Introduction

In 2019, a novel β-coronavirus [severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)] causing severe and potentially fatal pneumonia was identified in Wuhan city, Hubei province, China.^1-3 This virus and the subsequent illness, coronavirus disease 2019 (COVID-19) initiated a pandemic.⁴ Clinical symptoms of acute SARS-CoV-2 infection in a patient without immunity include fever, dry cough, myalgia, fatigue, and pneumonia with abnormal chest CT. Less commonly observed symptoms include sputum production, headache, hemoptysis, and diarrhea.^5-7 Further, heterogeneity in symptom frequency have been demonstrated with shifts in symptoms based upon different variants.⁸ The person-to-person transmission of SARS-CoV-2 includes direct transmission, such as cough, sneeze, saliva and other droplet inhalation transmission, distant airborne transmission of droplet nuclei, and contact transmission, such as the contact with oral, nasal, and eye mucous membranes.^9-11 Fomite transmission has also been proposed, although it is likely a very minor transmission pathway.¹¹

Prior to the COVID-19 pandemic, infection control in the dental office focused on bloodborne pathogens and Standard and Transmission based precautions limiting exposure to bodily fluids and other potentially infectious materials.^12-17 There are three categories of Transmission-based Precautions: contact precaution, droplet precautions, and airborne precautions associated with droplet nuclei.^15-17 During the initial days of the pandemic, the airborne transmission of SARS-CoV-2 was believed to pose particular issues for delivery of safe dental care. Dental health care personnel (DHCP) and their patients were presumed to be at increased occupational risk associated with aerosols in the dental office due to the frequency of close, personal face-to-face communication and exposure to saliva, blood, and other body fluids, and—indirectly—by the handling of sharp instruments and touching contaminated dental surfaces.^18-21 It has been well-established that delivery of many dental procedures results in the generation of aerosols, which could result in the airborne spread of infectious material and the perception of routes of transmission in dentistry have been altered by COVID-19 and the subsequent practices of enhanced infectious control during and following the pandemic.^22,23 Recent evidence has also shown that there may be a link between oral health and COVID-19 infection. Given these considerations, this course seeks to review the evidence on infectious diseases and oral and overall health that was gleaned during and after the COVID-19 pandemic and the implications on the provision of dental care.