Major approaches to antiseptic management for endodontic treatment in the COVID-19 pandemic: a guideline

Abstract

Introduction: In the COVID-19 pandemic scenario, in addition to the pathogenesis of SARS-CoV-2, microbial coinfection increases the difficulties of diagnosis, treatment, the prognosis of COVID-19, as well as it can worsen comorbidities and affect the risk of the life of patients. COVID-19 has had a profound impact on dentistry. In addition to endodontic treatment, a management protocol was suggested. Objective: To present the importance of effectively performing endodontic asepsis in the context of the COVID-19 pandemic, to elucidate that infection by the SARS-CoV-2 virus can lead to coinfection, worsening the conditions for endodontic treatment. Methods: The research was carried out from July 2021 to August 2021 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, following the Systematic Review-PRISMA rules. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: A total of 70 articles were found involving the endodontic treatment and COVID-19. A total of 58 articles were evaluated in full and 39 were included and evaluated in the present study. It was found that ozone has high antimicrobial action. N-acetylcysteine (NAC) has a potent effect against endodontic biofilms. Calcium hydroxide is more effective as a root canal disinfectant in primary teeth than formocresol and camphorphenol. The association of 2% chlorhexidine followed by ozone gas for 24 seconds promoted the complete elimination of Candida albicans and Enterococcus faecalis. Low-intensity laser therapy has the property of oral sterilization, facilitating tissue healing and sterilization. Combining antimicrobial photodynamic therapy with antimicrobial irrigants may provide a synergistic effect. Conclusion: There are effective treatments for the sterilization of endodontic tissues, to avoid as much as possible the coinfection with SARS-CoV-2 and the consequent worsening of the infectious condition, highlighting calcium hydroxide, ozone therapy, and laser therapy.