LAST UPDATE | 12 Aug 2020

THE WORLD HEALTH Organization (WHO) has said routine, non-essential dental work should be delayed until Covid-19 transmission rates drop sufficiently, cautioning against procedures that produce aerosol spray from patients’ mouths.

The WHO said check-ups, dental cleanings and preventive care could be postponed, as it released guidance for dentists on how to minimise the risk of transmission during the coronavirus pandemic.

The United Nations health agency has said now that dental services had begun to resume in many countries, several procedures could be done in a way that minimised aerosol, or micro-droplets that hang in the air.

“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,” the guidance says.

“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.”

The WHO said that, if possible, patients should be remotely screened before their appointments.

The interim guidance, dated 3 August, was aired by the WHO yesterday. 

The Irish Dental Association (IDA) has noted the WHO’s advice but said “no change is required as regards guidance to Irish dentists” as the necessary safety precautions are being taken. 

High risk of infection 

The WHO said dentists were at high risk of being infected with SARS-CoV-2, the virus that causes Covid-19.

“Oral health care teams work in close proximity to patients’ faces for prolonged periods,” the organisation said.

“Their procedures involve face-to-face communication and frequent exposure to saliva, blood, and other body fluids and handling sharp instruments. Consequently, they are at high risk of being infected with SARS-CoV-2 or passing the infection to patients.”

Aerosol-generating procedures (AGPs) include dental cleaning with an ultrasonic scaler and polishing, work with high or low-speed handpieces, surgical tooth extraction and implant placement.

The guidance lists ways in which broken dentures and orthodontic appliances, and extensive dental caries, could be treated while minimising or avoiding AGPs.

The WHO’s dental chief Benoit Varenne told reporters that oral disease was a neglected health burden in many countries, affecting people throughout their lives.

“At the global level, last estimates that are available show that 3.5 billion are affected by oral disease,” he said.

“Untreated dental caries in permanent teeth is the most common health condition in human beings.”

He said that in a survey, 75% of WHO member states said dental services had been completely or partially disrupted during the pandemic.

Varenne also voiced concern about the availability of personal protective equipment for dentists working during the pandemic.

Irish dentists 

The IDA today said “no change is required as regards guidance to Irish dentists”.

“The safety of patients, dental staff and dentists themselves is the highest priority for dentists across the country. The IDA is paying close attention to all guidance being issued in relation to Covid-19, including from the HSE, the Health Protection Surveillance Centre (HPSC), the National Public Health Emergency Team (NPHET) and WHO,” the IDA said in a statement issued.

“The WHO report makes clear that the suspension of routine treatments would only arise in the context of community transmission (which is very low here now) or where official recommendations at national or regional level suggest this.

“The report makes no mention of Ireland and recognises that national authorities, to whom this report is aimed, are best placed to provide guidance reflecting the circumstances and data in each country.”

The IDA noted that as, on 18 May, the HPSC advised that routine dental care could recommence in Ireland, a view which was endorsed by the Dental Council, “there is nothing in this WHO report to suggest that revised guidance is necessary in Ireland and therefore no change is required as regards guidance to Irish dentists”.

“Dental practices remain open for business, and they are adhering to all the necessary guidelines and infection control measures in order to maximise the safety of patients, their staff and themselves,” the statement added. 

- © AFP 2020 with reporting by Órla Ryan