The World Health Organization (WHO) continues to recommend the delay of routine dental procedures. The American Academy of Periodontology (AAP) the ADA, and the Academy of General Dentists (AGD), however, disagree with the WHO’s strict guidelines.
In a recent statement, the AAP stressed the importance of maintaining periodontal health during the COVID-19 outbreak. It also said that its members are committed to implementing rigorous safety measures to ensure the health and well-being of patients and reduce the risk of exposure during the pandemic.
“It is well-established science that periodontal disease and systemic disease are interconnected. As a result, establishing and maintaining healthy teeth and gums is fundamental to overall health,” said Dr. Bryan Frantz, AAP president.
“The COVID-19 pandemic has certainly affected most aspects of life, but with the right patient safety measures in place that align with state and local guidelines, it should not impact your ability to receive periodontal care,” said Frantz.
Periodontal disease can cause bleeding gums and bad breath, the AAP said, and if left untreated, it could lead to tooth loss. It also has been linked with several other serious conditions including diabetes, heart disease, and Alzheimer’s disease.
The WHO’s recommendations to delay non-essential dental care cite the risk of disease transmission as a result of the close proximity between dental professionals and patients and due to the aerosols produced by certain dental procedures, the AAP said.
However, the AAP added, there is limited evidence that dental offices pose an increased risk of spreading disease, including COVID-19. The AAP also said that routine visits with a periodontist are crucial to maintaining the health of teeth and gums.
“Many patients under the care of a periodontist are undergoing a comprehensive treatment plan,” said Frantz. “Regular checkups are an important part of this treatment, and any delay in care could lead to a worsening of their periodontal condition.”
According to Frantz, periodontists are uniquely experienced in infection control and other safety measures to protect themselves and their patients from disease exposure.
“As dental professionals who are predominantly involved with surgical procedures, periodontists have always been committed to ensuring that effective safety barriers are in place for patients,” Frantz said.
“While the COVID-19 pandemic is still with us, members of the AAP are adhering to COVID-19 mandates issued by state and local agencies and implementing additional measures to ensure the safety of both their patients and their staff,” said Frantz.
These additional measures include regular temperature checks for both staff and patients, social distancing, the use of personal protective equipment such as face shields, masks, and gloves, and rigorous infection control and sanitation procedures, the AAP said.
Meanwhile, the ADA said in a statement that it “respectfully yet strongly disagrees” with WHO’s recommendations to delay “routine” dental care in some circumstances due to the pandemic.
“Oral health is integral to overall health. Dentistry is essential healthcare,” said ADA president Chad P. Gehani, DDS, “Dentistry is essential healthcare because of its role in evaluating, diagnosing, preventing, or treating oral diseases, which can affect systemic health.”
When COVID-19 cases began to rise in the United States in March, the ADA called upon dentists to postpone all but urgent and emergency care in order to understand the disease and consider its effect on dental patients, dental professionals, and the greater community.
The ADA and the US Centers for Disease Control and Prevention then issued interim guidance for dental professionals related to COVID-19. The ADA said that its guidance calls for the highest level of PPE available, including masks, goggles, and face shields.
Also, the ADA recommends the use of rubber dams and high-velocity suction whenever possible and hand scaling when cleaning teeth rather than using ultrasonic scaling to minimize aerosols.
“Millions of patients have safely visited their dentists in the past few months for the full range of dental services,” Gehani said. “With appropriate PPE, dental care should continue to be delivered during global pandemics or other disaster situations.”
Representing nearly 40,000 general dentists, the AGD recommends that patients continue routine dental care, restoration treatment plans, and emergency procedures during the pandemic to ensure the maintenance of oral hygiene.
The AGD calls dental care an essential component of the overall healthcare model and notes that dental offices are practicing enhanced safety measures to address their patient needs during this time.
“Good oral health contributes to good overall health, and any recommendations against the continuum or oral care negatively impact dental patients,” said AGD president Connie L. White, DDS.
“Dental practices follow extensive infection control measures and have enhanced those efforts in recent months. This includes sterilization efforts that destroy all forms of the coronavirus and other endemic diseases in our communities,” White said.
“Dental offices also follow strict safety precautions, including the use of personal protective equipment and other tools that reduce risk of disease transmission,” she said.
Disagreeing with WHO guidelines discouraging the public from seeking essential care, the AGD said, patients should maintain their dental appointments for routine cleanings or conditions that cause pain. Delaying a dental visit may create further health issues and long-term problems, the AGD added.
“General dentists are responsible for the safety of patients, staff, and themselves. We are experts in oral health, and patients should speak with their dentist to learn more about what dentists are doing to promote and protect patient health during this pandemic,” said White.
“Our members follow updated guidance from the US Centers for Disease Control and Prevention and also their state dental boards, which monitor and provide direction on new guidance and safety standards,” White said.
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