Background COVID-19 is a novel viral respiratory disease caused by a member of the coronavirus family, SARS-CoV-2, and has been declared as a pandemic on March 2020. Dental practitioners are routinely exposed to infectious bodily excretions, for example, saliva, blood, and respiratory excretions. Therefore, they are in the first line of SARS-CoV-2 infection-prone health care providers. The purposes of the current review are to trace documented cases of COVID-19 transmission inside dental settings worldwide and to explore the clinical management of these cases. Methods We searched MEDLINE and Google Scholar for all possible reported cases of COVID-19 transmission in dental practice as of December 1, 2019, until May 13, 2020. Multiple terms and combinations were used, including “coronavirus,” “COVID-19,” “SARS-CoV-2,” “dental,” “dentistry,” “transmission,” and “nosocomial.” Articles that were not written in English were excluded. Results A total of 78 articles were found from December 29, 2019, until May 13, 2020. Of these, 31 articles discussed the risks related to dental practice and recommended infection management protocols for dental health care personnel. Of these articles, only 1 had reported data on transmission of COVID-19 in dental practice. Two possible transmissions of COVID-19 to dental personnel were reported in China before its recognition as an epidemic. Conclusions Although it seems that there are almost no reported cases of infection by SARS-CoV-2 during dental treatments, occupational or nosocomial transmission could not be ruled out. Hence, further prospective assessment of COVID-19 transmission is urgently required, and careful and protective measurements are necessary to avoid infection during dental practice.
atients with disabilities belong to a more vulnerable part of our society, particularly during the rapidly changing landscape of the COVID-19 outbreak. 1 According to the World Health Organization, 2 hearing loss is the third most common physical condition behind heart disease and arthritis, affecting approximately 15% of the global population. In the United States, hearing loss directly affects 23% of people 12 years or older, 3 and it is especially prevalent among workers exposed to noise. 4 Patients with disabilities have varying needs, and people with impaired hearing represent a large segment of dental patients who have faced many potential challenges receiving dental care throughout the COVID-19 pandemic.The COVID-19 pandemic has changed communication from before the pandemic when personal protective equipment (PPE) was already recommended universally but not during every encounter from admission desk to the patient's leaving. Because of a high theoretical risk of experiencing COVID-19 transmission in dentistry, all dental health care personnel (DHCP) are strictly obliged to use, without interruption, the best possible PPE. 5 However, PPE blocks all visibility of lip movements and most extraoral facial expression and adversely affects speech intelligibility. Speech reading is an integral part of speech processing and a mandatory part of speech perception, particularly for hearing-impaired people. 6 As was previously studied and documented, protective face masks and N-95 respirators result in up to 4% and 14% reductions of speech intelligibility, respectively. 7 Face coverings have a broader effect beyond those who lip-read; evidence shows that from 60% through 70% of communication is based on nonverbal cues from lip patterns and facial expressions, which are essential for all patients with communication difficulties. 8 Little evidence and attention were given to already existing clear transparent surgical masks and N-95 respirators, leaving this opportunity almost unavailable for use in health care settings. 9 Antivirus protective face shields might have an incremental negative effect on the quality and loudness of voice, which has not yet been elucidated quantitatively. Despite mass vaccination against COVID-19, the best possible PPE will still remain in use for its additive protection.In addition to PPE's adverse effect on communication capabilities, the pandemic also sets social limitations, which make the hearing-impaired patient's experience within the dental office even more complex. Because of infection control requirements, the "no-visitor" policies are particularly problematic for patients with severe and profound hearing loss who rely on assistance throughout all dental care processes, predominantly at admission. Social distancing of at least 2 m might also block communication for all hearing-impaired patients. All of these challenges are encountered in an already loud, stressful, crowded, unpleasant, and dynamic environment of a dental clinic, with sound pressure level reaching at times more than...
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