This PowerPoint presentation gives a brief insight into COVID-19, its oral manifestations and dental considerations during its outbreak.

1. COVID-19 & DENTISTRY
Dr. RASHMI.J.KURUP
3RD YEAR MDS
DEPARTMENT OF ORAL MEDICINE AND RADIOLOGY

2. CONTENTS
o Introduction
o CORONAVIRUSES ?
o Morphology
o transmission
o Pathogenesis
o Clinical features
o Oral manifestations
o Diagnosis
o Treatment
o Dentistry and COVID
o Conclusion

3. INTRODUCTION – A TIMELINE
A 55 year old from Hubei province in china reported with pneumonia on
NOVEMBER 17 , 2019
South China Morning Post
 Following November 17th case – 1 to 5 new cases – everyday
 By December 15 cases reached 27 and by December 20 it reached - 60.
On December 1st 2019 a new
case was reported with no
link to sea food market.

4. Dr. ZHANG JIXIAN
H.O.D
RESPIRATORY DEPARTMENT
HUBEI PROVINCE HOSPITAL
DECEMBER 27TH
Scientists suspected SARS-COV coronavirus
By the time around
180 individuals were
infected
NOVEL
CORONA
VIRUS

5. Wuhan Municipal Health Commission, China, reported a cluster of cases
of pneumonia in Wuhan, Hubei Province. (WHO COUNTRY OFFICE )
31ST DECEMBER 2019
• Isolation of novel coronavirus – 7th January 2020
• First death in china – 11th January 2020
• First case outside china – 13th January 2020 ( Thailand )
• on January 30th WHO – PHEIC
• ( Public Health Emergency Of International Concern )
WHO ON MARCH 11th 2020
On FEBRUARY 11th 2020 – COVID-19
(COrona VIrus Disease of 2019 )

6. IN INDIA
• On 30 January, the first case was confirmed in Kerala's Thrissur district in a
student who had returned home for a vacation from Wuhan University in
China
• A 76-year-old man from the southern state of Karnataka is India's first
SARS-CoV-2 fatality. He had traveled to Saudi Arabia in the days before his
death.

7. EPIDEMIOLOGY
As on 18/06/2020 As on 23/06/2020

8. CORONAVIRUSES ?
• FAMILY NIDOVIRALES - Arteviridae + Roniviridae +
Coronaviridae
• The Arteviridae family - swine and equine pathogens
• The Roniviridae family is composed of invertebrate
viruses
 Coronaviruses are divided into three genera (I to III),
usually referred to as groups and based on serological
cross-reactivity
 All three genera of viruses do not have only humans as
host instead they also have pigs, cats, mouse, chicken ,
turkey , cow etc.

9. • 229E
• NL63Group 1
• OC43
• HKU1
• SARS-COV
Group 2
•NO KNOWN HUMAN HOSTGroup 3

10. HISTORY OF INFECTIONS
• SEVERE ACUTE RESPIRATORY SYNDROME (SARS)- 2002/2003
Guangdong province of china
Beta coronaviruses
Transmitted from bats to civets to humans
Began in February 2003 and outbreak lasted till July 2003
> 8000 total cases , 774 deaths fatality rate -9.6 %
• MIDDLE EAST RESPIRATORY SYNDROME (MERS)- 2012
Saudi Arabia
Beta coronaviruses
Transmitted from camels to humans
>2400 cases ,858 deaths, fatality rate – 34.4%

11. MORPHOLOGY
 Enveloped viruses
 Round and sometimes pleiomorphic
 80 to 120 nm in diameter
 Coronaviruses contain positive-strand RNA
 ( Largest RNA genome )
Genome RNA is complexed - basic nucleocapsid (N) protein to form a helical capsid found
within viral membrane

12. MORPHOLOGY
The membranes of all coronaviruses contain at least three viral proteins.
 Type 1 glycoprotein- spike S
 Membrane protein -M
 Envelope protein – E
 Hemagglutinin Esterase -HE
 Nucleocapsid protein- N
All envelope proteins and N protein is present
in all virions but HE is only present in some beta
coronaviruses

13. SL.NO VIRAL PROTEINS FUNCTION
1. Spike protein (S) Virus entry, cell to cell spread, pathogenesis, morphologic
appearance
2. Membrane
protein (M)
Glycosylated form , regenerating virions in the cell
3. Nucleocapsid
protein (N)
It plays an important role in virion structure, replication
and transcription of coronaviruses
4. Envelope protein
(E)
Coronavirus E proteins play a critical role in the assembly
and morphogenesis of virions within the cell

14. TRANSMISSION
TRAMISSION
DIRECT
(Coughing,
sneezing, inhalation
of droplets )
CONTACT
(Contact with nasal,
oral and ocular
mucosa )

15. TRANSMISSION

16. PATHOGENESIS
Attachment to specific cellular receptors via spike proteins
Conformational change in structure of virus( TMPRSS2 enzyme)
Mediates fusion between virus and cell membranes
Release of nucleocapsid into cell

18. PATHOGENESIS

19. CLINICAL FEATURES

20. CLINICAL FEATURES
Recovery time: 3 weeks to 6 weeks
The incubation period for COVID-19, which is the time between
exposure to the virus (becoming infected) and symptom onset, is on
average 5-6 days, however can be up to 14 days.
During this period, also known as the “pre- symptomatic” period,
some infected persons can be contagious.

22. CLASSIFICATION
Symptoms were categorized as follows:
● Mild cases: The majority (81%) of these coronavirus disease cases were mild cases
include all patients without pneumonia or cases of mild pneumonia.
● Severe cases: This includes patients who suffered from shortness of breath, respiratory
frequency ≥ 30/minute, blood oxygen saturation ≤93%, PaO2/FiO2 ratio <300,30 and/or
lung infiltrates >50% within 24–48 hours.
● Critical cases: Include patients who suffered respiratory failure, septic shock, and/or
multiple organ dysfunction or failure.

23. ORAL MANIFESTATIONS
JOURNAL OF ORAL MEDICINE AND ORAL SURGERY

24. ORAL MANIFESTATIONS
JOURNAL OF ORAL DISEASES

25. Received: 20 April 2020 | Revised: 24 April 2020 | Accepted: 28 April 2020
ORAL MANIFESTATIONS
JOURNAL OF ORAL DISEASES
PATIENT 1 PATIENT 2

26. Received: 20 April 2020 | Revised: 24 April 2020 | Accepted: 28 April 2020
ORAL MANIFESTATIONS
JOURNAL OF ORAL DISEASES
PATIENT 3 ( COVID-POSITIVE)

27. ORAL MANIFESTATIONS
INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES

28. ORAL MANIFESTATIONS
• Oral unspecific ulcerations
• Dysgeusia and Hypogeusia
• Herpetic like ulcers
• Xerostomia
• Candidiasis
• Geographic tongue
• Petechiae
• Cervical lymphadenopathy
• Erythema multiforme like lesions

29. DIAGNOSIS
 Travel history
 CBC (leukopenia, seen in 30% to 45% of patients, and
lymphocytopenia, seen in 85% of the patients)
 Chest X-Ray (cheaper & easier with 60% sensitivity)
 PCR (30%-70% sensitivity)
 Chest CT Scan (95% sensitivity, low specificity)
 IgM/IgG combo test for COVID-19

30. • A nasopharyngeal (NP) swab and/or an
oropharyngeal (OP) swab are often recommended
for screening or diagnosis of early infection
• Saliva can also be used for analysis
• Sputum and/or bronchoalveolar lavage fluid
specimens
Specimen collection

31. Chest CT scan vs Chest X-Ray

32. Chest CT Scan findings

33. Rapid diagnostic tests
• ANTIGEN DETECTION
• HOST ANTIBODY DETECTION.

34. DIAGNOSIS
Current diagnostic tests for coronavirus include
• Reverse-transcription polymerase chain reaction(RT-PCR)
• Real-time RT-PCR (rRT-PCR)
• Reverse Transcription loop-mediated Isothermal amplification(RT-LAMP)

35. Treatment
1. Mild cases:
a. Supportive treatments (Antihistamine & Analgesics)
2. Moderate cases:
a. Oseltamivir (150 mg BID for 5 days)
b. Hydroxychloroquine, Chloroquine (500 mg BID for 14 days) or Ribavirin (for 5 days)
3. Severe cases:
a. Oseltamivir (150 mg BID for 5 days)
b. Kaletra (Lopinavir/Ritonavir) (for 5 days)
c. Hydroxychloroquine, Chloroquine (500 mg BID for 14 days) or Ribavirin (for 5 days)
4. Critical cases:
a. Oseltamivir (150 mg BID for 5 days)
b. Kaletra (Lopinavir/Ritonavir) (for 5 days)
c. Ribavirin (for 5 days)
d. d. Hydroxychloroquine or Chloroquine (for 14 days)

36. Prevention
● People can catch COVID-19 from others who have the virus.
● The disease can spread from person to person through small droplets from the nose or
mouth which are spread when a person with COVID-19 coughs or exhales. These droplets
land on objects and surfaces around the person. Other people then catch COVID-19 by
touching these objects or surfaces, then touching their eyes, nose or mouth.
● People can also catch COVID-19 if they breathe in droplets from a person with COVID-19
who coughs out or exhales droplets. This is why it is important to stay more than 1 meter (3
feet) away from a person who is sick

37. Prevention
● If someone sneezes with it, it takes about 10 feet before it drops to the
ground and is no longer airborne.
● If it drops on a metal surface it will live for at least 12 hours - so if you come
into contact with any metal surface - wash your hands as soon as you can with
a bacterial soap. On fabric, it can survive for 6-12 hours. normal laundry
detergent will kill it.
● Washing hands frequently as the virus can only live on hands for 5-10
minutes, but a lot can happen during that time - you can rub your eyes, pick
your nose unwittingly and so on.

38. Preventive measures to reduce the chances of infection include staying at home,
avoiding crowded places, keeping distance from others, washing hands with soap and
water often and for at least 20 seconds, practicing good respiratory hygiene, and
avoiding touching the eyes, nose, or mouth with unwashed hands
The U.S. Centers for Disease Control and Prevention (CDC) recommends covering the
mouth and nose with a tissue when coughing or sneezing and recommends using the
inside of the elbow if no tissue is available

40. Dental considerations during COVID outbreak

43. Screening Questionnaire

45. DONNING

46. DOFFING

49. The coronavirus (COVID-19) has challenged health professions and systems and has evoked different speeds of
reaction and types of response around the world.
The role of dental professionals in preventing the transmission of COVID-19 is critically important. While all routine
dental care has been suspended in countries experiencing COVID-19 disease during the period of pandemic, the need
for organized urgent care delivered by teams provided with appropriate personal protective equipment takes priority.
Dental professionals can also contribute to medical care.
Dental professionals felt a moral duty to reduce routine care for fear of spreading COVID-19 among their patients
and beyond.
CONCLUSION

50. Following the announcement of the disease outbreak by international or local authorities, dentists can play a significant role in
disrupting the transmission chain, thereby reducing the incidence of disease by simply postponing all non-emergency dental care
for all patients.
Dental professionals must be fully aware of 2019-ncov spreading modalities, how to identify patients with this infection, and,
most importantly, self-protection considerations..
A higher rate of virus exposure because of occupational commitments in health care workers is considered a key factor
associated with the increased risk of infection.
CONCLUSION

51. REFERENCES
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 www.who.int/covid-19/info
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54. Let us all join hands to flatten the
curve which is the need of hour