COVID-19 Outbreak: Routes of Transmission, Precautions, and Economic Impact on Dentistry-A Review Article

Abstract = 270 times | PDF = 82 times

Main Article Content

Mohammed Tahir Abdalqadir


In late 2019, a novel coronavirus appeared in Wuhan, Hubei province, China, and then rapidly spread around the world. The virus produces severe and even fatal pneumonia; the most common clinical symptoms among infected persons include fever, shortness of breath, cough, fatigue, and abnormal chest CT. Though the virus first traveled from animal to human, it can now spread from human to human through direct transmission such as coughing, sneezing, and inhalation of droplets; and through contact with mucus membranes of oral, nasal, and eye. COVID-19 also can be transmitted through saliva and the fecal–oral route. The risk of cross-infection between patients and dental practitioners is high due to the nature of dental work, so this outbreak has made a powerful impact, both medically and economically, on the dentistry sector. Dental practitioners should have comprehensive knowledge of the virus and its route of transmission, and they should take proper precautions during dental treatments to protect themselves and their patients. This article provides a review of COVID-19, its transmission routes, necessary precautions during dental setting, and the virus’s impact on the economy of the dental industry.


COVID-19, Dentistry, Coronavirus, SARS-CoV-2, Transmission, Economy


Download data is not yet available.

Article Details


[1] Z. Ge, L. Yang, J. Xia, X. Fu, and Y. Zhang, “Possible aerosol transmission of COVID-19 and special precautions in dentistry,” Journal of Zhejiang University-SCIENCE B (Biomedicine & Biotechnology),16, 1-8, 2020.
[2] T. Liu et al., “Transmission dynamics of 2019 novel coronavirus (2019-nCoV),” The Lancet, 2020, doi: 10.1101/2020.01.25.919787.
[3] N. Zhu et al., “A novel coronavirus from patients with pneumonia in China, 2019,” The New England Journal of Medicine, 382(8), 727-733, 2020.
[4] C. Wang, P. W. Horby, F. G. Hayden, and G. F. Gao, “A novel coronavirus outbreak of global health concern,” The Lancet, 395(10223), 4703, 2020.
[5] W. Guan et al., “Clinical characteristics of 2019 novel coronavirus infection in China,” The New England Journal of Medicine, 2020, doi: 10.1101/2020.02.06.20020974.
[6] C. Huang et al., “Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China,” The Lancet, 395(10223), 497-306, 2020.
[7] D. Wang et al., “Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China,” Journal of the American Medical Association, 323(11), 1061-1069, 2020.
[8] Q. Li et al., “Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia,” The New England Journal of Medicine, 382(13), 1199-1207, 2020.
[9] A. L. Phelan, R. Katz, and L. O. Gostin, “The Novel Coronavirus Originating in Wuhan, China: Challenges for Global Health Governance,” Journal of the American Medical Association, 323(8), 709-710, 2020.
[10] E. Mahase, “China coronavirus: WHO declares international emergency as death toll exceeds 200”, British Medical Journal, 2020. doi:10.1136/bmj.m408.
[11] A. E. Gorbalenya, “Severe acute respiratory syndrome-related coronavirus – The species and its viruses, a statement of the Coronavirus Study Group,” bioRxiv, 2020, doi: 10.1101/2020.02.07.937862.
[12] J. Guarner, “Three Emerging Coronaviruses in Two Decades: The Story of SARS, MERS, and Now COVID-19,” American Journal of Clinical Pathology, 395(10228), 420-421, 2020.
[13] S. Jiang et al., “A distinct name is needed for the new coronavirus.,” The Lancet (London, England), 395(10228), 949, 2020.
[14] J. F. W. Chan et al., “A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster,” The Lancet, 395(10223), 514-523, 2020.
[15] N. Chen et al., “Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study,” The Lancet, 395(10223), 507-513, 2020.
[16] A. R. Fehr and S. Perlman, “Coronaviruses: An overview of their replication and pathogenesis,” in Coronaviruses: Methods and Protocols, H. Maier, E. Bickerton, P. Britton, Humana Press, New York, NY, p.1-23, 2015.
[17] A. E. Gorbalenya, L. Enjuanes, J. Ziebuhr, and E. J. Snijder, “Nidovirales: Evolving the largest RNA virus genome,” Virus Research, 117(1), 17-37, 2006.
[18] M. Khan, S. Kazmi, A. Bashir, and N. Siddique, “COVID-19 infection: origin, transmission, and characteristics of human coronaviruses,” Journal of Advanced Reearch., 24(2020), 265-269, 2020.
[19] F. Wu et al., “A new coronavirus associated with human respiratory disease in China,” Nature, 579(7798), 265-269, 2020.
[20] P. Zhou et al., “A pneumonia outbreak associated with a new coronavirus of probable bat origin,” Nature, 579(7798), 270-273, 2020.
[21] R. Lu et al., “Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding,” The Lancet, 395(10224), 565-574, 2020.
[22] L. Wahba et al., “Identification of a pangolin niche for a 2019-nCoV-like coronavirus through an extensive meta-metagenomic search,” bioRxiv, 2020, doi: 10.1101/2020.02.08.939660.
[23] E. Mortola and P. Roy, “Efficient assembly and release of SARS coronavirus-like particles by a heterologous expression system,” Federation of European Biochemical Societies Leters., 576(1-2), 174-178, 2004.
[24] T. R. Dhama K, Pawaiya RNS, Chakraborty S and V. A. Saminathan M, “Coronavirus infection in equines: a review,” Asian Journal of Animal and Vetirnary Advances, 9(3), 164–176, 2014.
[25] C. Wang et al., “MERS-CoV virus-like particles produced in insect cells induce specific humoural and cellular imminity in rhesus macaques,” Oncotarget, 8(8), 12686-12694, 2017.
[26] S. Belouzard, J. K. Millet, B. N. Licitra, and G. R. Whittaker, “Mechanisms of coronavirus cell entry mediated by the viral spike protein.,” Viruses, 4(6), 1011-1033, 2012.
[27] H. C. Song et al., “Synthesis and Characterization of a Native, Oligomeric Form of Recombinant Severe Acute Respiratory Syndrome Coronavirus Spike Glycoprotein,” Journal of Viroogy., 78(19), 10328-10335, 2004.
[28] Y. L. Siu et al., “The M, E, and N Structural Proteins of the Severe Acute Respiratory Syndrome Coronavirus Are Required for Efficient Assembly, Trafficking, and Release of Virus-Like Particles,” Journal of Virology, 82(22), 11318-11330, 2008.
[29] M. P. Hantak, E. Qing, J. T. Earnest, and T. Gallagher, “Tetraspanins: Architects of Viral Entry and Exit Platforms,” Journal of Virology, 93(6), e01429-17, 2018.
[30] K. L. Siu et al., “Severe acute respiratory syndrome coronavirus M protein inhibits type I interferon production by impeding theformation of TRAF3·TANK·TBK1/IKKε complex,” Journal of Biological Chemistry, 284(24), 16202-16209, 2009.
[31] B. W. Neuman et al., “A structural analysis of M protein in coronavirus assembly and morphology,” Journal of Structural Biology, 174(1), 11-22, 2011.
[32] W. C. Hsin et al., “Nucleocapsid protein-dependent assembly of the RNA packaging signal of Middle East respiratory syndrome coronavirus,” Journal of Biomedical Science, 25(1), 47-58, 2018.
[33] A. Ghosh, D. Bhattacharyya, and A. Bhunia, “Structural insights of a self-assembling 9-residue peptide from the C-terminal tail of the SARS corona virus E-protein in DPC and SDS micelles: A combined high and low resolution spectroscopic study,” Biochimica et Biophysica Acta - Biomembranes, 1860(2), 335-346, 2018.
[34] Y. Cong et al., “Nucleocapsid Protein Recruitment to Replication-Transcription Complexes Plays a Crucial Role in Coronaviral Life Cycle,” Journal of Virology, 94(4), 1-21, 2019.
[35] Y. Chen, Q. Liu, and D. Guo, “Emerging coronaviruses: Genome structure, replication, and pathogenesis,” Journal of Medical Virology, 92(4), 418-423, 2020.
[36] Y. H. Li, C. Y. Hu, N. P. Wu, H. P. Yao, and L. J. Li, “Molecular Characteristics, Functions, and Related Pathogenicity of MERS-CoV Proteins,” Engineering, 5(5), 940-947, 2019.
[37] File:3D medical animation corona virus.jpg. Wikimedia; January 2020, Available from: https://commons.wikimedia, org/wiki/File:3D_medical_animation_corona_virus.jpg. Accessed 3 March 2020.
[38] K. K.-W. To et al., “Consistent detection of 2019 novel coronavirus in saliva,” Clinical Infectious Disease, 2020, doi: 10.1093/cid/ciaa149.
[39] R. S. Wax and M. D. Christian, “Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients,” Canadian Journal of Anesthesia, 2020, doi: 10.1007/s12630-020-01591-x.
[40] M. L. Holshue et al., “First case of 2019 novel coronavirus in the United States,” The New England Journal of Medicine, 2020, doi: 10.1056/NEJMoa2001191.
[41] H. Chen et al., “Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records,” The Lancet, 395(10226), 809-815, 2020.
[42] C. Rothe et al., “Transmission of 2019-NCOV infection from an asymptomatic contact in Germany,” The New England Journal of Medicine, 382(10), 970-971, 2020.
[43] L. Gamio, The Workers Who Face the Greatest Coronavirus Risk. The New York Times, Available online: (accessed on 15 March 2020).
[44] World Health Organization(WHO), “Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care,” WHO, Geneva, Switzerland, 2014.
[45] J. S. Kutter, M. I. Spronken, P. L. Fraaij, R. A. Fouchier, and S. Herfst, “Transmission routes of respiratory viruses among humans,” Current Opinion in Virology, 28, 142-151, 2018.
[46] C. Zemouri, H. De Soet, W. Crielaard, and A. Laheij, “A scoping review on bio-Aerosols in healthcare & the dental environment,” PLoS One, 12(5), 1-25, 2017.
[47] L. Liu et al., “Epithelial Cells Lining Salivary Gland Ducts Are Early Target Cells of Severe Acute Respiratory Syndrome Coronavirus Infection in the Upper Respiratory Tracts of Rhesus Macaques,” Journal of Virology, 85(8), 4025-4030, 2011.
[48] G. Kampf, D. Todt, S. Pfaender, and E. Steinmann, “Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents,” Journal of Hospital Infection, 104(3), 246-251, 2020.
[49] J. Chen, “Pathogenicity and transmissibility of 2019-nCoV—A quick overview and comparison with other emerging viruses,” Microbes and Infection, 22(2), 69-71, 2020.
[50] X. Peng, X. Xu, Y. Li, L. Cheng, X. Zhou, and B. Ren, “Transmission routes of 2019-nCoV and controls in dental practice,” International Journal of Oral Science, 12(1), 1-6, 2020.
[51] J. Atkinson, Y. Chartier, C. L. Pessoa-silva, P. Jensen, and Y. Li, Natural Ventilation for Infection Control in Health Care Settings WHO Publication / Guidelines Natural Ventilation for Infection Control in Health-Care Settings Edited by : World Health Organization, Geneva, Switzerland, 2009.
[52] H. F. Rabenau, G. Kampf, J. Cinatl, and H. W. Doerr, “Efficacy of various disinfectants against SARS coronavirus,” Journal of Hospital Infection, 61(2), 107-111, 2005.
[53] I. C. H. Fung and S. Cairncross, “Effectiveness of handwashing in preventing SARS: A review,” Tropical Medicine and International Health, 11(11), 1749-1758, 2006.
[54] World Health Organization, “Infection prevention and control during halth care when novel coronavirus (nCOV) infection is suspected,” WHO, Geneva, Switzerland, 2020c.
[55] World Health Organisation (WHO), “WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care,” WHO, Geneva, Switzerland, 2009.
[56] C. D. Bentley, N. W. Burkhart, and J. J. Crawford, “Evaluating spatter and aerosol contamination during dental procedures.,” Journal of the American. Dental Association, 125(5), 579-584, 1994.
[57] F. Nejatidanesh, Z. Khosravi, H. Goroohi, H. Badrian, and O. Savabi, “Risk of contamination of different areas of dentist’s face during dental practices,” International journal of preventive medicine, 4(5), 611-615, 2013.
[58] L. P. Samaranayake and M. Peiris, “Severe acute respiratory syndrome and dentistry: A retrospective view,” Journal of the American Dental Association, 135(9), 1292-1302, 2004.
[59] M. Feres, L. C. Figueiredo, M. Faveri, B. Stewart, and W. De Vizio, “The effectiveness of a preprocedural mouthrinse containing cetylpyridiniuir chloride in reducing bacteria in the dental office,” Journal of the American Dental Association, 141(4), 415-422, 2010.
[60] V. C. Marui, M. L. S. Souto, E. S. Rovai, G. A. Romito, L. Chambrone, and C. M. Pannuti, “Efficacy of preprocedural mouthrinses in the reduction of microorganisms in aerosol: A systematic review,” Journal of the American Dental Association, 150(12), 1015-1026, 2019.
[61] A. Wood and D. Payne, “The action of three antiseptics/disinfectants against enveloped and non-enveloped viruses,” Journal of Hospital Infection , 38(4), 283-295, 1998.
[62] S. K. Harrel and J. Molinari, “Aerosols and splatter in dentistry: A brief review of the literature and infection control implications,” Journal of the American Dental Association, 135(4), 429-437, 2004.
[63] L. P. Samaranayake, J. Reid, and D. Evans, “The efficacy of rubber dam isolation in reducing atmospheric bacterial contamination.,” ASDC Journal of Dentistry for Children, 56(6), 442-444, 1989.
[64] M. A. Cochran, C. H. Miller, and M. A. Sheldrake, “The efficacy of the rubber dam as a barrier to the spread of microorganisms during dental treatment.,” Journal of the American Dental Association, 119(1), 141-144, 1989.
[65] T. Hu, G. Li, Y. Zuo, and X. Zhou, “Risk of Hepatitis B Virus Transmission via Dental Handpieces and Evaluation of an Antisuction Device for Prevention of Transmission,” Infection Control and Hospital Epidemiology, 28(1), 80-82, 2007.
[66] D. R. House, C. L. Fry, and L. J. Brown, “The economic impact of dentistry,” Journal of the American Dental Association, 135(3), 347-352, 2004.
[67] H. Guo, Y. Zhou, X. Liu, and J. Tan, “The impact of the COVID-19 epidemic on the utilization of emergency dental services,” Journal of Dental Science, 2020, doi: 10.1016/j.jds.2020.02.002.