The World Health Organization (WHO) has taken a strong stance on oral health, urging people to put off routine visits to the dentist when COVID-19 is heavily circulating in their area.
In interim guidance published on Aug. 3, the WHO specifically 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.” This recommendation also applies to “aesthetic dental treatments,” the guidance says. However, the organization adds, urgent or emergency care visits “that are vital for preserving a person’s oral functioning, managing severe pain, or securing quality of life should be provided.”
The WHO specifically says in its guidance that it has concerns about aerosol-generating procedures (AGPs), which are “widely performed” in dental work. “The risk of airborne COVID-19 transmission when AGPs are performed can … not be excluded,” the WHO says.
Benoit Varenne, a WHO dental officer, echoed that sentiment in a news briefing on Tuesday, according to the New York Times. “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,” he said.
The American Dental Association (ADA) has had a mixed stance on this subject. While the ADA recommended in mid-March that dentists suspend their practices to “all but urgent and emergency care,” that recommendation expired on April 30 and was not extended for a period of time. “Oral health is an integral part of overall health,” the ADA said online in May. “Treatment of dental disease, as well as prevention, is important to help keep people healthy.”
But the ADA released new guidance in June that urged dentists to “treat only emergency patients,” noting that “some states or local governments have mandated this.” The ADA also expressed concerns that COVID-19 “may be spread through aerosols produced by high and low speed handpieces, ultrasonic scalers, air/water syringes, or an infected patient coughing, and even when taking intra-oral radiographs.”
August guidance from the Centers for Disease Control and Prevention recommends that doctors focus on patients who need care the most urgently. “Prioritize the most critical dental services and provide care in a way that minimizes harm to patients from delaying care and harm to personnel and patients from potential exposure” to COVID-19, the agency advises dentists.
Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security and an ER physician, tells Yahoo Life that he’s concerned about the recent recommendations on routine dental care. “Lack of dental care has other ramifications for the health care system,” he says. When people delay routine dental care, they’re more likely to develop serious tooth issues — and then they wind up in the emergency room, Adalja says. “That’s what happens when you close off dental care,” he says. “They come to the emergency department, where doctors are not properly equipped to deal with this kind of thing.” That can potentially open a patient up to people who may be infected with COVID-19 and are in the waiting room too, he says, noting that it can also be a drain on hospital resources that may be needed to deal with COVID-19 patients. “Dental care should not be disrupted,” Adalja says.
But infectious disease expert John Sellick Jr., a professor of medicine at the University of Buffalo School of Medicine and Biomedical Sciences, acknowledges the concerns that there are still a lot of unknowns with safety at the dentist’s office. “Dentists are working right up at the top of the respiratory tract, and that can be risky,” he tells Yahoo Life. “Dentists have to take extra precautions in terms of self-protection and the protection of everyone else because of the aerosols that can be generated.”
However, experts say it’s likely that a trip to the dentist’s office can be safe for everyone involved if offices screen patients beforehand, visits are spaced out to avoid crowded waiting rooms and staff wears face shields and masks while working on patients. “Routine dental visits can probably be done pretty safely if the proper precautions are taken,” Sellick says.
Dr. Mark Wolff, dean at the University of Pennsylvania School of Dental Medicine, tells Yahoo Life that much depends on local transmission rates. “If I’m a healthy person and I need to get my teeth cleaning, should I delay it? Probably not in the Northeast. We’re doing pretty well,” he says. “But would I in Texas, where cases are high? Maybe not.”
But dentists have always “taken universal precautions, which is a set of guidelines practitioners follow to avoid contact with patient bodily fluids and prevent transmission of pathogens,” Julie Cho, a dentist in New York City, tells Yahoo Life. “However, now we are more fastidious than we have ever been,” she says. “In addition to wearing masks, eye shields and gloves, which we have traditionally done, we are now wearing face shields, surgical caps and extra personal protective equipment. Furthermore, we have air purifiers and UV lights in each operatory, and our staff is taking temperatures of all patients who enter through our door and screening for symptoms. Because we are still on hyperalert, this is a good time to go to the dentist.”
Wolff urges people to seek regular care from a dentist if they’re in areas of low COVID-19 transmission or if they’re in pain. However, he admits, dentists are anxious about the pandemic too. “Of course we’re nervous,” he says. “We never want to put our patients or staff at risk.”
This all naturally raises questions about safety with other routine doctor’s visits, like ob-gyn checkups, your annual visit with your general practitioner and regular eye appointments.
There are a few factors to consider, Dr. William Schaffner, an infectious disease specialist and professor at the Vanderbilt University School of Medicine, tells Yahoo Life. He recommends calling your doctor’s office in advance to see what precautions they’re taking to keep patients safe. “You want to make sure everyone will be masked, there will be social distancing and that everyone is being very careful,” he says. “If you discover your local provider and everyone else in the office will not be wearing masks, you might want to ask about telemedicine. That is not an office I would recommend visiting at the present time.”
It’s also a good idea to keep an eye on local transmission rates, Schaffner says. “We ought to be careful throughout the U.S., but some parts of the country, like New England, have done very well controlling this virus so far,” he says. But, Schaffner adds, even if local case counts in your area are low, the virus can still be circulating. “It’s important to keep wearing masks and following the proper precautions when you see your doctor, regardless of local transmission,” he says.
If cases in your area begin to surge, Sellick says it’s OK to push your routine appointment back a little. “What is the magic number of cases? Nobody really knows that,” he says. “There is no set number.”
Adalja urges caution with pushing off routine visits for too long, though. “People are very short-term focused, and they don’t realize there are a lot of potential consequences of skipping routine visits,” he says. That’s why he urges people who are nervous about receiving routine care to talk to their doctor. “We have to get to a point where normal health care delivery can continue uninterrupted during this pandemic,” Adalja says.
For the latest coronavirus news and updates, follow along at https://news.yahoo.com/coronavirus. According to experts, people over 60 and those who are immunocompromised continue to be the most at risk. If you have questions, please reference the CDC’s and WHO’s resource guides.
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