COVID-19: Update: WHO issues guidance on dentistry
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- Published: Thursday, 13 August 2020 09:51
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The World Health Organization (WHO) has issued interim guidance on ‘Considerations for the provision of essential oral health services in the context of COVID-19’, developed under the lead of Dr Benoit Varenne, Dental Officer, Oral Health Programme, at WHO headquarters. It was the subject of a rather sensational article in the Daily Mail. GDPUK feels this is not aimed at UK, where very high standards of PPE and disinfection are in place, but most likely aimed at other areas of the world.
Chair of the BDA Mick Armstrong said: ‘The World Health Organisation (WHO) has cited best practice for widespread community transmission of COVID. ‘We have adopted a highly cautious approach in the UK and patients should be reassured that care is safe. UK dentists are now facing a huge backlog of patients who have struggled with pain through lockdown. Misrepresenting this guidance simply serves to discourage millions from seeking the care they need. Practices are already going over and above to minimise the risk of viral transmission. Reckless reporting will only mean patients bottling up problems, from decay to oral cancer.’
The purpose of the WHO document is to ‘address specific needs and considerations’ for essential oral health services in the context of COVID-19 in accordance with WHO operational guidance on maintaining essential health services.
The critical paragraphs in relation to dental attaendance are:
“WHO advises that routine non-essential oral health care – which usually includes oral health check-ups, dental cleanings and preventive care – be delayed until there has been sufficient reduction in COVID-19 transmission rates from community transmission to cluster cases or according to official recommendations at national, sub-national or local level. The same applies to aesthetic dental treatments.
“However, urgent or emergency oral health care interventions that are vital for preserving a person’s oral functioning, managing severe pain or securing quality of life should be provided.
“Urgent or emergency oral health care may include interventions that address acute oral infections; swelling; systemic infection; significant or prolonged bleeding; severe pain not controllable with analgesia; oral health care interventions that are medically required as a pre-intervention to other urgent procedures; and dental/orofacial trauma.
If an oral health care professional is in doubt, referral to a specialized treatment facility must be ensured.”
The document recommends the following apporoaches to treatment:
- Acute pain/swelling/abscess due to oral infection or fractured teeth: local anaesthesia, incision/drainage, antibiotic therapy, pulp devitalization of deep and open carious lesions or direct access in carious broken tooth with hand excavation and dressing, (non-surgical) tooth extraction (treatment adapted to diagnosis)
- Acute pain or bleeding due to acute periodontitis: local anaesthesia, hand scaling and cleaning, antibiotic therapy, antiseptic mouth rinse
- Broken denture: simple intraoral repair (re-lining) or laboratory repair after appropriate disinfection of prosthetic appliance
- Broken orthodontic appliances: removal or fixation of broken orthodontic appliances that hurt/cause irritation
- Extensive dental caries or defective restorations causing pain: manage with non-invasive restorative techniques as appropriate such as Silver-Diamine-Fluoride (SDF) application, or glass-ionomer application.
Extensive advice is also given on use of PPE, adequate ventilation (but not fallow period), cleaning, disinfection and maintaining 1 metre distancing where possible.
WHO: Considerations for the provision of essential oral health services in the context of COVID-19: interim guidance, 3 August 2020
Link: https://apps.who.int/iris/handle/10665/333625
The Daily Mail article[i] was headlined: ‘People should not go to non-urgent dentist appointments until ’unknown’ Covid-19 risk is better understood, World Health Organization warns’ appeared in the paper on August 12.
[i] https://www.dailymail.co.uk/news/article-8616515/People-not-non-urgent-dentist-appointments-World-Health-Organization-warns.html
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