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Letters to the editor

Send your letters to the Editor, British Dental Journal, 64 Wimpole Street, London, W1G 8YS. Email [email protected]. Priority will be given to letters less than 500 words long. Authors must sign the letter, which may be edited for reasons of space.

CORONAVIRUS patients attend for treatment and possible extremely rare. By looking up grey literature, OHE for spread prevention efects on post-operative recovery. We I have found only one study where only three Sir, there is increasing evidence that a number are confdent that the risk of contracting participants (9%) who received the infuenza of retail mouthwashes and dentifrices can COVID-19 while attending a surgical vaccine got oral side efects associated with inactivate the SARS-CoV-2 coronavirus. It appointment is signifcantly reduced by fu-like symptoms, thus implying that no has been suggested that these products could patient risk assessment, the use of personal statistically signifcant relationship could be potentially be an adjunct to other measures protective equipment, meticulous infection established.3 Owing to the mass vaccination which the public have been advised to adopt prevention and control measures, and strict strategies of COVID-19, dentists among other to reduce transmission of the virus. adherence to the relevant standard operating clinical specialists are supposed to provide Given the safety, ubiquity and high levels procedure. We still could not neglect the care to the recently vaccinated patients – at of use of such products by the public, there COVID-19 risk, albeit negligible. We are this moment, Hill’s criteria of causal inference would appear to be no signifcant downside obliged to inform the patients about the risk and rigorous anamnestic recording should be risk associated with pre-empting the of ‘COVID-19 complications’ based on the strictly followed before jumping to irrelevant outcome of ongoing research in this area, and Montgomery ruling. conclusions. advocating that those travelling on public We therefore added ‘COVID-19 A. Riad, Brno, Czech Republic transport, visiting high street businesses and complications’ as one of the risks in our those making bubble visits perform thorough consent form. Tis has also given us the References oral hygiene procedures beforehand and as opportunity to re-audit our consent process 1. Luyten J, Bruyneel L, van Hoek A J. Assessing vaccine hesitancy in the UK population using a generalized close to the time of contact with others as within primary care oral surgery service amid vaccine hesitancy survey instrument. Vaccine 2019; 37: practical. the pandemic. To date, all patients assessed and 2494–2501. Given the primacy and experience of treated were not averse to being informed of 2. Tarakji B, Umair A, Alakeel R et al. Hepatitis B vaccination and associated oral manifestations: A non- the dental profession in communicating the possible risk of ‘COVID-19 complications’; systematic review of literature and case reports. Ann dental health education to the public and in fact, some expressed their gratitude. Med Health Sci Res 2014; 4: 829. 3. Sawires L. Efects of the infuenza vaccine on the its potential capacity to do so directly J. Liew, M. Winston, Shefeld, UK oral cavity. University of Florida, 2018. Available with patients, there would appear to be an https://doi.org/10.1038/s41415-021-2614-y at: https://stars.library.ucf.edu/cgi/viewcontent. cgi?article=1306&context=honorstheses (accessed argument for assessing the potential for the Oral side efects of COVID-19 vaccine December 2020). profession to convey government-supported https://doi.org/10.1038/s41415-021-2615-x advice, directly to patients, electronically. Sir, vaccine hesitancy (VH) is an emerging MRONJ and COVID-19 caution P. V. McCrory, Stockport, UK public health challenge nourished by https://doi.org/ 10.1038/s41415-021-2605-z misinformation. Last year, a national cross- Sir, of late, monoclonal antibodies including sectional survey-based study found out that tocilizumab and sarilumab have been Informed consent aversion to the potential side efects of vaccines utilised in the treatment of COVID-19. Sir, COVID-19 has had a signifcant impact was the most frequent cause for VH among Both drugs were used in more than 3,900 on the consent processes amid the current population groups in the UK.1 Te oral side COVID-19 cases in 15 countries worldwide, pandemic. As one of the primary care efects following the administration of vaccines with encouraging results.1 A randomised oral surgery service providers within the like polio and diphtheria were inconsistently controlled trial reported a signifcant region, we swifly updated our consent reported with a low level of confdence; they diference in mortality rate between the process for all outpatient oral surgical have never been reported independently, eg group receiving tocilizumab (28%) or procedures under local anaesthesia with or they emerged typically in conjunction with sarilumab (22%) compared to those receiving without conscious sedation. Te current other dermatologic and systemic symptoms.2 standard care (35.8%).1,2 Both act against consent process includes the ‘material risk’ Te oral side efects of non-orally administered interleukin-6 receptors and are commonly of becoming infected with coronavirus as vaccines including infuenza vaccine are used in the treatment of rheumatoid 