Caminha, Raquel D’Aquino Garcia

Kallás, Monira Samaan

Santos, Paulo Sergio da Silva

Telles-Araujo, Gabriel de Toledo

English

Cadernos Espinosanos (E-Journal)

Teledentistry support in COVID-19 oral careGabriel de Toledo Telles-Araujo0000-0000-0000-0000 , Raquel D’Aquino Garcia Caminha0000-0000-0000-0000 , Monira Samaan Kallás0000-0000-0000-0000 ,Paulo Sergio da Silva Santos0000-0000-0000-0000 *Departamento de Cirurgia, Estomatologia, Patologia e Radiologia, Faculdade de Odontologia de Bauru, Universidade de Sao Paulo, Bauru, SP, BR.Telles-Araujo GT, Caminha RDG, Kallás MS, Santos PSS. Teledentistry support in COVID-19 oral care. Clinics. 2020;75:e2030*Corresponding author. E-mail: paulosss@fob.ups.brGiven the latest updates in scientific publications aboutthe impact of COVID-19 on oral health, such as the role ofsalivary glands as potential reservoirs for SARS-CoV-2 (1),the appearance of possible oral vesiculobullous lesions (2),and the presence maculopapular manifestations in suspectedand confirmed cases (3), we aimed to emphasize the inexo-rable need for close monitoring by a dentist specialized inoral medicine in such COVID-19 patients. Their skill andaccuracy in diagnosing mouth diseases could contribute to abetter understanding of the pathogenesis of SARS-CoV-2 inoral health.Based on the recent data, topical and systemic corticoster-oid therapy is not recommended for COVID-19 infection.Hence, positive patients with immune-mediated oral condi-tions (pemphigus, pemphigoid, lichen planus) may presentexacerbations of these manifestations during the periodof viral infection. Correspondingly, multidrug therapies inpatients positive for SARS-CoV2 and hospitalization condi-tions could also result in oral implications such as opportu-nistic infections, xerostomia, traumatic ulcerations due toorotracheal intubation, and periodontal disease (4).Due to the pandemic scenario of COVID-19 in Brazil andfollowing the recommendations of the Federal Council ofDentistry (5) and the National Health Surveillance Agency(6), dental care has been limited to emergencies and urgen-cies. Due to the aerosols produced during many oral pro-cedures, this measure is justified because of the higher riskof exposure of theses professionals to the virus and pre-vention of cross-infection between patients. Unfortunately,this endorsement has created a distance between patientsand dentists. Moreover, the incipient inclusion of a dentist ina hospital setting corroborates this detachment. Thus, there isstill limited scientific evidence on the relationship betweenSARS-CoV-2 and oral diseases.Aiming to bridge the gap between healthcare servicesand the population, telemedicine has been recognized andregulated in Brazil (7) as a tool to combat the pandemic ofCOVID-19. It favors the reduction of physical contactbetween professionals and patients and thus, spread of thevirus. In dentistry, the following three modes of operationhold great value for oral diagnosis. Teleorientation allowsprofessionals to perform screening, guide, and refer patientsin isolation to face-to-face assistance, if needed. Telemoni-toring permits professionals to visually monitor patientssuspected or positive for SARS-CoV-2 who present orallesions through photographic control. Finally, teleconsulta-tion enables the exchange of information between profes-sionals, assisting in the diagnosis and therapy to be institutedto the patient with greater agility and precision.The systems available for executing telemedicine and/orteledentistry are still restricted, but represent an easy, viable,and accessible tool, useful for both health professionals andpatients (8). This communication could occur through instantmessaging applications (WhatsApp, Telegram, Instagram,SMS, Messenger) and video calling applications (GoogleMeet, Skype, Facetime, WhatsApp). A study published byPetruzzi et al. (9) confirmed the use of WhatsApp as asupport in oral diagnosis, in which 82% of the teleconsultedcases agreed with the clinicopathological diagnosis, suggest-ing that it is a good option for teledentistry.However, one limitation of this technology includes poorresolution of the images provided by the patient. The imagesmust have an adequate resolution, without alterations withdigital filters and must encompass the entire area of themouth to be analyzed. These specifications will allow thecorrect evaluation by the oral medicine specialist. It is worthstressing that this diagnostic tool is palliative. Therefore, it isnot possible to be used in all cases.Thus, telemedicine is not a substitute for face-to-faceconsultation, and is mainly aimed at supporting the BrazilianUnified Public Health System (SUS) during the COVID-19pandemic. Whenever physical consultation is required afterteleorientation, the health measures of the regulatory agen-cies must be followed.’ ACKNOWLEDGMENTSThis study was financed in part by the Coordenação de Aperfeiçoamentode Pessoal de Nível Superior – Brasil (CAPES) - Finance Code 001.’ REFERENCES1. Xu J, Li Y, Gan F, Du Y, Yao Y. Salivary Glands: Potential Reservoirs forCOVID-19 Asymptomatic Infection. J Dent Res. 2020. https://doi.org/10.1177/00220345209185182. Martín Carreras-Presas C, Amaro Sánchez J, López-Sánchez AF,Jané-Salas E, Somacarrera Pérez ML. Oral vesiculobullous lesions asso-ciated with SARS-CoV-2 infection. Oral Dis. 2020. https://doi.org/10.1111/odi.133823. Galván Casas C, Català A, Carretero Hernández G, Rodríguez-Jiménez P,Fernández Nieto D, Rodríguez-Villa Lario A, et al. Classification of theDOI: 10.6061/clinics/2020/e2030Copyright & 2020 CLINICS – This is an Open Access article distributed under theterms of the Creative Commons License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in anymedium or format, provided the original work is properly cited.No potential conflict of interest was reported.1COMMENTScutaneous manifestations of COVID-19: a rapid prospective nationwideconsensus study in Spain with 375 cases. Br J Dermatol. 2020. https://doi.org/10.1111/bjd.191634. Dziedzic A, Wojtyczka R. The Impact of Coronavirus Infectious Disease19 (COVID-19) on Oral Health. Oral Dis. 2020. https://doi.org/10.1111/odi.133595. Conselho Federal de Odontologia – Código de Ética Odontológico – Riode Janeiro, CFO 2003.6. BRASIL ANVISA. Agência Nacional de Vigilância Sanitária. Resolução daDiretoria Colegiada - RDC No 166, 24/07/2017.7. Conselho Federal de Medicina. Resolução CFM no 1.643/2002. Availablefrom: https://portal.cfm.org.br/index.php?option=com_content&view=article&id=28636:2020-03-19-23-35-42&catid=3 [Accessed in May 13th, 2020]8. Böhm da Costa C, Peralta FDS, Ferreira de Mello ALS. How Has Tele-dentistry Been Applied in Public Dental Health Services? An IntegrativeReview. Telemed J E Health. 2019. https://doi.org/10.1089/tmj.2019.01229. Petruzzi M, De Benedittis M. WhatsApp: a telemedicine platform forfacilitating remote oral medicine consultation and improving clinicalexaminations. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;121(3):248-54. https://doi.org/10.1016/j.oooo.2015.11.0052Teledentistry during COVID-19Telles-Araujo et al.CLINICS 2020;75:e2030

Teledentistry support in COVID-19 oral care

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Teledentistry support in COVID-19 oral care

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