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      COVID-19 transmission risk and protective protocols in dentistry: a systematic review

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          Abstract

          Background

          Among several potential transmission sources in the spreading of the COVID-19, dental services have received a high volume of attention. Several reports, papers, guidelines, and suggestions have been released on how this infection could be transmitted through dental services and what should be done. This study aimed to review the guidelines in order to develop a practical feasibility protocol for the re-opening of dental clinics and the reorientation of dental services.

          Methods

          This study systematically reviewed the published literature and the guidelines of international health care institutions on dentistry and COVID-19. We searched Pubmed, Web of Science, and SCOPUS electronic databases using MESH terms. The recommendations identified were tested with a convenience sample of experienced practitioners, and a practical step-by-step protocol is presented in this paper.

          Results

          To the date this paper was drafted, 38 articles were found, of which 9 satisfied our inclusion criteria. As all the nine studies were proposed in a general consensus, any elective non-emergency dental care for patients with suspected or known COVID-19 should be postponed for at least 2 weeks during the COVID-19 pandemic. Only urgent treatment of dental diseases can be performed during the COVID-19 outbreak taking into consideration pharmacological management as the first line and contagion-reduced minimally invasive emergency treatment as the secondary and final management.

          Conclusions

          While the currently available evidence has not demonstrated a clear and direct relationship between dental treatment or surgery and the possibility of the transmission of COVID-19, there is clearly the potential for transmission. Therefore, following the protective protocols in the COVID-19 crisis is of utmost importance in a dental setting.

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          Most cited references32

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          The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application

          Background: A novel human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in China in December 2019. There is limited support for many of its key epidemiologic features, including the incubation period for clinical disease (coronavirus disease 2019 [COVID-19]), which has important implications for surveillance and control activities. Objective: To estimate the length of the incubation period of COVID-19 and describe its public health implications. Design: Pooled analysis of confirmed COVID-19 cases reported between 4 January 2020 and 24 February 2020. Setting: News reports and press releases from 50 provinces, regions, and countries outside Wuhan, Hubei province, China. Participants: Persons with confirmed SARS-CoV-2 infection outside Hubei province, China. Measurements: Patient demographic characteristics and dates and times of possible exposure, symptom onset, fever onset, and hospitalization. Results: There were 181 confirmed cases with identifiable exposure and symptom onset windows to estimate the incubation period of COVID-19. The median incubation period was estimated to be 5.1 days (95% CI, 4.5 to 5.8 days), and 97.5% of those who develop symptoms will do so within 11.5 days (CI, 8.2 to 15.6 days) of infection. These estimates imply that, under conservative assumptions, 101 out of every 10 000 cases (99th percentile, 482) will develop symptoms after 14 days of active monitoring or quarantine. Limitation: Publicly reported cases may overrepresent severe cases, the incubation period for which may differ from that of mild cases. Conclusion: This work provides additional evidence for a median incubation period for COVID-19 of approximately 5 days, similar to SARS. Our results support current proposals for the length of quarantine or active monitoring of persons potentially exposed to SARS-CoV-2, although longer monitoring periods might be justified in extreme cases. Primary Funding Source: U.S. Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases, National Institute of General Medical Sciences, and Alexander von Humboldt Foundation.
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            Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges

            Highlights • Emergence of 2019 novel coronavirus (2019-nCoV) in China has caused a large global outbreak and major public health issue. • At 9 February 2020, data from the WHO has shown >37 000 confirmed cases in 28 countries (>99% of cases detected in China). • 2019-nCoV is spread by human-to-human transmission via droplets or direct contact. • Infection estimated to have an incubation period of 2–14 days and a basic reproduction number of 2.24–3.58. • Controlling infection to prevent spread of the 2019-nCoV is the primary intervention being used.
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              World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19)

              An unprecedented outbreak of pneumonia of unknown aetiology in Wuhan City, Hubei province in China emerged in December 2019. A novel coronavirus was identified as the causative agent and was subsequently termed COVID-19 by the World Health Organization (WHO). Considered a relative of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), COVID-19 is caused by a betacoronavirus named SARS-CoV-2 that affects the lower respiratory tract and manifests as pneumonia in humans. Despite rigorous global containment and quarantine efforts, the incidence of COVID-19 continues to rise, with 90,870 laboratory-confirmed cases and over 3,000 deaths worldwide. In response to this global outbreak, we summarise the current state of knowledge surrounding COVID-19.
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                Author and article information

                Contributors
                Ashkan_m_sadeghi@yahoo.com
                Journal
                BMC Oral Health
                BMC Oral Health
                BMC Oral Health
                BioMed Central (London )
                1472-6831
                8 October 2020
                8 October 2020
                2020
                : 20
                : 275
                Affiliations
                [1 ]GRID grid.412571.4, ISNI 0000 0000 8819 4698, Health Policy Research Center, , Institute of Health, Shiraz University of Medical Sciences, ; Shiraz, Iran
                [2 ]GRID grid.412571.4, ISNI 0000 0000 8819 4698, Biomaterials Research Center, , School of Dentistry, Shiraz University of Medical Sciences, ; Shiraz, Iran
                [3 ]GRID grid.411583.a, ISNI 0000 0001 2198 6209, Department of Orthodontics, , Mashhad University of Medical Sciences, School of Dentistry, ; Mashhad, Iran
                [4 ]GRID grid.413020.4, ISNI 0000 0004 0384 8939, School of Dentistry, Yasuj University of Medical Sciences, ; Yasuj, Iran
                [5 ]GRID grid.412571.4, ISNI 0000 0000 8819 4698, School of Pharmacy, Shiraz University of Medical Sciences, ; Shiraz, Iran
                Article
                1270
                10.1186/s12903-020-01270-9
                7543039
                33032593
                b57d31f6-1c62-4cc3-95e2-ff7a2ff4242d
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 3 June 2020
                : 1 October 2020
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Dentistry
                covid-19,sars-cov-2,dentistry,dental practice management,dental public health,infection control

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