Context

The emergence of the novel coronavirus (COVID-19) pandemic and its impact on dental practitioners’ practice and dental students’ training has highlighted the critical role of the broad range of healthcare service providers in infectious disease outbreaks. Dentists and members of the dental team are amongst the most experienced health professional cohorts in infection prevention and control (IPC).  This means that enforcing strict infection control measures in dental settings has not been an obstacle in providing dental care to dental patients.
However, due to the aerosol transmission of SARS-CoV-2, new infection control challenges may have arisen during the pandemic that have affected the practice of dentistry significantly.

The maintenance of good oral health has, overall, not been considered a health policy priority in many countries.  Restrictions of the provision of many routine preventive, diagnostic and therapeutic oral health procedures, the exclusion of oral healthcare providers in the immediate response to the pandemic, ensuring adequate supplies of Protective Personal Equipment (PPE) and early access to vaccines were among the issues that dentists and members of the dental team faced early on during the COVID-19 pandemic. The increase in both the number of emergency room visits and antibiotic prescriptions for dental reasons during the pandemic was an alarming indicator of the serious consequences of discontinuing necessary preventive and therapeutic oral healthcare.

Scope

This Policy Statement (PS) addresses the lessons learned from the COVID-19 pandemic and how they can be used to effectively prepare dentists and members of the dental team for future outbreaks and health crises. This PS will address the following issues:

• The restriction of oral health services to urgent care only;
• Dentistry as essential health care and dentists as essential health care providers;
• The mandatory shut down of all dental practices in many countries;
• The deployment of dentists and members of the dental team to work in the frontline to carry out tasks beyond their usual scope of practice;
• The severe shortage of adequate PPE for healthcare providers;
• The sidelining of oral health because it was not considered a high priority in governments’ response plans.

This PS does not address the measures that dentists and members of the dental team need to take to minimize transmission of infectious disease in the dental settings.

Definitions

COVID-19 pandemic: a pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified in December 2019 in Wuhan, China.

Infectious outbreak: a sudden increase in occurrences of an infectious disease in a particular time and place.

Principles

Oral health is an essential and integral part of general health.

Oral healthcare services are necessary for the health and wellbeing of individuals.

Dentists and members of the dental team are important members of the frontline team in any health crisis. 

Policy

The FDI states that:

• the main role of dentists and members of the dental team during infectious diseases outbreaks is to provide safe and appropriate oral health care, including preventive, diagnostic and therapeutic care;
• If needed, dentists and members of the dental team with appropriate skills and training can support other health care professionals during infectious diseases outbreaks as members of the immediate health response frontline.

FDI emphasizes:

• the importance of the continuity of accessing oral health care, both therapeutic and preventive, during infectious diseases outbreaks;
• the importance of the relationship of oral health to general health and to the wellbeing of individuals;
• the importance of including oral health in the initial response to infectious diseases outbreaks;
• the chronic and long-term nature of many major oral diseases, and the effect that interruptions to care may have on the progression of such diseases.

FDI encourages dentists and members of the dental team  during infectious diseases outbreaks to:

• follow all national, sub-national and/or local guidelines and regulations in place during infectious diseases outbreaks to mitigate risk of transmission within the clinical setting;
• promote optimal oral health through prevention and patient education to empower patients to take care of their oral health;
• use innovative technology such as teledentistry (when appropriate) to enable remote synchronous or asynchronous diagnostic, preventive or therapeutic care for patients.

FDI encourages governments, in collaboration with local National Dental Associations (NDAs), to:

• include dentists and members of the dental team in all discussions and decisions related to the regulation and guidance of healthcare delivery and health professionals;
• ensure adequate access to appropriate PPE at reasonable costs; 
• provide continuing education modules on infection control, infectious diseases, immunity and other related topics to active practitioners;
• help facilitate appropriate financial and administrative support to dentists and members of the dental team during times of reduced practice hours in infectious disease outbreaks;
• provide appropriate financial and administrative support to public oral health care programmes to aid in covering off the additional costs of complying with local regulations in creating a safe practice environment;
• include dentists, dental students and members of the dental team in the    highest priority groups to receive vaccination;.
• include dentists and dental students with the appropriate training in vaccine administration programmes.

FDI encourages dental academic educational institutions to:

• prepare dental students to face infectious diseases outbreaks by including a curriculum that addresses public health and infectious diseases, including mode of transmission and infection prevention and control measures;
• ensure dental students are trained in evidence-based infection control and clinical procedures that may reduce the production of, and improve the management of, aerosols;
• Add relevant components in the curriculum that emphasize the importance of professional inter-collaboration in dental student learning;
• create opportunities for learning with integration of digital, virtual and in-person technology methodologies;
• provide students with the required knowledge and skills that enables them to integrate in any frontline emergency response.

FDI encourages research institutions to:

• advance research in infectious diseases transmission and how to minimize it in dental settings, specifically with respect to aerosol generating procedures and infection control practices.

Keywords

Infectious disease, outbreak, oral health

Disclaimer

The information in this Policy Statement was based on the best scientific evidence available at the time. It may be interpreted to reflect prevailing cultural sensitivities and socio-economic constraints.

References

1. FDI Council Statement on Dentistry and Oral Health During the COVID-19 Pandemic. Available from https://www.fdiworlddental.org/covid-19-library [Accessed 08 December 2020].
2. World Health Organization. Considerations for the provision of essential oral health services in the context of COVID-19. Interim guidance 3 August 2020. WHO/2019-nCoV/Oral_health/2020.1. 2020. Available from https://www.who.int/publications/i/item/who-2019-nCoV-oral-health-2020.1 [Accessed 08 December 2020].
3. Ran L, Chen X, Wang Y, et al. Risk factors of healthcare workers with corona virus disease 2019: a retrospective cohort study in a designated Hospital of Wuhan in China. Clin Infect Dis. 2020 Mar 17;ciaa287.
4. Kranz AM, Gahlon G, Dick AW, Stein BD. Characteristics of US Adults Delaying Dental Care Due to the COVID-19 Pandemic. JDR Clin Trans Res. 2021 Jan;6(1):8-14. Available from: doi/full/10.1177/2380084420962778
5. Shah, S., Wordley, V. & Thompson, W. How did COVID-19 impact on dental antibiotic prescribing across England?. Br Dent J 229, 601–604 (2020). Available from: doi.org/10.1038/s41415-020-2336-6
6. Estrich CG, Mikkelsen M, Morrissey R, et al. Estimating COVID-19 prevalence and infection control practices among US dentists. J Am Dent Assoc. 2020 Nov;151(11):815-824. Available from: doi.org/10.1016/j.adaj.2020.09.005
7. Meethil AP, Saraswat S, Chaudhary PP, Dabdoub SM, Kumar PS. Sources of SARS-CoV-2 and Other Microorganisms in Dental Aerosols. J Dent Res. 2021 Jul;100(8):817-823. Available from: doi/full/10.1177/00220345211015948
8. Ather A, Patel B, Ruparel NB, Diogenes A, Hargreaves KM. Coronavirus Disease 19 (COVID-19): Implications for Clinical Dental Care. J Endod. 2020 May;46(5):584-595. Available from: doi.org/10.1016/j.joen.2020.03.008
9. Bescos R, Casas-Agustench P, Belfield L, Brookes Z, Gabaldón T. Coronavirus Disease 2019 (COVID-19): Emerging and Future Challenges for Dental and Oral Medicine. J Dent Res. 2020 Aug;99(9):1113. Available from: doi.org/10.1177/0022034520914246 
10. Cochrane Oral Health. Recommendations for the re-opening of dental services: a rapid review of international sources 6 May 2020 Substantial update 16 May 2020 COVID-19 Dental Services Evidence Review (CoDER) Working Group. Available at  https://oralhealth.cochrane.org/news/recommendations-re-opening-dental-services-rapid-review-international-sources [Accessed 08 December 2020].

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