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GENEVA, Switzerland: The World Health Organization (WHO) has warned that dental settings may pose an even greater risk for the spread of SARS-CoV-2 than was previously thought, owing to the spread of the virus through airborne microparticles. It said that routine dental check-ups should be delayed until SARS-CoV-2 community transmission rates can be brought under control in order to protect dental patients and staff; however, dental associations disagree.
“WHO guidance recommends in case of community transmission to give priority to urgent or emergency oral cases, to avoid or minimise procedures that may generate aerosol, prioritise a set of clinical interventions that are performed using an instrument and of course to delay routine non-essential oral healthcare,” Dr Benoit Varenne, a WHO dental officer, told a news briefing on 12 August.
Varenne explained that the likelihood of SARS-CoV-2 being transmitted through aerosol, microparticles or airborne particles was unknown: “It’s open to question, at least. This means that more research is needed.”
The recommendation to delay non-essential care “until there has been sufficient reduction in COVID-19 transmission rates from community transmission” is part of new interim guidance from WHO, which also says that dental clinics must have adequate ventilation in order to reduce the risk of the virus spreading in indoor spaces. The new guidance was released after the health body was prompted by a letter from the scientific community to reconsider how SARS-CoV-2 spreads, and its call for adequate ventilation appears to be a capitulation to the scientists’ argument that the threat of airborne transmission should be met with preventive measures, including adequate ventilation and the use of air sanitisers.
A WHO spokesperson told Dental Tribune International that the guidance aims to protect dental patients and staff: “During the COVID-19 pandemic, many of us have needed, or will need, dental care. Given that oral healthcare providers involve face-to-face communication, use equipment that generate aerosols and are by consequence exposed to saliva, blood, and other body fluids, they are at high risk of being infected with COVID-19 or passing the infection to patients.”
The spokesperson continued: “The guidance, issued on 3 August, addresses 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.”
Dental associations disagree with WHO advice
Dental associations in the US and Germany have said that dentists in those countries should ignore the WHO’s recommendation and continue seeing patients for elective and routine care.
“The American Dental Association (ADA) respectfully yet strongly disagrees with the [WHO’s] recommendation to delay ‘routine’ dental care in certain situations due to COVID-19,” the association said in a press release. ADA President Dr Chad P. Gehani explained: “Oral health is integral to overall health. Dentistry is essential healthcare because of its role in evaluating, diagnosing, preventing or treating oral diseases, which can affect systemic health.”
“Millions of patients have safely visited their dentists in the past few months for the full range of dental services”
– Dr Chad P. Gehani, ADA President
The ADA said that its current safety guidance to US dentists—which recommends using a high level of PPE—was adequate to keep staff and patients safe.
“Millions of patients have safely visited their dentists in the past few months for the full range of dental services. With appropriate PPE, dental care should continue to be delivered during global pandemics or other disaster situations,” Gehani added.
According to various dental associations in Germany, the WHO’s recommendation does not apply to dentists in all countries. SARS-CoV-2 infection rates in Germany were still low in comparison with countries such as Brazil and the US, the Zahnärztekammer Berlin (Berlin dental association) said in a press release. It cited studies from China, Italy, South Korea and Germany, which it said showed that there was no increased risk of infection in dental practices if the correct PPE was used.
President of the Zahnärztekammer Berlin Dr Karsten Heegewaldt said in the press release: “Due to the high standard of hygiene in our practices, visits to the dentist are still possible. Dentist appointments should be kept at all costs and not postponed owing to the importance of oral health for general health.”
Heegewaldt appealed to dental patients not to be unsettled by the WHO’s advice, which it referred to as a “blanket, non-country-specific recommendation at the expense of oral health”.
Editorial note: This report was updated after publishing to include direct mention of transmission rates in the headline.