuhan, China, in late 2019 has put the entire human race at risk. The widespread destruction caused by novel coronavirus has led the World Health Organization to declare it a pandemic disease on March 11, 2020. Health workers, especially the dentist, are at great risk of getting infected due to the nature of dental procedure which requires close proximity to the patient's mouth. The risk of cross-infection from dental settings is high, so proper infection control measures are required to restrict the spread of infection. This article focuses on the effect of COVID-19 on dental fraternity, its management in dental setup to restrict cross-contamination, and information on various guidelines issued to render their services in COVID-19 situation.
Keywords: Aerosol, coronavirus, COVID-19, dental services, dentistry, severe acute respiratory syndrome-corona virus 2
How to cite this article:
Singh N, Gupta V, Verma SK, Kumari P. COVID-19 outbreak: A renaissance in dentistry. J Dent Res Rev 2021;8:59-64 |
| Introduction | |  |
The first case of novel coronavirus infection emerged in Wuhan in late 2019, and a fresh strain of coronavirus is considered to have its origin from the wet market in Wuhan, China.[1] Within a few months, this new virus spreads across the globe. The term COVID-19 was coined by the World Health Organization (WHO) for the fresh strain of coronavirus on February 11, 2020,[2] and declared it as a controllable pandemic disease on March 11, 2020.[3],[4] This new coronavirus shows resemblance to coronavirus species seen in bats and potentially pangolins, thus giving the evidence of its zoonotic nature.[5],[6] The total number of cases globally crossed more than 40 lakhs with more than 2.5 lakhs deaths[7] till May 2020.
The chances of spread of COVID-19 infection are high in dentistry due its nature of work which includes generation of aerosols, handling of sharp instruments, and nearness of the operator to the patients, and also, there is a theory of the presence of virus in the saliva of the infected person.[8],[9],[10] This review intends to elaborate the current recommendation for diagnosing, prevention of infection, and proper treatment protocol for COVID-19 patients. Although this information is up to May 2020, continued research and careful observation would open further avenues in terms of COVID-19 pandemic. The purpose of this article is to help to find adaptive structural changes and a new approach to future dentistry in terms of dental business, dental treatment, and a new mode of education.
| Historical Background | | |
The human coronavirus was first reported by Tyrrell and Bynoe in 1965 and they named it B814.[11] It was found in human embryonic tracheal culture obtained from the respiratory tract of an adult with a common cold. Tyrrell et al. conducted studies on human strains and animal viruses. This new strain of the virus was named coronavirus due to its crown-like appearance of surface projection.[12] In 2002, a new coronavirus emerged from southern China with symptoms of severe acute respiratory syndrome (SARS).[13],[14] A total of 29 countries were affected with 8098 patients infected by SARS with 774 SARS-related death.[15] In April 2012, Middle East respiratory syndrome-related coronavirus (MERS-COV) was discovered which showed similarity to coronavirus in bats, as both have Hcd26-binding mode.[16] In late December 2019, a pneumonia outbreak originated in Wuhan city, China. A novel coronavirus was announced as the causative agent on January 8, 2020, by Chinese center of disease control and prevention.[17] The infection caused by it was rampant and escalated from Wuhan to other provinces in China as well as to 24 countries.[18],[19] The symptoms of this new virus outbreak were different from SARS, as COVID patients have a loss of smell, sore throat also. The person-to-person transmission by this novel coronavirus is rapid compared to SARS.[20] In terms of fatalities, COVID-19 fatal rate was less (3.44%) compared to MERS-COV (39.4%) and SARS-COV (9.19%).[21]
| Structure of Virus | | |
On the basis of phylogenetic and genomic structure, COVID-19 belongs to betacoronavirus family. It has similar sequences to that of SARS-COV which uses angiotensin-converting enzyme 2 (ACE2) for binding.[22] The novel coronavirus is a single-stranded (positive sense) RNA virus which is spherical in shape that bears glycoprotein projections on its surface. Spike protein is the peculiar structure present on the membrane envelope found in COVID-19 and shows RNA polymerase, S chymotrypsin-like protease, papain-like protease, helicase, glycoprotein, and accessory proteins.[5],[23],[24] The COVID-19 enters the host by binding to the ACE2 by its spike protein. The protease TMPRSS2 is needed to activate spike protein (virus receptor) to adhere to ACE2 of the host which is common to both SARS-COV and SAR-COV2.[25],[26] The affinity for ACE2 is higher in SARS-COV2 compared to SARS-COV.[27],[28] Since the TMPRSS2 contributes to the activation of spike protein of COVID-19, TMPRSS2 inhibitor might prove a treatment option.[29]
| Signs and Symptoms of COVID-19 | | |
The alarming clinical symptoms of COVID-19 are fever, dry cough, and dyspnea[30] and other less common symptoms are hyposmia, dysgeusia, diarrhea, and nausea.[31] Some cases remain undiagnosed due to mild flu-like symptoms and seasonal allergies.[32] The asymptomatic patient serves as a carrier and also as a reservoir for re-emergence of infection. Although COVID-19 is known to be highly communicable when patients are most symptomatic, it is noteworthy that the incubation can occur before any symptoms are apparent.[33],[34] The higher risk patient population manifests symptoms typical of pneumonia of acute respiratory distress syndrome.[33]
| Route of Transmission | | |
General
Respiratory droplet of particle size 5–10 um in diameter can be a source of infection.[31] It is evident that SARS-COV2 has a possible route of spread through respiratory droplet or by contact transmission.[8],[35]It is evident from the studies that the spread of COVID-19 is not only restricted to the respiratory tract, but the virus has found an effective way to enter the body through the eye[8] and via saliva directly or indirectly.[36] The spread of droplets or aerosol occurs up to the radius of 6 feet when a symptomatic person coughs or sneezes. Fomites present in the immediate environment of an infected person are also responsible for the spread of infection.[37] SARS-COV2 has also shown fecal–oral transmission, and reverse-transcriptase–polymerase chain reaction testing can be helpful in detecting it from the stool sample.[38] Fecal oral spread and aerosol spread still need to be further investigated and confirmed. There is no confirmation of mother to their newborn transmission (vertical transmission).[39],[40]
In dental operatory
The nature of dental procedure makes dental professional highly susceptible to pathogenic microorganisms present in the oral cavity and respiratory tract. Dental procedures which involve face-to face communication and salivary contamination, aerosol generation, and handling of the sharp instrument have a higher risk of COVID-19 spread.[8] The presence of virus in infected person's saliva has been reported.[9] The airborne microorganisms along with aerosol produced during the treatment are small and can remain suspended in the air for long periods,[41] direct contact with blood, oral fluids, or other patient materials, contact of conjunctival, nasal, or oral mucosa with droplets and aerosols containing microorganisms make the dental care professionals more vulnerable to COVID-19 infection.
| Impact on Dentistry around the World | | |
On dental business
The outbreak of coronavirus has put dental industry at great financial risk. The dental shows like exhibition, trade fairs are great source of revenue generation for dental industry. Many dental events or conferences have been canceled or postponed to avoid mass gathering like Krakdent in Poland, Exponential in Spain, International dental exhibition and meeting (IDEM) of Singapore, and Chennai Expodent of India.[42] These events attract dental fraternity in large strength in terms of education, sales, and promotion of dental equipments and books. It is very much clear that the COVID-19 outbreak has caused huge decline in not only the dental business across the world. Many countries with larger economy and dental regulatory bodies like Canada, UK, and Ireland dental association are offering support to the dental practice.[43] An alternative in forms of dental education like webinars or online lecture has replaced the regular dental conferences and classroom lecturers.
On dentist
The outbreak of COVID-19 has forced the dentists to shut their clinic completely or they have restricted their treatment to only emergency cases. The dentists are facing great financial loss during this COVID-19 era with majority of dentists earning <5% of what is typical.[44] It has also put impact psychological health such as fear and anxiety.[45] It enhances the worry among the dentist, especially when there is no vaccine or no definite treatment available. Seeing the situation of fast-spreading virus, many health regulatory bodies (National Health Commission of China, American Dental Association, Consejo General of Spain, National Health Service of UK, and Dental Council of India) have released the guidelines for emergency or elective treatment procedures. The infection control guidelines issued by authorities have increased the burden on the dentist to upgrade their dental clinics by new equipment of the infection control.[57]
On dental education
During this challenging pandemic era, dental students are facing difficult times due to the closure of the dental institute. As per the guidelines of Ministry of Health India, Dental Council of India, the dental schools have been shut down completely owing to safety issues due to which students are facing difficulty in studies. Seeing the highly infectious nature of the novel coronavirus, it is very necessary to take a further step in educating students through online classes, webinars, so that student's education is not compromised.
| Guidelines for Dentistry | | |
Being among the high-risk professional, it is the matter of great concern for dental professional to practice proper infection control. Asymptomatic patients are also infectious, so following proper guidelines as stated by different health advisory bodies (WHO, Dental Council of India, and Indian Dental Association) should be made mandatory for the dental professionals. The dental recommendation for guidelines is explained in [Table 1].
| Conclusion | | |
The dental practitioners are in a state of anxiety and fright because of the SARS-COV2 impact in spite of having great knowledge and high standard of practice. The current situation of COVID-19 pandemic is alarming for health sector, especially for the dental professional, either they have modified their services according to the guideline or they have completely shut down their clinic. The dent caused in dental fraternity needs to be mended, and an initiative should be taken by the government to heal the revenue loss, anxiety, and fear among students in taking up dentistry, as profession should be properly taken care off. As stated by the WHO that coronavirus is here to stay till we do not get proper vaccines, so it is important for us to take wise decision, necessary steps to take care of our patients during this adverse time. The time has come to bring revolution in the dental operating system so that we are always prepared even during the times when new pandemic disease occurs in future. We have to adapt with COVID-19 era and perform all duties as dental professional with the same zeal and enthusiasm.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1]
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