DT India & South Asia No. 5, 2021

The changing goalposts of vaccine effectiveness / Saliva test for COVID-19 diagnosis and severity prediction / WHO statement on airborne transmission of SARS-CoV-2 / COVID-19 response by mobile apps in India / It’s time we used vitamin D to reduce the risk of COVID-19 severity / Clean-O-Denture – a device to improve denture hygiene

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Table of contents

DENTALTRIBUNE
The World’s Dental Newspaper · South Asia Edition

Published in India

www.dental-tribune.in

Saliva test

Airborne transmission

For COVID-19
diagnosis and
severity
prediction

WHO statement
on airborne
transmission of
SARS-CoV-2

Mobile apps

Clean-O-Denture
Clean-O-Denture – a
device to improve
denture hygiene – Dr.
Pranit Bora

COVID-19 response
by mobile apps in
India

” Page 03

” Page 02

05/21

” Page 04

” Page 06

The changing goalposts of vaccine
effectiveness
by Dr Ameet Revankar,
Dental Tribune South Asia
The measured efficacy/
effectiveness of the vaccine is
only a guide for approval and
not a benchmark for claiming
superiority of one vaccine over
another.
Unknowns are a norm in
the uncertain pandemic world.
When vaccines were first
announced for mass distribution,
their efficacy and effectiveness
were widely debated. Efficacy
refers to the ability of the vaccine
to prevent symptomatic disease
in the trial participants, whereas
effectiveness refers to the same
in the real-world setting. One
amongst the forerunners was
the viral vector-based OxfordAstraZeneca vaccine known
by various names in different
regions - Covishield, Vaxzevria.
The efficacy of this vaccine was
reported to be ranging from
50–80% as per trial data under
different dosages/ intervals.
When the mRNA-based
vaccines
(Pfizer
BioNtech
and Moderna) vaccines were
approved for use in the United
States, they showed more than
95% efficacy. The real-world
effectiveness of these mRNAbased vaccines also showed
an effectiveness above 90%
in
preventing
symptomatic
disease1. As vaccine recipients,
we are all desiring vaccines that
have higher effectiveness.
However,
the
vaccine‘s
effectiveness
in
preventing
‚breakthrough‘ infections also
depends on external factors
such as the kind of population
being vaccinated and their
exposure levels. The apparent
effectiveness of the vaccines is
an outcome heavily dependent
on the levels of exposure to the
virus. It is virtually impossible
to assess the true efficacy of the
vaccines unless challenge trials
are designed wherein the trial
participants are deliberately
exposed to the virus, which

understandably is unethical.
Furthermore, it is pertinent
to note that the more vaccine
coverage in the community, the
lesser exposure would translate
into better effectiveness and
vice versa. Thus, the measured
efficacy/ effectiveness of the
vaccine is only a guide for
approval and not a benchmark
for claiming superiority of one
vaccine over another.
The recent paper from the
UK confirms this fact wherein
both the AstraZeneca and
Pfizer vaccines were found to be
equally effective in preventing
symptomatic disease. Akin to the
preventive mitigation measures
with COVID-19 that emphasized
community
rather
than
individual behaviour, the vaccine
effectiveness also increases with
greater community coverage.
With only a minority immunized,
the vaccines would fail to protect
individuals when the disease
incidence or test positivity rate
is high during an outbreak,

which is currently in India.
Several reports of immunized
individuals
developing
symptomatic
disease,
with
questions being asked on the
effectiveness of vaccines being
used in this program (Covishield
predominantly and Covaxin in
the minority).
I am pretty confident that the
mRNA-based vaccines would
also face a similar fate under the
present circumstances. Therefore
widespread immunization of
the community is required not
only to rein in the outbreak at
a community level but also to
ensure that the immunized
remain protected. Get vaccinated
and motivate others to do the
same - Together, we can win!
References
1.
CDC says fewer than
6,000 Americans have contracted
Covid after being fully vaccinated
h t t p s : // w w w . c n b c .
c o m /2 0 2 1/0 4/19/c d c - s a y s t h e r e - h ave - b e e n - l e s s - t h a n -

6000 -brea kt h rough- covidcases-among-fully-vaccinatedamericans.html
2.
Pritchard E, Matthews
P, Stoesser N et. Al. Impact of
vaccination on SARS-CoV-2
cases in the community: a
population-based study using
the UK’s COVID-19 Infection
survey. Available at https://
w w w.me d r x iv.org/cont e nt/
10.1101/2021.04.22.21255913v1.
Accessed 24/04/2021

It is virtually impossible to
assess the true efficacy of the
vaccines unless challenge trials
are designed wherein the trial
participants are deliberately
exposed to the virus, which
understandably is unethical.
The measured efficacy/
effectiveness of the vaccine is
only a guide for approval, and
not a benchmark for claiming
superiority of one vaccine over
another.

Author:

Dr. Ameet Vaman Revankar

Associate
Professor,
Orthodontics, SDM College of
Dental Sciences, Dharwad, India
• drameetr@gmail.com
• Follow on Twitter: @drameetr

[2] =>

2

News

05/21

Saliva test for COVID-19 diagnosis
and severity prediction
by Dr Amisha Parekh,
Dental Tribune South Asian
The use of saliva has multiple
advantages over nasopharyngeal
swabs in terms of being noninvasive, its ease of collection
without professional help, and
without the need for transport
media. The growing evidence
on saliva being as accurate
as nasopharyngeal swab test
makes it a potential alternative
diagnostic test especially in
times like these when testing
demands have surged.
Saliva has been considered as
a potential pool for biomarkers
in several diseases for years. Its
importance in the diagnosis and
prognosis of COVID-19 cases has
increased multifold in the last
twelve months after the pandemic
outbreak.
Countries like South Korea,
Germany, and Japan have
implemented saliva testing for
COVID-19 detection and in the
USA, saliva testing is being used
for the reopening of educational
institutions [1]. Recently, a
smartphone-read
portable,
ultrasensitive and quantitative
saliva test for COVID-19 has
been developed which has a 15min sample-to-answer time that
does not require RNA isolation or
laboratory equipment [2].
Saliva
for
COVID-19
diagnosis:
Recently
several
studies have reported the
diagnostic potential of saliva for
COVID-19 [3-10] and the following
can be summarized
•
SARS-CoV-2 viral load in
saliva has been found to be either
higher or equivalent as compared
to standard nasopharyngeal
swab test and saliva is likely to
be constantly positive throughout
the course of infection.
•
SARS-CoV-2
can
be detected in the saliva of
asymptomatic persons.
•
Several
preliminary
reports showed that the viral
load in the saliva is comparable
with that in sputum and sputum
is superior to nasopharyngeal
swabs in the detection of SARSCoV-2 infection.
•
Overall median CT value
in saliva samples was found to be
higher than the nasopharyngeal
swab.
•
Anti-SARS-CoV-2 antibodies
in saliva have been found to reflect
concentrations in serum thus
making saliva testing a good

It‘s time we prioritized saliva testing over swabs for COVID-19. (Image: canva.com)

alternative
to
blood-based
antibody testing.
•
Saliva
has
been
suggested to be preferable for
gauging active rather than
historical infection which could
help in preventing unnecessarily
prolonged isolation periods.
•
Studies
that
used
methods involving clear saliva
(rather than sputum) and
processing to reduce the viscosity
(eg, homogenization) showed
greater
sensitivities
relative
to swabs. Methods requiring
forceful production of saliva, such
as by spitting or coughing instead
of drooling, reduced sensitivity.
Salivary viral load correlates
with COVID-19 severity and
mortality [11]
•
High salivary viral load
was correlated with increasing
levels of disease severity and
showed a superior ability over
nasopharyngeal viral load as a
predictor of mortality over time.
•
High salivary viral load
correlated with many known
COVID-19 inflammatory markers
such as IL-6, IL-18, IL-10, and type
1 immune response cytokines as
well as with progressive depletion
of platelets, lymphocytes, and
effector T cell subsets including
circulating follicular CD4 T cells.
•
The salivary viral load
has been found to be significantly
higher in those with COVID19 risk factors such as older age,
heart failure, cancer, and certain
immunosuppression
states,
hypertension, and chronic lung
disease as well as in males who
have been known to be at a higher
risk than females.

•
High salivary viral loads
required a higher antibody-tovirus ratio to successfully bring
down viral load. Thus, monitoring
salivary viral load could play
a very significant role when
considering the incorporation of
convalescent serum in patients.
Conclusion
The Lancet states that “A single
saliva sample can simultaneously
enable the identification of active
cases, previous cases, and vaccineinduced immune responses.
Importantly, salivary antibody
testing provides a scalable means
for monitoring herd immunity in
a post-vaccination world” [1].
A
simple
non-invasive
saliva test could not only help
in diagnosing COVID-19 cases
but also help in evaluating the
prognosis of patients. Mouth
rinses like chlorhexidine have
been known to reduce the viral
load in the oropharyngeal region
[12,13,14] and the use of such
rinses in patients diagnosed with
high salivary viral load could
help in reducing transmission
of the virus as well as may help
in improving the prognosis of
patients by reducing the salivary
viral load. Thus, a simple saliva
test is much needed in these
critical times.
References
1.
Lancet Respir Med 2021
Published Online April 19, 2021
https://doi.org/10.1016/
S22132600(21)00178-8.
2.
Ning B, Yu T, Zhang
S, et al. A smartphone-read
ultrasensitive and quantitative
saliva test for COVID-19. Sci Adv.

2021;7(2):eabe3703. Published 2021
Jan 8. doi:10.1126/sciadv.abe3703.
3.
Byrne RL, Kay GA,
Kontogianni K, et al. Saliva
Alternative to Upper Respiratory
Swabs for SARS-CoV-2 Diagnosis.
Emerging Infectious Diseases.
2020;26(11):2769-2770. doi:10.3201/
eid2611.203283.
4.
Hung KF, Sun YC,
Chen BH, et al. New COVID19 saliva-based test: How good
is it compared with the current
nasopharyngeal
or
throat
swab test?. J Chin Med Assoc.
2020;83(10):891-894. doi:10.1097/
JCMA.0000000000000396.
5.
Butler-Laporte
G,
Lawandi A, Schiller I, et al.
Comparison of Saliva and
Nasopharyngeal Swab Nucleic
Acid Amplification Testing for
Detection of SARS-CoV-2: A
Systematic Review and Metaanalysis [published correction
appears
in
doi:
10.1001/
j a m a i n t e r n m e d . 2 0 2 1 . 0 2 4 5 ].
JAMA
Intern
Med.
2021;181(3):353-360. doi:10.1001/
jamainternmed.2020.8876.
6.
Babady NE, McMillen T,
Jani K, et al. Performance of Severe
Acute Respiratory Syndrome
Coronavirus 2 Real-Time RT-PCR
Tests on Oral Rinses and Saliva
Samples. J Mol Diagn. 2021;23(1):39. doi:10.1016/j.jmoldx.2020.10.018.
7.
Wyllie AL, Fournier
J, Casanovas-Massana A, et
al. Saliva or Nasopharyngeal
Swab Specimens for Detection
of SARS-CoV-2. N Engl J
Med.
2020;383(13):1283-1286.
doi:10.1056/NEJMc2016359.
8.
Teo AKJ, Choudhury
Y, Tan IB, et al. Saliva is more
sensitive than nasopharyngeal
or nasal swabs for diagnosis of

asymptomatic and mild COVID-19
infection. Sci Rep. 2021;11(1):3134.
Published 2021 Feb 4. doi:10.1038/
s41598-021-82787-z.
9.
Rao M, Rashid FA,
Sabri FSAH, et al. COVID-19
screening test by using random
oropharyngeal saliva. J Med Virol.
2021;93(4):2461-2466. doi:10.1002/
jmv.26773.
10. Wyllie, Anne & Fournier,
John & Casanovas-Massana,
Arnau & Campbell, Melissa &
Tokuyama, Maria & Vijayakumar,
Pavithra & Geng, Bertie &
Muenker, mary catherine &
Moore, Adam & Vogels, Chantal &
Petrone, Mary & Ott, Isabel & Lu,
Peiwen & Venkataraman, Arvind
& Lu-Culligan, Alice & Klein,
Jonathan & Earnest, Rebecca &
Simonov, Michael & Datta, Rupak
& Ko, Albert. (2020). Saliva is
more sensitive for SARS-CoV-2
detection in COVID-19 patients
than nasopharyngeal swabs.
10.1101/2020.04.16.20067835.
11. Silva
J,
Lucas
C,
Sundaram M, et al. Saliva viral
load is a dynamic unifying
correlate of COVID-19 severity
and mortality. Preprint. medRxiv.
2021;2021.01.0 4.212492 36.
Published 2021 Jan 10. doi:10.1101
/2021.01.04.21249236.
12. Chitguppi,
Rajeev.
(2020). Chlorhexidine gluconate
is effective against the novel
coronavirus & other viruses.
10.13140/RG.2.2.18594.99524.
13. Chitguppi,
Rajeev,
Mouth Rinses with Substantivity
Can Prevent COVID-19 Spread
and Protect the Healthcare
Workers (June 30, 2020). Available
at
SSRN:
https://ssrn.com/
abstract=3638601 or http://dx.doi.
org/10.2139/ssrn.3638601.
14. Huang, YH, Huang, JT.
Use of chlorhexidine to eradicate
oropharyngeal SARS-CoV-2 in
COVID-19 patients. J Med Virol.
2021; 1- 4. https://doi.org/10.1002/
jmv.26954.

A
simple
non-invasive
saliva test could not only help
in diagnosing COVID-19 cases
but also help in evaluating
the prognosis of patients.
Monitoring salivary viral
load could play a very significant
role when considering the
incorporation of convalescent
serum in patients.

[3] =>

News

05/21

WHO statement on airborne transmission
of SARS-CoV-2

Infected people appear to be most infectious just before they
develop symptoms (namely two days before they develop symptoms)
and early in their illness. (Image: canva.com)

by Dr Amisha Parekh,
Dental Tribune South Asia
The
World
Health
Organization (WHO) updated
its communication on the
airborne transmission of SARSCoV-2 on 30 April 2021. This
article summarizes their current
opinion.
The authors of the article Ten
scientific reasons in support
of
airborne
transmission
of
SARS-CoV-2
published
in The Lancet on April 15,
2021, concluded that „there is
consistent, strong evidence that
SARS-CoV-2 spreads by airborne
transmission. Although other
routes can contribute, we believe
that the airborne route is likely
to be dominant. The public

health community should act
accordingly and without further
delay.“ [1]
On April 30, 2021, the
WHO updated their original
communication dated December
13, 2021, on the transmission of
SARS-CoV-2. Here are the salient
points:
Transmissibility
of
the
SARS-CoV-2 virus depends
upon various factors such as the
amount of viable virus being shed
and expelled by a person, type
of contact, and the settings and
circumstances involved.
•
A person can get
infected when aerosols or
droplets containing the virus
released from the mouth or nose

of an infected person in the form
of particles ranging from larger
respiratory droplets to smaller
aerosols are inhaled or come in
direct contact with the eyes, nose,
or mouth of the person.
•
Close contact with an
infected person typically within
1 meter (short-range).
•
Clinical settings where
aerosol-generating
procedures
are performed increases the risk
of aerosol transmission.
•
Although the presence
of viral RNA may not represent
replication
and
infection
(as a viable virus capable of
transmission
and
initiating
invasive infection is required),
the presence of viral RNA in air
samples of clinical settings in the
absence of aerosol-generating
procedures as well as the presence
of viable SARS-CoV-2 virus from
air samples in the vicinity of
COVID-19 patients warns the
spread of infection in specific
settings
and
circumstances
such as indoor, crowded and
inadequately ventilated spaces.
•
WHO has described
the settings where the SARSCoV-2 virus spreads more
easily using “Three Cs” which
represent Crowded places, Closecontact settings, and Confined
and enclosed spaces with poor
ventilation wherein the risk of

COVID-19 spreading is especially
high in places where these “3Cs”
overlap.
•
Touching contaminated
surfaces followed by touching
the eyes, nose, or mouth without
washing hands could also spread
COVID-19 infection.

Period of infectiousness of
infected individuals [2]:
•
Irrespective of whether
asymptomatic (infected but never
develops any symptoms) or presymptomatic (not yet developed
symptoms
but
develops
symptoms later), all infected
individuals can be contagious
and the virus can spread from
them to other people.
•
The period just before
individuals develop symptoms
(namely two days before they
develop symptoms), as well as
the early phase of their illness,
has been found to be the most
infectious stage and people who
develop severe disease could also
be infectious for longer periods.
Follow your “VOWS” to
reduce the risk of infection:
•
V – Vaccination: When
it’s your turn, get vaccinated and
follow the vaccination guidelines.
•
O – Opt to avoid the
“Three Cs” which represent
crowded places, close-contact

settings, and confined and
enclosed spaces with poor
ventilation as well as avoid
touching surfaces.
•
W - Wear a mask (wellfitting three-layer mask) and
wash hands frequently with soap
and water or alcohol-based hand
rub.
•
S - Social distancing:
Maintain at least a one meter
distance from others.
References:
1.
Greenhalgh T, Jimenez
JL, Prather KA, Tufekci Z,
Fisman D, Schooley R. Ten
scientific reasons in support
of airborne transmission of
SARS-CoV-2. Lancet. 2021 May
1;397(10285):1603-1605.
doi:
10.1016/S0140 - 6736(21)0 08692. Epub 2021 Apr 15. PMID:
33865497; PMCID: PMC8049599.
2.
Roadmap to improve
and
ensure
good
indoor
ventilation in the context of
COVID-19. Geneva: World Health
Organization; 2021. Licence:
CC BY-NC-SA 3.0 IGO. https://
www.who.int/publications/i/
item/9789240021280.
3.
Coronavirus
disease
(COVID-19): How is it transmitted?
ht t p s://w w w.who.i nt/n e ws room/q-a-detail/coronavirusd i s e a s e - c o v i d -19 - h o w- i s - i ttransmitted.

LifeCare Devices Private Limited
New Jubilee Building, Office no. 1
Laxmiben Chheda Road,
Nalasopara West, Palghar 401 203
Mumbai Metropolitan Region
Maharashtra, INDIA
Customer Service
: +91 99304 50170
Customer Service WhatsApp : +91 99304 50169
Management WhatsApp
: +91 99304 50163
+91 99997 86275

[4] =>

4

News

05/21

COVID-19 response by mobile apps
in India
facility available. Also, two apps
had the function of confirmed
cases with hot spot identification
and contact tracing.

For a country like India with a huge population and limited
resources for testing, these apps will immensely aid in identifying
the spots and individuals at risk at a faster level. (Image: canva.com)

by Dr Nilesh Pardhe et al.
The possible benefits by
which one can use mobile
applications (apps) for contact
tracking in managing the
COVID-19 pandemic have been
discovered. Various mobile
apps have been developed and
permitted by the Central and
State Govt. and some medical
organizations for controlling
COVID-19. India has launched
the Arogya setu ap p, the first of
its kind in disease surveillance
initiative used.
This study
provides a systematic review of
mobile apps used in the COVID19 pandemic and focuses on
developing future e-healthcare
services.
Introduction
COVID-19 pandemic has
spread to around 213 countries
worldwide. Due to the lack of
medical management for COVID19 at present, the main focus on
preventing spread by the public is
by following physical distancing,
hand hygiene practice and face
mask to slow its spread. [1] The
confirmed COVID-19 cases are
advised home quarantine or
hospital quarantine based on
the severity of the infection with
contact tracing. India reported its
first COVID-19 case on 30 January
2020, with 257,192 confirmed
cases and 7,207 deaths. Central
Govt.
imposed
nationwide
lockdown on 24 March 2020,
followed by vigorous testing and
contact tracing. [2]
Conventional
systems
used previously have not been
designed to meet challenges like
the one posed by the COVID19 pandemic. [2, 3] Modern
digital technology presents the
possibility of improving health
care efficiency in response to the
epidemic. Such mobile health
applications have been used
previously during Ebola and
Zika virus breakdown. Now is
the time to update our digital
surveillance system to help

control the existing pandemic
and avoid any such incidence in
the near future. [2]
National Informatics Center,
Government of India, developed
and launched the Aarogya setu
app to track COVID-19 in April
2020. [1] Various healthcare
agencies in India have developed
other apps to raise awareness,
follow up of quarantined people,
and enforce lockdown. [1, 3]
Aim of the study: To
systematically
identify
and
review mobile apps related to
the COVID-19 pandemic in India.
Materials and Methods
The iOS and android app
stores were searched with
keywords like a pandemic,
novel coronavirus, COVID-19.
The search was done from the
first week of December 2020 to
the Last week of January 2021.
The screening was based on app
titles with their description. The
gaming apps, apps on infections
or disease not specific to COVID19, and apps without English/
Hindi language were excluded.
Results
Around
300
COVID-19
apps were included; 30 met the
inclusion criteria. 270 apps were
excluded as they didn’t focus on
COVID-19 infections, few were
gaming apps, and some without
an English/ Hindi language
interface.
Only free apps without inapp purchases were included.
About 27 apps were for common
public use, 2 for the quarantined
foreigners, and one was for
healthcare workers.
Out of the fourteen apps
developed
for
quarantined
people, one had a self-asses
sment tool, six had telephonic
helplines, five had a function of
questions and answers related to
age, travel, underlying medical
condition, and symptoms, and
two had an electronic e pass

Discussion
Central Government, together
with the state government, is
involved in developing these
apps used in the country. [4] Many
functions like contact tracing,
quarantine, self-assessment were
common at state-level apps. The
information technology ministry
has successfully installed the
Aarogya setu app, which is
available in 11 languages. [1]
It is essential and has been
made compulsory for people to
download the app so that the
contact tracing is done efficiently.
Also, the state-specific app should
be encouraged to help at the local
level. With the rising cases, it is
vital to install teleconsultation
also in these apps. [5] Some
apps did not have functions that
could help health care workers,
like tracking types of equipment
and compile clinical data as used
in other countries. [6] As these
apps use Bluetooth connectivity,
it can pose a risk for national
security and user privacy. To
counter this, Singapore has
shared the app source code with
the researchers for independent
review. [7] Argentina is using
apps that collect and record
only the Bluetooth interaction.
[8] To prevent that, the Indian
government should address
these concerns to the public and
gather trust to set up these apps
at a larger scale. [1]
This is an excellent step by
the government of India for the
COVID-19 m-health initiative.
These apps are a source of
providing
disease-related
information and knowledge at a
larger level. [5]
Conclusion
For a country like India with
a huge population and limited
resources for testing, these apps
will immensely aid in identifying
the spots and individuals at risk
at a faster level.
References
1.
Mohanty B, Chughtai
A, Rabhi F. Use of Mobile Apps
for
epidemic
surveillance
and response – Availability
and gaps. Glob Biosecurity
2019; 1 : 37. Available from:
https://
jglobalbiosecurity.
com/article/10.31646/gbio.39/,
accessed on April 8, 2020.
2.
Ahmadi S, Bempong
NE, De Santis O, Sheath D,
Flahault A. The role of digital

technologies in tackling the Zika
outbreak: A scoping review. J
Public Health Emerg 2018; 2 :
1-20.
3.
Dujmovic J. Wildly
popular
coronavirus-tracker
app helps South Koreans steer
clear of outbreak areas. Market
Watch; 2020. Available from:
ht t p s://w w w.m a rk e t wat c h .
com/story/
wildly-popularcoronavirus-tracker-app-helpssouth-Koreans
-steer-clearof-outbreak-areas-2020-03-18,
accessed on April 11, 2020
4.
World
Health
Organization. WHO guideline:
Recommendations on digital
interventions for health system
strengthening. Geneva: WHO;
2019.
5.
Ministry of Health and
Family Welfare, Government
of India. Telemedicine practice
guideline: Enabling registered
medical practitioners to provide
healthcare using telemedicine.
Available
from:
https://
w w w. m o h f w. g o v. i n /p d f /
Telemedicine. Accessed on April
12, 2020.
6.
Wood CS, Thomas MR,
Budd J, et al. Taking connected
mobile-health diagnostics of
infectious diseases to the field.
Nature 2019; 566(7745): 467-74.
7.
Lavallee DC, Lee JR,
Austin E, et al. mHealth and
patient generated health data:
stakeholder perspectives on
opportunities
and
barriers
for transforming healthcare.
Mhealth 2020; 6: 8.
8.
Morley J, Floridi L. The
limits of empowerment: how to
reframe the role of mHealth tools
in the healthcare ecosystem.
Science Eng Ethics 2019: 1-25.

Dr. Anil Chandra

Dr. Anil Chandra, Dean,
Faculty of Dental Sciences,
Department of Conservative
and Endodontics, King George’s
Medical University, Lucknow

Dr. Mohd Parvez Khan

Dr. Mohd Parvez Khan,
Professor,
Department
of
Anesthesia and critical care, King
George’s Medical University,
Lucknow

Dr. Nilesh Pardhe

Dr. Nilesh Pardhe, Zonal
Clinical Head, Clove Dental,
Rajasthan - Jaipur

Authors:

Dr. Priyanka Singh

Dr Pradkhshana Vijay

Dr. Pradakhshana Vijay,
Senior Resident, Department of
Oral Pathology, King George’s
Medical University, Lucknow

Dr.
Priyanka
Singh,
Associate Professor, Department
of Oral Pathology, King George’s
Medical University, Lucknow
Corresponding author: Dr.
Nilesh Pardhe.
Email: drpardhenilesh@hotmail.com,
nilesh.pardhe@clovedental.in

[5] =>

News

05/21

It’s time we used vitamin D to
reduce the risk of COVID-19
severity
studies, we have enough evidence
supporting the use of vitamin D
supplements for COVID-19 and the
current situation demands such
immediate measures. Recently, The
Lancet has also advised the same
“Particularly in countries where
the pandemic situation continues
to worsen (and will continue to
do so during the winter months
before the effects of vaccinations
become perceptible), additional
evidence could come in just too
late. In an ideal world, all health
decisions would be made based
on overwhelming evidence, but a
time of crisis may call for a slightly
different set of rules” [8].
Vitamin D deficiency can increase the risk of COVID-19 severity. It is very essential to correct vitamin D
deficiency. (Image: canva.com)

by Dr Amisha Parekh,
Dental Tribune South Asia
People
that
traditionally
exhibit vitamin D deficiency, such
as older adults and nursing home
residents, are the same groups
that have also been excessively
impacted by the COVID-19
pandemic. New guidance (Dec 22,
2020) from the UK government
allowed the extremely clinically
vulnerable people to receive a
free four-month supply of daily
vitamin D supplements—similar
to an initiative launched earlier in
Scotland.
Vitamin
D
deficiency
associated problems:
•
Lower levels of vitamin D
are associated with several factors
such as ethnicity, variation in sun
exposure at higher latitudes, season,
time of day, clothing, sunscreen
use, and skin pigmentation, age,
lower sun exposure, obesity, and
chronic illnesses [1].
•
Previous studies have
shown that vitamin D deficiency
is associated with an increased
incidence of several autoimmune
diseases and is also associated with
a longer course of acute respiratory
infection [2].
•
Studies have also shown
that vitamin D supplementation
could prevent respiratory infections
[2].
Vitamin D deficiency and
COVID-19 severity: Several articles
have been published previously
assessing the correlation between
Vitamin D deficiency and COVID19 severity [1,2,3,4]. The following
conclusions can be summarized
from these:
•
Vitamin D deficiency
is associated with COVID-19 in

terms of increased risk of disease
development,
higher
disease
severity, higher frequency of
intensive care unit hospitalization,
and mortality risk.
•
Vitamin D deficient
individuals were observed to be
having higher levels of IL-6 and
were associated with inflammatory,
pro-thrombotic, and metabolic
markers of severity, thereby
having experienced a greater
inflammatory response.
•
A study has also
suggested that vitamin D levels
could be used as a marker of an
impaired response to infection
within the pulmonary epithelium,
especially in those with severe
deficiency.
Benefits of vitamin D
supplementation in COVID19 patients: Several studies
have concluded that the use
of vitamin D supplementation
could reduce the risk, severity, and
mortality of COVID-19 infection
[1,2,3,4]. The following benefits
were observed on vitamin D
supplementation:
•
As vitamin D levels
increased:
1.
The patients‘ risk of
getting
COVID-19
infection
decreased.
2.
The number of lung
segments with common groundglass appearance decreased.
3.
The level of D-dimer and
CRP decreased considerably.
4.
Duration of the hospital
stay
of
COVID-19
patients
decreased.
•
Some
alveolar
cells
that express ACE2 receptors are
very essential for the production
of surfactant in the lungs that
regulate the alveolar surface

tension. Vitamin D increases the
ACE2 expression in the lungs
that has been downregulated
due to SARS-CoV-2 viral binding,
thereby assisting the production of
surfactant [2].
Vitamin D supplements:
Previously, articles on Dental
Tribune have reflected studies
that show worldwide vitamin D
deficiency and insufficiency [5,6].
To maintain the optimal level
of vitamin D in the blood, the
National Health Service advises
taking a 10 µg supplement of the
vitamin a day [5]. The oral spray
(sublingual) method of delivering
vitamin D has also been found to
be as effective as taking a capsule
and has supported the same rate of
improvement in vitamin D levels
[7].
Dental Tribune South Asia
has previously covered the role of
Vitamin D in COVID-19.
1.
https://in.dental-tribune.
com/news/mak i ng-a- case-forv i t a m i n - d - d u r i n g- c o v i d -19 subhasree-ray- cli n ical-publichealth-nutritionist/
2.
https://in.dental-tribune.
com/news/14-lines-of-evidenceto-support-the-critical-role-ofvitamin-d-in-covid-19-subhasreeray/
3.
https://in.dental-tribune.
com/news/f i rst- cl i n ica l-t r ia lv it a m i n- d-preve nt s - cov id-19 complications-in-hospitalizedpatients/
Conclusion:
Vitamin D supplementation
could prove to be beneficial not
only for COVID-19 but also for
many other complications with the
added benefit of being affordable
and easily available. Barring few

References:
1.
Vanegas-Cedillo
PE,
Bello-Chavolla
OY,
RamírezPedraza N, et al. Serum Vitamin
D levels are associated with
increased COVID-19 severity and
mortality independent of visceral
adiposity. medRxiv; 2021. DOI:
10.1101/2021.03.12.21253490.
2.
Sulli, A.; Gotelli, E.;
Casabella, A.; Paolino, S.; Pizzorni,
C.; Alessandri, E.; Grosso, M.;
Ferone, D.; Smith, V.; Cutolo, M.
Vitamin D and Lung Outcomes
in Elderly COVID-19 Patients.
Nutrients 2021, 13, 717. https://doi.
org/10.3390/nu13030717.
3.
Teshome A, Adane A,
Girma B and Mekonnen ZA (2021)
The Impact of Vitamin D Level on
COVID-19 Infection: Systematic
Review and Meta-Analysis. Front.
Public Health 9:624559. doi: 10.3389/
fpubh.2021.624559.
4.
Demir, M, Demir, F,
Aygun, H. Vitamin D deficiency
is associated with COVID-19
positivity and severity of the
disease. J Med Virol. 2021; 93: 2992–
2999.
https://doi.org/10.1002/
jmv.26832.
5.
h t t p s://w w w.d e n t a l t r ib u n e.com/n ews/su n sh i n e vitamin-d-and-covid-19-is-there-acorrelation/
6.
h t t p s://w w w.d e n t a l tribune.com/news/importanceof-vitamin-d-in-dentistry-couldit-play-a-role-i n-resista nce-toinfectious-diseases/
7.
h t t p s://w w w.d e n t a l t r i b u n e . c o m/n e w s/v i t a m i n d- spray- e qu a l ly- e f fe c t ive - a s capsules-study-finds/
8.
The Lancet Diabetes
Endocrinology. Vitamin D and
COVID-19: why the controversy?.
Lancet
Diabetes
Endocrinol.
2021;9(2):53.
doi:10.1016/S22138587(21)00003-6.

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Opinions expressed by authors are
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of Dental Tribune International
GmbH.

[6] =>

News

05/21

Clean-O-Denture – a device to improve
denture hygiene
by Dr Pranit Bora et al.
Numerous products are
available in the market to clean
the dentures but inconclusive
outcomes of these products
discourage the population to
use them as a routine denture
hygiene measure. So in order
to address these issues, a device
combing all possible features of
cleaning denture is designed to
attain conclusive outcomes.
Why did you create it?
Deprived denture hygiene
is associated with a dearth of
guidance, intrinsic characteristics
of the denture, and weakened
manual dexterity of most
denture wearers due to old age.
Poor denture hygiene leads to
an accumulation of biofilm,
which is a dense microbial layer.
It has also been suggested that
oral microorganisms are allied
with systemic disease and that
dentures epitomize a reservoir for
these microorganisms. Denture
plaque is associated not only with
oral diseases, such as denture
stomatitis, periodontitis, and
caries, but also systemic diseases,
including aspiration pneumonia,
gastrointestinal infection, and
pleural infection. Thus, effective
denture plaque control is vital to
avert these infections, especially
in elderly people. To meet these
prerequisites of cleaning denture
numerous products are available
in the market but inconclusive
outcomes of these products
discourage the population to
use them as a routine denture
hygiene measure. So in order to
address these issues, a device
combing all three measures of
cleaning denture is designed so
as to attain conclusive outcomes.
What problem
address and solve?

does

The device contains features combining the multiple requirements of denture users. (Image: canva.com)

Moreover, denture brushing is
often challenging for older and
physically impaired denture
wearers.
There are three methods of
denture cleaning: mechanical,
chemical,
and
ultrasonic.
The mechanical method uses
brushes, the chemical method
involves soaking the denture
in cleansers, and the ultrasonic
method involves the use of
ultrasonic devices.
An amalgamation of all
denture cleaning methods is
more effective at improving
objective denture cleanliness
than the mechanical method
alone. Although a combination
of mechanical and chemical
methods reduces the abundance
of biofilm on dentures to a
greater extent has been proven
in various studies. So a device
combing all the methods in order
to give irrefutable results has
been developed.
How did you test it?

Figure 1 – Showing Entire
Assembly Along With
Provisional Storage Facility.

Although dentists tend to
objectively evaluate denture
cleanliness, elderly patients often
show little interest in the matter.

Figure 2- UV Storage And
Display Screen

The efficacy of denture
washers has been tested in three
different stages.

1.
A study was conducted
in patients reporting with the
old set of dentures to Dept of
Prosthodontics, K. M. Shah
Dental
College,
Vadodara
underwent cleaning in this
prototyped device, and cleaning
efficacy was tested.
2.
A prototyped device
was presented to an old age
home. The process was shown to
denture wearers and caretakers.
Their review regarding the
device was recorded. The main
concern of caretakers, like the
spread of splatter and obnoxious
feeling while cleaning dentures
was taken care of by this device.
As well people having issues
with manual dexterity found the
device accessible and stress-free
to handle.
3.
Study regarding pre
and post microbiological load
is been undergoing results are
awaited.
Tell us something about its
current status and your future
plans
A prototype device has
been devised and has been
tested for cleaning efficacy, and
the device has been applied
for a design patent. Further
product
development
and
commercialization will be done
with the financial support of
startups and entrepreneurs.

Authors:

Dr. Pranit Bora

Dr. Tabassumben Mansuri

Dr. Pranit Bora is currently
pursuing MDS in Prosthodontics,
crown & bridge at KM Shah
Dental College & Hospital,
Vadodara.

Dr. Tabassumben Mansuri
is currently pursuing MDS in
Prosthodontics, crown & bridge
at KM Shah Dental College &
Hospital, Vadodara.

Dr. Rajesh Sethuraman

Dr. Meet Shah

Dr. Rajesh Sethuraman is
currently Professor, HOD, and
Additional Dean at KM Shah
Dental College & Hospital,
Vadodara.

Dr. Meet Shah is currently
pursuing MDS in Prosthodontics,
crown & bridge at KM Shah
Dental College & Hospital,
Vadodara.

[7] =>

Sydney, Australia

26-29 September 2021

Broadcast from the International Convention Centre
4 day Streamed Scientific Programme
200+ sessions on-demand for an extended period of 60 days
High quality International and Local presenters
Europe, America, Africa, Middle East, Asia, Australia & New Zealand
Extensive virtual Exhibition with product demonstrations
Meet the exhibitor’s in a virtual showroom
Interact live with speakers, ask questions
Passport competition with great prizes

Australian CPD Requirements
Dental practitioners in Australia are required to complete a minimum
of 60 hours of CPD activities over a three-year CPD cycle (current cycle
ends Wednesday 30th November 2022).

ADA CERP
The FDI World Dental Association is an ADA CERP Recognised Provider. ADA
CERP is a service of the American Dental Association to assist dental
professionals in identifying quality providers of continuing dental education.
ADA CERP does not approve or endorse individual courses or instructors, nor
does it imply acceptance of credit hours by boards of dentistry.
This continuing education activity has been planned and implemented in
accordance with the standards of the American Dental Association Continuing
Education Recognition (ADA CERP) through joint efforts between FDI
World Dental Association and the Australian Dental Association.
Concerns or complaints about a CE provider may be directed to the provider
or to the Commission for Continuing Education Provider Recognition
at ADA.org/CERP.

Educating for Dental Excellence

www.world-dental-congress.org

[8] =>

7 News

Amelotech
Synahealth Singapore Pte. Ltd.
16 Raffles Quay
#41-01 Hong Leong Building
Singapore 048581

7/19

LifeCare Devices Private Limited
New Jubilee Building, Office no. 1, Laxmiben Chheda Road,
Nalasopara West, Palghar 401 203. Mumbai Metropolitan Region,
Maharashtra, INDIA. | E: info@lifecare.in | Website: www.lifecare.in
| Customer Service : +91 99304 50170
| Customer Service WhatsApp : +91 99304 50169
| Management WhatsApp : +91 99304 50163/+91 99997 86275

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[cover] => DT India & South Asia No. 5, 2021

[toc] => Array ( [0] => Array ( [title] => The changing goalposts of vaccine effectiveness [page] => 1 ) [1] => Array ( [title] => Saliva test for COVID-19 diagnosis and severity prediction [page] => 2 ) [2] => Array ( [title] => WHO statement on airborne transmission of SARS-CoV-2 [page] => 3 ) [3] => Array ( [title] => COVID-19 response by mobile apps in India [page] => 4 ) [4] => Array ( [title] => It’s time we used vitamin D to reduce the risk of COVID-19 severity [page] => 5 ) [5] => Array ( [title] => Clean-O-Denture – a device to improve denture hygiene [page] => 6 ) ) [toc_html] =>

Table of contents

[toc_titles] =>

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