Asymptomatic pediatric dental patients as potential SARS-CoV-2 carriers
CHICAGO, U.S.: In a recent study, researchers have examined the prevalence of COVID-19 in pediatric dentistry by testing children during their visit at the pediatric dentist’s office. The study reported that, although all the children who took part in the study were asymptomatic, some of them tested positive after undergoing polymerase chain reaction (PCR) tests. This suggests that testing pediatric dental patients could help better identify potential SARS-CoV-2 carriers and subsequently reduce transmission rates.
According to the World Health Organization, presently over 152 million cases of COVID-19 have been confirmed worldwide. The U.S. has the most confirmed cases, over 63 million. Although more than 1 billion vaccine doses have been administered globally, the pandemic continues to pose a health and psychological threat to the lives of billions of people who bear the consequences of social distancing as well as other restrictions imposed on their daily lives.
According to the authors of the study, children with COVID-19 are typically asymptomatic, and severe illness owing to SARS-CoV-2 in children is rare. That is why screening programs often target the adult population only. However, although asymptomatic, children can potentially carry high viral loads of SARS-CoV-2 and thus be a source of infection.
Reporting on positivity rate 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 from the University of Illinois at Chicago (UIC) and included 921 patients who visited UIC dental clinics for emergency dental procedures from April 1 to Aug. 1, 2020. All participants were screened over the phone before coming to the clinic and were asymptomatic when they arrived for their appointments.
Once at the clinic, the patients were given a PCR test for SARS-CoV-2 infection. Talking about the testing process, co-author Dr. Flavia Lamberghini, clinical assistant professor in the department of pediatric dentistry at UIC, said that the children tolerated the test well. “We were trained by a pediatrician on how to conduct 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 told the kids, ‘We are putting a butterfly in your nose’,” Lamberghini stated.
The patients tested were aged between 2 to 18, with a median age of 6. The researchers abstracted their sociodemographic characteristics and calculated their positivity rates. Out of 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 could 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 regarding social distancing 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 the recommended guidelines to prevent the spread of the disease.
The researchers commented that there was slight confusion among the caregivers who had not been aware that their children had COVID-19. “For most of them, it was a surprise to learn their child tested positive,” Lamberghini stated. However, letting the families know about the positive results is crucial, she noted, especially because some extended families live together in communities. Additionally, the results are equally important for the oral health care providers who attend to the children and run the risk of infection.
“As dentists, we are more exposed to the COVID-19 disease because we work close to the mouth, and our tools generate aerosols that can infect the dentist and dental assistant—whoever is around,” she noted.
The importance of testing asymptomatic pediatric dental patients
Typically, children who receive dental procedures are not required to undergo PCR tests. However, in line with the findings, the researchers suggested that testing asymptomatic pediatric patients for COVID-19 could prove useful.
“Our findings […] support the notion that the implementation of SARS-CoV-2 testing may be particularly useful in pediatric dental clinics that provide care to sociodemographic groups with elevated prevalence of the disease based on local registries. In addition, our findings confirm that the implementation of questionnaires, although useful to identify high-risk patients, does not eliminate completely the risk of SARS-CoV-2 spreading in dental offices,” the researchers wrote.
“Our findings confirm that the implementation of questionnaires [...] does not eliminate completely the risk of SARS-CoV-2 spreading in dental offices”
— Dr. Flavia Lamberghini, UIC
To this end, the researchers commented that the use of rapid COVID-19 tests could offer increased protection in a dental office, but that the costs are rather 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 did not observe transmission to clinic staff. This, according to the researchers, highlights the effectiveness of personal protective equipment.
The study, titled “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 Associatiohttps://am.dental-tribune.com/?p=285377&cwpreview=1n.