To provide a comprehensive summary of the implications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) on orthodontic treatment, contingency management, and provision of emergency orthodontic treatment, using currently available data and literature.

Materials and Methods

Orthodontically relevant sources of information were searched using electronic databases including PubMed and Google Scholar and current reports from major health bodies such as Centers of Disease Control and Prevention, World Health Organization, National Institutes of Health, and major national orthodontic associations.


Where available, peer-reviewed and more recent publications were given priority. Due to the rapidly evolving nature of COVID-19 and limitations in quality of evidence, a narrative synthesis was undertaken. Relevant to orthodontics, human-to human transmission of SARS-CoV-2 occurs predominantly through the respiratory tract via droplets, secretions (cough, sneeze), and or direct contact, where the virus enters the mucous membrane of the mouth, nose, and eyes. The virus can remain stable for days on plastic and stainless steel. Most infected persons experience a mild form of disease, but those with advanced age or underlying comorbidities may suffer severe respiratory and multiorgan complications.


During the spread of the COVID-19 pandemic, elective orthodontic treatment should be suspended and resumed only when permitted by federal, provincial, and local health regulatory authorities. Emergency orthodontic treatment can be provided by following a contingency plan founded on effective communication and triage. Treatment advice should be delivered remotely first when possible, and where necessary, in-person treatment can be performed in a well-prepared operatory following the necessary precautions and infection prevention and control (IPAC) protocol.

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Author notes


Professor and Director, Graduate Orthodontics, Faculty of Dentistry, University of Toronto; and Staff Orthodontist, The Hospital for Sick Children, Toronto, Canada.


Instructor, Orthodontics, Faculty of Dentistry, University of Toronto, Toronto, Canada.


Former Consultant Orthodontist, Max Hospital, Gurgaon, India.


Student, International Dentists Advanced Placement Program, Faculty of Dentistry, University of Toronto, Toronto, Canada.


Resident, Graduate Orthodontics, Faculty of Dentistry, University of Toronto, Toronto, Canada.

EDITOR'S NOTE: The information contained in this article was accurate as of the date of acceptance (April 6, 2020). Because of the dynamic changes and developments regarding the spread and treatment of COVID-19, readers are cautioned and advised to consult Centers for Disease Control and Prevention and applicable dental association recommendations and guidelines as well as to adhere to all local and national restrictions regarding the practice of dentistry during and in the wake of the pandemic. – sjl