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COVID-19 Information and evolving best practices


Information and evolving best practices

COVID-19 Intro text

The need for information on COVID-19 is great, and more information is emerging on a continuous basis. As your academic partner, we have undertaken to gather the most useful information related to dentistry that is currently available. In order to make the information more accessible, we have divided it into five categories. This page is being updated continuously.

Nested Applications

COVID-19 Risk Assessment Teaser


COVID-19 Risk Assessment

Addendum to the SAC Classification

This document is intended to address specific potential risks associated with transmission of SARS-CoV-2 during implant therapy.

COVID 19 Accordions

Current scientific literature on COVID-19 and SARS-CoV-2

Single Dose Administration, And The Influence Of The Timing Of The Booster Dose On Immunogenicity and Efficacy Of ChAdOx1 nCoV-19 (AZD1222) Vaccine
This pre-print paper currently in review at the Lancet offers new data on the Oxford AstraZeneca vaccine administered to 17,177 participants in UK, Brazil and South Africa that backs a 12-week dosing interval as an effective strategy for reducing disease and achieving an optimal rollout of a pandemic vaccine when supplies are limited in the short term.
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Safety and Immunogenicity of SARS-CoV-2 mRNA-1273 Vaccine in Older Adults
This phase 1, dose-escalation, open-label trial included 40 older adults, who were stratified according to age (56 to 70 years or ≥71 years). The participants were assigned sequentially to receive two doses of either 25 μg or 100 μg of vaccine administered 28 days apart. The 100-μg dose induced higher binding- and neutralizing-antibody titers than the 25-μg dose, which supports the use of the 100-μg dose in a phase 3 vaccine trial. Reported adverse events associated with the mRNA-1273 vaccine were mainly mild or moderate.
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Immunological memory to SARS-CoV-2 assessed for up to 8 months after infection
The aim of this study was to fill gaps in the basic understanding of immune memory after COVID-19. Simultaneous measurement of multiple compartments of adaptive immunity were performed in a group of subjects with a full range of disease, and distributed from short time points after infection out to 8 months later. Each component of SARS-CoV-2 immune memory exhibited distinct kinetics but the data also showed that immune memory in at least three immunological compartments was measurable in ~95% of subjects 5 to 8 months PSO, indicating that durable immunity against secondary COVID-19 disease is a possibility in most individuals.
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The Comparative Clinical Performance of Four SARS-CoV-2 Rapid Antigen Tests and Their Correlation to Infectivity In Vitro
The findings of this evaluation suggested that large-scale use of faster, less expensive, and simpler-to-use SARS-CoV-2 Ag-RDT-based testing can be considered for detecting potentially infective individuals and reducing the virus spread.
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Comparison of Saliva and Nasopharyngeal Swab Nucleic Acid Amplification Testing (NAAT) for Detection of SARS-CoV-2 A Systematic Review and Meta-analysis
The findings from this systematic review and meta-analysis suggested that saliva NAAT represents an attractive alternative to nasopharyngeal swab NAAT and may significantly bolster massive testing efforts.
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Afucosylated IgG characterizes enveloped viral responses and correlates with COVID-19 severity
This article offers a detailed insight into IgG function in relation to COVID-19 disease and therapy. Described as a double-edged sword, the variable composition in humans of highly conserved N-linked glycan within the IgG-Fc tail and its role in amplifying pro-inflammatory cytokine release and acute phase responses is contrasted with therapeutic use of plasma enriched with fucosylated anti-SARS-CoV-2 antibodies.
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Challenges in creating herd immunity to SARS-CoV-2 infection by mass vaccination
This comment in The Lancet examines different projections for achieving herd immunity by mass vaccination. It also explains the need for phase 3 trial information on efficacy and safety to be followed by well-designed phase 4 trials for recording serious adverse events and identifying infections and severity of disease in repeatedly exposed individuals. The phase 4 trials should be based on representative and large numbers of those vaccinated and followed up over time.
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Durability of responses after SARS-CoV-2 mRNA-1273 Vaccination
This letter to the editor reports on immunogenicity data 119 days after the first vaccination in 34 healthy adult participants in the same trial who received two injections of vaccine at a dose of 100 μg. The findings provide support for the use of a 100-μg dose of mRNA-1273 in an ongoing phase 3 trial, which has also recently shown a 94.5% efficacy rate in an interim analysis.
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Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK
This article reports on the data from four ongoing blinded, randomized, controlled trials done across the UK, Brazil, and South Africa with a total of 23,848 enrolled participants. The findings confirm that ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials.
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What we know about COVID-19 vaccine development
This publication from the WHO’s Information Network for Epidemics (EPI-WIN) provides a very useful overview of vaccines. It sets out the general rationale for vaccines as well as an explanation of vaccine types and development before going into more specific details on the progress of COVID-19 vaccines
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An mRNA Vaccine against SARS-CoV-2 - Preliminary Report
This paper reports on a trial including 45 healthy adults, 18 to 55 years of age, who received two vaccinations, 28 days apart. The mRNA-1273 vaccine induced anti-SARS-CoV-2 immune responses in all participants, and no trial-limiting safety concerns were identified. These findings support further development of this vaccine.
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Rapid, pointofcare antigen and molecularbased tests for diagnosis of SARSCoV2 infection
This Cochrane systematic review looks at the accuracy of rapid tests for diagnosing COVID-19 that were performed during a health-care visit (point-of-care). The hope is that they can help people to isolate early and reduce the spread of infection. At this point, however, the review concludes that the evidence currently is not strong enough and more studies are urgently needed to be able to say if these tests are good enough to be used in practice.
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Dexamethasone in hospitalised patients with COVID-19: addressing uncertainties
This article provides a helpful overview of the current status of understanding of the beneficial therapeutic effect of moderate dose dexamethasone in the treatment of hospitalized COVID-19 patients. The article also outlines the uncertainties that still exist and the further research that is needed to resolve these. As other new and potentially beneficial therapeutics are tested, the article also highlights the need for ongoing assessment of their interaction with dexamethasone.
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Types of COVID-19 vaccines
This primer from the Corona Virus Resource Center at Johns Hopkins University & Medicine consists of a series of brief reports on vaccine development, allocation, and deployment both in the United States and globally. The topics addressed include ensuring the safety and efficacy of Covid-19 vaccines, principles for vaccine allocation, strategies for deployment and delivery of Covid-19 vaccines, vaccine confidence and demand, and the economics of Covid-19 vaccines.
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Saliva or Nasopharyngeal Swab Specimens for Detection of SARS-CoV-2
This study suggests that collection of saliva samples by patients themselves would carry the advantages of negating the need for direct interaction between health care workers and patients, alleviate the demand for supplies of swabs and personal protective equipment, and assist the growing need for testing in the diagnosis of SARS-CoV-2 infection.
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Influenza in the COVID-19 Era
This clinical update stresses the importance of the 2 most effective infection-prevention tools currently available to address the population vulnerable to concurrent influenza and COVID-19 epidemics: widespread implementation of seasonal influenza vaccination and preservation of non-pharmacologic interventions until community immunity is achieved through an effective SARS-CoV-2 vaccine and/or natural infection.
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Persistent Symptoms in Patients After Acute COVID-19
This article recommends ongoing monitoring of symptoms persisting after recovery from COVID-19 in order to gain a clearer picture and understanding of long-lasting effects.
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Six symptom clusters identified.
An analysis of data obtained from a symptom tracker app has shown that there are six distinct “types” of COVID-19, each distinguished by a cluster of symptoms. The researchers suggest that these types could be used to predict the need for respiratory support in severe COVID-19.
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Sudden onset, acute loss of taste and smell in coronavirus disease 2019 (COVID-19): a systematic review
This systematic review is based on reports from eight studies that met the selection criteria. In a total of 11,054 COVID-19 patients, anosmia and dysgeusia symptoms were present in 74.9% and 81.3% ambulatory as well as hospitalized, mild-to-severe cases, respectively.
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Enanthem in Patients With COVID19 and Skin Rash
This article describes itself as reporting preliminary observations that are limited by the small number of cases and the absence of a control group. Despite the increasing reports of skin rashes in patients with COVID-19, establishing an etiological diagnosis is challenging. However, the presence of enanthem is a strong clue that suggests a viral etiology rather than a drug reaction, especially when a petechial pattern is observed.
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Adverse outcomes and mortality in users of non-steroidal anti-inflammatory drugs who tested positive for SARS-CoV-2: A Danish nationwide cohort study
This nationwide cohort study with 9,236 PCR-positive individuals in the period from February 27 to April 29 reported that use of NSAIDs was not associated with 30-day mortality, hospitalization, ICU admission, mechanical ventilation, or renal replacement therapy in Danish individuals who tested positive for SARS-CoV-2.
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An mRNA Vaccine against SARS-CoV-2 — Preliminary Report
This candidate vaccine mRNA-1273 encodes the stabilized prefusion SARS-CoV-2 spike protein. It induced an anti-SARS-CoV-2 immune response in all participants and no trial-limiting safety concerns were identified. The vaccine is now going into further development.
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Prevalence of SARS-CoV-2 Infection Among Health Care Workers in a Tertiary Community Hospital
This research letter concludes that PPE, when available and properly used, confers protection and lower infection rates of COVID-19 among health care workers when compared with reported infection rates in the general public.
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COVID-19 Research in Brief: December, 2019 to June, 2020
This article provides an overview of biomedical research into clinical testing, drug repurposing, candidate vaccines, pathogenesis, immunity and transmission.
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Simulated Sunlight Rapidly Inactivates SARS-CoV-2 on Surfaces
This article reports that sunlight may rapidly inactivate SARS-CoV-2 on surfaces, suggesting that persistence, and subsequently exposure risk, may vary significantly between indoor and outdoor environments. The study also indicates that natural sunlight may be effective as a disinfectant for contaminated nonporous materials.
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Clinical Course and Molecular Viral Shedding Among Asymptomatic and Symptomatic Patients With SARS-CoV-2 Infection in a Community Treatment Center in the Republic of Kore
This cohort study of 303 symptomatic and asymptomatic patients with SARS-CoV-2 infection isolated for three weeks in a community treatment center in Cheonan, Republic of Korea, found that the viral load in asymptomatic patients was similar to that in symptomatic patients. The study therefore suggests that identification and isolation of asymptomatic patients may be necessary to control the spread of SARS-CoV-2.
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Risk of COVID-19 in health-care workers in Denmark: an observational cohort study
This study found that the prevalence of health-care workers with antibodies against SARS-CoV-2 was low but higher than in blood donors in the same geographic region. The risk of SARS-CoV-2 infection in health-care workers was related to exposure to infected patients. More than half of seropositive health-care workers reported symptoms attributable to COVID-19.
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Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19)
This review published in July 2020 provides both a summary overview as well as a more in-depth evaluation of progress in observations related to Covid-19 as well as advances in prevention and effective management.
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Oral saliva and COVID-19
This article provides an overview of saliva, its association with COVID-19, and a three-step guideline for differential saliva gland disease diagnostics.
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Rapid Decay of Anti–SARS-CoV-2 Antibodies in Persons with Mild Covid-19
In this letter to the editor, concern is raised regarding findings of early antibody decay in 34 patients at a mean of 86 days after onset of symptoms (range, 44 10 119).  
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Evolution of Altered Sense of Smell or Taste in Patients With Mildly Symptomatic COVID-19
This article reports on the findings of a prospective study at the 4-week time point from onset of SARS-C0V-2 infection. Of the 202 patients, 55 patients (48.7%) reported complete resolution of smell or taste impairment, 46 (40.7%) reported an improvement in the severity, and only 12 (10.6%) reported the symptom was unchanged or worse. The article points out that persistent loss of smell or taste was not associated with persistent SARS-CoV-2 infection.
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Safety and immunogenicity of the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2: a preliminary report of a phase 1/2, single-blind, randomised controlled trial
This article reports that ChAdOx1 nCoV-19 showed an acceptable safety profile, and homologous boosting increased antibody responses. These results, together with the induction of both humoral and cellular immune responses, support large-scale evaluation of this candidate vaccine in an ongoing phase 3 program.
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The Covid-19 Vaccine-Development Multiverse
This NEJM editorial looks at the progress of developing a safe, efficacious COVID-19 vaccine in record time. There is specific reference to a preliminary phase 1 report, also featured here, on mRNA-1273 vaccine-induced anti–SARS-CoV-2 immune responses in a group of 45 healthy adults aged 18-55 years.
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A Dynamic Immune Response Shapes COVID-19 Progression
This article reports on profiling of the inflammatory response of three COVID-19 patients. The findings include:

  • Early immune response in COVID-19 patients is highly dynamic
  • Most pro-inflammatory genes, except IL1, were induced after respiratory function nadir
  • Reduced T cell activation in mild cases may contribute to prolonged RNAemia

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COVID-19 infection: the perspectives on immune responses
This article from March 2020 examines the knowledge base on the following points regarding COVID-19 pathogenesis:

  • Two-phase immune responses
  • Cytokine storm and lung damage
  • HLA haplotypes and SARS-CoV-2 infection
  • Hyaluranan: a potential cause of fatalities

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Multisystem Inflammatory Syndrome in U.S. Children and Adolescents (MIS-C)
This article reports on a targeted surveillance for MIS-C from March to May 2020 in pediatric health centers across the US. The aim was to understand the epidemiology and clinical course of MIS-C and its temporal association with coronavirus disease 2019 (Covid-19). The surveillance found that MIS-C associated with SARS-CoV-2 led to serious and life-threatening illness in previously healthy children and adolescents.
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Could there be a link between oral hygiene and the severity of SARS-CoV-2 infections?
This paper seeks to answer this question through discussion of the following key points:

  • Description of what COVID-19 is and the associated risk factors for developing complications.
  • Investigation of whether bacteria contribute to COVID-19 complications by causing bacterial superinfections.
  • Examination of whether there is a link between the oral microbiome and COVID-19 complications.

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Validation of predictors of disease severity and outcomes in COVID-19 patients: a descriptive and retrospective study
With increasing focus on predictive indicators for the severity and outcome of COVID-19 disease, the following findings are reported by this study:

  1. Inflammatory cytokines, lymphocytes and viral load predict prognosis in COVID-19 patients.
  2. Inflammatory cytokines, lymphocytes and viral load indicate disease severity.
  3. Lymphocytes and C-reactive protein distinguish between severe and moderate types.
  4. Lymphocyte count is the most effective indicator of disease severity and prognosis.

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Artificial Intelligence (AI) applications for COVID-19 pandemic
This article offers a review the role of AI as a decisive technology to analyze, prepare for prevention and the fight with COVID-19 (Coronavirus) and other pandemics. It is suggested that AI may play a vital role in understanding and suggesting the development of a vaccine for COVID-19. This technology can be used for prescreening, analyzing, prediction and tracking of current patients and likely future patients. The significant applications are applied to track data of confirmed, recovered and death cases.
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Prevalence of Gastrointestinal Symptoms and Fecal Viral Shedding in Patients With Coronavirus Disease 2019
The findings of this systematic review and meta-analysis reports suggest that 12% of patients with COVID-19 will manifest GI symptoms; however, SAR-CoV-2 shedding was observed in 40.5% of patients with confirmed SARS-CoV-2 infection.
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False Negative Tests for SARS-CoV-2 Infection — Challenges and Implications
This perspective review the current progress on SARS-CoV-2 tests and proposes the following conclusions:

  • diagnostic testing can assist safer reopening after lockdown.
  • tests need to be highly sensitive and validated under realistic conditions against a clinically meaningful reference standard.
  • measuring test sensitivity in asymptomatic people is an urgent priority.

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All you need to know about COVID-19 candidate vaccines in clinical trials
There are currently 10 COVID-19 candidate vaccines in clinical evaluation. These candidates are based on 5 different vaccine technologies including inactivated variants of SARS-CoV-2, RNA, DNA, protein subunits, and non-replicating viral vectors. This article provides an overview of the main advantages and limitations of these vaccine systems.
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Validation of predictors of disease severity and outcomes in COVID-19 patients: a descriptive and retrospective study
With increasing focus on predictive indicators for the severity and outcome of COVID-19 disease, the following findings are reported by this study:

  1. Inflammatory cytokines, lymphocytes and viral load predict prognosis in COVID-19 patients.
  2. Inflammatory cytokines, lymphocytes and viral load indicate disease severity.
  3. Lymphocytes and C-reactive protein distinguish between severe and moderate types.
  4. Lymphocyte count is the most effective indicator of disease severity and prognosis.

Read more

Artificial Intelligence (AI) applications for COVID-19 pandemic
This article offers a review of the role of AI as a decisive technology to analyze, prepare for prevention and the fight with COVID-19 (Coronavirus) and other pandemics. It is suggested that AI may play a vital role in understanding and suggesting the development of a vaccine for COVID-19. This technology can be used for prescreening, analyzing, prediction and tracking of current patients and likely future patients. The significant applications are applied to track data of confirmed, recovered and death cases.
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Real-time tracking of self-reported symptoms to predict potential COVID-19
This brief communication reports on a free symptom-tracker Smart Phone App that was launched in the UK and US on  March 29, 2020. It collects data from both symptomatic and asymptomatic individuals and trackshow the disease progresses in real time by recording self-reported health information on a daily basis, including symptoms, hospitalization, reverse-transcription PCR (RT-PCR) test outcomes, demographic information and pre-existing medical conditions. Based on data from over 2.6 million users, the proportion of participants who reported loss of smell and taste was higher in those with a positive SARS-CoV-2 test result (4,668 of 7,178 individuals; 65.03%) than in those with a negative test result (2,436 of 11,223 participants; 21.71%) (odds ratio = 6.74; 95% confidence interval = 6.31–7.21).
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Saliva is a non‐negligible factor in the spread of COVID‐19
This article reports on saliva as a potential transmission route for COVID-19 and suggests experience-based protective measures that can help reduce the risk of saliva-related transmission.
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Remdesivir for the Treatment of Covid-19 — Preliminary Report
This article reports on the positive findings that remdesivir is superior to placebo in shortening the time to recovery in adults hospitalized with COVID-19 and evidence of lower respiratory tract infection.
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COVID-19: what has been learned and to be learned about the novel coronavirus disease
This article attempts to provide a timely, comprehensive helpful review of the basics of the epidemiology, etiology, virology, diagnosis, treatment, prognosis, and prevention of the disease.
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Asymptomatic Transmission, the Achilles’ Heel of Current Strategies to Control Covid-19
This editorial explains and argues for the importance of broadening SARS-CoV-2 testing to include asymptomatic persons in prioritized settings as part of the eventual need to relax current social distancing practices.
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Infection fatality rate of SARS-CoV-2 infection in a German community with a super-spreading event
This sero-epidemiological study conducted in a small German town following a superspreading event reports the following: the infection status in the study population was five-fold higher than the reported number of cases for the community (3.1%); ranked by odds ratios, significant, characteristic symptoms were loss of smell; loss of taste; fever; sweats and chills; fatigue, cough, muscle joint ache; chest tightness; headache; sore throat and nasal congestion; 22.2% of infected individuals were asymptomatic; participation in carnival festivities increased both infection rate and number of symptoms.
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Serological tests for Covid-19 antibodies: limitations must be recognised
Serological tests for COVID-19 antibodies have been hailed as a potential “game-changer” that could limit the spread of infection and lead to the relaxation of some of the current restrictions relating to social distancing. This article emphasizes the importance of recognizing the complexity and, especially, the limitations of these tests.
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Compassionate Use of Remdesivir for Patients with Severe Covid-19
An overview of the Remdesivir anti-viral agent: It is a nucleotide analogue prodrug that inhibits viral RNA polymerases and has shown in vitro activity against SARS-CoV-2. Remdesivir has been undergoing clinical trials for its effectiveness as an agent used in treatment of COVID-19. Preliminary results were leaked last week and then withdrawn but the final results are due for official release and publication soon. Remdesivir is also mentioned in the article ‘Mild or Moderate Covid-19’ referenced below.
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Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19)
This narrative review summarizes the ongoing efforts to identify effective drugs for the prevention and treatment of COVID-19. No proven effective therapies exist at present but clinical trials are under way looking at repurposing existing drugs, new investigational drugs and adjunctive therapies. The review also comments on current clinical treatment experience and recommendations.
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Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young 
This correspondence from the health system in New York City reports on five cases of large-vessel stroke in patients younger than 50 years of age. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was diagnosed in all five patients. The report raises the concern that the patients had not connected their symptoms with COVID-19 and suggests that this association in younger patients requires further investigation. 
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Mild or Moderate COVID-19
This article begins with a case vignette highlighting a common medical clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, if they exist. The article also provides an overview of ongoing clinical trials testing the effectiveness of a range of agents. The article ends with the authors’ clinical recommendations.
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Coronavirus Disease 2019 (COVID-19): Emerging and Future Challenges for Dental and Oral Medicine
This article from Wuhan University, School and Hospitality of Stomatology, China introduces relevant guidelines based on the knowledge, research and experience gained about COVID-19 and nosocomial infection in dental settings.
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Virology, Epidemiology, Pathogenesis, and Control of COVID-19
This article published 27 Mar 2020 aims to provide a comprehensive review and summary of the present understanding of COVID-19.
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Recognition of aerosol transmission of infectious agents: a commentary
Overview that outlines transmission terminology and discusses potential for intervention. The overview suggests that the most obvious sources of infection are the contacts outside of the professional environment as these are only partially under control. However, even if aerosol transmission in the clinical environment accounts for only a minority of cases they may also be the more severe and specific interruption is therefore required.
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Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1
Results on potential for transmission of SARS-CoV-2 indicate that aerosol and fomite transmission of SARS-CoV-2 are plausible since the virus can remain viable and infectious in aerosols for hours and on surfaces for days.
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The Untold Toll — The Pandemic’s Effects on Patients without Covid-19
This article looks at the challenge of offering continued support for patients without COVID-19 who may be reluctant to come forward for assessment and treatment.
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Recommendations for dental care during COVID-19

Guideline: Dealing with aerosol-borne pathogens in dental practices
These living guidelines present recommendations for dental practitioners during the COVID-19 pandemic for adequate protective measures against pathogens transmitted via droplets or aerosols from the patients’ oral cavity. The guidelines developed in Germany are based on a search of electronic databases together with reports and guidelines from major health authorities, national dental associations and health regulatory bodies.

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Estimating COVID-19 prevalence and infection control practices among US dentists
This article reports on the findings of a web-based survey conducted in June 2020. The survey found that COVID-19 prevalence and rates of positive tests were low among practicing US dentists. The article concludes that the findings indicate that the current infection control recommendations may be sufficient to prevent infection in dental settings.
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Mitigation of Aerosol Generating Procedures in Dentistry A Rapid Review
This recently published document by the Scottish Dental Clinical Effectiveness Programme offers a comprehensive review of the AGP topic. The document is intended to inform policy (it is clearly stated that it does not assume the status of guidance) and it covers definitions, procedural and environmental mitigation. An agreed position statement follows each of the subtopics covered under these three headings. Look out also for the helpful overview tables on pages 10 and 23.
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American Dental Association Responds to World Health Organization Recommendation: Dentistry is Essential Health Care
The ADA issued this statement in response to the WHO’s recommendation to delay routine dental care. The ADA strongly disagrees on the basis that oral health is integral to overall health. With the introduction of additional, specific COVID-19 precautions and following the safe treatment of millions of patients with a full range of services in the past months, the ADA advocates continuation of dental care during this pandemic. 
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Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
The aim of this rapid review was to assess how dental aerosol generating procedures (AGPs) were defined in international dental guidelines, what mitigation processes were advised and whether they were linked to COVID-19 epidemiology.
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Management of Dental Problems During COVID-19 Pandemic
This links provides access to two documents authored by the SDCEP Scottish Dental Effectiveness Program with clear and helpful overviews on management of acute dental problems and drugs for management of dental problems during the COVID-19 pandemic.
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Possible aerosol transmission of COVID-19 and special precautions in dentistry
This review examines the new challenges and responsibilities for dental professionals associated with the emergence of COVID-19 to identify and introduce special precautions in addition to standard measures to prevent disease transmission from asymptomatic carriers.
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Use Personal Protective Equipment (PPE) When Caring for Patients with Confirmed or Suspected COVID-19
This two-page generic and illustrated pdf offers clear, practical explanations and guidance for two levels of personal protective equipment and the sequence of steps in donning and doffing at outset and completion of clinical patient contact and procedures.
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Recommendations for the re-opening of dental services: a rapid review of international sources
This living document from the Cochrane Oral Health offers a review of internationally produced guidance for re-opening dental services. The document includes a helpful rapid overview and has been updated with the addition of a further five countries.
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Being a front-line dentist during the Covid-19 pandemic: a literature review
This article addresses all information collected to date on the virus, in accordance with the guidelines of international health care institutions, and provides a comprehensive protocol for managing possible exposure to patients or those suspected of having coronavirus.
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COVID-19 Transmission in Dental Practice: Brief Review of Preventive Measures in Italy
This article details the literature search, documented clinical experience and measures for professional prevention that forms the current basis of Italy’s recommendations for patient management and treatment in dental practice.
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Dental Care and Oral Health under the Clouds of COVID-19
This comprehensive review article starts with an explanation of the bare basics of SARS-CoV-2, its spread amongst humans and the challenge of transmission by asymptomatic/pre-symptomatic patients. It then moves on to discuss the oral health implications of SARS-CoV-2 and provision of dental care during the COVID-19 pandemic, before rounding off with a look ahead to the efforts needed for better future emergency preparedness.
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This site links to the latest recommendations from the Australian Dental Association as provision of dental care moves to level 2 restrictions: provision of dental treatments that are unlikely to generate aerosols or where aerosols generated have the presence of minimal saliva/blood due to the use of rubber dam.
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Transmission routes of 2019-nCoV and controls in dental practice
A summary of possible transmission routes in dental care settings compiled by Stomatology department in Wuhan, China and published March 2020. The summary also includes recommendations for cross infection control measures for dental practice to block person-to-person transmission.
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Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents
Review of existing literature on all available information on persistence on inanimate surfaces of human and veterinary coronaviruses.
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Considerations for everyday practice during COVID-19

The efficacy of bio-aerosol-reducing procedures used in dentistry: a systematic review
The objective of this systematic review was to evaluate available data on three major measures: rubber dam application, pre-procedural oral rinse, and high-volume evacuators (HVE) aimed at reducing bio-aerosols. The review concludes that no one measure provides a blanket cover but a combination of strategies of rubber dam with a pre-procedural antimicrobial oral rinse and HVE may contain bio-aerosols during operative procedures.
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Prevalence of mucocutaneous manifestations in 666 patients with COVID‐19 in a field hospital in Spain: oral and palmoplantar findings
This research letter reports on patients who were hospitalized and had either positive realtime reversetranscription polymerase chain reaction (RTPCR) testing for SARSCoV2, or bilateral pneumonia. In this patient group, 304 (45.7%) presented with one or more mucocutaneous manifestations. Of specific dental interest, oral cavity findings were seen in 78 cases (25.7%). These included transient lingual papillitis (11.5%), glossitis with lateral indentations (6.6%), aphthous stomatitis (6.9%), glossitis with patchy depapillation (3.9%) and mucositis (3.9%). Burning sensation was reported in 5.3% of patients, and taste disturbances (dysgeusia) were commonly associated.
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Virucidal Efficacy of Different Oral Rinses Against Severe Acute Respiratory Syndrome Coronavirus 2
This in-vitro study reported evidence that SARS-CoV-2 can be efficiently inactivated by commercially available oral rinses within short exposure times of 30 seconds. Of eight products tested, three demonstrated a significant reduction of viral infectivity to undetectable levels: Dequonal (dequalinium chloride, benzalkonium chloride), Iso-Betadine mouthwash 0% (polyvidone-iodine) and Listerine Cool Mint (Ethanol, essential oils). Next step trials for study of in-vivo effect have been registered.
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A prospective clinical pilot study on the effects of a hydrogen peroxide mouth rinse on the intraoral viral load of SARS-CoV-2
This study reports that a 1% hydrogen peroxide mouth rinse does not reduce the viral load of SARS-CoV-2 and continued recommendation for its use as a preprocedural measure for dental treatment is therefore questionable and should no longer be supported.
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The efficacy of an extraoral scavenging device (EOS) on reduction of splatter contamination during dental aerosol generating procedures: an exploratory study
The findings from this study suggest that EOS devices can contribute to risk mitigation of aerosol-generating procedures but use of other conjunctive measures including four-handed dentistry and rubber dam should also continue to maximize mitigation.
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Is the oral cavity relevant in SARS-CoV-2 pandemic?
This discussion paper suggests that antiseptic mouthwashes may be able to decrease oral viral load in infected subjects but also that the evidence on their efficacy is indirect and weak.
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Hand Hygiene During COVID-19: Recommendations from the American Contact Dermatitis Society
This article provides an overview of the most frequently used hand-hygiene products and their associations with contact dermatitis as well as recommendations from the ACDS on how to treat and prevent further dermatitis.
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Medical masks vs N95 respirators for preventing COVID‐19 in healthcare workers: A systematic review and meta‐analysis of randomized trials
In contrast to a previously featured systematic review (1990 to 2014) on effectiveness of surgical versus N95 masks for protecting health care workers, this systematic review covers the period from 2014 to 2020 and includes data from the COVID-19 period. The available evidence appears to be limited by indirectness and imprecision, and cautious recommendations are offered on this basis.
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Airborne Transmission of SARS-CoV-2 Theoretical Considerations and Available Evidence
This viewpoint examines the gap between demonstrating that speaking and coughing can generate aerosols or that it is possible to recover viral RNA from air and proving that this results in aerosol-based transmission.
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Rapid In-Vitro Inactivation of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Using Povidone-Iodine Oral Antiseptic Rinse
This study investigated optimal contact time and concentration for viricidal activity of preparation of povidone‐iodine (PVP‐I) against SARS‐CoV‐2 (USA‐WA1/2020 strain) to mitigate the risk and transmission of the virus in the dental practice. Rapid inactivation of SARS‐CoV‐2 virus in vitro by PVP‐I oral antiseptic preparation was present at the lowest concentration of 0.5 % PVP‐I and at the lowest contact time of 15 seconds. This finding supports the argument that use of pre-procedural oral rinsing with PVP‐I (for patients and healthcare providers) may be useful as an adjunct to personal protective equipment for dental and surgical specialties during the COVID‐19 pandemic.
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Headaches and the N95 face-mask amongst healthcare providers
A survey from 2006 reports on mandatory use of N95 masks during the 2003 SARS epidemic. The survey included 212 healthcare workers (47 male, 165 female and men with a mean age of 31 years rangng between 21-58). It concluded that  headaches may develop following use of N95 masks and shorter duration of face-mask wear may reduce frequency and severity of these headaches.
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Correlation Between N95 Extended Use and Reuse and Fit Failure in an Emergency Department
This research letter comments on fit test failures associated with reuse of two common types of N95 masks.
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What you need to know: PPE and fit-testing
In this link to the British Dental Association COVID-19 blog, an accredited fit-tester for NHS England shares 10 things it is recommended that the dental profession knows about fit-testing PPE and the dental practice.
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Guide to classification of masks (German/English)
This German/English overview provides international information on classification and standards of facial respiratory masks.
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Correlation Between N95 Extended Use and Reuse and Fit Failure in an Emergency Department
This research letter comments on fit test failures associated with reuse of two common types of N95 masks.
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Comment on: Oral Manifestation of COVID-19 as an inaugural symptom?
In this letter to the editors, the two authors recommend that early diagnosis of COVID-19 can be assisted by identification of oral symptoms with high prognostic potential: both loss of taste (amblygeustia) by itself and in combination with zerostomia can be used in patient screening/triage criteria.
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The effect of rubber dam on atmospheric bacterial aerosols during restorative dentistry
This study from 2016 reports interesting findings associated with use of rubber dam that are relevant to PPE considerations for covering the head and neck areas of the treating clinician during this COVID-19 period. The study found that use of rubber dam resulted in significantly higher aerosol levels on various aspects of the clinician’s head than without it. 
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Non-compliant respirators/misrepresentation of NIOSH approval
This article from US CDC raises awareness of non-compliant respirator products that are falsely marketed and sold as being NIOSH-approved and may not be capable of providing appropriate respiratory protection to workers.
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Effect of single- versus double-gloving on virus transfer to health care workers’ skin and clothing during removal of personal protective equipment
This article from 2012 reports on a study where a harmless virus was used to obtain quantitative data on transfer during doffing of personal protective equipment. The study concluded that if incorporated into practice, double gloving can reduce the risk of viral contamination of health care workers’ hands during PPE removal.
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There is no time after COVID-19, only before and now.
This is a helpful overview compiled by two German oral maxillofacial surgeons offering their take on dental challenges and their management in the current COVID-19 situation.
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Understanding Mask Types
This one-page guide from the US ADA provides a helpful overview of surgical masks, N95 and N95-equivalent masks.
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The use of Povidone Iodine nasal spray and mouthwash during the current COVID-19 pandemic may reduce cross infection and protect healthcare workers
Proposal by a group of experts for a routine protocol use of intra-nasal and oral application of Povidone-iodine PVP-I for both patients and their attendant healthcare workers (HCWs) during the current COVID-19 pandemic to help limit the spread of SARS-CoV-2 from patients to healthcare workers and vice versa. The authors acknowledge that the proposal is based on extrapolation of in-vitro findings into the vivo setting and that assumptions have been made that under normal circumstances would have been confirmed with in-vivo data prior to recommendations for use.
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Maxillofacial surgery and COVID-19, The Pandemic!!
This review of the COVID-19 situation from an oral-maxillofacial perspective comments on the challenges, precautions and best management to minimize risk to the operating team and to help prevent community spread.
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Consistent Detection of 2019 Novel Coronavirus in Saliva
This study published Feb 2020 looks at the detection of the 2019 novel coronavirus (2019-nCoV) in self-collected saliva from 91.7% (11/12) of patients. The study concluded that saliva is a promising non-invasive specimen for diagnosis, monitoring, and infection control in patients with the 2019-nCoV infection. However, based on the findings the article also argues the case for use of surgical masks against transmission of 2019-nCoV directly or indirectly via saliva with patients who do not show coughing or other respiratory symptoms.
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Discussion of dental aerosols and coronavirus transmission risks
General information about aerosols and their droplet sizes, contamination areas/distances, transmission modalities/ability along with protective strategies against coronavirus in aerosols.
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Effectiveness of N95 Respirators Versus Surgical Masks in Protecting Health Care Workers From Acute Respiratory Infection: A Systematic Review and Meta-Analysis
This May 2017 comparison from between surgical masks and N95 respirators on the prevention of transmissible acute respiratory infections in protection of health care workers concluded that there was insufficient data to definitively determine superiority of N95 in the clinical setting.
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Correct donning and doffing of face masks
Clearly illustrated demonstration of safe use of ear loop surgical face masks (German language).
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Guidance on Preparing Workplaces for COVID-19
US Dept of Labor March 2020 general guidance for workplaces and personal protective equipment (PPE).
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What to Do if Someone on Your Staff Tests Positive for COVID-19
ADA recommended action steps in event of staff positive test for ensuring health and safety of others and reducing likelihood of additional transmissions.
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Disinfectants for Use Against SARS-CoV-2
Detailed list of products that meets US Environment Protection Agency's criteria for use against SARS-CoV-2 including product specific disinfection directions and information.
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National guidelines

Due to the increase in COVID-19 in Victoria, the Australian Dental Association site has updated its information.
Consult the latest ADA resource update and associated links

Belgium and Luxembourg
This Belgian Union of Orthodontic Specialists and Belgian Society of Periodontology site provides information in Dutch and French on the resumption of dentistry as of May 4, 2020 and recommendations for Sars Covid-19 cross-infection control protocols.
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In Canada, the COVID-19 strategy and guidance for return to practice fall under provincial jurisdictions, and the rules and recommendations therefore vary across Canada. Links to four different examples of provincial guidance across Canada are available here:

This document in Spanish covers general protocols for safety including indications for personal protection and contact follow-up.
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Beijing Municipal Health Commission:
In China, since each region and city have different situations, there is no unified COVID-19 government guideline for general dental practitioners or even the medical industry. The guidelines are individually designed by each region or city.

As the capital of China, Beijing Municipal Health Commission latest guidance for hospitals:

  • You need an appointment for non-emergency treatment
  • The elderly and those with chronic illnesses are encouraged to make use of the community health service

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Dental services have returned to provision of regular care. However, dental procedures that represent great risk of cross-infection should not be carried out on COVID-19 positive patients. Where COVID-19 risk is judged to be present, the patient should be referred for testing first.
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Réouverture des cabinets - guide pratique à partir des recommandations d'experts validées - 7 mai:
This link offers practical guidance related to reopening dental practices following the COVID-19 lockdown.
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This link offers practical interim COVID-19 guidance for dental treatment.
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Dental care is restricted to emergencies (risk to patient life) and urgent (priority dental needs). Elective dental treatment should not be undertaken and where possible aerosol-generating procedures should be avoided. Triage is required to identify patients with symptoms, known contact with other COVID-19 positive persons and/or travel history to COVID-19 hot spots. Patients with suspected COVID-19 positive status should be referred to the local medical hospital. 
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COVID-19 Guidance on Managing Infection Related Risks in Dental Services:
This link offers guidelines from HSE Health Protection Surveillance Centre for reopening dental practices in Ireland.
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Information from Korean Dental Association:
Dedicated website for COVID-19 information. It contains

  • Guidelines for dental clinics in practices
  • Required safety measures for the dental clinic
  • List of government supports for the dental clinic
  • Printable posters

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Regular dental care can resume for patients who have no COVID-19 symptoms or who have recovered from COVID-19 and been symptom-free for 14 days. Oral care should be postponed in patients with definite or suspected COVID-19 disease or in quarantine with COVID-19-positive persons. Emergency care should be referred to specific (CAM) units.

UPDATE: Reduction in rate of COVID-19 infection in the Netherlands is reflected in the updated guidance for dental practices effective from July 1, 2020.
View guidance and associated useful links
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New Zealand
Now on Alert level 2 restrictions according to which NZ-based dentists, specialists, hygienists and therapists are able to provide routine dental treatment for all patients who are not suspected of having COVID-19, nor had contact with COVID-19 positive patients, or any links to recent overseas travel. This includes aerosol-generating procedures. PPE required is per standard existing guidelines detailed in this pdf.

For COVID-19 positive or suspected positive patients, urgent and emergency dental treatment can only be provided when the specified room and PPE requirements can be met. These are detailed in this pdf.

With effect from April 27, dental treatment can be carried out nationwide under the following circumstances:

  • Covid-19 Triage is undertaken prior to/on arrival at practice
  • Patients are encouraged to wear masks on arrival
  • Patient temperature is taken at entrance (max. accepted temperature 37.5 °C)
  • Patient disinfect their hands at entrance
  • Waiting time should be limited to 15 minutes with minimum 2-meter social distancing. Where possible use of waiting room avoided
  • Treatments limited to rooms that can be ventilated for 15 minutes between appointments
  • Patient should rinse with povidone-iodine or hydrogen peroxide before treatment
  • Dental hygiene procedures limited to use of hand instruments
  • Symptomatic patients and health care workers or those with known close contact to an infected person in the last 2 weeks should remain at home in isolation for 14 days
  • Covid-positive patients: only emergency treatments and only with dedicated equipment.

Download article in German (PDF)

Management of Acute Dental Problems During COVID-19 Pandemic:
This link provides access to two documents authored by the SDCEP Scottish Dental Effectiveness Program with clear and helpful overviews on management of acute dental problenms and drugs for managment of dental problems during the COVID-19 pandemic.
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UK FCDP COVID-19: latest guidance and resources for General Dental Practitioners:
Updates on the key instructions from government agencies compiled by the Faculty of General Dental Practitioners, UK 28 May 2020.

Dental practices may reopen from Monday 8 June for all face-to-face care, where practices assess that they have the necessary infection prevention and control together with personal protective equipment requirements in place. 

Sequencing and scheduling of patients for treatment as services resume should take into account:

  • The urgency of needs
  • The particular unmet needs of vulnerable groups
  • Available capacity to undertake activity

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In order to protect staff and preserve personal protective equipment and patient care supplies, as well as expand available hospital capacity during the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) recommends that dental facilities postpone elective procedures, surgeries, and non-urgent dental visits, and prioritize urgent and emergency visits and procedures now and for the coming several weeks.
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ADA Interim Guidance for Minimizing Risk of COVID-19 Transmission:
This guidance is divided into the three sections of before, during and after dental treatment.
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ADA Interim Guidance for Management of Emergency and Urgent Dental Care:
Three emergency and urgent dental care triage algorithms:

  • Algorithm 1: Triaging Patients for Emergency and Urgent Dental Care
  • Algorithm 2: Screening to Identify COVID-19 Infection for Emergency and Urgent Dental Patients
  • Algorithm 3: Minimize Risk of COVID-19 Transmission for Emergency and Urgent Dental Patients and HCP

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ITI Online Seminars

ITI Mumbai Freeway Study Club Meet 6th June 2020
This online seminar organized by ITI Section India and Young ITI India. Five ITI Scholars from India representing different disciplines seek to demystify the industry-driven COVID-19 fight with evidence-based, effective and practical solutions for dentists and their practice.
Watch online seminar

UK & Ireland Section COVID-19 open panel online seminar
Section Chair and ITI Fellow Colin Burns leads a COVID-19 discussion surrounding the current dental situation and issues in the UK and Ireland. Among his discussion partners are Thomas Lamont from the Cochrane Oral Health Group for input from the ongoing review of international recommendations for re-opening of dental practices. ITI Fellow and Oral Maxillofacial Surgeon Bilal Al Nawas reports on experiences from the continued provision of dental care in Germany throughout the pandemic. Julia Furley and Victoria Holden provide current perspective on legal and indemnity aspects of reopening.
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Findings of COVID-19 in the Dental Medical Field - A Scientific Update by Professor Dr. med. Dr. med. dent. Bilal Al-Nawas
This online seminar outlines the background of the pandemic situation, the idea of hygiene measures in the dental office and practical examples from around the globe.
Watch online seminar

ITI Canada Section online seminar: Impact of COVID-19 on the dental profession and how do we open our practices?
This online seminar is hosted by ITI Canada Section Education Delegate and ITI Fellow, Majd Al Mardini. After opening remarks by ITI President-elect Charlotte Stilwell, the invited speaker from University of Toronto, Faculty of Dentistry, Michael Glogauer, provides an overview of the impact of COVID-19 on dentistry going forward and how the profession can best prepare for this. This is followed by a Q&A session.

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