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

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

I.D. Author (Year)/ Country Guidelines offered Procedural considerations Authors’ comments on the literature gap
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