COVID–19, the newly discovered coronavirus disease first diagnosed in China in 2019, has become pandemic across the world in a relatively short period. It has affected almost all aspects of human life worldwide. Many protocols have been established to minimize the number of infected people, yet this virus has already spread to all five continents, affecting all communities regardless of borders, nationalities, or climate conditions (1, 2). Up to May 31, 2020, the number of people who have been officially reported to be infected by COVID–19 around the globe was more than 5,934,936 individuals, among which 367,166 deaths have been reported (3). It seems that the real numbers might be much higher than those figures.
COVID–19 has transmission pathways similar, but not identical, to those of other SARS-CoV infections, mainly through the respiratory system (4, 5). Many considerations about the possible hazardous activities or workplaces have risen based on both our experience from previous SARS-CoV infections and our observation of the transmission pattern of the SARS-CoV–2 itself in this short time of its appearance. Among them, the potential transmission of the virus through dental procedures and dental settings has attracted much attention leading to either mandatory or voluntary suspension of routine dental care (6, 7).
The concern about dental practice coronavirus transmission has been widely recognized around the world. Recently, The New York Times noted that dentistry was the most at-risk profession for nCoV–19 among various occupations(8). Based on the nature of the dental procedures, and the close proximity of the dental team with patients, the disease could readily spread from infected patients to the dental team, and vice versa, and subsequently to other patients, if appropriate protective infection control measurements are not undertaken (9, 10).
Dental teams, led by the dentist, are very familiar with universal personal protective equipment and other cross infection control measures and risk assessment. Whilst these issues have become prominent during the pandemic; there has been uncertainty regarding the most appropriate Personal Protective Equipment (PPE) and way of working. Each country of the world has been required to develop policy very rapidly and has interpreted medical and scientific evidence and advice from the WHO in very different ways. Similarly, the guidelines written for COVID–19 and advice published for the safe and effective practice of dentistry have shown much variation around the world and also within countries. Perhaps this is due to the lack of evidence-based. It is likely to take some time to develop an effective vaccine and implement widespread immunization, and so it is critical that find new ways of working so that we can offer much-needed care for patients with oral health issues. The long term consequences of this pandemic are currently unknown but undoubtedly will result in a ‘new normal’ for the provision of dental care.
Many suggestions and protocols have been issued for re-opening or reorientation of dental clinics in a short period of time. However, many of the protocols have been produced quickly (for understandable reasons) with a focus on the ideal rather than a realistic point of view (11–13). This systematic review focuses on the risk of the transmission of the COVID–19 during dental treatments and provides pathways and protective protocols to minimize them, bearing in mind the long-term necessity of actions and realistic, practical measures.