Table 1 An overview of the guidelines provided for Coronavirus 2019 in dentistry by articles

1

Alharbi et al. (2020)/ Saudi Arabia [15]

I.) Emergency Tx (fracture and infection compromising patient’s airway, uncontrolled bleeding) for all patients

I.) Restrict Intraoral imaging

-Lack of a guideline for patients who need dental Tx before an imminent transplant.

II.) Preprocedural use of 0.23% povidone-iodine mouth-wash at least 15 s

II.) Minimally invasive urgent care without aerosol generation for asymptomatic suspect, stable active and recovered patients

-Lack of a guide on proper saliva ejectors or surgical aspiration

III.) Single-use devices

IV.) Use a rubber dam

III.) Invasive urgent care with aerosol generation for asymptomatic suspect

V.) Avoid aerosol-generating procedures

VI.) Avoid administering Ibuprofen

2

Ather et al. (2020)/ The United States [14]

I.) Perform dental Tx if lack of travel hx/epidemiological link

I.) Personal protective equipment and hand hygiene

-Lack of a guideline for patients who need dental Tx before an imminent transplant.

II.) Defer elective care for suspect at least 2 weeks

-Lack of a guide on proper saliva ejectors or surgical aspiration

III.) Urgent care for suspect in case of tooth pain and/or swelling using pharmacological management as the first line and emergency care as the secondary management

II.) Preprocedural mouth rinse

III.) single-use devices

IV.) Avoid Intraoral radiography

V.) Use a rubber dam

VI.) Minimize ultrasonic instruments, high-speed handpieces, and 3-way syringes

VII.) Dilute Naocl to 1%

VIII.) Negative-pressure treatment rooms

IX.) Disinfect inanimate surfaces

3

Izzetti et al. (2020)/ Italy [16]

I.) Identify potentially at-risk cases and support them in contacting the health authorities

I.) 1-min mouth rinse with 0.2 to 1% povidone, 0.05 to 0.1% cetylpyridinium chloride, or 1% hydrogen peroxide

-Lack of a precise guideline on the management of patients at various stages of the disease, from positive to asymptomatic to healed ones.

II.) Understand the real need for professional consultation and preferably address the issue with just pharmacologic prescription

II.) Hand washing for at least 60 s and then hand rubbing with 60-70% hydroalcoholic solution before wearing a glove

III.) Organize a contagion-reduced treatment for the subjects with unknown risk of contagion who are experiencing an acute dental problem that requires immediate treatment

III.) Personal protective equipment

IV.) Preparation of all instruments in advance

V.) Total protection through disposable cover

VI.) Avoid, when possible, use of handpieces/ultrasonic instruments

VII.) Use a rubber dam

VIII.) Surgical aspiration system

IX.) If possible, prefer 4-hands technique

X.) Limit overall Tx time if possible

4

Lee and Auh (2020)/ Korea [17]

I.) Routine pre-check the general health status and travel history to epidemic areas

I.) Use basic personal protective equipment for potential asymptomatic carriers

-Lack of a precise guideline on the management of patients at various stages of the disease, from positive to asymptomatic to healed ones.

II.) Patients with suspected or known COVID-19 should be isolated or postpone their non-emergency dental care during the COVID-19 pandemic

II.) Hand washing is essential

III.) Must avoid or minimize procedures producing droplets or aerosols or stimulate salivary secretion or coughing.

IV.) Use high-volume saliva ejectors with the four-handed technique

V.) Minimize using the three-way syringe

VI.) Acquisition of extraoral radiographs rather than intraoral radiographs

VII.) Use an oxidative or antimicrobial mouth rinse before dental procedures

VIII.) Treatment in an isolated and well-ventilated environment

IX.) Disinfect the surface of equipment with 62–71% ethanol before and after dental procedures

5

Mallineni et al. (2020)/ Saudi Arabia- The United Kingdom- The United States-Brazil [18]

I.) Contemporary minimally invasive procedures that minimize or eliminate aerosol generation should be employed where intervention is indicated throughout the pandemic

I.) Hand hygiene

-Lack of a precise guideline on the management of pediatric patients at various stages of the disease, from positive to asymptomatic to healed ones.

II.) Personal protective equipment

III.) Respiratory hygiene/cough etiquette

II.) Once restrictions begin to be eased, continue management of dental disease with minimally interventive concepts, e.g., atraumatic restorative treatment, fissure sealants, silver diamine fluoride, selective caries removal, and the Hall Technique while viral transmission risk remains high

IV.) Sharps safety and safe injection practices

V.) Sterilization and disinfection of patient-care items and devices

VI.) Environmental infection prevention and control

VII.) Dental unit water quality

6

Meng and Hua (2020)/ China [19]

I.) In areas where COVID-19 spreads, non-emergency dental practices should be postponed.

I.) Hand hygiene

-Lack of a precise guideline on the management of patients at various stages of the disease, from positive to asymptomatic to healed ones.

II.) Personal protective equipment

II.) Pulp exposure in symptomatic irreversible pulpitis could be made with chemomechanical caries removal.

III.) Thorough disinfection of all surfaces

IV.) Particulate respirators (e.g., N-95 masks or FFP2)

III.) If a tooth needs to be extracted, an absorbable suture is preferred.

IV.) For patients with facial soft tissue contusion, debridement, and suturing should be performed.

V.) The 4-handed technique is beneficial

VI.) Use saliva ejectors with low or high volume

V.) Life-threatening cases with oral and maxillofacial compound injuries should be admitted to the hospital immediately.

VII.) Preoperative antimicrobial mouth rinse

VIII.) Minimize aerosol-generating procedures, such as the use of a 3-way syringe

IX.) Acquisition of extraoral radiographs rather than intraoral radiographs

X.) Rubber dam

XI.) Isolated and well-ventilated room or negatively pressured rooms if possible

7

Peng et al. (2020)/ China [20]

I.) If a patient replies “yes” to screening questions, and body temperature is below 37.3 °C, the dentist can defer the treatment until 14 days after the exposure event.

I.) Hand Hygiene

Lack of a precise guideline as to which dental treatments can be performed in case the patient replies “no” to all screening questions and his/her body temperature is below 37.3 °C

II.) Personal protective measures for the dentists

II.) If a patient replies “yes” to screening questions, and body temperature is no less than 37.3 °C, the patient should be immediately quarantined and reported to the infection control department.

III.) A Preprocedural mouth rinse containing oxidative agents such as 1% hydrogen peroxide or 0.2% povidone especially when a rubber dam cannot be used

III.) If a patient replies “no” to all screening questions, and his/her body temperature is below 37.3 °C, the dentist can treat the patient with extra- protection measures and avoids spatter or aerosol-generating procedures.

IV.) If using a rubber dam, use extra high-volume suction for aerosol and spatter along with regular suction with a four-hand operation

IV.) If a patient replies “no” to all screening questions, but his/her body temperature is no less than 37.3 °C, the patient should be instructed to specialized clinics for COVID-19.

V.) If a rubber dam isolation is not possible, manual devices, such as Carisolv and hand scaler, are recommended for caries removal and periodontal scaling

VI.) the use of dental handpieces without anti-retraction function should be prohibited during the epidemic period of COVID-19

VII.) Disinfection of the clinic settings

8

Prati et al. (2020)/ Italy [21]

I.) Triaging patients to detect by history and with a respiratory infection, flu, acute respiratory illness, conjunctivitis, and cardiovascular abnormalities

I.) Regular, meticulous and effective hand wash

The study provides a guideline for dental school; however, more precise guides on the management of patients at various stages of the disease, from positive to asymptomatic to healed ones, are required.

II.) Separation of patients with respiratory symptoms to limit their contact with the dental staff, students and patients

II.) Use face masks

III.) Decontamination of all surfaces with 0.1% sodium hypochlorite or 70% ethanol or 0.5% hydrogen peroxide

III.) Avoiding dental treatment if at all possible

IV.) Respiratory hygiene/cough etiquette

V.) Isolate the patient in a dedicated single-patient room (with closed door)

VI.) Use a rubber dam

VII.) Application of powerful air/water surgical suction pump (aspirator) close to the tooth and a second suction close to the nose to prevent aerosol and saliva droplet diffusion

VIII.) Use high-speed handpiece with no exhaust

IX.) Decontamination of equipment, surgeries/ operatories after each patient

9

Spagnuolo et al. (2020)/ Italy [22]

I.) Dentists should avoid the scheduling of any patient: only such urgent dental diseases can be considered during the COVID-19 outbreak.

I.) Staff should work at an adequate distance from patients

-Lack of a precise guideline as to which dental Tx should be considered as urgent dental disease

II.) Handpieces must be equipped with anti-reflux devices to avoid contaminations

III.) Avoid or minimize operations that can produce droplets or aerosols

IV.) Use of saliva ejectors with a low volume or high volume