Routine dental visits should be delayed where there is still community transmission: WHO
TORONTO -- The World Health Organization (WHO) is recommending that routine, non-essential dental visits should be delayed in areas where there is still community transmission of COVID-19.
According to the interim guidance released in early August, oral health check-ups, dental cleanings, aesthetic treatments, and preventative care should be postponed until community transmission is reduced to cluster cases, or according to official recommendations at the national, sub-national, or local level.
Instead, the WHO said, patients should be given advice on how to maintain good oral hygiene through remote consultations or social media channels.
While the organization said routine dental visits should be delayed, urgent or emergency health-care interventions that are vital for preserving a patient’s oral functioning, managing severe pain, or securing their quality of life should still be provided.
The WHO said urgent or emergency oral health care may include “interventions that address acute oral infections; swelling; systemic infection; significant or prolonged bleeding; severe pain not controllable with analgesia; oral health-care interventions that are medically required as a pre-intervention to other urgent procedures; and dental/orofacial trauma.”
Dental workers are at an increased risk of contracting the coronavirus or passing the infection on to patients due to the nature of their work, according to the WHO.
“Oral health care teams work in close proximity to patients’ faces for prolonged periods. Their procedures involve face-to-face communication and frequent exposure to saliva, blood, and other body fluids and handling sharp instruments,” the guidance states.
In an oral health-care setting, the WHO said COVID-19 is transmitted in three main ways: through the inhalation of droplets from coughing or sneezing; through exposure of mucous membrane, such as eye, nasal or oral mucosa, to infectious droplets; and through indirect transmission via contaminated surfaces
The WHO said aerosol-generating procedures (AGPs), such as “three-way air/water spray, dental cleaning with ultrasonic scaler and polishing,” also pose a risk because they create airborne particles or aerosols, which “can remain suspended in the air, travel over a distance and may cause infection if they are inhaled.”
In settings with widespread community transmission, the WHO said, “oral health care involving AGPs should be avoided or minimized, and minimally invasive procedures using hand instruments should be prioritized.”
The updated guidance also recommends screening patients using virtual technology or telephone before they arrive at the facility and implementing public health measures, such as physical distancing, wearing personal protective equipment, proper hand hygiene, and adhering to cleaning and disinfection procedures.
The Canadian Dental Association (CDA) released a statement on Wednesday clarifying the World Health Organization's guidance, saying that delay of oral health care is “not relevant for the current status in Canada since there is not wide-spread community transmission of COVID-19 in our country.”
The statement said Canada is experiencing “cluster-contained outbreaks” which allow for routine oral health care to be provided. According to the statement, Canadian dentistry takes its guidance from the Public Health Agency of Canada, Health Canada, and the dental regulatory authorities in each province.
“The Government of Canada, CDA, provincial dental associations, and dentists continue to monitor the COVID-19 pandemic closely,” the statement read. “Canadians can rest assured that dentists are infection control experts, and that dental offices continue to follow strict provincial guidelines and regulations that protect the health of patients and dental staff.”
The CDA recommends that Canadians stay home and cancel or reschedule dental appointments if they have flu-like symptoms.