WHO COVID-19 Guidelines Continue to Generate Discussion

Dentistry Today
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Earlier this August, the World Health Organization (WHO) recommended delaying routine and elective dental treatment in areas experiencing community transmission of the COVID-19 virus. Now, the American Dental Education Association (ADEA) and FDI World Dental Federation have joined other organized dentistry groups in opposing these recommendations.

However, the nonprofit DentaQuest Partnership for Oral Health Advancement and Catalyst Institute said that the WHO’s recent guidance requires clarification and that it is not seeking the delay of all routine dental care.

The ADEA

Noting that oral health is crucial to overall healthcare, the ADEA said that it is important for routine oral healthcare is allowed to continue during the pandemic, provided that specific safety protocols are followed, including the use of personal protective equipment (PPE).

“A commitment to overall health demands that oral and primary healthcare be viewed in an integrated fashion,” said Karen West, DMD, MPH, ADEA president and chief executive officer.

“The fact is dental offices and clinics have already reopened their doors and are providing their patients with comprehensive and safe care,” said West.

“Healthcare professionals, including those in oral healthcare, are dedicated to stopping the spread of COVID-19. We can fight the pandemic without sacrificing patient care if we continue to educate ourselves, take the proper precautions, and work together,” West said.

Discouraging routine dental care also would have a detrimental effect on access to oral health professionals in the future, West added. Such a move could interrupt the ongoing training at dental schools and programs where students provide care to underserved populations, she said.

“We need to make sure that patients get the dental care they need and that dental and dental hygiene students get the clinical training they need so that our commitment to treating patients holistically is not eroded during this pandemic and beyond,” West said.

The FDI World Dental Federation

The FDI said that the provision of oral health services can continue during the pandemic, but it must comply with official recommendations at each country’s national, subnational, and local levels.

Noting that misinterpretation of the WHO’s recommendations has led to widespread confusion and misleading reporting in some media outlets, the FDI said that people can safely visit the dentist and utilize oral health services if their country’s regulations permit them.

Also, the FDI pointed out that the WHO said routine oral treatment such as checkups, cleanings, and preventive care can continue in countries where there has been a sufficient reduction in transmission rates from community transmission to cluster cases.

Further, the FDI considers the WHO recommendations as guidance and not guidelines, with no “one size fits all” solution. Official guidelines already in place at the national, subnational, and local level may vary and should be followed, FDI said.

The FDI agreed that oral healthcare is essential to maintaining overall health and that routine care is necessary for the early detection, prevention, and control of oral diseases. The organization added that every opportunity should be used to reinforce oral health promotion and prevention messages to help reduce the need for avoidable dental visits.

But at the same time, the FDI said, governments must ensure continued and equitable access to essential oral healthcare services as well as the availability of appropriate PPE to avoid an even bigger burden on health systems in the future.

The FDI said that it and its approximately 200 member associations in 130 countries have enacted measures to ensure that patients and staff are adequately protected from infection risk to avoid viral transmission, including:

  • Screening and triaging patients
  • Implementing strict hand hygiene and disinfection measures
  • Ensuring the availability and correct use of PPE by all staff
  • Enforcing physical distancing and use of masks by patients in waiting rooms
  • Using teledentistry for patient consultations
  • Carrying out stringent sterilization measures for all dental instruments, devices, and equipment
  • Ventilating dental practices to reduce the risk of transmission of COVID-19

Further research into the transmission of COVID-19 including specific considerations for dental practice is paramount so recommendations evolve according to emerging evidence, the FDI said, allowing the safest oral healthcare protocols to be implemented.

The FDI said it will contribute to this evidence base by soon publishing key findings from a global survey of 92 dental associations from 80 nations to define common strategies that have been effective in preventing and controlling COVID-19 within dental settings.

DentaQuest

Dentaquest emphasized that the WHO guidance defers to official recommendations at the national and local levels, a fact that has been overlooked by some reports suggesting that WHO is urging an overall delay in routine dental care.

Public health and other dental organizations including the Centers for Disease Control and Prevention, the Occupational Safety and Health Administration, the ADA, and the American Dental Hygienists Association have issued guidance for infection control measures that dental practices can use to ensure safe care, DentaQuest said, adding that the WHO guidance supports adherence to these national recommendations.

Recently, DentaQuest worked with the Organization for Safety Asepsis and Prevention (OSAP) to develop a comprehensive set of best practices based on the guidance issued by the public health and dental organizations in the United States for dental providers as well as a companion piece for patients to support the safe return to preventive dental care for all.

“Recent WHO guidance has caused quite a bit of confusion at a time we can least afford it. Let us be clear. Oral health directly impacts overall health, and this guidance does nothing to prevent people in the US from continuing preventive dental care during this pandemic,” said Dr. Myechia Minter-Jordan, president and CEO of DentaQuest and the Catalyst Institute.

In fact, DentaQuest said, WHO guidance specifically defers to recommendations at the national and local levels. In the United States, leading public health organizations have issued clear infection control measures for dental practices to implement to ensure that in-person preventive care can be administered as safely as possible, DentaQuest said.

DentaQuest also said that it has worked to compile these best practices into easily accessible resources for dental providers and patients to follow. As long as national and local recommendations support it, and dental providers follow these procedures, the nonprofit said, patients do have the option to visit their dentists for routine care.

“We urge people to continue addressing their oral health needs in whatever way they are most comfortable, whether at home, via teledentistry appointments, or by visiting their dental provider,” said Minter-Jordan. “Delaying oral treatment now can lead to more significant health problems down the line.”

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