Dental profession reacts to latest WHO guidance for oral health services

The profession has slammed the latest oral health advice from the World Health Organisation – with calls for better communication

The profession has slammed the latest oral health advice from the World Health Organisation – with calls for better communication.

This week, it emerged the WHO is urging for more research into COVID-19 transmission in the dental setting.

It warns of the ‘unknown’ consequences of AGPs for dental teams and their patients.

WHO dental officer Benoit Varenne said: ‘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 delay routine non-essential oral health care.

‘The likelihood of COVID-19 being transmitted through aerosol, micro-particles or airborne particles…today I think is unknown, it’s open to question at least. This means that more research is needed.’

In guidance released this month, the organisation set out a number of considerations for the provision of essential oral health care.

It states: ‘In settings with widespread community transmission during the COVID-19 pandemic, an essential oral health service concept is warranted. Oral health care involving AGPs should be avoided or minimised. Minimally invasive procedures using hand instruments should be prioritised.’

The full document can be read here. 

Nail in the coffin

Christina Chatfield is a dental hygienist and owner of Dental Health Spa in Brighton. She believes better communication was needed from associations within the profession.

‘We can be quick to criticise a news article but the information did come from the WHO first,’ she says.

‘The problem is that this has come out in a consumer-facing article. Why were none of the associations on it? Why are we firefighting again?

‘The comments in the articles show exactly what the public think of us. But we need to be proactive and not reactive.

‘We know there’s been no incidents of transmissions in dental practices. I also haven’t been ill and I don’t know any colleagues who have been either. We’ve been back for seven weeks now and at a really high price, because private practices have had very little support.

‘We were told that the government won’t close dental practices again. But even restricting treatments will be the nail in the coffin for many private practices.

‘I believe that practices are adhering to strict measures. But all it takes is one or two practices to not do it for the whole of dentistry to be in disrepute.

‘Everybody needs to be working together. The biggest failure in all of this is not having this information before it was released by the press. Therefore, all of the associations should be sending it to us and keeping us informed.’

Ashamed

Similarly, Gemma O’Callaghan – clinical director and lead dental hygienist at The Cosmetic Dental Hygienist – believes the advice is inappropriate for the dental setting.

‘The WHO should be utterly ashamed of itself,’ she said.

‘”Non-essential” care – really? You want to class preventative care and “dental cleanings” as routine and non-essential? Not to mention we are the profession with the highest cross infection protocols and always have been.

‘There’s also not been a single case of confirmed COVID-19 having been transferred to patients within the dental setting in the UK. As a professional that actually cares about her patients, to say I’m mad right now is an understatement.’

The British Dental Association (BDA) has also spoken out and warned against misinterpretation of the advice.

It points out that the guidance states: ‘Oral health care involving AGPs (aerosol generating procedures) should be avoided or minimised, and minimally invasive procedures using hand instruments should be prioritised’. This applies to settings ‘with widespread community transmission’.

Additionally, it argues that the guidance is ‘inappropriate’ in the UK setting, where practices use high levels of PPE. It also points out they need to implement a 60-minute fallow period when undertaking AGPs.

Reassurance necessary

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.

‘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.’


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