**Abstract**

The aim of this chapter is to look more closely at the impact that the crisis generated by the SARS-CoV-2 is having on health, the economy and education in the field of dentistry. The considerations that must be taken into account in dental practice will be presented, as well as the usefulness that the use of teledentistry (TD) could have in times of pandemic, reflecting on the different specialties of dentistry that can benefit from this modality, as well as the advantages and disadvantages that its use can present. Likewise, teaching has been condemned to a lack of presence, having to resort to distance learning, both synchronous and non-synchronous, which can cause needs and deficiencies in undergraduate and postgraduate students. We will analyse the health risks in the dental field and the changes and needs for safe dentistry in times of pandemic. We will also break down the effect of the crisis on the medical-dental sector and the economy, from the point of view of patients and professionals, especially in times of increased restriction and confinement worldwide.

**Keywords:** oral health, protection, COVID-19, crisis, education, teledentistry, SARS-Cov-2, pandemics

#### **1. Introduction**

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causal agent of coronavirus disease (COVID-19), is a 60–140 nm single-stranded RNA virus that belongs to the genus β-Coronavirus, has a corona appearance because of the presence of glycoproteins in the envelope, and it is substantially different genetically from MERS-Cov but similar to SARS-CoV [1]. It can be transmitted between humans and its intermediate host is still under investigation [2]. The Covid-19 pandemic has caused huge changes in all fields, including dentistry.

It is known that several viruses, such as herpes simplex virus, cytomegalovirus and Zika are transmitted through saliva and are able to infect and replicate in the oral mucosa, causing painful ulcers. Currently some authors have reported oral manifestations of COVID-19 disease [3]. These can have a variety of clinical presentations,

presumably supporting the hypothesis of thrombus formation and vasculitis [4]. These include necrotic ulcers and aphthous ulcerations that develop early in the course of the disease, as well as dysgeusia. Awareness of these oral manifestations is important because lesions may precede typical respiratory symptoms by several days, and worsening oral lesions may precede a more severe clinical scenario [3].

Saliva from asymptomatic persons with COVID-19 has also been observed to have potential for viral transmission and a positive correlation between salivary viral load and loss of taste [5]. SARS-CoV-2 utilises host entry factors, such as members of the ACE2 (angiotensin-converting enzyme, the major host cell receptor of SARS-CoV-2) and TMPRSS (TMPRSS2 and TMPRSS4) family that have been expressed in salivary glands and oral mucosal epithelia [5, 6]. These data demonstrate that the oral cavity is an important site for SARS-CoV-2 infection and implicate saliva as a possible route of SARS-CoV-2 transmission.

In addition, it is considered that some oral diseases could be exacerbated by COVID-19, especially those of autoimmune aetiology, as these are related to a compromised immune system or long-term pharmacotherapy, [7], which indicates that we should pay special attention to the dental care of these patients. Patients with oral psychosomatic illnesses are more susceptible to stress and this could be exacerbated in the current pandemic situation, so they may need emergency consultations and psychological counselling. The dentist must provide comprehensive care to patients and to this end, teleconsultation may be useful. [8].

Healthcare workers have a higher rate of exposure to the virus (face-to-face interaction, exposure to body fluids such as blood and saliva) which increases the risk of infection, as we try to illustrate in **Figure 1**. Dental practice presents a potential risk of cross-contamination and staff are at risk of transmission of infections. [9] In this situation, it may be advisable to use teleconsultations. The advantages of teledentistry (TD) during the COVID-19 crisis have been observed through a pilot study, where it was determined that TD allowed a monitoring of all patients, reducing costs and contact, therefore decreasing the risk of COVID-19 spreading [10]. The Australian Dental Association has published the guidelines for TD and it considers that teleconsultation is most suited to patients who require follow up, and, likewise it is very convenient for patients presenting with an acute dental problem that needs to be deal with outside of normal practising hours, for those who are unable to attend the clinic due to illness or quarantine, and for vulnerable patients

**Figure 1.** *SARS-CoV-2 in dentistry.*

*Economic, Health-Care and Teaching-Learning Impact of COVID-19 (SARS-CoV-2) on Dentistry DOI: http://dx.doi.org/10.5772/intechopen.98387*

during the pandemic, including those who meet the triage protocol criteria for suspected Covid-19 infection [11].
