Dental care during the COVID-19 pandemic: an integrative review

MELO, Laércio Almeida de; OSÉAS, Jéssica Mayara de Figueirêdo; FARIA, Júlio César Brigolini de; MENDONÇA, Beatriz de Pedro Netto; LIMA, Camila Moreira; LEITE, Fabíola Pessôa Pereira; CARREIRO, Adriana da Fonte Porto

doi:10.1590/1981-86372022003320200125

Laércio Almeida de MELO Correspondence to: LA Melo. E-mail: laercio_melo91@hotmail.com.

Universidade Federal do Rio Grande do Norte, Departamento de Odontologia. Av. Senador Salgado Filho, 1787, Lagoa Nova, Natal, RN, Brasil.

http://orcid.org/0000-0002-9276-0116

Jéssica Mayara de Figueirêdo OSÉAS

Universidade Federal do Rio Grande do Norte, Departamento de Odontologia. Av. Senador Salgado Filho, 1787, Lagoa Nova, Natal, RN, Brasil.

http://orcid.org/0000-0003-1421-3405

Júlio César Brigolini de FARIA

Universidade Federal de Juiz de Fora, Faculdade de Odontologia, Departamento de Odontologia. Juiz de Fora, MG, Brasil.

http://orcid.org/0000-0001-9698-9498

Beatriz de Pedro Netto MENDONÇA

Universidade Federal de Juiz de Fora, Faculdade de Odontologia, Departamento de Odontologia. Juiz de Fora, MG, Brasil.

http://orcid.org/0000-0001-6364-5912

Camila Moreira LIMA

Universidade Federal de Juiz de Fora, Faculdade de Odontologia, Departamento de Odontologia. Juiz de Fora, MG, Brasil.

http://orcid.org/0000-0001-8252-2168

Fabíola Pessôa Pereira LEITE

Universidade Federal de Juiz de Fora, Faculdade de Odontologia, Departamento de Odontologia. Juiz de Fora, MG, Brasil.

http://orcid.org/0000-0001-6316-5679

Adriana da Fonte Porto CARREIRO

Universidade Federal do Rio Grande do Norte, Departamento de Odontologia. Av. Senador Salgado Filho, 1787, Lagoa Nova, Natal, RN, Brasil.

http://orcid.org/0000-0002-0833-1926

Correspondence to: LA Melo. E-mail: laercio_melo91@hotmail.com.

Collaborators

LA Melo, conception, design, intelectual and scientific contente of the study; acquisition, interpretation and analysis of data; manuscript writing. JMF Oséas, acquisition, interpretation and analysis of data; manuscript writing. JCB Faria, BPN Mendonça, CM Lima and FPP Leite, manuscript writing; critical revision. AFC Carreiro, participated in the study design and coordenation; analyzed and interpreted the data; helped to draft the manuscript; critical revision.

Assistant editor: Luciana Butini Oliveira

DATABASE	STRATEGY
Pubmed/Medline	((((((Coronavirus disease 2019) OR Coronavirus 2019) OR Covid-19) OR 2019-ncov) OR Sars-cov2)) AND (((((Dental practice) OR Dental care) OR Dentistry) OR Dental medicine) OR Oral medicine)
Web of Science	TS=(Coronavirus disease 2019 OR Coronavirus 2019 OR Covid-19 OR 2019-ncov OR Sars-cov2) AND TS=(Dental practice OR Dental care OR Dentistry OR Dental medicine OR Oral medicine)
Cochrane Library	“Coronavirus disease 2019” OR “Coronavirus 2019” OR “Covid-19 OR 2019-ncov” OR “Sars-cov2” and “Dental practice” OR “Dental care” OR “Dentistry” OR “Dental medicine” OR “Oral medicine”
Scopus	ALL (“Coronavirus disease 2019” OR “Coronavirus 2019” OR “Covid-19 OR 2019-ncov” OR “Sars-cov2”) AND ALL (“Dental practice” OR “Dental care” OR “Dentistry” OR “Dental medicine” OR “Oral medicine”)
LILACS	“Coronavirus disease 2019” OR “Coronavirus 2019” OR “Covid-19 OR 2019-ncov” OR “Sars-cov2” and “Dental practice” OR “Dental care” OR “Dentistry” OR “Dental medicine” OR “Oral medicine”
Scielo	“Coronavirus disease 2019” OR “Coronavirus 2019” OR “Covid-19 OR 2019-ncov” OR “Sars-cov2” and “Dental practice” OR “Dental care” OR “Dentistry” OR “Dental medicine” OR “Oral medicine”

Study	Study location and type	Objective	Sample	Institution, organization, or professional that adopted or guided preventive conduct	Types of preventive measures to COVID-19
Edwards et al. [⁷7 Edwards SP, Kasten S, Nelson C, Elner V, McKean E. Maxillofacial trauma management during covid-19: multidisciplinary recommendations. Facial Plast Surg Aesthet Med. 2020;2(3):157-159. http://dx.doi.org/10.1089/fpsam.2020.0158 https://doi.org/10.1089/fpsam.2020.0158... ]	United States; Case report	A multidisciplinary Michigan Medicine team met to obtain and report consensus on the management of maxillofacial trauma during the COVID-19 pandemic	1 medical unit	Michigan Medicine	The institution recommends dental treatment only in urgent cases. In emergency cases of facial trauma, common coats plus waterproof disposable coats should be used, as well as N95 masks, goggles, face shields, and gloves
Dave M et al. [¹1 Dave M, Seoudi N, Coulthard P. Urgent dental care for patients during the COVID-19 pandemic. Lancet. 2020;395(10232):1257. http://dx.doi.org/10.1016/S0140-6736(20)30806-0 https://doi.org/10.1016/S0140-6736(20)30... ]	London; Recommendation letter to the editor	Recommend urgent dental care procedures in the COVID-19 pandemic season	There are no reports	Manchester University	Dental treatment only in urgent cases; Use of complete Personal Protective Equipment (PPE); Extraction of teeth with poor prognosis and testing all dental professionals for the disease
Khader Y et al. [⁸8 Khader Y, Nsour M, Al-Batayneh OB, Saadeh R, Bashier H, Alfaqih M, et al. Dentists’ awareness, perception, and attitude regarding COVID-19 and infection control: A cross-sectional study among Jordanian dentists. J Public Health Surveill. 2020;6(2):e18798. http://dx.doi.org/10.2196/18798 https://doi.org/10.2196/18798... ]	Jordan; Observational	Assess the level of awareness, perception, and attitude towards COVID-19 and infection control among dentists in Jordan	368 dentists	Jordanian dentists	Treat only urgent cases; Regular hand washing by professionals and patients; use of absolute isolation with rubber dikes; Use of complete PPE and disinfection of surfaces with 70% alcohol
Mallineni et al. [⁹9 Mallineni SK, Innes NP, Raggio DP, Araujo MP, Robertson MD, Jayaraman J. Coronavirus disease (covid-19): characteristics in children and considerations for dentists providing their care. Int J Paediatr Child Dent. 2020;30(3):240-245. http://dx.doi.org/10.1111/ipd.12653 https://doi.org/10.1111/ipd.12653... ]	No location specification; Literature revision	Report current data on the pediatric population affected by COVID - 19 and highlight considerations for dentists who assist children during this pandemic.	There are no reports of the number of studies included	National Health Surveillance Agency (ANVISA) - Brazil and American Academy of Pediatric Dentistry	Treat only urgent cases; Use of N95 masks associated with disposable surgical masks and use of face shields. Always follow local, regional and national guidelines and guidelines regarding the use of preventive measures to COVID-19.
Yang et al. [²2 Yang Y, Zhou Y, Liu X, Tan J. Health services provision of 48 public tertiary dental hospitals during the COVID-19 epidemic in China. Clin Oral Investig. 2020;24(5):1861-1864. http://dx.doi.org/10.1007/s00784-020-03267-8 https://doi.org/10.1007/s00784-020-03267... ]	China; Observational	Assess the provision of health services in tertiary public hospitals during the COVID-19 epidemic in China and assess the regional difference in telehealth.	48 public dental hospitals	Public dental hospitals - China	Dental care only in emergency cases and dental call centers
Spagnuolo et al. [¹⁰10 Spagnuolo G, De Vito D, Rengo S, Tatullo M. COVID-19 outbreak: an overview on dentistry. Int J Environ Res Public Health. 2020;17(6):2094. http://dx.doi.org/10.3390/ijerph17062094 https://doi.org/10.3390/ijerph17062094... ]	No location specification; Literature revision	Assess the impact of COVID-19 on dentistry	There are no reports of the number of studies included	World Health Organization; American Dental Association; Wuhan University; Stomatology Hospital - Wuhan	Treat only dental emergencies; Use of complete PPE; Use of powerful suckers; Protect all places of handling by the professional with film paper; Disinfect contact surfaces by professionals and patients with 70% alcohol and prefer treatments that generate less aerosols
Yang et al. [¹¹11 Yang Y, Soh HY, Cai ZG, Peng X, Zhang Y, Guo CB. Experience of diagnosing and managing patients in oral maxillofacial surgery during the prevention and control period of the new coronavirus pneumonia. Chin J Dent Res. 2020;23(1):57-62. http://dx.doi.org/10.3290/j.cjdr.a44339 https://doi.org/10.3290/j.cjdr.a44339... ]	Beijing, China; Case report	Summarize the experience with prevention and clinical recommendations for the control of the COVID-19 epidemic	1 medical unit	Department of Oral and Maxillofacial Surgery and Stomatology Hospital (Beijing University)	Treat only emergencies; Suspect patient care in an isolated environment; Constant hand washing; Use of complete PPE and disinfection of alcohol-based surfaces
Wang et al. [¹²12 Wang Y, Zhou CC, Shu R, Zou J. Oral health management of children during the epidemic period of coronavirus disease 2019. Sichuan Da Xue Xue Bao Yi Xue Ban. 2020;51(2):151-154. http://dx.doi.org/10.12182/20200360101 https://doi.org/10.12182/20200360101... ]	China; Literature revision	To present preventive measures to COVID-19 in the dental care of pediatric patients	There are no reports of the number of studies included	Infectious Disease Prevention and Control Act - China	Perform only emergency treatments that do not generate aerosols, such as atraumatic restorations; Guide parents to train their children to wash their hands, maintain good oral hygiene, drink plenty of water and eat a healthy diet; Use of PPE by professionals and everyone in the dental environment
Meng et al. [⁵5 Meng L, Hua F, Bian Z. Coronavirus Disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. J Dent Res. 2020;99(5):481-487. http://dx.doi.org/10.1177/0022034520914246 https://doi.org/10.1177/0022034520914246... ]	China; Literature revision	Provide recommended management protocols for dentists and students in areas affected by COVID-19	There are no reports of the number of studies included	Wuhan University Stomatology School and Hospital	Treatment of dental emergencies only; Avoid treatments that generate aerosols; Always work with 4 hands; Check the signs and symptoms of COVID-19 in patients and, in their presence, suspend the service
Peng et al. [¹³13 Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci. 2020;12(1):9. http://dx.doi.org/10.1038/s41368-020-0075-9 https://doi.org/10.1038/s41368-020-0075-... ]	China; Literature revision	Recommend infection control measures during dental practice	Não há There are no reports of the number of studies included	China National Health Commission	Treat only urgent cases; In the identification of signs and symptoms of COVID-19 (fever, cough and / or shortness of breath in the last 14 days), reschedule the patient; Hand washing by the professional and patient; Use white fabric coats associated with disposable coats, N95 and surgical masks, face shields and disposable gloves; Provide mouthwash before service
Ge et al. [¹⁴14 Ge Z, Yang L, Xia J, Fu X, Zhang Y. Possible aerosol transmission of COVID-19 and special precautions in dentistry. J Zhejiang Univ Sci B. 2020;21(5):361-368. http://dx.doi.org/10.1631/jzus.B2010010 https://doi.org/10.1631/jzus.B2010010... ]	China; Literature revision	Report precautions to be taken in dental environments to prevent COVID-19	There are no reports of the number of studies included	Chinese Stomatology Association; World Health Organization	Treat only urgent cases; Assess signs and symptoms of COVID-19 and, in the presence, reschedule the patient; Use complex levels of individual protection (N95 mask, use of common coats associated with disposables and facial protectors); Hand washing and disinfection of surfaces with 70% alcohol

Study	Delimitation	Methodological limitations	Inconsistency	Indirect evidence	Inaccuracy	Other considerations	Quality (GRADE)
Edwards et al. [⁷7 Edwards SP, Kasten S, Nelson C, Elner V, McKean E. Maxillofacial trauma management during covid-19: multidisciplinary recommendations. Facial Plast Surg Aesthet Med. 2020;2(3):157-159. http://dx.doi.org/10.1089/fpsam.2020.0158 https://doi.org/10.1089/fpsam.2020.0158... ]	Case report	Severe (type of study)	Severe (do not have estimates of effects)	Severe (do not compare interventions)	Severe (no confidence intervals)	No additional considerations	Very low
Dave et al. [¹1 Dave M, Seoudi N, Coulthard P. Urgent dental care for patients during the COVID-19 pandemic. Lancet. 2020;395(10232):1257. http://dx.doi.org/10.1016/S0140-6736(20)30806-0 https://doi.org/10.1016/S0140-6736(20)30... ]	Letter of recommendations	Severe (type of study)	Severe (do not have estimates of effects)	Severe (do not compare interventions)	Severe (no confidence intervals)	No additional considerations	Very low
Khader et al. [⁸8 Khader Y, Nsour M, Al-Batayneh OB, Saadeh R, Bashier H, Alfaqih M, et al. Dentists’ awareness, perception, and attitude regarding COVID-19 and infection control: A cross-sectional study among Jordanian dentists. J Public Health Surveill. 2020;6(2):e18798. http://dx.doi.org/10.2196/18798 https://doi.org/10.2196/18798... ]	Observational	Severe (type of study)	Severe (do not have estimates of effects)	Severe (do not compare interventions)	Severe (no confidence intervals)	No additional considerations	Very low
Mallineni SK et al., 2020 [⁹9 Mallineni SK, Innes NP, Raggio DP, Araujo MP, Robertson MD, Jayaraman J. Coronavirus disease (covid-19): characteristics in children and considerations for dentists providing their care. Int J Paediatr Child Dent. 2020;30(3):240-245. http://dx.doi.org/10.1111/ipd.12653 https://doi.org/10.1111/ipd.12653... ]	Literature revision	Severe (type of study)	Severe (do not have estimates of effects)	Severe (do not compare interventions)	Severe (no confidence intervals)	Review done without methodological details	Very low
Yang Y et al., 2020 [²2 Yang Y, Zhou Y, Liu X, Tan J. Health services provision of 48 public tertiary dental hospitals during the COVID-19 epidemic in China. Clin Oral Investig. 2020;24(5):1861-1864. http://dx.doi.org/10.1007/s00784-020-03267-8 https://doi.org/10.1007/s00784-020-03267... ]	Observational	Severe (type of study)	Severe (do not have estimates of effects)	Severe (do not compare interventions)	Severe (no confidence intervals)	No additional considerations	Very low
Spagnuolo et al., 2020 [¹⁰10 Spagnuolo G, De Vito D, Rengo S, Tatullo M. COVID-19 outbreak: an overview on dentistry. Int J Environ Res Public Health. 2020;17(6):2094. http://dx.doi.org/10.3390/ijerph17062094 https://doi.org/10.3390/ijerph17062094... ]	Literature revision	Severe (type of study)	Severe (do not have estimates of effects)	Severe (do not compare interventions)	Severe (no confidence intervals)	Review done without methodological details	Very low
Yang Y et al., 2020 [¹¹11 Yang Y, Soh HY, Cai ZG, Peng X, Zhang Y, Guo CB. Experience of diagnosing and managing patients in oral maxillofacial surgery during the prevention and control period of the new coronavirus pneumonia. Chin J Dent Res. 2020;23(1):57-62. http://dx.doi.org/10.3290/j.cjdr.a44339 https://doi.org/10.3290/j.cjdr.a44339... ]	Case report	Severe (type of study)	Severe (do not have estimates of effects)	Severe (do not compare interventions)	Severe (no confidence intervals)	No additional considerations	Very low
Wang et al., 2020 [¹²12 Wang Y, Zhou CC, Shu R, Zou J. Oral health management of children during the epidemic period of coronavirus disease 2019. Sichuan Da Xue Xue Bao Yi Xue Ban. 2020;51(2):151-154. http://dx.doi.org/10.12182/20200360101 https://doi.org/10.12182/20200360101... ]	Literature revision	Severe (type of study)	Severe (do not have estimates of effects)	Severe (do not compare interventions)	Severe (no confidence intervals)	Review done without methodological details	Very low
Meng L et al., 2020 [⁵5 Meng L, Hua F, Bian Z. Coronavirus Disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. J Dent Res. 2020;99(5):481-487. http://dx.doi.org/10.1177/0022034520914246 https://doi.org/10.1177/0022034520914246... ]	Literature revision	Severe (type of study)	Severe (do not have estimates of effects)	Severe (do not compare interventions)	Severe (no confidence intervals)	Review done without methodological details	Very low
Peng X et al., 2020 [¹³13 Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci. 2020;12(1):9. http://dx.doi.org/10.1038/s41368-020-0075-9 https://doi.org/10.1038/s41368-020-0075-... ]	Literature revision	Severe (type of study)	Severe (do not have estimates of effects)	Severe (do not compare interventions)	Severe (no confidence intervals)	Review done without methodological details	Very low
Ge Z et al., 2020 [¹⁴14 Ge Z, Yang L, Xia J, Fu X, Zhang Y. Possible aerosol transmission of COVID-19 and special precautions in dentistry. J Zhejiang Univ Sci B. 2020;21(5):361-368. http://dx.doi.org/10.1631/jzus.B2010010 https://doi.org/10.1631/jzus.B2010010... ]	Literature revision	Severe (type of study)	Severe (do not have estimates of effects)	Severe (do not compare interventions)	Severe (no confidence intervals)	Review done without methodological details	Very low

[1] Correspondence to: LA Melo. E-mail: laercio_melo91@hotmail.com.

They did not present preventive measures against COVID-19 by professionals or organizations/institutions (5)
	Martelli-Júnior et al. [¹⁵15 Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100. http://dx.doi.org/10.1371/journal.pmed.1000100 https://doi.org/10.1371/journal.pmed.100... ]
	Farooq & [¹⁶16 GRADE working group: the Grading of Recommendations Assessment, Development and Evaluation [Internet] [cited 2020 Apr 20]. Available from: <http://www.gradeworkinggroup.org. 2014>. http://www.gradeworkinggroup.org... ]
	Gu et. al. [¹⁹19 Martelli-Júnior H, Machado RA, Martelli DRB, Coletta RD. Dental journals and coronavirus disease (COVID-19): A current view. Oral Oncol. 2020;196:104664. http://dx.doi.org/10.1016/j.oraloncology.2020.104664 https://doi.org/10.1016/j.oraloncology.2... ]
	Sabino-Silva et al. [²⁰20 Farooq I, Ali S. COVID-19 outbreak and its monetary implications for dental practices, hospitals and healthcare workers. Postgrad Med. 2020;96(1142):791-792. http://dx.doi.org/10.1136/postgradmedj-2020-137781 https://doi.org/10.1136/postgradmedj-202... ]
	Guo et al. [²¹21 Gu J, Han B, Wang J. COVID-19: gastrointestinal manifestations and potential fecal-oral transmission. Gastroenterology. 2020;158(6):1518-1519. http://dx.doi.org/10.1053/j.gastro.2020.02.054 https://doi.org/10.1053/j.gastro.2020.02... ]
They analyzed another type of coronavirus, which was not 2019 (1)
	Gaffar et al. [²²22 Sabino-Silva R, Jardim ACG, Siqueira WL. Coronavirus COVID-19 impacts to dentistry and potential salivary diagnosis. Clin Oral Investig. 2020;24(4):1619-1621. https://doi.org/10.1007/s00784-020-03248-x https://doi.org/10.1007/s00784-020-03248... ]

Brasil

Brasil

Dental care during the COVID-19 pandemic: an integrative review

Cuidados odontológicos durante a pandemia do COVID-19: uma revisão integrativa

ABSTRACT

Objective:

Methods:

Results:

Conclusion: