COVID-19: a dental perspective
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The COVID-19 pandemic has thrown several challenges at dentists and their patients. At the same time, it has given us the opportunity to rethink and realign our approach to oral health in the context of a new normal.
In a webinar recorded for the ICMDA recently, I talked about the impacts of COVID on the world of dentistry. The short talk was limited to general dental practice, and it provided a background to the challenges faced in providing dental care, as well as the potential opportunities. Taking that webinar forward here, I want to focus on the opportunities and how they can transform how we provide oral care to people.
Background
The outbreak of SARS-CoV-2, responsible for the coronavirus disease (COVID-19), has caused chaos in every healthcare sector and across all countries, whether high or low income.
The burden on general healthcare facilities has largely focused upon the management of acutely ill individuals who were admitted to hospitals. The virus has a predominantly respiratory transmission through aerosol and droplets. The importance of infection control is therefore crucial in limiting the effects of virus diffusion.
The working environment of dentists in clinical settings leaves them, their staff and patients exposed to airborne particles produced by high-speed rotary instruments and/or compressed air used to dry the tooth. Much of clinical dentistry relies on compressed air to drive the rotary instruments, water spray to cool the drills and water sprays to remove debris. These aerosol-generating procedures set the risk for disease transmission and cross contamination. The SARS-Cov-2 is a respiratory transmitted virus and therefore it is difficult to manage in clinical dentistry as the distance of the patient’s mouth to dental personnel makes mitigation procedures difficult. Procedures such as pre-treatment antiseptic mouthwash, rubber dam, high vacuum suction and surgery-based air vacuum extraction systems have been recommended. These systems include allowing a prolonged period between patients (fallow time) to clean surgeries and to allow time for air particles to settle or be removed through high suction units.
These mitigation procedures have raised the costs of providing dental care or simply to make it too expensive for many in low-income settings. A large proportion of dentistry relies on patient charges. Now, with increased costs and a reduction in people attending the dentists – either due to travel restrictions, or patient concerns with safety – the challenges facing dental care are considerable. However, the purpose of this post is to focus upon three opportunities that COVID-19 has given increased attention to:
- Developing leadership in oral health care
- Promotion of innovative dental prevention
- Embracing integration of medical and dental health care
Developing leadership in oral health care
Dentistry in a post COVID world will, like many sectors of everyday life, require good leadership.
Healthcare leaders set the tone of institutions and organisations in which they work, and leadership initiatives are more likely to be effective if ethical values are understood and respected, especially when supported by robust systems of governance. Planning for the new structures that will be needed and for the dental reforms to work in practice, there needs to be a willingness to change, which comes first from attitudes and behaviours demonstrated by individual leaders.
Good healthcare leaders have the power to change the environment and conversation in which they work for the benefit of the populations that they serve within the global community, which is the main driver for developing inspirational leadership programmes.
The concept of ethics and governance is not yet fully entrenched in health leadership training. But this will be important in order to ensure that new ways of doing things do reduce global and local oral health inequalities. Therefore, in any leadership training there is a need to embrace ethics and healthcare governance in their local settings. You can hear about our project, the Senior Dental Leadership (SDL) programme, in the ICMDA webinar starting at about 3:40 minutes.
Promotion of innovative dental prevention
Despite advances in dental care over recent years, dental caries is still a global health problem. Untreated decay is all too often a result of cost of treatment, lack of trained dental personnel, cooperation of the individual (especially if they are young children), or simply low oral health literacy of the individual.
The COVID pandemic has given a stimulus for developing and indeed embracing innovative preventive products. Health ministries should lead this development and implement existing and/or encourage new developments of innovative, affordable and equitable dental prevention.
An example of a novel, community-based approach is the use of Silver Diamine Fluoride (SDF), which was first developed in Japan. It is low cost, simply applied (in many countries applied by trained assistants and not dentists) and it arrests dental caries and prevents pain. Watch this video to know more about how SDF is transforming dental caries programmes. This video was produced by the Global Child Dental Fund (GCDFund).
Embracing integration of medical and dental healthcare
The oral health and general health crisis that we currently face globally can only be rectified through the integration of oral and general health policy, practice, and education.
Oral health impacts upon general health and of course general health has a significant effect on dental health. They are both intrinsically linked but all too often their provision is not.
In many low- and medium-income countries (LMICs) the integration of oral and general healthcare is critical to ensure equal access to quality health services. The success of integrated care depends on the knowledge, skills, motivation, and development of the health workforce. However, at present, there is a lack of qualified health staff in many LMICs. The traditional siloed approach, whereby medicine and dentistry work individually in prevention and treatment efforts, must be addressed in a post-COVID world. This will rise higher in any priority agenda to improve access to dental care. Watch this video to know more about why integrating general and oral health is so important.
In conclusion, the COVID-19 pandemic has created turmoil in how dentistry is provided and how the business of dentistry is undertaken. Financial sustainability for many practices is strained, and if prolonged periods of restrictions occur, then inevitably government support will be needed to ensure that dental practices are viable. I have highlighted three main opportunities to reshape the landscape of oral health provision: developing better dental leadership to ensure we have more equitable dental provision, more intensity in developing preventative products and implementation of existing ones, and finally, driving dental and medical integration. Financial support from governments should and must be linked with this agenda.
Professor Raman Bedi is the founding chairman of the Global Child Dental Fund, GCDFund. He was Chief Dental Officer for England, 2002-2005.
