Avoid Nonessential Dental Care NOW? How Dentistry Heard the WHO

Earlier this month all of us in dentistry were surprised by broadcast and published reports about an article from the World Health Organization regarding recommendations for dentistry in coping with COVID-19.

The article, which fetched a lot of immediate attention and became a headline on major networks and news outlets, seemed to say there was a new recommendation that dentists should be seeing ONLY emergency patients in our offices. This represented a seismic shift from where all of us believed we were and seemed to nullify the safety measures that we've taken great care to create and reinforce as dental practices worked to safely reopen from the closures earlier in the year.

Here are a some of the headlines released as they were reported:

• “Delay routine dental checkups in areas of COVID spread: WHO” (This Reuters headline was actually a correction to its original headline on the same report. Reuters explained that the correction was made because the “WHO advises delaying check-ups in areas with community spread, not that it advises delaying checkups until risk is known.”)
• “Amid coronavirus, avoid nonessential dental care, WHO says” (Fox News)
• “WHO urges postponing dental checkups during pandemic” (The Hill)

These headlines and others seemed to indicate that the WHO recommended dentists should immediately fall back to providing only essential treatment. I personally received a flurry of messages about the reports from dentists who wondered what had changed and caused WHO authorities to advise all dental practices worldwide to immediately consider limiting “routine non-essential oral health care – which usually includes oral health check-ups, dental cleanings and preventive care.”

All of the clinicians at Spear have fully supported the WHO positions during the pandemic, but the Aug. 3 article seemed counter to the state and CDC recommendations and guidelines that we've been following and sharing with our members since we were permitted to return to our offices. Many Spear dentists messaged faculty to express concern, if not fear, over how best to proceed given this seemingly “NEW” guideline.

Focus on established CDC, ADA safety protocols

The WHO article's authors stated that “non-essential” procedures, which include esthetic treatments, “be delayed until there has been sufficient reduction in COVID-19 transmission rates from community transmission to cluster cases or according to official recommendations at national, sub-national or local level.”

The article also explained how “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.”

Seems to be exactly what were advised to do, and in many cases mandated to do, in March at the beginning of the pandemic. In fact, this WHO recommendation aligns perfectly with what the CDC and ADA had advised us at the beginning of COVID-19 shutdowns.

The headline does not always convey the whole story

In reporting, it's important to grab the attention of the listener or reader. That's what the headline does, and unfortunately for us listeners, TV rarely if ever can truly provide for “the rest of the story.” It turns out that the WHO, a WORLD organization, was making a recommendation to the WORLD about the highest level of safety that could be applied to dentistry. We DID that a long time ago.

Not reported in many news reports, though it was reported by the WHO toward the top of its article, was a re-statement of the headline with a bit more information noted (which I identified in bold italics below):

The “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 or according to official recommendations at national, sub-national, or local level. The same applies to esthetic dental treatments.”

That part in italics puts a whole new spin on the WHO recommendation that is aimed at the planet, not at the U.S. alone. We fully support this recommendation, including a recommendation to news reporting services that it is reported fully. We continue to recommend that every practice follow CDC and ADA guidelines and recommendations, just as we always have. We also believe you should be seeing your patients for “regular” and “routine” care if the mandates, guidelines and recommendations of your state and locality permit that.

On Aug. 12, the ADA responded to the WHO in a statement that the ADA “respectfully yet strongly disagrees with the (WHO's) recommendation to delay 'routine' dental care in certain situations due to COVID-19,” adding that oral health is integral to overall health.

“Dentistry is essential health care because of its role in evaluating, diagnosing, preventing or treating oral diseases, which can affect systemic health,” ADA President Dr. Chad P. Gehani said in the statement. “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.”

“We fully support this recommendation, including a recommendation to news reporting services that it is reported fully. We continue to recommend that every practice follow CDC and ADA guidelines and recommendations, just as we always have. We also believe you should be seeing your patients for 'regular' and 'routine' care if the mandates, guidelines and recommendations of your state and locality permit that.” – Dr. Gary DeWood

As most or all of you are clearly aware, and as Dr. Gehani explains in the statement, the ADA's interim guidance, fully adheres to CDC standards and “calls for the highest level of PPE available – masks, goggles and face shields,” and also for “the use of rubber dams and high velocity suction whenever possible and hand scaling when cleaning teeth rather than using ultrasonic scaling to minimize aerosols.”

Today, the risk-benefit is variable

We also recognize that the risk-benefit is variable, and what we recommend for an individual patient can change based on the regional situation and the patient's condition. Based on some of the recent media reports, patients may be confused and ask you for clarity on safety in your practice.

In a recent video to Spear Practice Solutions members, I shared my belief that it's our job as dentists and leaders to move past the conjecture we are all faced with as the world continues to navigate the COVID-19 pandemic and mitigate the spread of the virus.

It's important to remind ourselves of, and continue to convey to patients, the “3 Keys” that are fundamental to everything we teach and recommend at Spear:

• Key 1: Keep ourselves and patients safe by applying all appropriate safety measures (personal protective equipment [PPE], sterilization, etc.).
• Key 2: Help our patients avoid pain and complications.
• Key 3: Minimize our patients' time in the office and maximize their oral health.

Dr. Mitch Ellingson detailed the “3 Keys” in a recent Spear Digest article. These keys are the foundation of Spear's recent efforts to equip member practices with clear information that explains how dental practices have augmented longstanding infection-control measures to address COVID-19 safety protocols to protect patients and dental team members through the pandemic.

In his article, Dr. Ellingson also alludes to the success stories from many of our Practice Solutions clients, including instances in which practice teams faced with the intensity of layoffs and financial uncertainty have managed to keep their teams and patients safe while rallying together to create a more supportive and cohesive practice.

Spear faculty, community reinforce patient safety communication

This alarm can mark an opportunity for doctors, patients, and team members to be reminded that we are doing now what we have always been doing for as long as I've been doing this – following the mandates, recommendations, and guidelines of national, state, and local authorities to provide ourselves and our patients with a safe clinical environment.

Inform your patients! Tell them the information and recommendations in the WHO article are accurate, that you fully support it, and that you remain committed to protecting everyone, especially vulnerable patients in at-risk categories, through the guidelines stated in the article and applied in compliance with the CDC and the ADA recommendations.

All Spear Online members have access to materials so that you can share the “3 Keys to Optimal Oral Health” with patients, including hand-out materials and an FAQ that any team member can easily use to convey safety measures and the actual realities of maintaining oral health in this time of added concern over potential exposure. Spear Online members can contact their Customer Success Manager to download those materials.

Additionally, if your situation means patients must gather in the reception area, Spear members have access to a Patient Education lobby video that helps patients visualize the enhanced safety measures that dental practices have in place to prevent COVID-19 transmission.

These resources help our member practices provide patients with the assurance that their dentist and dental team have undergone the training required and are applying what they learned to treat people safely, quickly and efficiently, which limits their risk.

We acknowledge that things can change, in fact MANY things have changed quickly and drastically in what seems like an instant, repeatedly across the world since the early spring.

Managing those changes causes us to react quickly, and sometimes erroneously based on new information.

Always get the whole story. When there seems to be a difference between what you hear and what your national, state, and local officials are recommending, seek out information that clarifies the path forward for YOU.

My personal response, and that of the ADA, immediately took a position of challenge to what we heard. Further investigation, in this case reading the complete article, made it apparent for me that we are not only on the same side, but recommending the same things.

Stay safe. Doing that ensures the safety of others, especially your patients.

Note: Special thanks to Digest Senior Editor Michael Ferraresi, one of the dedicated Spear team members who are always working behind the scenes with our faculty and content producers to provide you with current and accurate information. Michael is just one of the large group of people you have as part of YOUR team when you are part of the Spear family. Reach out to him anytime at mferraresi@speareducation.com with questions about Digest or ideas for new articles.

Gary DeWood, D.D.S., M.S., is Executive Vice President of Spear Education and a member of Spear Resident Faculty. As one of the founding members of Spear, he directed Curriculum and Clinical Education for nearly a decade prior to joining in the launch of Spear Practice Solutions.