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Lessons Learned: Patient Screening During the Pandemic,

A Scoping Review

By Richard Yang and Lin Yang

ABSTRACT The disease was named coronavirus virus 2019 (COVID-19).
Accurate patient screening protocols were needed due to the
Background highly contagious nature of the virus and the number of worldwide
SARS-CoV-2, the leading cause of the COVID-19 pandemic, re- fatalities. Although the virus is reported to be most transmissible
sulted in tremendous disruption in patient treatment and student during the symptomatic stage, one study showed that transmission
education at dental education centers around the world. Under the is possible during the incubation period. According to the CDC, the
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Centers for Disease Control (CDC) and American Dental Associa- incubation period of the virus ranges from 2 to 14 days after initial
tion’s (ADA) interim guidance framework, many dental education exposure, which increases the spread potential. Dental healthcare
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centers established unique patient screening protocols with the aim providers belong to one of the highest risk groups that are susceptible
of reducing transmission and safeguarding people’s lives in clini- to COVID-19 due to our unique working environment. Rotary
cal education settings. The purpose of this article is to provide an instruments, air water syringes and ultrasonic scalers form droplets
overview of the different patient screening methods used at various that contain saliva, blood, and microorganisms, which increases
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dental education centers during the pandemic. infectious risk to dental operators. Transmission characteristics of
SARS-CoV-2 virus require appropriate patient screening protocols
Methods to prevent the spread of infection among patients and healthcare
We conducted an electronic search of literature published from Jan- providers.
uary 1, 2020 to March 14, 2021 in the following databases: Google
Scholar, Medline, PubMed, and Cochrane Review. Studies related Coronavirus had a significantly negative impact upon dentistry
to patient screening in dental education centers were included. We during the first months of the pandemic, including dentistry
excluded articles not written in English or only published in pre- in dental education centers. During the pandemic, most dental
print servers. Two independent reviewers evaluated the articles for offices and schools were forced to suspend in person classes and
inclusion or exclusion. Descriptive analysis was conducted. discontinue clinical patient treatment. Many dental education
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programs around the world adopted teledentistry as well as remote
Results pre-clinical simulation and lectures to allow dental education to
Our search strategy initially led us to nineteen articles. Twelve articles continue during this period. However, remote treatment, diagnosis
met the inclusion criteria, of which eight were review articles, three and learning were not viable alternatives to direct clinical treatment
were original articles, and one was an opinion article. Three addition- and training with close patient contact. The delayed clinical training
al articles were included as references, two of which were guidance experience added an additional layer of stress to administrators,
from the CDC and ADA on controlling COVID-19 transmission in patients, and students alike. The balance between infection control
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dental settings. One review article detailing tuberculosis transmission and maintaining the standard of dental care became a challenge in
control was used as historical comparison, but was not included in most dental settings.
screening tabulation. The articles showed that all identified education
centers used pre-appointment questionnaires administered remotely Dental educational centers play a fundamental role in patient
as the first screening method as well as non-contact forehead tempera- care. These places usually serve a large patient pool in the local
ture reading just prior to the appointment. While most dental clinical community. Unfortunately, most of the dental educational centers
centers used only regional CDC and ADA recommendations, a few were closed at the height of the pandemic. All elective dental care
centers provided creative methods that integrated teledentistry. Ar- was suspended and only patients with medical-dental emergencies
ticles from Asian countries emphasized contact tracing while North were treated. These emergencies included uncontrolled bleeding,
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American literature emphasized COVID-19 symptomatology during bacterial infection with intraoral or extraoral swelling that could
pre-screening. potentially compromise the patient’s airway, or trauma involving
facial bones. 6,8,11 The sudden disruption of patient care demanded
Conclusion efficient patient screening protocols to ensure a safe return to work
This scoping literature review found that all articles demonstrated for health educators and students alike.
common themes regarding patient screening during the COVID-19
pandemic. Patient screening was divided into three phases: pre-ap- Appropriate infection control is a critical component that allows
pointment, at appointment and post-appointment phases. Differenc- the continuation of dental education and routine dental care in any
es in patient screening may result from regional geo-cultural views dental education center. In the United States, the CDC and ADA
on infection control. A prospective study should investigate the im- made recommendations for infection control during the height of the
pact on healthcare quality and costs related to the additional admin- pandemic that included postponing elective dental care, teletriage
istrative burden incurred by COVID-19 screening. prior to dental appointments, screening patients for COVID-19
symptoms, asymptomatic viral testing, and use of appropriate
Keywords personal protective equipment (PPE). 4,5,10
COVID-19 Patient Screening, Dental Education Centers, Teleden-
tistry, Scoping Review This scoping review aims to provide an overview of the screening
protocols for COVID-19 patients in dental education centers and
BACKGROUND compare them with official guidelines of that time. To achieve this
SARS-CoV-2 virus is an RNA virus of the coronaviridae family that goal, publications in English were systemically filtered, reviewed,
is highly contagious. Current established symptoms include acute and tabulated to summarize the reported protocols for COVID-19
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respiratory distress syndrome, fever, muscle ache, and dry cough. screening.
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