Impact of the Coronavirus on Providing Oral Health Care in the Netherlands

OBJECTIVE: Transmission of SARS-CoV-2 during oral health care is potentially increased compared to regular social activities. Specific amendments to the Dutch national infection control guidelines were promulgated. This study aimed to map the impact of the coronavirus pandemic on providing oral health care during the first wave of the coronavirus pandemic in 2020 in the Netherlands. METHODS: A cross-sectional web-based survey was sent via email to a representative sample of dental hygienists and dentists in the Netherlands. RESULTS: Of the 1,700 oral health care practitioners approached, 440 (25.9%) responded to the survey. Patient access to oral health care was severely restricted during the lockdown in the Spring of 2020. A total of 1.6% of the oral health care practitioners had laboratory-confirmed COVID-19 during the study period, although this is likely to be an underrepresentation due to limited access to testing. Over half of the participants perceived an increased risk of virus transmission during aerosol-generating treatments in their practices. A large majority (65.0 – 87.1%) of the oral health care practitioners followed the COVID-19-specific amendments to the national infection control guidelines. Compared to the pre-pandemic period, additional personal protective equipment and protocols were applied. Factors related with compliance with the additional recommendations were age, employment status and occupation. CONCLUSIONS: The pandemic had a profound impact on both the accessibility and practice of oral health care. This survey study found that most Dutch oral health care practitioners paid extra attention to hygiene and infection control. Also, a low number of COVID-19 infections detected amongst Dutch oral health care practitioners was reported in the Netherlands. These overall outcomes suggest that safe oral health care can be provided when following the current infection control recommendations

The COVID-19 pandemic and its global effects on dental practice. An international survey

Objectives: A multicentre survey was designed to evaluate the impact of COVID-19 outbreak on dental practice worldwide, estimate the COVID-19 related symptoms/signs, work attitudes and behaviour and the routine use of protective measures and Personal Protective Equipment (PPE). Methods: A global survey using a standardized questionnaire with research groups from 36 countries was designed. The questionnaire was developed and pretested during April 2020 and contained three domains: 1) Personal data; 2) COVID-19 positive rate and symptoms/signs presumably related to the coronavirus; 3) Working conditions and PPE adopted after the outbreak. Countries’ data were grouped by the Country Positive Rate (CPR) during the survey period and by Gross-National-Income per capita. An ordinal multinomial logistic regression model was carried out with COVID-19 self-reported rate referred by dental professionals as dependent variable to assess the association with questionnaire items. Results: A total of 52,491 questionnaires were returned with a male/female ratio of 0.63. Out of the total respondents, 7,859 dental professionals (15%) reported symptoms/signs compatible with COVID-19. More than half of the sample (n = 27,818; 53%) stated to use FFP2/N95 masks, while 21,558 (41.07%) used eye protection. In the bivariate analysis, CPR and N95/FFP2 were significantly associated (OR = 1.80 95%CI = 1.60/2.82 and OR = 5.20 95%CI = 1.44/18.80, respectively), while Gross-National-Income was not statistically associated with CPR (OR = 1.09 95%CI = 0.97/1.60). The same significant associations were observed in the multivariate analysis. Conclusions: Oral health service provision has not been significantly affected by COVID-19, although access to routine dental care was reduced due to country-specific temporary lockdown periods. While the dental profession has been identified at high-risk, the reported rates of COVID-19 for dental professionals were not significantly different to those reported for the general population in each country. These findings may help to better plan oral health care for future pandemic events

Red fluorescent dental plaque: An indicator of oral disease?

Oral diseases are worldwide the most common diseases, with dental caries and periodontal inflammatory diseases as most frequently occurring diseases. Both are strongly associated with dental plaque, which is the mass of bacteria (biofilm) that grows on surfaces in the mouth. Some dental plaque fluoresces red when illuminated with violet light. In this thesis red fluorescence of dental plaque and its applicability as an indicator for oral diseases were studied. During in vitro research it was found that the thickness and age of a biofilm are associated with fluorescence intensity. Also the nutrients available to the biofilm, affected the amount of red fluorescence: Higher fluorescence intensities were seen from biofilms grown in the presence of serum (gingivitis simulation) compared to sucrose (simulation of cariogenicity). The fluorescence was not homogeneously distributed throughout the biofilms. In vivo, the total quantity of disclosed plaque correlated moderately with red fluorescent plaque, while ‘old’ blue disclosed plaque correlated weakly with red fluorescent plaque. Results from a 14-days-no-brushing (gingivitis inducing) challenge showed that red fluorescent plaque was related to the participant’s risk for developing gingival inflammation. Further clinical studies revealed no relevant correlations between the presence of red fluorescent plaque and (early) carious lesions. However, clear differences were found in the composition of phenotypically different plaque samples: red fluorescent plaque contained more Gram-negative, anaerobic taxa and was more diverse compared to not red fluorescing plaque. In summary, in this thesis associations were found between red fluorescent plaque and oral diseases, although the clinical applicability of red fluorescence of plaque seems currently limited