Infection

IntroductionCoronavirus (COVID-19) has dramatically changed the landscape of dentistry including Paediatric Dentistry. This paper explores paediatric patient data within a wider service evaluation completed within an Urgent Dental Care Centre in the North East of England and North Cumbria over a 6-week period. AimTo assess demand for the service, patient demographics and inform paediatric urgent dental care pathways. Main outcome methodsData collected included key characteristics of paediatric patients accessing Paediatric Dental Services from 23rd March to 3rd May 2020. Descriptive statistics were used for analysis. ResultsThere were 369 consultations (207 telephone, 124 face-to-face and 38 Out of Hours consultations). The mean age of children accessing the service was 7 years old. 7% of those attending face-to-face visits were reattenders. The most common diagnoses were irreversible pulpitis and dental trauma. 49% of face-to-face consultations resulted in extractions, 28% with General Anaesthetic, and 21% with Local Anaesthetic. ConclusionManagement of dental emergencies provided by the Urgent Dental Care Centre for paediatric patients has largely been effective and confirmed the efficacy of patient pathways established. O_LSTThree in Brief PointsC_LST Describes the approach adopted in the North East of England and North Cumbria to managing paediatric dental emergencies during the coronavirus pandemic Provides an overview of dental problems and management provided to paediatric patients in the first 6 weeks of the coronavirus pandemic Confirms the need for general anaesthetic services for exodontia in the paediatric population

The COVID-19 pandemic highlighted the need for effective protection and rapid development of tests to track and quantify seroconversion through natural infection and vaccination. Recombinant proteins, consisting of the SARS-CoV-2 nucleocapsid and Spike Receptor Binding Domains (RBD) fused with nanoluciferase reporters (GloBodies) were designed and produced. The SARS-CoV-2 specific antibody within serum, from venous blood or eluted from local or remotely-obtained dried blood spots, form a complex with the GloBody, which can be captured on immobilized Protein G or anti-isotype antibody with the retained nanoluciferase activity being proportional to specific antibody levels. Natural infection, vaccination and human and animal SARS-CoV-2 specific antibodies were detectable. These were used to serially monitor infection and vaccination responses in dental healthcare workers (n=82), medical healthcare workers (n=72) and laboratory-based scientists (n=62) within the Royal London, dental and medical hospitals and associated university research institute in Whitechapel, East London. This indicated temporally distinct infection and vaccination profiles, consistent with hospital deployments and local and national lockdowns by dentists and scientists. As such, medical healthcare workers had twice the odds of experiencing COVID-19 symptoms (2.01 95%CI 1.13- 3.58. P<0.001) compared to dentists, who were more at risk than scientists. Likewise, those who performed virus exposure-prone procedures exhibited twice (1.98. 95% CI 1.18-3.34 P=0.01) the odds of symptoms and exhibited higher nucleocapsid titres (0.21 95%CI 0.05-0.38. P=0.012), indicative of higher infection levels. As predicted vaccination was associated with reduced infection risk as shown by reduced titre of nucleocapsid titres (-0.21 95% CI -0.34- - 0.17. P<0.001 and elevated Log10 RBD GloBody titres (1.18. 95%CI 1.09-1.26. P<0.001). The GloBody technology proved to be a versatile and scalable platform for rapid deployment.

This study describes the establishment of the National Dental Center Singapore Oral Disease Registry (NDCS-ODR), a large-scale, electronic health records registry designed to capture real-world data on oral diseases. The NDCS-ODR was developed to standardize and integrate oral health data within Singapore Health Services, the countrys largest healthcare cluster. Its development, governance, and data architecture are described, with an overview of individuals with oral diseases recorded in the registry. Data collection from 2013 to June 2025 has been completed. As of June 2025, the NDCS-ODR comprises 229,249 unique patients, with a mean (SD) age of 49.1 (19.5) years and an approximately equal sex distribution. Most were of Chinese ethnicity (77.6%), and Singapore citizens (92.5%). Clinical variables indicated substantial disease and treatment burden, with a mean of 7.9 (7.7) missing teeth, 4.8 (6.2) restored surfaces, and 2.8 (3.4) restored teeth per patient. Among 108,517 recorded periodontal diagnoses, Stage III periodontitis (2018 EFP/AAP Classification) and severe chronic periodontitis (1999 Classification of Periodontal Diseases and Conditions) were most common. The NDCS-ODR represents Singapores first large-scale, real-world oral disease registry embedded within a national specialty center, demonstrating the feasibility of leveraging electronic health record data for research and service evaluation.

IntroductionDental settings have been considered high risk setting s for COVID-19. A Dental Public Health Team in South East Scotland have worked to risk assess the situation timeously to break chains of transmission. AimTo present routine data produced from a contact tracing service for COVID-19 cases in the dental setting with a focus on transmission. DesignObservational retrospective analysis of a routine data set of COVID-19 cases associated with a dental setting reported via the national contact tracing system for two health board areas in the east of Scotland. MethodsCOVID-19 cases were confirmed by PCR testing. Descriptive statistics are used to summarise the data collected over a 13-month period (Oct 2020-Dec 2021). A narrative presents themes identified during contact tracing that led to transmission within a dental setting and includes a case study. ResultsA total of 811 incidents are included. No evidence of staff to patient transmission or vice versa was found in this study. Staff to staff transmission occurred in non-clinical areas contributing to 33% of total staff cases. ConclusionTransmission of COVID-19 in a dental setting in the context of this study appears to be confined to non-clinical areas. Future pandemic plans should include tools to aid with implementation of guidance in non-clinical areas. In brief pointsO_LIOutbreaks of COVID-19 in a dental setting appear to be confined to the non-clinical areas of dental practices. C_LIO_LIWe have found no evidence of staff to patient transmission or vice versa using our contact tracing methods. C_LIO_LIFuture pandemic preparedness would benefit from including current quality improvement tools to aid with implementation of new standard operating procedures and other regularly changing guidance. C_LI

Universal masking the health care setting and in the community to contain the spread of SARS-CoV-2 has been recently recommended by the WHO, but supporting data are rare. The City of Jena was the first community in Germany to issue an order on mandatory public masking. Here, we report the development of the number of novel infections in our hospital and in the city of Jena after implementation of universal masking in our hospital and the city.

The prevalence and consequences of traumatic dental injuries (TDI) make them a public health problem. Trustworthy TDI Clinical Practice Guidelines (CPGs) can assist clinicians in making a proper diagnosis, and guide them to the most appropriate therapy for every case. The aim of this study was to identify and evaluate the quality of CPGs for the diagnosis, emergency management and follow-up of TDIs. A systematic search was carried out in MEDLINE, EMBASE, Epistemonikos, Trip database, CPG websites, and dental societies to identify documents providing recommendations for the emergency and sequelae management of TDIs. Reviewers assessed the included guidelines independently and in duplicate, using the AGREE II instrument. T-student or ANOVA tests were used to determine the attributes of CPGs associated with the total score in AGREE II. Ten CPGs published between 2010 and 2020 were included, mostly from Europe (n=6). The overall agreement between reviewers was very good (0.94; 95%CI 0.91-0.97). The mean scores for each domain were as follows: Scope and purpose 78.0 {+/-} 18.9%; Stakeholder involvement 46.9 {+/-} 29.6%; Rigour of development 41.8 {+/-} 26.7%; Clarity of presentation 75.8 {+/-} 17.6%; Applicability 15.3 {+/-} 18.8% and Editorial independence 41.7 {+/-} 41.7%. The overall mean rate was 4 {+/-} 1.3 out of a maximum score of 7. Only two guidelines were recommended by the reviewers and rated as high quality. The CPGs developed by governments showed a significantly higher overall score. The overall quality of CPGs on TDI was suboptimal. Therefore, the CPGs developers need to use a methodology that allows them to formulate recommendations in a structured, transparent, and explicit way.

There is limited information describing features and outcomes of patients requiring hospitalization for COVID19 disease and still no treatments have clearly demonstrated efficacy. Demographics and clinical variables on admission, as well as laboratory markers and therapeutic interventions were extracted from electronic Clinical Records (eCR) in 4712 SARS-CoV2 infected patients attending 4 public Hospitals in Madrid. Patients were stratified according to age and stage of severity. Using multivariate logistic regression analysis, cut-off points that best discriminated mortality were obtained for each of the studied variables. Principal components analysis and a neural network (NN) algorithm were applied. A high mortality incidence associated to age >70, comorbidities (hypertension, neurological disorders and diabetes), altered vitals such as fever, heart rhythm disturbances or elevated systolic blood pressure, and alterations in several laboratory tests. Remarkably, analysis of therapeutic options either taken individually or in combination drew a universal relationship between the use of Cyclosporine A and better outcomes as also a benefit of tocilizumab and/or corticosteroids in critically ill patients. We present a large Spanish population-based study addressing factors influencing survival in current SARS CoV2 pandemic, with particular emphasis on the effectivity of treatments. In addition, we have generated an NN capable of identifying severity predictors of SARS CoV2. A rapid extraction and management of data protocol from eCR and artificial intelligence in-house implementations allowed us to perform almost real time monitoring of the outbreak evolution.

Digital technologies are becoming essential to address and optimize the suboptimal performance of healthcare systems. Teledentistry involves the use of information and communication technology to improve access to oral health care and the quality of oral health care delivery. Several systematic reviews (SRs) have been conducted to synthesize evidence on the effectiveness of teledentistry but with conflicting results. The aim of this review is to comprehensively summarize available SRs and provide evidence on the impact of teledentistry on access to oral care, patients and oral healthcare providers outcomes, quality of oral health care and costs. This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42022373964). Six electronic databases including MEDLINE (Ovid), Embase (Embase.com), CINAHL (EBSCO), Web of Science, Cochrane Library and Epistemonikos will be searched for SRs of quantitative, qualitative, and mixed reviews evaluating teledentistry modalities involving both patients and/or oral health care providers (OHCPs). We will include only studies published in English or French. The primary outcomes will be considered from the patients perspective (e.g., access to oral health care, patient-reported outcomes, and experiences). The secondary outcomes will include outcomes from patients and OHCPs (e.g., clinical outcomes, safety, behaviors, and costs). Two independent reviewers will perform data screening, data extraction and will assess the quality of included studies using the AMSTAR 2 and ROBIS tools. Data will be synthesized narratively and presented by tables and graphs. We will report any overlap of primary studies in the SRs. A statement on the strength of evidence for each outcome will be provided if possible. This review will inform decision-makers, patients, OHCPs, and researchers on the potential effectiveness, benefits, and challenges of teledentistry and support them in making recommendations for its use. Results will be disseminated through peer-reviewed publications, presentations at conferences, and on social media.

BackgroundDespite advances in Temporomandibular disorders (TMDs) diagnosis, the diagnostic process continues to be problematic in non-specialist settings. ObjectiveTo complete a Delphi process to shorten the Diagnostic Criteria for TMD (DC/TMD) to a brief DC/TMD (bDC/TMD) for the diagnoses with the most utility in general dentistry settings. MethodsA international Delphi panel was created with 23 clinicians representing major specialities, general dentistry, and related fields. The process comprised a full day workshop, four virtual meetings, six rounds of electronic discussion, and finally an open consultation at a virtual international symposium. ResultsWithin the physical axis (Axis 1) the self-report Symptom Questionnaire of the DC/TMD did not require shortening from 14 items for the bDC/TMD. The compulsory use of the TMD pain screener was removed reducing the total number of Axis 1 items by 18%. The DC/TMD Axis 1 10-section examination protocol (25 movements, up to 12 sets of bilateral palpations) was reduced to 4 sections in the bDC/TMD protocol involving 3 movements and 3 sets of palpations. Axis I then resulted in two groups of diagnoses: painful TMD (inclusive of secondary headache), and common joint-related TMD with functional implications. The Psychosocial Axis (Axis 2) was shortened to an ultra-brief 11 item assessment. ConclusionThe bDC/TMD represents a substantially reduced and likely expedited method to establish (grouping) diagnoses in TMDs. This may provide greater utility for settings requiring less granular diagnoses for the implementation of initial treatment, for example non-specialist general dental practice.

Perioperative anaphylaxis (POA) is a severe complication with a low incidence and diverse risk factors. Its low incidence makes a detailed survey of POA challenging. Recent large-scale surveys in Japan have focused on identifying the causative agents using the basophil activation test. Only facilities, such as university hospitals, that can dispatch samples for this test participate, which may introduce bias. We surveyed the incidence of POA primarily in secondary hospitals, such as the Saiseikai hospitals, throughout Japan. We targeted data collection for the year 2021. Thirty-five facilities answered (Supplementary 1, 2); we excluded 1 reporting no surgeries. In total, 70,523 surgeries were performed, with POA diagnosed in 7 cases. For diagnosis, the skin test was used in 3 cases and quantification of histamine and tryptase in 1 case. In 3 cases, diagnosis was based on the time to onset of POA after drug use. Multiple tests are important to ensure patient safety. However, in this survey, no hospital performed in vitro tests to identify the cause. This is major limitation, however, as many hospitals do not have experimental laboratories, we believe that this study, which focuses on secondary care institutions, contributes to the literature significantly by presenting the current situation in clinical practice.

Oral conditions are highly prevalent worldwide. Recent studies have been supporting a potential bidirectional association of oral disorders with systemic noncommunicable diseases (NCDs). Robust evidence supports the greater prevalence of oral conditions in people suffering from NCDs limiting the ability of oral self-care. As for the relationship with other NCDs, the lines of evidence have increased exponentially but not always with the proper coherence. This umbrella review of meta-analyses appraises the strength and validity of the evidence for the association between oral health and systemic health. An extensive search included systematic reviews that have provided meta-analytic estimates on the association of an oral condition with a NCD. The overall strength of evidence was found to be unfavorable and with methodological inconsistencies. Twenty-two NCDs, four types of cancer and circulating levels of CRP were strongly associated with oral diseases. Among the significant NCDs are diabetes mellitus, cardiovascular diseases, depression, neurodegenerative conditions, rheumatic diseases, inflammatory bowel disease, gastric helicobacter pylori, stroke, obesity, diabetes mellitus or asthma. Most evidence is unlikely to change which indicates a relatively robust consistency of the available body of evidence.

ISARIC (International Severe Acute Respiratory and emerging Infections Consortium) partnerships and outbreak preparedness initiatives enabled the rapid launch of standardised clinical data collection on COVID-19 in Jan 2020. Extensive global participation has resulted in a large, standardised collection of comprehensive clinical data from hundreds of sites across dozens of countries. Data are analysed regularly and reported publicly to inform patient care and public health response. This report, our 18th and final report, is a part of a series published over 3 years. Data have been entered for 945,317 individuals from 1807 partner institutions and networks across 76 countries. The comprehensive analyses detailed in this report includes hospitalised individuals of all ages for whom data collection occurred between 30 January 2020 and up to and including 10 January 2023, AND who have laboratory-confirmed SARS-COV-2 infection or clinically diagnosed COVID-19. For the 845,291 cases who meet eligibility criteria for this report, selected findings include: O_LIMedian age of 57 years, with an approximately equal (50/50) male:female sex distribution C_LIO_LI29% of the cohort are at least 70 years of age, whereas 6% are 0-19 years of age C_LIO_LIThe most common symptom combination in this hospitalised cohort is shortness of breath, cough, and history of fever, which has remained constant over time C_LIO_LIThe five most common symptoms at admission were shortness of breath, cough, history of fever, fatigue/malaise, and altered consciousness/confusion, which is unchanged from the previous reports C_LIO_LIAge-associated differences in symptoms are evident, including the frequency of altered consciousness increasing with age, and fever, respiratory and constitutional symptoms being present mostly in those 40 years and above C_LIO_LI15% of patients with relevant data available (845,291) were admitted at some point during their illness into an intensive care unit (ICU), which has decreased from 19% during the 3 years of ISARIC reporting C_LIO_LIAntibiotic agents were used in 37% of patients for whom relevant data are available (802,241), a significant reduction from our previous reports (80%) which reflects a shifting proportion of data contributed by different institutions; in ICU/HDU admitted patients with data available (64,669), 90% received antibiotics C_LIO_LIUse of corticosteroids was reported in 25% of all patients for whom data were available (809,043); in ICU/HDU admitted patients with data available (64,713), 71% received corticosteroids C_LIO_LIOutcomes are known for 762,728 patients and the overall estimated case fatality ratio (CFR) is 22% (95%CI 21.9-22), rising to 36% (95%CI 35.6-36.1) for patients who were admitted to ICU/HDU, demonstrating worse outcomes in those with the most severe disease C_LI To access previous versions of ISARIC COVID-19 Clinical Data Report please use the link below: https://isaric.org/research/covid-19-clinical-research-resources/evidence-reports/

Statement of problemDental implant failure remains a significant clinical concern, with early loss often attributed to impaired osseointegration. Recent research has considered the role of serum vitamin D in implant integration, yet the precise relationship between vitamin D status and implant loss, particularly when distinguishing early and late failures, is not fully established. PurposeThe objective of this analysis was to evaluate the association between explicit serum vitamin D cut-off values and clinically confirmed dental implant failure, with a particular focus on differentiating early (pre-loading) from late (post-loading) failures. The review also sought to determine whether primary studies used multivariate adjustment for potential confounders. Material and methodsThe draft of this revision was registered in PROSPERO (CRD420251049631, https://www.crd.york.ac.uk/PROSPERO/view/CRD420251049631). A comprehensive literature search was conducted using AI-assisted tools to identify primary research studies, including randomized controlled trials and cohort studies, published in English, Spanish, French, German, or Italian. Eligible studies required explicit vitamin D threshold categorization, clinically verified implant loss, and clear differentiation of early and late failures. Data extraction included study design, vitamin D categorization, analytical methods, and outcomes. ResultsIdentified studies predominantly consisted of retrospective and prospective cohorts examining early implant failures, frequently using cut-offs such as >30 ng/mL, 10-30 ng/mL, and <10 ng/mL for serum vitamin D. Results suggested a higher frequency of early failures in individuals with severe vitamin D deficiency; however, all studies relied on univariate analyses without multivariate adjustment for confounders. Late implant failures were rarely addressed. ConclusionsCurrent evidence indicates a possible association between low serum vitamin D and early dental implant failure, but the lack of robust statistical adjustment prevents definitive conclusions. High-quality studies with rigorous confounder control and explicit early versus late failure analysis are needed.

The deterioration of motor skills and fine hand movement impairment associated with Parkinsons disease (PD) hinders the performance of daily oral hygiene procedures. This study examined the periodontal health of people with PD using clinical and microbiological periodontal parameters measured at two time points during their medical follow-up. This prospective cohort study included participants with PD. Clinical oral health data, including oral hygiene and periodontal status, as well as microbiological samples were collected at baseline and after follow-up for at least 3 months. Forty people with PD were recruited (35% female; median [Q1-Q3] age: 65.3 [57.9- 72.8] years) and 35 were followed up. The participants had good hygiene habits, and the proportion of participants with a "good" plaque index improved during follow-up (+21 points, p = 0.239). The proportion of patients with periodontal pockets > 6 mm decreased from 20% to 3% (p = 0.131). This improvement was associated with a reduction in the Treponema denticola bacterial load (p = 0.003). The oral hygiene of people with PD improved during this study. Although these promising results require confirmation, they are an important step toward enhancing oral care support for PD patients. ClinicalTrials.gov Identifier: NCT03827551, registered on January 31, 2019, (https://clinicaltrials.gov/study/NCT03827551)

A systematic review was performed to answer the following questions: 1) Do dental, oral and maxillofacial (OMF) surgical procedures generate bioaerosols (and if so, which ones), which can result in transmission of COVID-19?; 2) Are aerosolized airborne droplets (and to which extent is splatter) in dental and OMF procedures infective?; 3) Is enhanced personal protective equipment (PPE) an essential to prevent spreading of COVID-19 during dental and OMF aerosol generating procedures (AGPs)? Authors performed a systematic review to retrieve all pertinent literature that assessed effectiveness of surgical mask vs respirators for protecting dental health care workers during dental and OMF AGPs surgical procedures. Additionally, studies which assessed potential aerosolization during dental, OMF and orthopaedic surgeries were retrieved. There is moderate evidence showing that ultrasonic scaling and bone drilling using high speed rotary instruments produces respirable aerosols. Additionally, there is very weak/inconclusive evidence to support the creation of infectious aerosols during dental procedures. According to available very weak/inconclusive evidence, transmission of SARS-CoV-2 via infective aerosol during AGPS, so far, must remain speculative and controversial. As, however, this is a probable opportunistic way of transmission which at least cannot be sufficiently excluded and therefore should not be dismissed out of hand prematurely, proper and equally important properly applied protective equipment (i.e., N95 respirators or FFP-2 masksv or above regarding mouth and nose protection) should always be used during AGPs.

ObjectivePrimary health care (PHC) professionals must care for patients with oral problems while performing gatekeeping for specialized care. We explored the effect of a strategy combining referral protocols and teleconsultations on a waiting list. Study designThis retrospective cohort study analyzed data from PHC to specialized oral medicine care from May/2014 to May/2016. The program started in May/2015, and referrals were divided into control and exposed groups. The median waiting time for in-person consultation and the proportion of referrals managed in PHC were analyzed for general and priority cases. ResultsThere were 1464 referrals. The median waiting time for specialized consultation was reduced from 212 days (95%CI 196-227) to 131 days (I95%CI 95-166). For priority referrals, the control group had 37 days (95%CI 0 - 89) of median waiting time, and the exposed group had 12 days (95%CI 6 - 17). ConclusionsStructured referral protocol and professional-to-professional consultations for oral disease improve referral waiting times. This benefit seems related to improving PHC efficacy.

BackgroundThe detection of SARS-CoV-2 RNA by real-time polymerase chain reaction (PCR) in respiratory samples from COVID-19 patients is not a direct indication of the presence of viable viruses. The isolation of SARS-CoV-2 in cell culture system however, can acts as surrogate marker of infectiousness. Cell culture based studies performed mostly with hospitalized and moderate/severe COVID-19 claims that no replication competent virus is found after 9 days of the symptoms onset in respiratory samples. Therefore, it is now recommended 10 days isolation before patient discharge. MethodsWe cell-cultured 29 SARS-COV-2 RT-PCR positive respiratory samples at the 10th day after the illness in Vero E6 cells. After two passages, cytopathic effect and cycle threshold (CT) lower than the obtained in the original sample were used to determine positivity. FindingsWe found viable particles in (7/29) 24% of samples tested. The positivity in cell culture was strongly associated (p<0.0001) to the low cycle thresholds in clinical samples (Ct <21). ConclusionThis data adds important knowledge to the current protocols for de-isolation of patients with non-hospitalized mild COVID-19.

IntroductionRespiratory Syncytial Virus (RSV) is a major cause of morbidity in older adults. With the emergence of the coronavirus disease 2019 (COVID-19) and the subsequent changes in respiratory viral circulation, it is crucial to reassess RSV-associated healthcare burden in adults. This study assessed RSV-associated healthcare burden in adults in six European countries before and during the COVID-19 pandemic. MethodsWe conducted a retrospective analysis using national hospital admissions data from Denmark, England, Finland, the Netherlands, Scotland, and regional surveillance data from the Valencia region (Spain). We included patients aged [&ge;]18 years hospitalised for respiratory tract infections (RTIs) from 2016 to 2023. We assessed RSV-coded and laboratory-confirmed hospitalisations, intensive care unit (ICU) admissions, in-hospital length of stay (LOS), and mortality. ResultsRSV-associated hospitalisations significantly reduced during the 2020/2021 season across all countries, coinciding with strict COVID-19 preventive measures, but resurged in subsequent seasons. We observed the highest hospitalisation rates in adults aged [&ge;]85 years. RSV-coded hospitalisations were found to underestimate the true burden when compared with laboratory-confirmed cases. Underestimation factors ranged from 1.1 to 4.3 times across countries. No significant differences were observed in LOS or ICU admission rates for RSV-associated hospitalisations compared to RTIs. DiscussionOur findings underscore the complex epidemiology of RSV in older adults. The differences between RSV-coded and laboratory-confirmed cases highlight the critical need for improved surveillance and diagnostic practices to better assess the true burden. Our findings could be vital for guiding public health strategies, particularly with the recent introduction of RSV vaccines for older adults.

Introduction & ObjectivesThe COVID-19 pandemic has been raging across the globe since early January 2020. India has reported over 27 million cases and more than 3, 00,000 deaths. This study was planned to analyze the differences in demographic, clinical features and oral manifestations of COVID 19 patients hospitalized during COVID-19 pandemic. MethodsThis observational pilot study had total 36 participants, 12 each of mild, moderate and severe RT-PCR positive COVID cases hospitalized during COVID 19 pandemic. All demographic, clinical features, treatment details and oral manifestations were noted from first day of admission to hospital till treatment completion with follow up of minimum 7 days. ResultsMean age of the patients was 39.44 {+/-}9.13 years with M: F ratio of 5:4. Most common clinical presentation was fever, shortness of breath and treatment involved was symptomatic with supplemental oxygen & mechanical ventilation. Most common oral site involved was tongue & oral lesions observed were herpes labialis, mucositis, burning sensation, dryness of oral cavity, angular chelitis, aphthous ulcers, geographic tongue, fissuring of tongue, candidiasis, coated tongue, sublingual varicosity, & scalloped tongue. Interpretation and ConclusionAll demographic, clinical and oral manifestations were significantly different in mild, moderate and severe cases of covid hospitalized patients. Though clinical symptoms were improved, oral lesions were worsened. Oral Lesions seen in covid patients were associated with multiple drug therapy for illness along with poor oral hygiene, but further etiology for lesions needs to be evaluated. Sublingual varicosity was observed in our hospitalised covid patients, but large sample observation is required for confirmation of findings and may be an early oral feature for covid detection. Prevention is always better than cure, so all patients positive for Covid should have a full mouth examination. Oral health should be priority during overall management of COVID patients and dentists should be a part of Covid management team.

BackgroundAccumulation of dental plaque can lead to gum problems. A fluoride toothpaste containing naturally occurring enzymes and proteins has been shown to improve gingival health and reduce supragingival plaque in European populations. The objective of the current study was to evaluate the ability of this toothpaste to improve gingival condition and reduce supragingival plaque in an alternative study population. MethodsThis was a double-blind (participant, examiner, investigator, statistician), randomised, parallel group, efficacy study conducted at a Chinese university dental hospital. Participants (age 18-70) with a mean gingival index (GI) [&ge;] 1.0 and mean modified Quigley and Hein plaque index (MQHPI) [&ge;] 1.5 were randomised using sex stratification to twice-daily brushing with either test toothpaste (n=127) or control fluoride toothpaste (n=124) for 26 weeks. Assessments of GI (primary outcome) and MQHPI were conducted at baseline and after 4, 13 and 26 weeks of product use. Results were analysed using ANCOVA model for between product comparison (= 0.05). ResultsOne hundred and six participants using test toothpaste and 92 using control toothpaste completed the study. The test toothpaste was more effective than control toothpaste in improving gingival condition after 4, 13 and 26 weeks of product use, with estimate product differences in GI of -0.18 at week 4 (p < 0.0001, 95% CI -0.23 to -0.12), -0.16 at week 13 (p < 0.0001, 95% CI -0.20 to -0.11) and -0.53 at week 26 (p < 0.0001, 95% CI -0.60 to -0.46). The test toothpaste was also significantly more effective than control toothpaste in reducing supragingival plaque after 4, 13 and 26 weeks of product use, with estimated product differences of -0.29 at week 4 (p < 0.0001, 95% CI -0.38 to -0.21), -0.35 at week 13 (p < 0.0001, 95% CI -0.45 to 0.25) and -0.96 at week 26 (p < 0.0001, 95% CI -1.06 to -0.85). ConclusionThe study demonstrated that a toothpaste containing naturally occurring enzymes and proteins significantly improved gingival health and reduced supragingival plaque compared to a control toothpaste, after 4, 13, and 26 weeks of use.