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A study by researchers in Palestine suggests that the medical model of dentistry may better prepare dental teams for future health crises. (Image: DisobeyArt/Shutterstock)

Study shows dentistry must adapt to be prepared for future crises

By Jeremy Booth, Dental Tribune International
April 13, 2021

JERUSALEM, Palestine: A May 2020 survey asked dentists located in the West Bank area about their preparedness to resume offering routine dental care after the practice closures that were necessitated by the SARS-CoV-2 pandemic. The researchers published a study in February this year which found that the challenges that emerged during the pandemic showed that dentistry needed to adapt in order to be better prepared for future crises.

Researchers from Al-Quds University in Jerusalem, the Palestinian Ministry of Health in Ramallah, and the University of Iowa in Iowa City in the US surveyed 488 dentists practising in the West Bank area. The participants were asked about their perception of the risks related to COVID-19, their level of preparedness to resume providing elective dental care, how confident they felt treating patients that were suspected of having COVID-19 and about a range of factors related to their level of confidence. The study also examined the participants’ perceptions of their own financial stability and role in the pandemic response.

Close to 60% of respondents said that they felt unprepared to reopen their dental practices. On the topic of treating patients with COVID-19, around 13% of respondents said that they had no confidence, and almost two-thirds (64%) said that they had little to moderate confidence. The authors found that dentists who had received training on infection control—or specific training related to COVID-19—reported higher levels of confidence. Close to 75% of respondents said that the financial hardship that they were facing was so great that they could not meet their financial commitments in the current month.

The authors found that financial and ethical factors were the main reasons for the participants to resume the provision of elective care. Dentists in Palestine had not been called upon to assist in the pandemic response, and more than 18% of respondents said that their offer of assistance had not been accepted. Around 19% said they had wanted to volunteer in the local pandemic response but had been unsure of how they could become involved. The vast majority (89.7%) of respondents felt that their role in the pandemic response had been to provide urgent dental care to patients and to educate others about COVID-19 (82.4%).

“[The] medical model of dentistry requires dentists to be competent in many medical aspects of health. These competencies would prepare dentists to be more willing and more confident to serve in pandemics and other health crises when needed”
– Dr Elham Kateeb, Al-Quds University

“Data from this study highlights the fragility of private dental practice in emergency situations. Ethical, health, and financial challenges that emerged during COVID-19 require dentists to adapt and be better prepared to face future crises,” the authors wrote. They said that the study results highlighted the fact that dentistry is carried out in isolation from other forms of healthcare. The authors pointed out that dentists in the survey sample had rarely participated in efforts relating to the pandemic response, and that just 58% of respondents had engaged with medical colleagues in order to gain information about SARS-CoV-2 and COVID-19.

In a survey of 488 dentists practicing in the West Bank area in Palestine, 60% said that they felt unprepared to reopen their dental clinics after the first lockdown in 2020. (Image: Elham Kateeb)

“Dentistry has traditionally focused almost exclusively on the restorative and rehabilitation model of care instead of promoting the health and the well-being of individuals, leaving dentists with limited ability to respond to or be fully used in a major health crisis,” the authors stated. “The future holds the challenge to better integrate dental care with primary and specialty medical care. Such integration will assure that oral health will be addressed as an important part of the overall health of individuals and will not be ignored,” they concluded.

Lead author of the study, Dr Elham Kateeb, associate professor of dental public health at Al-Quds University, told Dental Tribune International: “Dentists in our sample viewed their main role in the pandemic as providers of urgent dental care and their role to a lesser extent as workers on the front line with their peers in other medical professions. I think this is simply because of the way in which we train our dentists globally, as dental education is completely separated from medical education in the majority of educational institutions.”

She continued: “The current model trains dentists to be competent in restoring teeth in isolation of the whole body. There is little focus on the medical model of dentistry which deals with risk assessment, disease diagnosis, prevention, minimal intervention and the integration of oral health treatment plans in plans for the general health and well-being of people. Teaching the medical model of dentistry requires dentists to be competent in many medical aspects of health. These competencies would prepare dentists to be more willing and more confident to serve in pandemics and other health crises when needed.”

“It would be very interesting to evaluate curricula in different institutions to see how much weight of learning is devoted to restorative and rehabilitation training and how much is devoted to disease diagnosis, health promotion, public health and the systemic–oral health link in addition to basic knowledge of infectious diseases and other essential general aspects of health,” Kateeb commented.

The study, titled “Reopening dental offices for routine care amid the COVID-19 pandemic: Report from Palestine”, was published online on 13 February 2021 in the International Dental Journal, ahead of inclusion in an issue.

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