Primary Dental Care During COVID-19 and Future Airborne Pandemics

By Hyewon Lee & WFPHA Oral Health Working Group Members 

Oral health is an integral part of primary care. While oral diseases pose a major health and financial burden globally, oral health is widely neglected and considered as optional or specialty care. Recognizing the global public health importance of major oral disease, the World Health Assembly adopted resolution WHA74.5 on oral health in 2021 and stated oral health is an integral part of the health and healthcare system.

COVID-19 has infected almost 400 million people around the world with 6 million deaths, changing the pattern of daily lives and the healthcare system. Oral health practitioners are among the most at risk professionals for COVID-19 and other airborne diseases. In view of the discordance in the guidelines for dental practice since the outbreak of the COVID-19 pandemic, the WFPHA Oral Health Working Group (OHWG) recognizes the need for clear guidelines on dental care delivery during the COVID-19 pandemic and future outbreaks of airborne diseases, and a consistent definition of primary dental care. Therefore, 24 public health focused dental professionals from 13 countries collaborated to publish a resolution entitled Urgent, Essential and Primary Dental Care during COVID-19 and Future Airborne Pandemics, which represented various WHO regions. The resolution presents core elements for the safe delivery of dental care during pandemics and a working definition of urgent, essential, and primary oral health care. This resolution was accepted and approved by the WFPHA General Council in May 2022. The WFPHA OHWG calls to action to provide coordinated oral health during pandemics to promote and improve oral health and overall health for all and recommend the following:

1. Strategic planning and communication: All oral health care programs should have a clear plan, process, and communication strategy to screen or identify confirmed cases and related exposures, based on national and regional guidelines. Oral health care personnel should be considered as an essential part of the greater public health team and undertake activities to support public health at all times, including during pandemics.
2. Personal protective equipment (PPE) and facility design: All healthcare facility personnel should wear well-fitting surgical face masks to cover a person’s mouth and nose to prevent spread of respiratory droplets. Practitioners and care staff should use face masks or other respirators approved by national guidelines.
3. Urgent dental care: Urgent dental care includes medically necessary care which addresses acute oral health infection, severe pain not controllable with analgesia, and care involving dental/orofacial trauma. Urgent care and associated diagnostic examinations should be provided for all patients. AGPs should be avoided or minimized whenever possible, and atraumatic restorative treatments (ART) using hand instruments should be prioritized.
4. Essential dental care: In 2021, the WHO defined essential dental care as fluoride toothpaste, glass ionomer cement, and silver diamine fluoride. ART, such as glass ionomer cement, and silver diamine fluoride, can be delivered with minimal or no involvement of AGP, and is also listed as basic dental packages by the World Dental Federation. Essential dental care, including fluoride application, should be provided for all patients, including patients with confirmed infection if it falls under urgent care.
5. Primary dental care: Primary dental care includes routine dental exam, cleaning, radiographs, permanent restorations, periodontal treatment, endodontic treatment in addition to urgent and essential dental care. Providing primary dental care for all patients with minimal risks during the pandemic is recommended and only urgent and essential dental care on an emergency basis for patients with COVID-19 and other highly infectious airborne diseases should be provided. When urgent, essential, or primary dental care needs AGPs for patients with minimal risks, use mitigation methods, such as four-handed dentistry, high evacuation suction, and isolation devices to minimize droplets and aerosols. Providers can consider oral antiseptic rinse based on scientific evidence.
6. Oral hygiene for hospitalized patients and those living in long-term care facilities: The oral health of hospitalized patients and those living in long-term care facilities should be maintained throughout pandemics. Optimal oral hygiene practices should be performed daily with help from nurses or caregivers.
7. Oral health care and education for mothers, children, and caretakers of people with special needs: Oral health needs to be integrated into primary and prenatal care for these populations, focusing on prevention of dental caries, home oral hygiene practice, and low-cariogenic diet. Oral health education for mothers can set life-long healthy habits and diets for young children. Oral health education, especially for expecting mothers, children, and people with disabilities and their caretakers should be provided.

We recommend that oral health care should continue in this challenging time as an integral part of primary care, and dental care should be integrated into a larger health system, such as primary health care, perinatal health care, long-term facilities and schools, and nutrition.

The WFPHA OHWG is open for collaboration with both dental and non-dental health organizations for this goal. Please reach out to the Chair of the OHWG, Dr Hyewon Lee, at hyewon@idasociety.org 

Economic-Financial Drivers of an Unequal World

The People’s Global Summit. Co-building a New Eco-Social World: Leaving No One Behind starts 29 June to 2 July 2022. The Summit will run 24 hours for four days.

During the Summit people will be able to share their experiences and stories in different ways including presentations from people in communities, live panels, open mic rooms, storytelling, interviews, and many more.

WFPHA facilitates a live panel, Economic-Financial Drivers of an Unequal World, on 29 June, at 14:30 (UTC). This panel highlights that we have to revise our incentives and learn how to counteract the prevailing economic drivers in order to preserve the health of people and the planet.

Join us to contribute to a new eco-social world that leaves no one behind.

The People’s Global Summit

The People’s Global Summit. Co-building a New Eco-Social World: Leaving No One Behind has been initiated by 24 diverse global organisations representing different faiths, philosophies, rights movements, workforces, generations, traditions, and cultures. This historical event brings together people from across the world. The summit seeks to create new ways to work together to ensure sustainability and good quality of life.

The summit provides spaces where everyone can contribute. These include keynote sessions, live panels, live open mic rooms, Indigenous-led sessions, interviews, academic presentations, and many more.

The summit will run 24 hours a day for four days, 29 June to 2 July 2022. The WFPHA is very proud to be a partner to the summit.

Join us to contribute to a new eco-social world that leaves no one behind.

Public Health and the Duty to Abolish Nuclear Weapons

The first Meeting of States Parties to the United Nations Treaty on the Prohibition of Nuclear Weapons (TPNW) took place in Vienna, Austria, in June 2022.

Several side events were organised during this meeting. On 23 June 2022, WFPHA delegate Prof. Bettina Borisch participated in the “Public Health and the Duty to Abolish Nuclear Weapons” side event, organized by the Permanent Mission of the Republic of Costa Rica and the International Physicians for the Prevention of Nuclear War (IPPNW), to build upon a recent joint statement and call for the abolition of nuclear weapons.

During the side event, Prof. Borisch said:

“As of today, we must acknowledge: The state of the world is not really great. Everyday news is overwhelming. We are at a point with two main existential threats: Climate crisis and the nuclear threats.

The existing nuclear weapons around the world are enough to wipe out all of humanity. Since the end of the Cold War, there has been a steady decline in nuclear weapons. This trend is now reversing. Nuclear competition and nuclear risk are increasing.

I represent the voice of public health community around the world. For us it is absolutely clear when it comes to nuclear weapons. We have enough evidence that they have to be abolished, it is now time for advocacy, we have to persuade the governments around world.

I started saying that the world is not in a great state; this may sound desperate, but it is not!

This side event is organized by the Permanent Mission of the Republic of Costa Rica and IPPNW. Costa Rica is an example to the world that it is possible to live in an unarmed democracy. This was a decision of the government, and this has allowed Costa Rica to become a pacifist, civilian nation, that resolves conflicts and external threats by using instruments provided by International Law. The abolition of the army marked a new experience, showing it is possible for a country to live without an army, and investing these resources in education and health.

I mentioned at the beginning two main threats that we have right now. How is climate crisis dealt with in Costa Rica? Costa Rica was named the second most sustainable country in the world by the World Energy Council. Costa Rica takes care of its nature and its biodiversity.

Let me conclude by this positive note. We are able to reverse threats! Let me cite Former President Rodrigo Carazo Odio, who said, “Costa Ricans have cultivated a spirit of seeking peaceful solutions to conflicts; education has fostered such an attitude and because in the absence of [military] weapons with which to impose an idea, the only weapon left is reason.”

Let us use reason!”

Intersection between Climate Change, Public Health, and International Law: A Report

By Hannah Marcus

Recently, our Environmental Health Working Group published a new report titled “Legal implications of the climate-health crisis: a case study analysis of the role of public health in climate litigation” in PLOS One. This report contributes significantly to the current knowledge base concerning the intersection between climate change, public health, and international law, which is of growing prominence in the current global context.

As climate attribution science matures, the legal implications of climate change are gaining more attention. Similarly, there is greater public awareness of climate-health links, which supports increased use of public health claims in allegations of wrongdoing. Few researchers, however, have adopted a specifically public health lens when studying such legal implications, despite the evidence-backed merit of claims that climate disruption is a breach of the very laws intended to safeguard human health and well-being.

The evidence presented in this report comes from a global review of case studies of climate litigation, with a focus on the diplomatic framing and judicial consideration of public health concerns when justifying legal actions taken. Considering the shortcomings identified in the use and acceptance of public health claims in legal argumentation used for litigation, the report concludes with a series of practical recommendations. These largely concern the creation of new legal incentives to position public health as a central focus in climate litigation and the promotion of greater public and industry awareness of climate-health links.

This report not only bridges the gaps in current literature on the topic, but it also provides a stronger knowledge base on which to build legal frameworks supportive of health-protective climate action. This offers important academic and practical contributions to the legal and policy realm associated with the intensifying climate crisis.