Enhanced community surveillance is a key pillar of the public health response to coronavirus disease 2019 (COVID-19). Asymptomatic carriage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a potentially significant source of transmission, yet remains relatively poorly understood. Disruption of dental services continues with significantly reduced capacity. Ongoing precautions include preappointment and/or at appointment COVID-19 symptom screening and use of enhanced personal protective equipment (PPE). This study aimed to investigate SARS-CoV-2 infection in dental patients to inform community surveillance and improve understanding of risks in the dental setting. Thirty-one dental care centers across Scotland invited asymptomatic-screened patients aged over 5 y to participate. Following verbal consent and completion of sociodemographic and symptom history questionnaire, trained dental teams took a combined oropharyngeal and nasal swab sample using standardized Viral Transport Medium–containing test kits. Samples were processed by the Lighthouse Lab and patients informed of their results by SMS/email with appropriate self-isolation guidance in the event of a positive test. All positive cases were successfully followed up by the national contact tracing program. Over a 13-wk period (from August 3, 2020, to October 31, 2020), 4,032 patients, largely representative of the population, were tested. Of these, 22 (0.5%; 95% CI, 0.5%–0.8%) tested positive for SARS-CoV-2. The positivity rate increased over the period, commensurate with uptick in community prevalence identified across all national testing monitoring data streams. To our knowledge, this is the first report of a COVID-19 testing survey in asymptomatic-screened patients presenting in a dental setting. The positivity rate in this patient group reflects the underlying prevalence in community at the time. These data are a salient reminder, particularly when community infection levels are rising, of the importance of appropriate ongoing infection prevention control and PPE vigilance, which is relevant as health care team fatigue increases as the pandemic continues. Dental settings are a valuable location for public health surveillance.
This study sets out to review the literature on 'the oral health of adults with intellectual disabilities' and would have benefitted from defining the term 'intellectual disabilities'. The research was carried out in the USA and it is important to appreciate the different terminology used in different countries, combined with the variety and complexity of disabilities limiting comparisons outside the host country.How good is the systematic review? First it has to be asked whether the review was focussed enough to be a systematic review as the question asked was very broad. Secondly, can the results be interpreted sufficiently to draw evidence-based conclusions? There was no attempt to carry out meta-analyses on specific outcomes (eg, DMFT), some studies had small population numbers and there were substantial differences between the included studies, limiting the potential to generalise conclusions.Papers from across the world were included in the review but the study could have benefitted from using wider search terms to capture more literature as well as the use of grey literature and additional contacts with experts in the field. The research question concentrated on intellectual disabilities without considering the implications of the consequences of confounding factors (educational ability or deprivation), or the severity of the disability which impact on oral health.The time period used to gather the literature has seen changes in the demographics of the population; 1 with an increased life expectancy and increase in the number of patients with complex and long-term medical needs. There has also been a change in cultural values with tooth loss being less acceptable. 2 There has been a shift away from living in institutions to living independently in the community with an appropriate level of care. As life expectancy has increased there has been a change in the patterns of oral disease and therefore the treatment plans associated with the disease and the disability.A non-weighted scoring system, totalling 10, was used to assess the quality of the studies included in the review with a minimum score of 3 allowing inclusion into the study. Use of these types of scoring systems is not recommended by the Cochrane Collaboration. 3 Owing to the methodological limitations the results of the review should be interpreted with care. The use of English only studies and narrow search terms must raise questions in relation to the reviews' conclusions which concentrate focus more on professionally focussed strategies to address disparities for patients with ID whichhave not yet been fully elucidated. Emma O'KeefeDepartment of Public Health, NHS Fife, Leven, Scotland, UK SUMMARY REVIEW/DELIVERY OF CAREData sources Medline, PubMed, Clinical Queries and PsychLIT.Study selection The studies were evaluated independently by two reviewers and only included studies that had been published in English since 1975. The studies included had to meet three criteria; adult humans with mental retardation or a similar ID, had at least ...
Enhanced community surveillance is a key pillar of the public health response to COVID-19. Asymptomatic carriage of SARS-CoV-2 is a potentially significant source of transmission, yet remains relatively poorly understood. Disruption of dental services continues with significantly reduced capacity. Ongoing precautions include pre- and/or at appointment COVID-19 symptom screening and use of enhanced personal protective equipment (PPE). This study aimed to investigate SARS-CoV-2 infection in dental patients to inform community surveillance and improve understanding of risks in the dental setting. Thirty-one dental care centres across Scotland invited asymptomatic screened patients over 5-years-old to participate. Following verbal consent and completion of sociodemographic and symptom history questionnaire, trained dental teams took a combined oropharyngeal and nasal swab sample using standardised VTM-containing testkits. Samples were processed by the Lighthouse Lab and patients informed of their results by SMS/e-mail with appropriate self-isolation guidance in the event of a positive test. Over a 13-week period (from 3August to 31October2020) n=4,032 patients, largely representative of the population, were tested. Of these n=22 (0.5%; 95%CI 0.5%, 0.8%) tested positive for SARS-CoV-2. The positivity rate increased over the period, commensurate with uptick in community prevalence identified across all national testing monitoring data streams. All positive cases were successfully followed up by the national contact tracing program. To the best of our knowledge this is the first report of a COVID-19 testing survey in asymptomatic-screened patients presenting in a dental setting. The positivity rate in this patient group reflects the underlying prevalence in community at the time. These data are a salient reminder, particularly when community infection levels are rising, of the importance of appropriate ongoing Infection Prevention Control and PPE vigilance, which is relevant as healthcare team fatigue increases as the pandemic continues. Dental settings are a valuable location for public health surveillance.
A systematic review of risk factors during first year of life for early childhood caries.
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