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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 4  |  Page : 879-881

Authors' reply to Mehra et al., Gugnani et al., and Chandrashekar et al.


1 Department of Dental and Prosthetic Services, Homi Bhabha National Institute, Tata Memorial Hospital, TMC, Parel; Department of Dental and Prosthetic Services, Homi Bhabha National Institute, Tata Memorial Centre-Advanced Centre for Treatment, Research and Education in Cancer, TMC, Mumbai, Maharashtra, India
2 Department of Dental and Prosthetic Services, Homi Bhabha National Institute, Tata Memorial Centre.Advanced Centre for Treatment, Research and Education in Cancer; Department of Dental and Prosthetic Services, Tata Memorial Centre-Advanced Centre for Treatment, Research and Education in Cancer, TMC, Mumbai, Maharashtra, India

Date of Submission12-Oct-2020
Date of Decision19-Oct-2020
Date of Acceptance20-Oct-2020
Date of Web Publication25-Dec-2020

Correspondence Address:
Madhura R Sharma
Assistant Dental and Prosthetic Surgeon, Department of Dental and Prosthetic Services, Homi Bhabha National Institute, Tata Memorial Centre-Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Mumbai 410 210, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_319_20

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How to cite this article:
Dholam KP, Sharma MR, Gurav SV, Singh G, Manjrekar N. Authors' reply to Mehra et al., Gugnani et al., and Chandrashekar et al. Cancer Res Stat Treat 2020;3:879-81

How to cite this URL:
Dholam KP, Sharma MR, Gurav SV, Singh G, Manjrekar N. Authors' reply to Mehra et al., Gugnani et al., and Chandrashekar et al. Cancer Res Stat Treat [serial online] 2020 [cited 2021 Jan 17];3:879-81. Available from: https://www.crstonline.com/text.asp?2020/3/4/879/304989



We express our gratitude toward Mehra et al.,[1] Gugnani and Gugnani,[2] and Chandra Shekar et al.[3] for their comments about our article titled, “Dental measures during the COVID-19 pandemic in cancer patients.” The main objective of our paper was to outline the various repercussions of COVID-19 on dental practices and to underline the significance of stringent infection control in a dental clinic in such times. It is a report of tertiary-care institutional experience based on guidelines given by nodal authorities.

In complete agreement with Mehra et al.,[1] we need to integrate a multidimensional approach in the dental treatment of cancer patients in such unprecedented times.[4] Currently, all efforts are concerted toward vaccine preparation worldwide, but still this pandemic is far from over. A recent prospective report on the outcomes of elective major cancer surgeries during COVID-19 at the Tata Memorial Center advocated continuation of elective major cancer surgeries.[5] Providing a dignified quality of life for patients with debilitating cancer has always been the main aim of our institute. Restoration of oral functions helped in improving the nutritional status of cancer patients undergoing treatment.

Prevention is the need of the hour, and oral health promotion is the key. Proper oral health instructions need to be given to all cancer patients, which will prevent the development of dental caries and decrease the need to perform aerosol-generating procedures in future.

As correctly pointed out by many authors, tobacco consumption is associated with poorer prognosis in cancer patients who develop COVID-19.[6],[7] Preventive oncology services of our hospital have been involved in active screening of patients who report with tobacco habits. In addition, the tobacco cessation clinic provides counseling and education to all patients at risk to spread awareness about the harmful effects of tobacco consumption in general, and especially during the pandemic.

We appreciate the role of dental health-care personnel (DHCP) as a point of first contact to screen patients for SARS-CoV-2 virus. Much of the research using saliva as a tool to detect SARS-CoV-2 has been published in July/August 2020.[8],[9] Azzi et al.[9] have also opined that saliva may also provide information about the clinical evolution of the disease. This could be taken up as an exploratory study at our center as well.

Our center strictly follows guidelines put forth by the Ministry of Health and Family Welfare, Government of India, which makes it mandatory for all citizens to wear proper masks at all times.[10] We would like to clarify the ambiguity felt by the authors, by reiterating that all patients entering the hospital premises were initially screened for the symptoms of COVID-19. Any suspected patient was referred to the “fever clinic” for further investigations and/or, reverse transcription-polymerase chain reaction test. Often, patients belonging to low socioeconomic strata, who were using a piece of their clothing as masks, were given a good-quality face mask. A second-tier screening was done when patients reported to the dental clinic. Any patient found to be wearing a mask of inappropriate quality or size, was duly given a three-ply surgical mask.

The strict nationwide lockdown with resultant decrease in outpatient numbers, allowed us to strategically plan appointments for patients requiring obturators/guide-bite prosthesis/occlusal guard. In order to expedite the process of rehabilitation, in the morning schedule, accurate impressions were made using an irreversible hydrocolloid impression material and poured immediately in dental stone. Subsequently, critical prostheses were fabricated in self-cure acrylic resin by in-house maxillofacial prosthetics, and delivered to the patients by afternoon. This significantly helped us in completing the process of rehabilitation within 1 day, thus reducing patient visits and the resultant exposure.

Tele-consultation services are actively provided to all mildly symptomatic patients who cannot report in person at the outpatient department due to health or logistic reasons. This includes those patients who have recently undergone rehabilitation and who may require basic instructions regarding the daily wear of prosthesis.

We agree with Shekar et al. that while undertaking elective dental procedures, the DHCP should comply with the updated guidelines. As time passes by, newer emerging research has allowed better understanding of the pandemic situation. However, the authors feel that essential dental procedures hampering/delaying cancer treatment should not be deferred as far as possible.

Acknowledgment

The authors would like to acknowledge all members working in the Department of Dental and Prosthetic Services (TMC and ACTREC) during the COVID pandemic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mehra R, Mehra K, Kapoor S. Bringing Public Health to Dentistry Amidst COVID-19 Pandemic. Cancer Res Stat Treat 2020;3:876-7.   Back to cited text no. 1
  [Full text]  
2.
Gugnani N, Gugnani S. Addressing the oro- dental needs of cancer patients in COVID times – are we equipped? Cancer Res Stat Treat 2020;3:875-6.   Back to cited text no. 2
  [Full text]  
3.
Chandra Shekar BR, Suma S, Bhagyalakshmi A. Dental Practice during COVID – 19 pandemic. Challenges and the way forward. Cancer Res Stat Treat 2020;3:878-9.   Back to cited text no. 3
    
4.
Rosenbaum L. The untold toll-The pandemic's effects on patients without Covid-19. N Engl J Med 2020;382:2368-71.  Back to cited text no. 4
    
5.
Shrikhande SV, Pai PS, Bhandare MS, Bakshi G, Chaukar DA, Chaturvedi P, et al. Outcomes of elective major cancer surgery during COVID 19 at Tata Memorial Centre: Implications for cancer care policy. Ann Surg 2020;272:e249-52.  Back to cited text no. 5
    
6.
van Zyl-Smit RN, Richards G, Leone FT. Tobacco smoking and COVID-19 infection. Lancet Respir Med 2020;8:664-5.  Back to cited text no. 6
    
7.
Singh AG, Chaturvedi P. Tobacco use and vaping in the COVID-19 era. Head Neck 2020;42:1240-2.  Back to cited text no. 7
    
8.
Nagura-Ikeda M, Imai K, Tabata S, Miyoshi K, Murahara N, Mizuno T, et al. Clinical evaluation of self-collected saliva by quantitative reverse transcription-PCR (RT-qPCR), direct RT-qPCR, reverse transcription-loop-mediated isothermal amplification, and a rapid antigen test to diagnose COVID-19. J Clin Microbiol 2020;58:e01438-20.  Back to cited text no. 8
    
9.
Azzi L, Carcano G, Gianfagna F, Grossi P, Gasperina DD, Genoni A, et al. Saliva is a reliable tool to detect SARS-CoV-2. J Infect 2020;81:e45-50.  Back to cited text no. 9
    
10.




 

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