How COVID-19 has affected

dentistry
• The concern about dental practice coronavirus transmission has
been widely recognized around the world based on the nature of
the dental procedures, and the proximity of the dental team with
patients.

NY Times article dated

March 2020
Guidelines that should be adopted in a dental
setting during COVID-19
Before Dental Treatment,prior to entering a dental office
 At the dental clinic

Banakar, M., Bagheri Lankarani, K., Jafarpour, D. et al. COVID-19 transmission risk and protective protocols in dentistry: a
systematic review. BMC Oral Health 20, 275 (2020). https://doi.org/10.1186/s12903-020-01270-9
During and After dental treatment
 Fallow Time
Public Health England guidance currently recommends a fallow period
of 60 minutes in a treatment room with less than ten air changes per
hour from the point that an aerosol-generating procedure is completed.

A 'benchmark' time of 15-30 minutes varies depending on type and

length of procedure, the employment of procedural mitigations such as
high-volume suction and rubber dam, and the availability of
environmental mitigations such as air ventilation.

Dental Fallow Time Calculator launched. Br Dent J. 2020 Oct;229(8):511. doi: 10.1038/s41415-020-2309-9. PMID:
33097877; PMCID: PMC7582439.
Teledentistry
Subunits: Teleconsulation, Telediagnosis, Teletriage, Telemonitoring

Assess and record the oral health status postoperatively

Monitor the treatment outcomes using mobile photography
Consultation, supervision or continuing education
Provide educational videos regarding maintenance of oral hygiene

If not fully replace, at least teledentistry can complement the existing

compromised dental system during the current pandemic.

Ghai S. Teledentistry during COVID-19 pandemic. Diabetes Metab Syndr. 2020 Sep-Oct;14(5):933-935. doi:
10.1016/j.dsx.2020.06.029. Epub 2020 Jun 16. PMID: 32593116; PMCID: PMC7297180.
Clinical consequences
• Routine care was suspended in most countries,hence a progression of
undiagnosed and managed oral disease is expected
• Natural progression of conditions such as caries and periodontitis is
inevitable without diagnosis and management
• Missed opportunity for oral cancer screening during regular check ups
• Elective surgery in hospitals has been postponed to free up bed space for
COVID-19 patients.

Coulthard, P., Thomson, P., Dave, M. et al. The COVID-19 pandemic and dentistry: the clinical, legal and
economic consequences - part 2: consequences of withholding dental care. Br Dent J 229, 801–805 (2020).
https://doi.org/10.1038/s41415-020-2406-9
Economic consequences
• Suspension of routine dental care had substantial financial impact.
• Return to routine care will be slow, with prioritisation of non-AGPs while we look to
further understand methods to mitigate transmission risk via infected aerosol and spatter.
• Cost of personal protective equipment and the lower volume of patients pose a continued
threat to businesses.
• The longer Covid-19 mitigation/suppression measures are upheld, the greater the
financial distress imposed onto dental clinics will be, affecting especially those with
higher operational costs.

• Schwendicke, F., Krois, J., & Gomez, J. (2020). Impact of SARS-CoV2 (Covid-19) on dental practices: Economic analysis. Journal of Dentistry,
103387. doi:10.1016/j.jdent.2020.103387
• Coulthard, P., Thomson, P., Dave, M. et al. The COVID-19 pandemic and dentistry: the clinical, legal and economic consequences - part
2: consequences of withholding dental care. Br Dent J 229, 801–805 (2020). https://doi.org/10.1038/s41415-020-2406-9
Fear and anxiety amongst dentists
• Healthcare workers are at greater risk of COVID-19 infection than the general population
because of their frequent contact with affected individuals.
• In a pandemic, fear raises anxiety and stress levels in healthy persons and escalates the
symptoms. The number of persons whose mental health is affected tends to be greater
than the number of persons affected by infection.
• A cross-sectional study assessed the fear of infection between Egyptian dentists practicing
during the present COVID-19 pandemic found 92.6% dental professionals were afraid of
becoming infected with COVID-19 while 90.7% became anxious to treat patients showing
suspicious symptoms. About 69.9% wanted to close their practice until the number of
COVID-19 cases starts declining and 72.2% felt nervous when talking to patients in close
vicinity

• Aly, M.M., Elchaghaby, M.A. Impact of novel coronavirus disease (COVID-19) on Egyptian dentists’ fear and
dental practice (a cross-sectional survey). BDJ Open 6, 19 (2020)
Report finds COVID-19 rate among dentists
is less than 1 percent.
First longitudinal study designed to track infection control
practices and infection rates among US dentists.

The web based survey had 2195 US dentists from the 50

states of the US and Puerto Rico participating. They were
asked about any symptoms and protective measures taken
while practicing dentistry.

As of June 2020, an estimated 0.9% (95% confidence

interval, 0.5 to 1.5) of US dentists have or have had COVID-
19. This is similar to infection rates reported in health care
workers in the Netherlands (0.9%) and China (1.1%)
Limitations of study
• As it is survey based, nonrespondents might differ from
respondents, which can reduce the validity and generalizability
of these results.
• selection bias-underestimation due to dentists who have been
hospitalized or have died from the disease
• Possibility that respondents had limited access to COVID-19
testing and might have had undiagnosed infection
Estimating COVID-19 prevalence and infection control practices among US dentists Cameron G. Estrich, MPH,
PhD ,Matthew Mikkelsen, MA,Rachel Morrissey, MA; J Am dent Asso 2020 Nov;151(11):815-824
Shift towards a prevention centric approach
to care.
From only seeing emergency cases, most dentists in Malaysia are
providing routine care currently however with additional protocols in
place.

With limitation of the number of AGP cases seen each day, the focus
has shifted towards prevention of dental diseases.