Challenges, limitations, and solutions for orthodontists during the coronavirus pandemic: a review

Malekshoar, Milad; Malekshoar, Mehrdad; Javanshir, Bahareh

Objectives Orthodontic patients around the world had to miss appointments during the early months of the COVID-19 pandemic. A significant problem with this virus is its high transmission power. Asymptomatic patients can transmit the virus. This aim of this review is to examine orthodontic emergency situations and the necessary strategies and measures for emergency and non-emergency during the coronavirus pandemic. Methods The following databases were comprehensively searched: PubMed, MEDLINE, Scopus, and Google Scholar. Up-to-date data released by major health organizations such as WHO and major orthodontic associations involved in the pandemic were also evaluated. Results Few studies are conducted on how to manage orthodontic offices or clinics during the pandemic and mostly are not of high quality. Appropriate communication is the most important issue in managing orthodontic patients, particularly virtual counseling. Many cases of orthodontic emergencies can be managed in this way by patients themselves. Most studies recommend using the FFP2 masks, equivalent to N95 masks for non-COVID-19 cases undergoing aerosol-generating procedures and all suspected or confirmed COVID-19 cases in orthodontic visits. Conclusions At this time, there are no definitive clinical protocols supported by robust evidence for orthodontic practice during COVID-19 pandemic. Orthodontists should not rush to return to routine orthodontic work and should follow state guidelines. Non-emergency orthodontic visits should be suspended during the SARS-CoV-2 pandemic in high-risk areas. Resuming orthodontic procedures during the pandemic requires paying special attention to screening, performing maximum efforts to reduce aerosol, appropriate PPE, proper ventilation, and full adherence to sterilization and disinfection principles.