Introduction — A Slice of Time

Kerry K. Carney, DDS, CDE

When you observe a fossil encased in the veneer stone of a marble wall, you are witnessing a slice of time. You may dismiss it as an ancient artifact. But it is a snapshot of the life of an organism in the context of its environment. To make the point clear, think of finding an old, yellowed photo of your grandparents at their wedding. You do not dismiss it as just a very old photo of a young couple related to you. Instead, you think of what was happening to them. What were they experiencing in that moment? You think of them in the context of their lives. This issue of the Journal of the California Dental Association is a slice of time.

We are living in an interesting and rapidly changing environment. Data about the spread of the SARSCoV-2 virus and the tally of those who have succumbed to COVID-19 change daily. In this issue, we have compiled several articles detailing our current understanding of COVID-19; however, it goes without saying that figures cited in these pages will have changed by publication.

Given the dynamic environment, the CDA Journal is being presented as a slice of time. We know that in 18 months, five years or a decade from now the information we have gathered, processed and built on will be astounding. This event might even become a scientific watershed. We may categorize our knowledge of virology, epidemiology, public health and dental practice in terms of our pre-COVID-19 and post-COVID-19 understanding. This special COVID-19 issue is not only designed to update the contemporary reader but will serve as an archive for future researchers. This issue provides a context for how we reacted to this unfolding pandemic. The articles herein illustrate what we think we know at this time.

Molayem et al. take a periodontal perspective in their article “The MouthCOVID Connection: Il-6 Levels in Periodontal Disease-Potential Role in COVID-19-Related Respiratory Complications.” In their review, they explore the association between periodontal therapy, serum IL-6 levels, systemic inflammatory activity and COVID-19 severity. Mair et al. in their article “Decoding Dental Aerosols in the Age of COVID-19” posit that dentistry has a strong record of effective dental aerosol mitigation and an overemphasis on dental aerosols may distract from the importance of preventing nonclinical transmission through physical distancing, face masks and optimized ventilation. The authors hypothesize that public confidence in the safety of dental office visits may be undermined as a result of the dental aerosol mitigation emphasis.

“Global Impact of COVID-19 on Service Delivery and Vulnerable Populations’ Access to Dental Care” by Ramos-Gomez et al. helps us step back and see how other countries and their oral health care providers have been impacted by the pandemic. In addition, it underscores how this pandemic is making the environment even more difficult for those most at risk and reminds us that less-invasive treatment strategies may allow us to manage disease without using an aerosolproducing drill.

In the article “Oral Pathology in the Context of COVID-19: Perspectives Based on a Compilation of Literature Data,” Libório-Kimura et al. provide a review of indexed articles related to SARS-CoV-2 over a six-month period. In addition, the authors review literature addressing relevant aspects that oral pathologists, stomatologists and general dentists need to be aware of in the context of the COVID-19 pandemic.

Personal protective equipment has become a linchpin in this pandemic. Bhaskar has provided a review of face masks in her article entitled “Face Masks and Respirators for the Dental Health Care Provider.” The breakdown in the supply chain for acceptable, traditional masks has made our profession consider powered air-purifying respirators (PAPRs) as a potential replacement for the N95 when respiratory protection is called for. In the article “COVID-19: New Considerations for Respiratory Protection in Dental Practice,” Whitcher discusses PAPRs and how they might fit into our standard PPE armamentarium in a post-COVID-19 future.

Finally, Iyer et al.’s article “Teledentistry 101: A Primer for Dental Professionals for the New Normal” reviews teledentistry, a technological modification to our traditional practice. Teledentistry can remove the risk of infection by eliminating or abbreviating some face-to-face interactions.

Dental offices, though deemed essential, were advised to reduce the pressure on the supply of PPE by limiting patient treatment to only emergency care.

In addition to these articles about COVID-19, we are using this issue of the CDA Journal to archive resources CDA developed and made available to members and nonmembers through this time of crisis.

Early in March 2020, it became clear that SARS-CoV-2 transmission was a significant threat in America and throughout the world and authorities began recommending that health care prioritize vital services and protection of front-line health care workers. Dental offices, though deemed essential, were advised by government and public health officials to reduce the pressure on the supply of PPE by limiting patient treatment to only emergency care.

CDA turned its attention to supporting dentists and dentistry during this crisis. CDA President Richard Nagy, DDS, appointed a 15-member clinical care workgroup comprised of practicing general dentists and specialists, dental school deans and academicians and representatives from dental hygiene and dental assisting. The group was tasked with developing guidance for care during the pandemic.

In particular, it was clear that heading back to practice after a prolonged break in normal operations and patient care would require significant changes. New patient- and staff-screening protocols and changes to office spaces and disinfection procedures would need to be developed, streamlined and disseminated. Co-chaired by Dr. Nagy and California State Dental Director Jayanth Kumar, DDS, MPH, this COVID-19 clinical care workgroup discussed issues of concern, sought answers to commonly asked questions, clarified areas of confusion and identified and developed helpful resources and training. Named “Back to Practice,” this special section of the CDA website continues to be updated regularly as information becomes available, but highlights of the work have been extracted from cda.org and are provided here for readers’reference. (These resources are updated frequently; the Back to Practice section in this issue was accessed Aug. 28, 2020.)

For full and free access to these Back-toPractice materials, visit cda.org/Home/ Practice/Back-to-Practice.