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One would hope that advice would generally be given with a view to helping a given situation but, in my view, the recent interim guidance from the World Health Organization (WHO) regarding the current provision of essential oral health services1 falls short of that hope. Its purpose is ‘to address specific needs and considerations for essential oral health services in the context of COVID-19, with the guidance being intended for public health authorities, chief dental officers and oral health care personnel working in private and public health sectors’.
It starts, rightly, by stating that effective prevention of oral problems should remain a high priority, with patients being given advice through remote consultation or social media channels. The document then suggests screening of patients before appointments or triage done on arrival, again something that readers would, I feel, agree with. So far, so good! It then adds that ‘only patients requiring urgent or emergency (care) – (that word seems to have been omitted in the document) receive treatment and that they have no symptoms suggestive of COVID-19 infection’. This was reported in the UK press on 11 August, as ‘people should not go to non-urgent dentist appointments until COVID-19 risk is better understood’. Not helpful.
Unfortunately, this, to me, seems (i) unrealistic and (ii) appears to indicate that the 15 authors of the document are a long way distanced (excuse me using this word) from the real world of general dentistry. I analysed the authorship, many being distinguished researchers, epidemiologists and public health dentists and, while I could not find one member via Google, I could only identify three who appeared to presently be carrying out clinical dentistry. While there are many good recommendations in the document (hand hygiene, ventilation, de-cluttering of work surfaces, avoiding the use of a spittoon, etc) which are well worth reading, the document would have been massively more useful if it had suggested practical ways by which general dentists, worldwide, could return to work using, wherever possible, non-AGP procedures, as I have already suggested.2 The WHO document concurs with this suggestion, stating that ‘minimally invasive procedures using hand instruments should be prioritized’. The British Dental Association (BDA) has also spoken out and warned against misinterpretation of the advice.
I am not the only critic! The Canadian Dental Association and the American Dental Association (ADA) stated that they respectfully but strongly disagreed with the WHO guidance that routine, non-essential oral health care be delayed, with the ADA President, Dr Chad Gehani, stating that ‘Oral health is integral to overall health – dentistry is essential health care’, adding that ‘millions of patients have safely visited their dentists in the past few months for the full range of dental services’, and, ‘with appropriate PPE, dental care should be considered to be delivered during global pandemics or other disaster situations’.
Where does that leave us? I am sure that some readers will have had to explain the unhelpful Press statement to their patients on 12 August, always a difficult task, given that some patients will have totally believed what they read. My recommendation to readers would be to read the WHO document, take the good advice offered in some sections, but ignore the recommendation on not carrying out routine care. In some ways, my recommendation is pragmatic, given that it is essential that UK dental practices follow those in other parts of the world in negotiating a way to continue to carry out the routine dentistry that our patients need. I hope that these comments are helpful.
PS. I had already written the Comment for this issue prior to reading the WHO document. Hence two Comments from me for the first time ever! Double value or a double whammy, depending on your point of view!