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Journal of Dental Sciences xxx (xxxx) xxx

Available online at www.sciencedirect.com 61

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2 ScienceDirect 63
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6 journal homepage: www.e-jds.com
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9 Perspective 71
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12 Oral healthcare during the COVID-19 73
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14 pandemic 75
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Q2 Ondine Lucaciu ay, Dorottya Tarczali by, Nausica Petrescu a*y 78
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Department of Oral Health, Faculty of Dentistry, “Iuliu Hat‚ieganu” University of Medicine and 81
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Pharmacy, Cluj-Napoca, Romania 82
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Regional Hospital, Cluj-Napoca, Romania 83
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Received 20 April 2020; Final revision received 26 April 2020 85
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26 Q1 Introduction  Fatigue 88
27  Sputum 89
28  Shortness of breath
The Coronavirus Disease 2019 (COVID-19) epidemic began in 90
29  Dry throat
Wuhan, China, in December 2019.1 On January 1st, 2020, 91
30  Headache
WHO announced that this outbreak represents an interna- 92
31  Digestive manifestations in a small percentage of
tional public health emergency, affecting 2,725,920 people 93
32 patients1
by April 24, 2020, causing, 191,061 deaths.2 On February 11, 94
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The International Committee on Taxonomy of Viruses has 95
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made public the name of the virus causing COVID-19: severe The fraction of severe, critical cases and mortality rate 96
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acute respiratory syndrome coronavirus 2 (SARS-CoV-2).3 is higher, compared to influenza. The number of deaths per 97
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day relative to the total number of cases gives us a per- 98
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centage of 3e4%.4 99
38 Transmission paths 100
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Control of infection in oral healthcare settings 101
40 The two modes of transmission are via aerosols, through 102
41 drops of fluid spread by coughing, sneezing, and fecal-oral 103
42 In light of the thread of COVID-19 pandemic, the conception
(digestive).1 104
43 of strict and efficient protocols for oral healthcare settings
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44 is of paramount importance. This specialty is prone to cross
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45 Characteristics of COVID-19 infection among patients and healthcare workers. This
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46 article provides recommendation on patient evaluation,
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47 The incubation period is 1e14 days, most commonly 3e7 treatment approach for dental emergencies and infection
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48 days. Patients are contagious in the latency period. On control protocols.
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49 average, a patient can infect another 2e2.5 people.4
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50 The main symptoms are represented by: Screening for COVID-19 status and triaging for 112
51  Fever
dental treatments 113
52  Cough (especially dry)
114
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During the pandemic, it is recommended to perform 115
54 * Corresponding author. Department of Oral Health, Faculty of
Dentistry, “Iuliu Hat‚ieganu” University of Medicine and Pharmacy, No. exclusively emergency dental procedures to protect the 116
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15, Victor Babes street, 1st floor, Cluj-Napoca, 400012, Romania. medical personnel, the patients and to reduce as much as 117
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E-mail address: nausica_petrescu@yahoo.com (N. Petrescu). possible the consumption of personal protective equip- 118
57 y
All authors contributed equally to the work. ment. Patients’ general health assessment before dental 119
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https://doi.org/10.1016/j.jds.2020.04.012 121
60 1991-7902/ª 2020 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier B.V. This is an open access article under 122
the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Please cite this article as: Lucaciu O et al., Oral healthcare during the COVID-19 pandemic, Journal of Dental Sciences, https://doi.org/
10.1016/j.jds.2020.04.012
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55 Figure 1 Screening for COVID-19 status and triaging patients for dental treatments and guidelines of dental problem 117
56 assessment.5,6 118
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59 treatment is very important (Fig. 1), as dental health Transmission-Based Precautions are available. The indica- 121
60 workers can identify undiagnosed COVID-19 patients. tion for SARS convalescing patients was to postpone dental 122
61 Emergency dental patients that test positive for SARS-CoV-2 treatments for 1 month.7 Same recommendation could be 123
62 should be referred for emergency care where appropriate adopted for COVID-19 patients. 124

Please cite this article as: Lucaciu O et al., Oral healthcare during the COVID-19 pandemic, Journal of Dental Sciences, https://doi.org/
10.1016/j.jds.2020.04.012
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25 Figure 1 (continued). 87
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29 What is considered an emergency in dentistry, according Fig. 1. Dental practitioners should aim to ease patients 91
30 to ADA? suffering and alleviate the burden that dental emergencies 92
31 Dental emergencies are those that put the patient’s life would place on hospital emergency departments. 93
32 at risk and require immediate treatment to stop bleeding, 94
33 reduce pain and stop infection. The emergency dental Effective control of infection in the dental office 95
34 cases are represented by: 96
35 Social distancing protocol for patients should be adopted in 97
36  Severe pain of pulp origin the dental office. Appointments should be scheduled apart 98
37  Pericoronaritis, pain in the third molar region to minimize contact between patients. If this standard is 99
38  Postoperative osteitis, dry alveolitis not applicable, patients can wait in their personal vehicle, 100
39  Dental fractures causing pain or soft-tissue injuries until it is their turn. 101
40 caused by trauma Since the main route of transmission of the virus is the 102
41  Luxations, dental avulsions aerial one, it is necessary to use personal protective 103
42  Dental treatments required before general medical equipment, gloves, face masks (N-95 or FFP2), goggles or 104
43 procedures facial shield to protect the skin and mucous membranes of 105
44  Final cementation of crowns, decks if provisional resto- the medical personnel as well as waterproof robes, jump- 106
45 ration is lost, deteriorated or causes gum irritation suits. If the mask is damaged, or the doctor has difficulties 107
46  Biopsies breathing, the mask should be changed. Dental health 108
47 worker should have a seasonal flu vaccine this year, ill- 109
48 Other emergencies shall be considered as follows: health status of medical personnel has to be assessed daily. 110
49 Rigorous hand hygiene and surfaces in the dental office is 111
50  Extended cavities or damaged restorations causing pain the most important measure of reducing the transmission of 112
51 (Temporary restorations are performed) microorganisms to patients. Depending on surface type, 113
52  Suppression of suture threads temperature, humidity, SARS-CoV-2 may persist on surfaces 114
53  Dental treatments of oncology patients from a few hours to a few days. All reading materials, mag- 115
54  Dental adjustments when function is impaired azines and toys should be removed from the dental office. 116
55  Change of temporary fillings in endodontic access cav- To minimize the formation of drops and aerosols, it is 117
56 ities, if they have caused pain recommended to perform minimally invasive procedures, 118
57  Adjustment of the orthodontic apparatus if it has caused to use the surgical vacuum cleaner, 4-hand work, and rub- 119
58 pain or ulceration on the oral mucosa.8 ber dam isolation of the operator field. Before dental pro- 120
59 cedures it is recommended that the patient rinses with 121
60 Assessment of the gravity of the dental emergency is antimicrobial oral solutions.9 Resorbable sutures after sur- 122
61 very important. The evaluation of the dental and general gical procedures are recommended. Aerosol generating 123
62 health status of the patient is based on the workflow in procedures should be scheduled at the end of the program. 124

Please cite this article as: Lucaciu O et al., Oral healthcare during the COVID-19 pandemic, Journal of Dental Sciences, https://doi.org/
10.1016/j.jds.2020.04.012
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1 If procedures were performed without N95 masks, both the References 43

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Please cite this article as: Lucaciu O et al., Oral healthcare during the COVID-19 pandemic, Journal of Dental Sciences, https://doi.org/
10.1016/j.jds.2020.04.012