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and upper respiratory tract infection. in the education centers depending on the contact temperature measurement during
COVID-19 symptom-related questions type of procedures they needed. North an appointment regardless of country
were predominantly found in questionnaires American articles (Table 1 serial 1, 5, 6, of origin. Only Meng et al mentioned
provided by Western dental education 7, 9, 10) closely mirrored CDC and ADA’s conducting targeted SARS-CoV-2 testing
centers. In these articles, symptomatology return to work guidelines with patient risk to identify patients that are asymptomatic
questions made up the majority of the assessments. Non-North American regions or pre-symptomatic as suggested by CDC
questions (70%). In contrast, Asian countries such as China, Taiwan, United Kingdom and Guidelines to Dental Settings. In addition,
placed a greater emphasis on contact tracing. Australia also followed a remarkably similar CDC/ADA recommended repeating the
Greater than 50% of their questionnaires pathway, showing consensus across the questionnaire chairside before commencing
relating to exposure by chronology or globe. Falahchai et al and Abramovtiz et al the procedure as well as a follow-up
3,7
geography in a mix of open and closed reported that procedures that were deemed questionnaire within 48 hours. No articles
questions. In addition, questionnaires were as having a high risk for transmission, mentioned repeating these questionnaires as
used to identify true dental emergencies such as invasive or surgical procedures, per CDC/ADA recommendations, but the
including dental trauma, fever, swelling would require a negative COVID-19 test. articles from non-North American countries
and uncontrolled bleeding. 11 These All articles indicated COVID-19 positive may follow different nationally based
emergencies required immediate attention patients should be treated in hospital settings guidelines.
and had separate guidelines according to the (100%). Negative pressure operating rooms
American Dental Association. or airborne infection isolation rooms were DISCUSSION
strongly recommended when treating There is a perception among some
7,9
Symptomatologic Screening emergency patients with COVID-19. epidemiologists that the current pandemic
All articles indicated the use of non-contact Abramovtiz et al further divided COVID-19 may become a part of the routine “flu
forehead temperature measurement and confirmed patients into two groups based season”. 15,16 Currently, many different
risk assignment except for Amorim et al. on whether they had stable or unstable variations of the virus have been reported
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However, Amorim et al indicated that they respiratory disease. Patients with unstable and there is the possibility of achieving
operated a dedicated fever clinic, which respiratory disease were to defer all invasive herd immunity in certain geographic
would have certainly included non-contact dental treatment and used pharmacological regions. The nature of dental procedures
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forehead temperature checks. There are agents as needed for emergency care. For involving aerosol generation and surgical
some discrepancies in terms of determining those who had stable respiratory disease, procedures matches the reported COVID-19
the temperature for a fever. Huang et al stated minimally invasive emergency dental care transmission methods. 1,6 Therefore,
that if a patient’s body temperature is above could be performed. correctly screening for potential COVID-19
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38°C, and the patient has no visible signs or patients at dental education centers is at
symptoms of COVID-19, emergency dental Technology Use the core of patient and provider safety.
care could be performed in a hospital setting. Teledentistry offers an efficient solution for Vaccination rates among dental providers
However, 37.5°C is considered the deciding remote patient screening. It has gradually are another key component of safety.
temperature according to Abramovitz et been incorporated into routine dental care
al. The CDC states that fever is either a as it satisfies the need of social distancing. The majority of articles in this review have
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measured temperature ≥100.0°F (37.7°C) There are various forms of teledentistry a similar approach to screening patients for
or subjective fever. including: teletriage, teleconsultation, COVID-19. They involve: 1) information
telediagnosis and telemonitoring. Patients collection; 2) risk assessment; 3) teletriage;
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Epidemiological History/Contact Tracing can take pictures of their oral lesions and and 4) non-contact forehead temperature
Travel, occupation, contact and cluster describe their symptoms to dental providers. check. For the most part, they are in alignment
(TOCC) were investigated in depth by Routine recall visits can be minimized by with their respective national regulatory
Chang et al and Peng et al. Both articles telemonitoring, and disease progression bodies. However, besides symptomatology,
3,7
investigated the patient’s COVID-19 can be closely monitored without delaying Asian education centers placed emphasis
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exposure status, including active movement treatment. There are multiple programs on epidemiological history/contact tracing.
tracking. Chang et al described patient designed to aid telediagnosis in dentistry. Further study efforts can elucidate the direct
contact tracing that utilized digital Mouth Screening Anywhere (MeMoSA®) effect of different screening methods on
information from public infrastructure and tablet-based mobile microscope reducing COVID-19 patient infectivity
records. According to Chang et al, the public (CellScope device) are smartphone apps in both patients and providers. Closed
insurance system in Taiwan has a database that are designed to screen patients for question style questionnaires can potentially
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that provides travel history of its citizens. In potential oral cancer. Teletriage has been increase the likelihood of missing key
Peng et al, approximately 70% of the self- indicated in 70% of all articles except for epidemiological information compared to
reported questionnaire contents involved Chang et al and Peng et al. Engaging in open-ended questions. However, Friborg et
contact tracing that extensively investigated remote screening prior to appointments al reported no new insights were gained from
potential COVID-19 exposure status in a and completion of questionnaires relied open-ended questions in their prediction of
chronologically dependent manner. on digital means such as telescreen apps mental health. 18
and email. Amorim et al indicated the use
Patient Risk Assessment of social media platforms (Whatsapp) as The use of commonplace social media
Some type of a patient risk assessment were communication means for remote screening platforms with a wide user base is an
included in all but one article (90%). Self- and patient risk assessment. All the innovative way to increase questionnaire
reported questionnaires allowed screening articles indicated adopting existing digital completion rate and reduce communication
agencies to separate patients broadly into communication platforms (100%). barriers for post-procedure follow-ups.
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suspected vs low risk categories. Patients For instance, the use of Whatsapp in North
were further divided into subcategories CDC and ADA Recommendations America, and Wechat in China have reported
based on their need for emergency 90 percent of all articles followed CDC/ positive results with patient communication
treatment as compared to needing more ADA’s recommendations in using a pre- compliance, particularly in pediatric and
elective procedures. Patients were directed appointment questionnaire, COVID-19 adolescent groups.
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either towards hospital or outpatient settings risk assessment, teletriage and non-
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