THE WORLD Health Organization’s (WHO) has issued an Interim Guidance for essential oral health services in the context of COVID-19.
The document deals with specific needs and considerations in accordance with WHO operational guidance on maintaining essential health services.
The Interim Guidance is intended for public health authorities, chief dental officers at departments of health and oral health care personnel, including dentists.
COVID-19 is transmitted in dental clinics mainly in three way. One is the direct transmission through inhalation of droplets generated through coughing or sneezing.
Two is the direct transmission via exposure to infectious droplets of the mucous membrane such as that of the eye, nasal or oral mucosa.
And three, through indirect transmission via contaminated surfaces.
Many procedures conducted in the dental clinic generate aerosol.
Aerosol-generating procedures (AGPs) are defined as any medical, dental and patient care procedure that results in the production of airborne particles less than five micrometers in size which can remain suspended in the air, travel over a distance and may cause infection if they are inhaled.
Clinical procedures that use spray-generating equipment lead to rapid contamination of surfaces and presents the possibility for the infection to spread.
COVID-19 transmission when AGPs are performed is real.
Oral health care teams are at high risk of being infected with SARS-CoV-2, the virus that causes COVID-19. They may also pass the infection to patients.
This is because oral health care teams work close to the face of patients for prolonged periods. Their work involves face-to-face communication and frequent exposure to saliva, blood and other body fluids and handling sharp instruments.
This is why the WHO advises that routine non-urgent oral health care be delayed until there has been sufficient reduction in COVID-19 transmission according to official recommendations at the national or local level.
Non-urgent oral health care usually includes oral health check-ups, dental cleanings, preventive care and aesthetic dental treatments.
Urgent or emergency oral health care interventions involve preserving a person’s oral functioning, managing severe pain or ensuring a good quality of life without pain or discomfort.
These may include interventions that address acute oral infections; swelling; infection; significant or prolonged bleeding; severe pain not controllable with pain killers; interventions that are medically required as a pre-intervention to other urgent procedures; and dental trauma.
The WHO recognizes the importance of timely management of urgent or emergency oral health care interventions. These help patients avoid seeking treatment at hospital emergency departments. Doctors are then available to serve individuals seeking treatment related to more urgent needs such as treatment of COVID-19.
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Dr. Joseph D. Lim is the former Associate Dean of the UE College of Dentistry, former Dean of the College of Dentistry, National University, past president and honorary fellow of the Asian Oral Implant Academy, and honorary fellow of the Japan College of Oral Implantologists. Honorary Life Member of Thai Association of Dental Implantology. For questions on dental health, e-mail jdlim2008@gmail.com or text 0917-8591515./PN
