Asymptomatic pediatric dental patients as potential SARS-CoV-2 carriers : Coronavirus (COVID-19) microsite

By Iveta Ramonaite, Dental Tribune International
May 6, 2021

CHICAGO, USA: In a recent study, researchers examined the prevalence of COVID-19 in pediatric dentistry by testing children during their visit to the pediatric dentist. The study reported that although all of the children enrolled in the study were asymptomatic, some of them tested positive after undergoing polymerase chain reaction (PCR) tests. This suggests that testing pediatric dental patients can help better identify potential SARS-CoV-2 carriers and then reduce transmission speed.

Currently, more than 152 million cases of COVID-19 have been confirmed worldwide, according to the World Health Organization. The US has the most confirmed cases, more than 63 million. Although more than 1 billion vaccine doses have been administered worldwide, the pandemic continues to pose a health and psychological threat to the lives of billions of people suffering the consequences of social detachment and other restrictions placed on their daily lives.

According to the study authors, children with COVID-19 are generally asymptomatic and serious illness due to SARS-CoV-2 in children is rare. Therefore, screening programs are often only aimed at the adult population. Although asymptomatic, children can potentially carry high viral loads of SARS-CoV-2 and thus be a source of infection.

Positivity rate reporting for SARS-CoV-2 in dentistry

The study is the first to report on the positivity rate for SARS-CoV-2 in dentistry. It was conducted by researchers at the University of Illinois at Chicago (UIC) and included 921 patients who attended UIC dental clinics from April 1 to August 1, 2020 for emergency dental procedures. All participants were screened by phone before coming to the clinic. and were asymptomatic when they arrived for their appointments.

Once in the clinic, patients received a PCR test for SARS-CoV-2 infection. Co-author Dr. Flavia Lamberghini, clinical assistant professor in the department of pediatric dentistry at UIC, said of the testing process that the children tolerated the test well. “We have been trained by a pediatrician to perform the test,” she said in a press release. When using the nasal swab, the researchers tried to make the testing process as pleasant as possible. “We said to the kids, ‘We’ll put a butterfly in your nose,’” said Lamberghini.

Patients tested were between 2 and 18 years old, with a median age of 6 years. The researchers abstracted their sociodemographic characteristics and calculated their positivity percentages. Of the 921 patients, the overall SARS-CoV-2 positivity rate was found to be 2.3%. The researchers noted that the positivity rates were statistically higher for Latino patients (3.1%). However, this can be explained by the fact that 63% of the children studied were Latino.

Lamberghini noted that the study did not include variables and that the participants were not asked to answer questions about social distance and exposure to the virus. Nevertheless, once a child tested positive for COVID-19, the researchers contacted the child’s pediatrician and caregivers and encouraged them to follow recommended guidelines to prevent the spread of the disease.

The researchers noted that there was slight confusion among the health care providers who were unaware that their children had COVID-19. “It was a surprise to most of them to learn that their child tested positive,” said Lamberghini. However, it is crucial to let the families know about the positive results, she noted, especially as some extended families live together in communities. In addition, the results are equally important for the oral care providers who care for the children and who are at risk of infection.

“As dentists, we are more exposed to COVID-19 disease because we work close to the mouth, and our tools produce aerosols that can infect the dentist and dental assistant – whoever is around,” she noted.

The importance of testing asymptomatic pediatric dental patients

Typically, children undergoing dental procedures do not need to undergo PCR tests. However, consistent with the findings, the researchers suggested that testing asymptomatic pediatric patients for COVID-19 could be helpful.

“Our findings […] support the idea that the implementation of SARS-CoV-2 testing may be particularly useful in pediatric dental clinics providing care to sociodemographic groups with increased disease prevalence based on local registries. In addition, our findings confirm that the implementation of questionnaires, while useful to identify high-risk patients, does not completely eliminate the risk of spreading SARS-CoV-2 in dental offices, ”the researchers wrote.

“Our findings confirm the implementation of questionnaires […] does not completely eliminate the risk of spreading SARS-CoV-2 in dental offices ”
– Dr. Flavia Lamberghini, UIC

To that end, the researchers noted that using COVID-19 rapid tests could provide more protection in a dental office, but the cost is quite prohibitive. However, dental practices, especially those resuming care, should consider adding SARS-CoV-2 testing to the use of screening tools, personal protective equipment and source control strategies before using aerosol-generating procedures, the researchers concluded.

Finally, although some children tested positive in the study, the researchers saw no transfer to the clinic staff. According to the researchers, this emphasizes the effectiveness of personal protective equipment.

The study, entitled “Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Asymptomatic Pediatric Dental Patients,” was published in the April 2021 issue of the Journal of the American Dental Association P = 285377 & cwpreview = 1n.

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