Immunocompromised patients and coronavirus disease 2019: a review and recommendations for dental health care

Abstract

In less than four months, an unprecedented pandemic changed the world scenario, closing institutions and commerce, paralyzing sports championships, blocking frontiers, and putting almost all populations in a house quarantine regimen. Immunocompromised patients are within the high-risk group to severe outcomes from COVID-19. However, there is no clear evidence of the association between impaired immune host status and complications from SARS-CoV-2 infection so far. The virus is transmitted by inhalation or direct contact with infected secretions, and therefore the dental office is a highly susceptible environment for such transmission. Here, we review the literature and discuss immunological COVID-19 related issues. We also make suggestions for immunocompromised patients' support in this new emerging context of clinical dental practice. Until comprehensive findings are published, individuals with impaired immunity should be considered as high-risk. Cross infection control procedures for the clinical care of immunocompromised patients should follow the same guidelines that are being proposed for immunocompetent ones. However, during the active outbreak, people under immunosuppressive conditions should not receive elective procedures, even if they do not have symptoms or exposure history to COVID-19, and in case of emergence, care must be done in a separate airborne room. In the pos-pandemic phase, the dental care general recommendations should be the same for all subjects. Changes in the current guidelines have been proposed to SARS-CoV-2 infection control in order to provide the best and safe dental practice. However, they still need to be validated by future studies.

A 63-Year-Old Woman with a History of Non-Hodgkin Lymphoma with Persistent SARS-CoV-2 Infection Who Was Seronegative and Treated with Convalescent Plasma

“…Antibody-dependent enhancement has been seen in dengue, influenza, and flavivirus and is a phenomena of virus-antibody immunocomplexes binding to cells with complement or Fc receptors promoting viral cell uptake [ 18 , 23 ]. Our understanding of the biological response to SARS-CoV-2 infection and the host’s immunological status is limited, as demonstrated by reports both refuting and supporting immunosuppression as a risk factor for more fatal COVID-19 outcomes [ 24 ].…”

Dental Care Provision during Coronavirus Disease 2019 (COVID-19) Pandemic: The Importance of Continuous Support for Vulnerable Patients

“…This category of patients should remain under the highest risk group label due to the severe progression of the illness. Similarly, dental patients who suffer from chronic autoimmune and/or inflammatory conditions such as pemphigus, Sjögren syndrome, or lupus erythematosus and who are undertaking long-term immunomodulatory therapy (using corticosteroids) are also predisposed to severe COVID-19 progression due to a reduction in host antiviral mechanisms [ 11 ]. These persons must be encouraged and advised to continue their therapy during the pandemic, as the potential exacerbation of the autoimmune-related oral lesions is likely to occur.…”

Safety recommendations for dentists and maxillofacial surgeons during COVID-19 pandemic

“…Deferred diagnosis of a malignant condition, such as oral cancer when suspected or even dysplasia in oral leucoplakia cases vastly implies the clinical outcome, influencing treatment and prognosis, subsequently 16 . Furthermore, chronic autoimmune disorders with oral manifestations, such as mucous membrane pemphigoid or pemphigus vulgaris, can be exacerbated as a result of delayed OM follow-ups, dental care and self-management or even interruption of long-term therapy 17,18 . In addition, the psychological stress-related issues during this COVID-19 situation cannot be ignored as this would potentially trigger the manifestation of periodontal diseases.…”