key: cord-0011672-2m0romx0
authors: Shaath, M.
title: Progression of specialist trainees
date: 2020-05-22
journal: Br Dent J
DOI: 10.1038/s41415-020-1697-1
sha: b1e6205d9eaf52a5aec99c33c6b7532ccddda00f
doc_id: 11672
cord_uid: 2m0romx0

nan

This route can facilitate transmission via fomites in the surrounding environment, in much the same way as indirect respiratory droplet transmission. Where toothbrushes are placed in close proximity to a toilet, there may be a heightened risk of harbouring SARS-CoV-2 from infected individuals. That families often house toothbrushes together, the risk of infecting other individuals could be made easier.

Rightly, the dental profession have reason to fear the aerosol generation from dental handpieces, particularly when the inversesquare law is applied to project the extent of dispersal. In a mechanistically similar way, toilet plumes may pose a similar challenge. Professor Addy offered reason to reinforce the role of toothbrushing with toothpaste, given the antimicrobial properties of toothpaste ingredients. 3 Awareness and advice to limit toothbrush contamination might prove beneficial. Though the evidence base is yet to be established, no harm exists in recommending this as a precautionary measure in the preventive approach to COVID-19.

J. Patel, Leeds, UK trainees approaching the end of the pathway across all specialities. All resources should and will be directed into ensuring facilities and measures to protect the safety and wellbeing of patients. However, a structure needs to be developed to account for the disruption in training COVID-19 has caused and facilitate the progression of the trainees without compromising the quality and integrity of the respected specialities.

M. Shaath, Manchester, UK https://doi.org/10.1038/s41415-020-1697-1

Sir, the established modes of SARS-CoV-2 transmission may be an incomplete picture.

In their most recent scientific brief, the World Health Organisation acknowledge the evidence to support contact and respiratory droplet transmission of SARS-CoV-2. Accordingly, much of the government's infection prevention and control guidance for COVID-19 is centred around minimising transmission via these methods. The coronaviruses implicated in the previous SARS and MERS outbreaks caused enteric manifestations in conjunction with the respiratory symptoms experienced by many with COVID-19. Since the early retrospective cohort studies of patients in Wuhan, more recent observational studies report common gastrointestinal symptoms to be more prevalent than previously thought. 1 SARS-CoV and MERS-CoV RNA were frequently detected in stool specimens of infected individuals. The New England Journal of Medicine case report of the first COVID-19 patient in the USA detected high SARS-CoV-2 viral load in their stool sample. 2 Experts recognise the hypothesised faecal-oral route to be a plausible mode of transmission.

Sir, amid the many current uncertainties dental practitioners have, trainees also have an additional worry regarding their training and how this will impact them in the future. The bearing COVID-19 has had on clinical activity means that many patients being treated and prepared for cases will be delayed, target case numbers and important clinical exposure will reduce, negatively impacting trainees' progression. Additionally, redeployment into other areas of the trust to aid with the response to COVID-19 may divert trainees' attention from their own speciality. With royal colleges already cancelling and postponing courses and exams, this adds the stress on

Sir, the COVID-19 pandemic has caused significant disruptions in dental services including both undergraduate and postgraduate dental training. Newly qualified dentists who commenced dental foundation training in September 2019 would have only had seven months of clinical practice before the lockdown resulted in cessation of routine dentistry in the UK. 1 There are likely to be outstanding competencies and the loss of clinical experience and mentoring will need to be identified and fulfilled through a personal development plan (PDP).

The enhanced continuing professional development (CPD) scheme was introduced by the General Dental Council (GDC) on 1 January 2018 for dentists. 2 This involves completion of the prerequisite 100 hours of CPD per cycle but also in ensuring that this is tailored to meet individual PDPs to make sure maximum benefit is gained and to encourage reflective practice.

At present, PDPs are not a routine part of the undergraduate curricula 3 and as such, newly qualified dentists will be faced with the new challenge of having to proactively plan their CPD to fulfil outstanding competencies from their current training course. This is also likely to be the case for dentists in dental core training, speciality training and those undertaking formal postgraduate qualifications.

GDC standards allow PDPs to be completed individually or in conjunction with peers including employers. 2 Dentists in training should seek advice from their educational supervisors and postgraduate deaneries by identifying areas within their professional activities where further training is needed, identify suitable courses   BRITISH DENTAL JOURNAL | VOLUME 228 NO. 10 | MAy 22 2020 735 UPFRONT

High prevalence of concurrent gastrointestinal manifestations in patients with SARS-CoV-2: Early experience from California

First Case of 2019 Novel Coronavirus in the United States

Toothbrushing against coronavirus