Primary Dental Care During COVID-19: Global Guidance for Safe Oral Health Services

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 optional or specialty care. Recognizing the global public health importance of major oral disease, the World Health Organization’s governing body adopted resolution WHA74.5 on Oral Health in 2021, affirming that oral health is an integral part of the health and healthcare system.

The COVID-19 pandemic has infected almost 400 million people worldwide and caused approximately 6 million deaths, fundamentally changing daily life and healthcare delivery. Oral health practitioners are among the professionals most at risk of infection due to exposure to airborne droplets and aerosols generated during dental procedures.

In response to inconsistent dental practice guidelines during the pandemic, the World Federation of Public Health Associations (WFPHA) Oral Health Working Group recognized the need for clear global guidance on the delivery of dental care during pandemics and future airborne disease outbreaks. A group of 24 public health–focused dental professionals from 13 countries collaborated to publish a resolution titled “Urgent, Essential and Primary Dental Care during COVID-19 and Future Airborne Pandemics.”

The resolution outlines core elements for the safe delivery of dental care during pandemics and proposes a working definition of urgent, essential, and primary dental care during COVID-19. It was accepted and approved by the WFPHA General Council in May 2022.

The WFPHA Oral Health Working Group calls for coordinated oral health action during pandemics to protect oral and overall health for all. The following recommendations outline how dental services can be safely maintained.

Strategic Planning and Clear Communication in Dental Care

All oral health programs should establish clear plans and communication strategies to screen for or identify confirmed cases and potential exposures, in line with national and regional public health guidelines.

Oral health professionals should also be recognized as an essential part of the broader public health workforce. This includes supporting public health initiatives and maintaining preparedness during pandemics and other public health emergencies.

PPE and Facility Measures to Reduce Airborne Transmission

Personal protective equipment (PPE) and facility design play a critical role in infection prevention during pandemics.

All healthcare facility personnel should wear well-fitting surgical masks that cover the mouth and nose to reduce the spread of respiratory droplets. Dental practitioners and care staff should use face masks or respirators approved by national guidelines.

These protective measures help reduce transmission risks while maintaining safe dental services.

Urgent Dental Care During COVID-19

Urgent dental care refers to medically necessary treatment that addresses:

• Acute oral infections
• Severe pain that cannot be controlled with analgesia
• Dental or orofacial trauma

Urgent care and associated diagnostic examinations should be provided for all patients.

Aerosol-generating procedures (AGPs) should be avoided or minimized whenever possible. Instead, atraumatic restorative treatments (ART) using hand instruments should be prioritized to reduce aerosol production while ensuring necessary care.

Essential Dental Care and Preventive Treatments

In 2021, the World Health Organization defined essential dental care as the use of:

• Fluoride toothpaste
• Glass ionomer cement
• Silver diamine fluoride

These materials allow preventive and restorative care with minimal or no aerosol generation. Treatments such as ART using glass ionomer cement and the use of silver diamine fluoride are also recognized in basic dental care packages by the FDI World Dental Federation.

Essential dental care, including fluoride application, should be provided for all patients, including those with confirmed infection, if the treatment falls under urgent care.

What Primary Dental Care Includes During a Pandemic

Primary dental care during COVID-19 includes a wide range of routine dental services, such as:

• Routine dental examinations
• Professional cleaning
• Radiographs
• Permanent restorations
• Periodontal treatment
• Endodontic treatment

These services are provided in addition to urgent and essential dental care.

Providing primary dental care with minimal risk during pandemics is recommended. However, for patients with COVID-19 or other highly infectious airborne diseases, only urgent and essential dental care should be delivered on an emergency basis.

When aerosol-generating procedures are necessary for low-risk patients, mitigation strategies should be used, including:

• Four-handed dentistry
• High-volume evacuation suction
• Isolation devices to reduce droplets and aerosols

Providers may also consider oral antiseptic rinses based on scientific evidence.

Protecting Oral Health in Hospitals and Long-Term Care Facilities

Hospitalized patients and individuals living in long-term care facilities are particularly vulnerable to oral health deterioration during pandemics.

Daily oral hygiene practices should be maintained, with assistance from nurses or caregivers when necessary. Consistent oral care helps reduce infection risks and supports overall health outcomes for these populations.

Oral Health Education for Mothers, Children, and Caregivers

Oral health should be integrated into primary and prenatal care for mothers, children, and individuals with special needs.

Preventive strategies should emphasize:

• Dental caries prevention
• Proper home oral hygiene practices
• Low-cariogenic diets

Education for mothers is particularly important because it helps establish lifelong healthy habits and dietary practices for children.

Oral health education should also be provided to caregivers of people with disabilities to support consistent oral hygiene and preventive care.

Integrating Dental Care into the Broader Health System

Oral health services should continue even during global health crises. Dental care must be recognized as a fundamental component of primary care and integrated into broader health systems, including:

• Primary health care
• Perinatal health care
• Long-term care facilities
• Schools
• Nutrition programs

Ensuring access to oral health services strengthens both individual health outcomes and public health resilience during pandemics.

A Call for Global Collaboration on Oral Health

The WFPHA Oral Health Working Group invites collaboration with dental and non-dental health organizations to advance these goals and improve oral health globally.

For collaboration inquiries, please contact the former Chair of the Oral Health Working Group, Dr. Hyewon Lee, at hyewon@idasociety.org

By Hyewon Lee & the WFPHA Oral Health Working Group Members

Intersection between Climate Change, Public Health, and International Law: Litigation, Liability, and Legal Reform

The Intersection between Climate Change, Public Health, and International Law is no longer theoretical; it is unfolding in courtrooms around the world. Our Environmental Health Working Group recently published a peer-reviewed study in PLOS One titled “Legal implications of the climate-health crisis: a case study analysis of the role of public health in climate litigation.” The findings contribute to a growing body of scholarship examining how legal systems are responding to climate disruption as a public health emergency.

As climate attribution science advances and public awareness of climate-related health harms increases, public health arguments are entering climate litigation with greater frequency. Yet few researchers have evaluated this legal landscape through a dedicated public health lens. This report addresses that gap.

Why the Climate–Health–Law Nexus Demands Attention

There is now overwhelming scientific evidence that climate change is a public health emergency. Courts across jurisdictions are increasingly asked to determine whether governments and corporations are meeting their obligations under environmental law, human rights law, and climate policy frameworks.

Despite this, public health remains underutilized in legal argumentation.

Environmental degradation, biodiversity collapse, and rising greenhouse gas emissions continue despite decades of legal regulation. The health consequences are tangible:

• Rising food and water insecurity

• Deteriorating air quality

• Expansion of infectious diseases

• Increased frequency of floods, wildfires, droughts, and heatwaves

• Mental health impacts, including ecological grief and trauma

These harms demonstrate that climate change directly and indirectly undermines the legal commitments designed to protect life, health, and well-being.

How We Studied Climate Litigation Through a Public Health Lens

To evaluate the Intersection between Climate Change, Public Health, and International Law, we conducted a global review of documented climate litigation filed between 1990 and September 2020.

Scope of Analysis

• 1,641 total climate litigation cases identified

• Legal databases reviewed across jurisdictions

• Cases assessed for explicit or implicit public health framing

• 65 cases categorized as public health–linked climate litigation

We extracted structured data from case documents, including plaintiff, defendant, legal precedent, decision status, and the presence of health-related argumentation.

Key Findings from Three Decades of Climate Litigation

1. Climate Litigation Is Increasing Rapidly

Case numbers are trending upward, particularly in high-income countries. Over half remain pending, reflecting the recent surge in filings.

2. Public Health Framing Is Rare but Rising

Only 3.96% of cases explicitly centered on public health as part of the litigation strategy. While mentions of “health” are increasing, the public health lens remains underdeveloped in courtrooms.

3. Courts Are Receptive, but Reform Is Needed

Among the 65 health-linked cases:

• 11 resulted in the plaintiff winning

• 11 resulted in losses

• 43 remain undecided

Although courts demonstrate openness to public health science, structural legal reform is needed to ensure health evidence carries sufficient weight in adjudication.

International Legal Frameworks Shaping Climate Litigation

The Intersection between Climate Change, Public Health, and International Law operates within a complex legal architecture.

Global Climate Governance

The United Nations Framework Convention on Climate Change acknowledged the global nature of climate change and the need for international cooperation.

The Paris Agreement, endorsed by 196 countries, emphasizes the right to health and outlines mitigation and adaptation commitments. However, enforcement mechanisms remain limited.

The United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (“Ensure healthy lives and promote well-being for all ages”), reinforce health-centered development objectives—though they are not legally binding.

Human Rights and Environmental Law

International Environmental Law (IEL) and International Human Rights Law (IHRL) increasingly intersect in climate cases. Courts are asked to interpret:

• The right to life

• The right to health

• The right to a healthy environment

• Intergenerational equity principles

More than 80% of UN Member States now recognize the right to a healthy environment in law.

The Rise of Eco-Centric Legal Paradigms

Legal systems historically grounded in anthropocentric principles are beginning to evolve.

Countries including Ecuador, Bolivia, and Panama have adopted eco-centric frameworks granting rights to nature. France has passed legislation recognizing the crime of ecocide. These shifts reflect a broader reimagining of law beyond resource extraction toward ecological protection.

The key question moving forward:

Will eco-centric law integrate a clear public health mandate?

Embedding public health within eco-centric legal systems could ensure climate rulings systematically prioritize human and planetary well-being.

Climate Attribution Science and Legal Causation

Litigation depends on demonstrating causation. Advances in climate attribution science now allow courts to quantify proportional responsibility for extreme weather events and climate-related health impacts.

As attribution methodologies mature, they strengthen:

• Claims of foreseeability

• Demonstrations of negligence

• Quantification of attributable risk

• Economic valuation of health harms

Robust scientific evidence increases the likelihood that public health arguments will influence judicial reasoning.

Financial Systems, Liability, and Health Risk

The economic dimension of climate litigation is central to the intersection of climate change, public health, and international law.

Courts are increasingly asked to:

• Price the health impacts of pollution

• Evaluate financial disclosures on climate risk

• Assess corporate duty of care

• Consider investor activism strategies

Financial institutions, asset managers, and fossil fuel companies are facing mounting litigation. Market forces are gradually internalizing previously externalized public health costs.

The expectation that governments and corporations prioritize human health over short-term profit is rising, particularly following global responses to the COVID-19 pandemic.

Barriers to Access and Structural Limitations

Several limitations shape the current landscape:

• Western-centric case databases

• Limited documentation from certain jurisdictions

• Restricted access to subscription-based legal resources

• Underreporting of criminal climate litigation

These barriers may exacerbate climate injustice, particularly in low-income regions most vulnerable to climate-health harms.

Practical Recommendations for Legal and Public Health Stakeholders

To strengthen the role of public health within climate litigation, we recommend:

1. Initiate health-backed legal cases across jurisdictions

2. Advocate for eco-centric laws with explicit health mandates

3. Mobilize funding for climate-health attribution research

4. Integrate climate-health curricula in higher education

5. Establish environmental health expert panels for court testimony

Legal epidemiology (the study of law as a determinant of health) should expand into climate law to ensure legislation actively protects human well-being.

Conclusion: Repositioning Health at the Center of Climate Law

The legal field of environmental governance is undergoing rapid transformation. Courts can no longer dismiss the scientific consensus linking anthropogenic climate disruption to harm to human health.

Litigation offers a powerful mechanism to:

• Drive decarbonization

• Establish financial liability

• Protect vulnerable populations

• Advance intergenerational justice

However, the Intersection between climate change, public health, and international law will only reach its full potential if public health becomes central, not peripheral, to climate legal strategy.

Integrating health risk into economic cost structures, strengthening eco-centric legal paradigms, and mobilizing interdisciplinary expertise can shift legal systems toward a well-being–centered economy.

The future of climate litigation may ultimately depend on one fundamental principle:

The protection of planetary health is inseparable from the protection of human health.

The original report was done by Hannah Marcus, Co-Chair of our Environmental Health Working Group.

THE WFPHA Statement Condemning the Bombing in Iran and the Middle East 

The World Federation of Public Health Associations (WFPHA) strongly condemns the recent actions by Israel and the United States of America, which initiated an act of war that was without any justification under international law, is contrary to the UN Charter, and has led to the widespread loss of life in Iran and the Middle East. 

The WFPHA unequivocally rejects all acts of war and political violence. This comes alongside a strain of work in peace and health, such as the Treaty on the Prohibition of Nuclear Weapons, as well as Palestine and Venezuela more recently. Bombing as a tool of foreign policy and regime change places civilians – families, children, healthcare workers, and entire communities – directly in harm’s way, undermining the most fundamental public health principles and human rights. 

Public safety is the number one public health issue of our time. Yet military actions like these do not increase public safety. They do not protect populations from harm; they expand the scope of suffering, endanger health systems, increase displacement, and worsen long-term physical and mental health outcomes for millions. Violence and war disrupt vital services, destroy infrastructure, and set back progress on health, equity, and security for entire populations. 

We reaffirm that safety is inseparable from peace. Sustainable public safety and the health of individuals and communities cannot be secured through bombing campaigns, targeted killings, or escalation of conflict. Evidence and history alike show that militarized approaches to conflict often entrench cycles of violence and instability rather than resolve underlying causes. 

The WFPHA stands in solidarity with all people affected by this crisis and urgently calls on: 

• Immediate de-escalation of military operations and cessation of all hostilities.
• A shift toward peaceful diplomacy, conflict resolution, and dialogue grounded in international law and human rights.
• Protection of all civilians and civilian infrastructure in accordance with international humanitarian law.
• Global leadership focused on public health, human security, and the prevention of violence, not its expansion. 

We recognize that war is a leading threat to life and population safety on the planet, rivaling climate change, pandemics, and environmental degradation as global health emergencies. The loss of life in Iran, whether civilian or political, is a human tragedy. It must serve as a stark reminder that violence is never a path to health, justice, or well-being. 

Public health demands peace. Public safety demands peace. Humanity demands peace. 

View all of our policies on war and peace here.

The Disability Pandemic: What COVID Revealed About Who Gets to Live

The pandemic has been a brutal reminder that disabled people don’t matter. Living through this, as a disabled person with a wonky immune system, has been a reminder that my life doesn’t matter to most.

Where I do matter is in my disability community, the community of people at such risk of this deadly disease who have rallied and worked together to protect ourselves. After two years of lockdowns, fear, forgetting, and being ignored, my nerves are sanded raw. A new variant is announced. Restrictions for me creep back in. I’m left wondering if this is how it will be from now on: no more music, no more crowds, no more indoor anything really, and maybe no more footy. For the rest of my life.

The past two years, and the many before them, showed me that I can build a life in four walls. I can survive terrible things. But isolation is not neutral. It wears you down. And what the disability pandemic has shown is that survival often depends less on government systems and more on each other.

What Is “The Disability Pandemic”?

The disability pandemic refers to the disproportionate risk, neglect, and systemic exclusion experienced by disabled people during COVID-19—especially in access to healthcare, vaccination, social supports, and public policy decisions.

While COVID-19 was a global crisis, its impact was not evenly distributed. In Britain, 60 per cent of those who died from COVID were disabled people. In Australia, that data isn’t properly collected. We aren’t counted.

Instead, we are hidden behind phrases like “underlying health conditions.”

Who is valued?
Whose life is worth saving?
Who gets the ventilator?
Who is triaged out?

These questions were not abstract for disabled people. They were immediate and terrifying.

“You Would Die”: Locking Down Before the World Did

In February 2020, my GP was kind but blunt.

You have to go into lockdown now, she told me. This virus is very serious for you. With all your…and she waved her hands to indicate my entire body. You can’t get this. You would die.

I walked home along Katoomba Street, my stick pressing into the pavement, navigating around people suddenly rendered dangerous. I closed the door to my flat and would not go out again for five months.

A few years earlier, my heart had failed. Doctors stood at the end of my hospital bed and told me I was about to die. It turned out I didn’t want to.

I did everything they told me: restricted fluids, cardiac rehab, and medication. I would place my hand over my heart and whisper to it, willing it to keep beating. Eventually, it did.

During COVID, that same adrenaline-fuelled panic returned. Every surge in cases meant locking down weeks before everyone else. Checking supplies. Preparing to disappear again. This time, I could only control my small part. The rest depended on whether everyone else also didn’t want me to die.

I wasn’t entirely confident.

Living in Two Worlds During COVID

The disability pandemic created a strange split reality.

In one world, things became more accessible than ever. Meetings moved online. Arts events went virtual. I could give evidence to a royal commission without having to navigate inaccessible spaces. For once, everyone was on screen, not just me stuck on someone’s phone in the corner.

In the other world, my supports collapsed. I didn’t see another person for months. Gym and physio disappeared. My arthritis tightened its grip. When I couldn’t get food, I cobbled together strange cupboard meals. When I was lonely, I didn’t say it out loud.

On screen, no one saw my disfigured skin or wonky hands. They didn’t see me limping. In screen-land, I looked like everyone else. That virtual erasure made it harder to explain what was happening behind the camera.

The social model of disability tells us that when environments become accessible, we become less disabled. But during COVID, accessibility sometimes masked a crisis.

Triage Fears and the Shadow of Eugenics

Early reports from overwhelmed health systems overseas raised another fear: rationed care.

Disabled people around the world spoke about being triaged out. Alice Wong imagined a doctor reading her chart and deciding she was a waste of precious resources.

Those fears were not paranoia. They were rooted in history.

Australia has a long record of institutionalizing disabled people. Eugenics found fertile ground here. The Immigration Restriction Act of 1901 excluded people based not only on race, but also on mental and physical health.

Writer Amanda Tink observed that eugenic thinking did not end with World War II; it mutated.

During COVID, people across the political spectrum argued for policies that placed disabled people at higher risk of dying, then shouted at us when we objected.

If disabled people are the ones dying, then the pandemic can feel like it’s happening somewhere else, to someone else.

That is the quiet logic of the disability pandemic.

Government Failure and Community Response

When the pandemic hit, disabled people began making frantic calls:

• I can’t get food.

• My supports have stopped.

• I can’t afford essential medication.

• What are the rules?

• What is Telehealth?

Fifteen to twenty per cent of the population was effectively forgotten.

Advocacy organizations (many run by disabled people) scrambled to respond while facing the same barriers themselves. Governments stonewalled. Complaints were redirected. Concerns were minimized.

The Disability Royal Commission later found that failure to consult disabled people in early pandemic planning led to neglect of our needs during an unprecedented emergency.

The vaccine rollout repeated the pattern. Disabled people were told we were prioritized. In practice, many could not access vaccines. Some group homes were among the last to receive them.

“Everything’s fine,” governments said.

Everything bloody well was not.

Disabled Mutual Aid: Webs of Care That Kept Us Alive

While governments faltered, disabled people organized.

Online groups became information clearinghouses. People translated public health orders. Shared state-by-state updates. Explained income support changes. Crowdfunded emergency funds. The Disability Justice Network of Australia distributed over $40,000 (mostly raised by disabled people for disabled people).

Writer Leah Lakshmi Piepzna-Samarasinha calls these networks “webs of care.” The ways we kept each other alive during COVID, they argue, were nothing short of heroic.

This is what the disability pandemic revealed most clearly: we survive because we build each other’s safety nets.

Not as charity. As solidarity.

First Peoples With Disability and Vaccine Inequity

The failures were even sharper for First Peoples with disabilities.

Damian Griffis, CEO of First Peoples Disability Network, warned that First Nations people with disabilities were at risk of being triaged out or receiving inadequate support. Vaccine access required centre-based appointments, which were not accessible to many.

The fear was justified. The rollout repeatedly failed to reach those most vulnerable.

The disability pandemic intersects with colonial history. Australia’s federation was built on exclusion: white, able, male. That foundation shapes who is visible, who is protected, and who is forgotten.

Freedom for Whom?

I watch people chanting about their freedom and think about what I’ve lost.

Will I ever go to the footy again? I’ve been going to AFL games since I was a kid, sneaking into Princes Park, singing “We are the Navy Blues,” watching my grandmother yell at Hawthorn.

The idea that I might never sit in a crowd again is unbearable.

I have had three vaccine doses. But the people in the ICU, while vaccinated, the ones dying, are people like me. People with “underlying health conditions.”

Friends make complicated plans to see me. Rapid tests. Isolation before visits. Carefully rationed social contact.

Is this how it will be now?

Flavia Dzodan asks what it means to protest public health measures in a country built on occupying space by obliterating others. The question lingers.

Freedom, during the disability pandemic, often meant freedom from considering us.

The Small Things That Are Everything

Leah Lakshmi Piepzna-Samarasinha writes that sometimes we think we must save the world, and anything less is nothing.

But we, in our small crip circles, are the world.

The small, low-key things we do to keep each other alive are nothing. They are everything.

That is the quiet lesson of the disability pandemic.

Disabled people have always built networks of care. We will continue to. These webs will endure beyond COVID, beyond the next crisis, beyond the next wave of forgetting.

We survive because we refuse to let each other disappear.

About the Author
El Gibbs is an award-winning writer and disability advocate. Her work has featured in Growing up Disabled in Australia, Overland, Eureka Street, and Croakey.

Oral Health Care for the Institutionalized Elderly

Life expectancy has risen significantly across most countries over the past two decades, according to the World Health Organization Global Health Estimates. At the same time, older adults (particularly in countries such as the United States) are far more likely to retain their natural teeth into later life.

While this reflects progress in preventive dentistry, it also introduces new clinical and public health challenges. Without consistent and effective oral hygiene support, poor oral health can intensify systemic conditions and increase health risks, especially among residents of long-term care facilities.

This makes oral health care for the institutionalized elderly a growing global priority.

When Oral Health Declines, Overall Health Follows

For elderly individuals in residential care, oral health is not a cosmetic issue; it is directly connected to chronic disease management and survival outcomes.

Research has linked inadequate oral hygiene with:

• Worsening Type 2 diabetes

• Increased risk and progression of dementia

• Higher incidence of hospital-acquired and aspiration pneumonia

• Greater levels of frailty

Residents in care homes are particularly vulnerable. Many depend on carers for daily hygiene routines, and compromised immune systems amplify the consequences of neglected oral care.

Featured Snippet Summary

Why is oral health care important for institutionalized elderly people?
Poor oral hygiene can worsen diabetes, increase dementia risk, raise the likelihood of pneumonia, and contribute to frailty, particularly among elderly residents who rely on caregivers for daily support.

Recognition at Policy Level: Governments Begin to Respond

Several countries have formally acknowledged the gap in oral health provision within aged care systems.

In England, the National Institute for Health and Care Excellence published guidelines addressing oral health for adults in care homes. This was followed by a review by the Care Quality Commission, which found that many care home owners and staff were unaware of how to ensure that residents’ daily oral hygiene met acceptable standards.

Subsequently, NHS England introduced the Framework for Enhanced Health in Care Homes, followed by a government-issued oral health toolkit for adults in care homes.

In the United States, the comprehensive Smiles for Life curriculum, developed by Smiles for Life, includes a geriatric dentistry module designed to strengthen clinical knowledge.

Earlier pilot initiatives had already demonstrated that structured intervention could improve outcomes. However, scaling those efforts remains an ongoing challenge.

Access Barriers: When Residents Need a Dentist

Daily hygiene is only one component. Access to professional dental services remains a persistent obstacle in many care facilities.

Transport limitations, workforce shortages, and medical complexity often delay in-person dental visits. In response, teledentistry has emerged as a promising solution.

Recent implementations in:

• France

• Japan

• Australia

have demonstrated that remote consultations can support preliminary diagnosis and clinical advice. Digital tools reduce unnecessary transfers while improving timely assessment.

Featured Snippet Summary

How can teledentistry support oral health care for older adults in institutional settings?
Teledentistry enables remote consultation, preliminary diagnosis, and professional advice without requiring residents to travel, improving access and reducing delays in care.

Technology as a Force Multiplier

Emerging technologies are further expanding possibilities.

Research on the evaluation of mobile phone images by off-site dental practitioners has demonstrated effectiveness in screening schoolchildren. Similar approaches can be adapted for aged care settings.

Additionally, real-time artificial intelligence tools, such as Smilio.ai, offer innovative, cost-efficient, and person-centred opportunities to screen for oral diseases in institutional settings.

These tools do not replace clinicians. Instead, they enhance early detection, streamline referrals, and make oral health care for institutionalized older adults more scalable.

Workforce Integration: Training Beyond Dentistry

Sustainable improvement depends on empowering those already providing daily care.

In the United Kingdom, Knowledge Oral Healthcare delivers oral health training to nurses, allied health professionals, and carers in the aged and disability sectors. In Australia, Seniors Dental Care Australia provides similar programs.

A notable systems-level intervention occurred within the U.S. Department of Veterans Affairs, where oral health care was integrated into inpatient services via the nursing workforce. Translating research into clinical practice resulted in measurable improvements in oral hygiene and significant reductions in hospital-acquired pneumonia.

This model demonstrates that embedding oral health responsibilities into existing care frameworks can yield substantial public health gains.

Advocacy and Public Accountability

Policy reform is often accelerated through coordinated advocacy.

In Australia, twelve key stakeholder organizations (including the Public Health Association of Australia and the Australian Dental Association) issued a joint media release on World Oral Health Day, prior to the federal election, calling for stronger aged-care oral health strategies.

The Australian Dental Association’s “Stop the Rot” campaign further highlights the need for systemic reform in aged care.

Media engagement has also played a role. The Australian Health Journal released a World Oral Health Day video advocating for the prioritisation of oral health in aged care and disability services.

The Demographic Reality We Cannot Ignore

As life expectancy increases and more older adults retain their natural dentition, oral health demands will intensify rather than decline.

Improving oral health care for the institutionalized elderly requires coordinated effort from:

• Governments

• Aged care providers

• Dental practitioners

• Nurses and allied health professionals

• Consumer and advocacy organizations

Innovation in teledentistry, mobile imaging, and artificial intelligence offers meaningful opportunities. However, technology alone cannot resolve systemic gaps. Policy alignment, workforce training, and sustained political commitment remain essential.

Closing Perspective

The evidence is clear: oral health is inseparable from general health. For elderly residents in institutional care, neglecting the mouth risks compromising the whole person.

Ensuring high-quality oral health care for the institutionalized elderly is fundamental to maintaining dignity, preventing disease, and achieving equitable health outcomes in ageing societies.

By Kenneth Eaton & Leonie Short

Mental Health a Priority for the Global Healthcare Workforce

The COVID-19 pandemic placed extraordinary pressure on health systems worldwide, and nowhere has this strain been more visible than in the mental health and well-being of healthcare workers. As the world confronts the aftermath of COVID-19 and future public health emergencies, making mental health a priority for healthcare professionals is no longer optional. It is essential for patient safety, workforce sustainability, and health system resilience.

This article provides an evidence-based overview of the mental health challenges faced by healthcare workers during crises, with particular attention to COVID-19. It also outlines practical, organizational, and policy-level actions needed to protect and promote mental well-being in emergencies and in routine care.

A Second Pandemic: Mental Health After COVID-19

While infection rates have declined in many regions, the psychological consequences of the pandemic continue to unfold. Communities worldwide are facing increased trauma, grief, substance use, loneliness, and economic insecurity. Within this broader crisis, healthcare workers are among the most affected groups.

Even before COVID-19, healthcare professionals faced high levels of occupational stress. The pandemic intensified existing vulnerabilities through prolonged workloads, repeated exposure to death and suffering, moral dilemmas, and personal risk of infection. As a result, mental health must be treated as a priority not only during crises but throughout recovery and rebuilding phases.

Stress, Burnout, and Psychological Harm in Healthcare Settings

Healthcare workers are routinely exposed to conditions that elevate psychological risk, including:

• Long working hours and heavy workloads

• Insufficient staffing and limited resources

• Moral conflicts and ethical dilemmas

• Workplace bullying or lack of social support

• Limited control over work environments

These stressors contribute to burnout, anxiety, depression, sleep disorders, and trauma-related symptoms. Burnout, recognized by the WHO as an occupational phenomenon, is characterized by exhaustion, emotional detachment from work, and reduced professional efficacy.

Importantly, burnout not only harms workers. Research consistently links burnout to lower quality of care, increased medical errors, higher absenteeism, staff turnover, and reduced patient satisfaction. Making mental health a priority is therefore directly tied to patient safety and system performance.

Moral Injury and Vicarious Trauma on the Frontlines

Beyond burnout, healthcare workers frequently experience moral injury, a psychological distress resulting from actions (or inaction) that conflict with deeply held moral values. During crises, clinicians may be forced to make life-and-death decisions under resource scarcity, such as rationing ventilators or oxygen.

Moral injury is not itself a mental illness, but it increases vulnerability to depression, PTSD, suicidal ideation, and intentions to leave the profession. Similarly, vicarious traumatization, secondary trauma from empathic engagement with suffering patients, can lead to fatigue, emotional numbness, sleep disturbances, and despair.

Stigma, Silence, and the Risk of Suicide

Despite high levels of distress, many healthcare professionals suffer in silence. Stigma around mental illness, fear of professional consequences, and concerns about licensing or career advancement discourage help-seeking.

Global evidence shows elevated suicide rates among healthcare workers, particularly among women and certain medical specialties. Mental health struggles, burnout, and compassion fatigue are also leading drivers of workforce attrition worldwide. When healthcare workers leave or are lost to suicide, health systems lose irreplaceable skills, experience, and institutional memory.

Mental Health a Priority During Pandemics and Public Health Emergencies

COVID-19 magnified existing risks. Studies across dozens of countries report high prevalence of depression, anxiety, PTSD, sleep disturbances, and emotional exhaustion among healthcare workers during the pandemic. Women, nurses, frontline staff, younger workers, and those in low-resource settings were disproportionately affected.

Similar patterns have been documented during earlier outbreaks, including SARS, MERS, Ebola, and large-scale disasters. The evidence is clear: public health emergencies consistently produce long-lasting psychological harm among healthcare responders, particularly where protections and support systems are weak.

Why Mental Well-Being Is More Than the Absence of Diagnosis

Mental health is not defined solely by diagnosable disorders. Chronic stress, fear of infecting loved ones, overwork, moral conflict, guilt, and exhaustion can severely impair well-being even when diagnostic thresholds are not met.

Large longitudinal studies now underway will provide deeper insights into long-term impacts. However, existing evidence already justifies early intervention, prevention, and sustained support rather than waiting for clinical illness to emerge.

The Role of Self-Care in Sustaining the Workforce

Healthcare professionals are trained to prioritize patients, often at the expense of their own well-being. Yet research consistently shows that self-care is essential for resilience, compassion, and long-term effectiveness.

Effective self-care includes:

• Self-awareness and emotional regulation

• Maintaining sleep, nutrition, and physical activity

• Mindfulness, relaxation, or spiritual practices

• Strong social connections

• Allowing emotional expression rather than suppression

Self-care supports not only individual well-being but also safer, more empathetic, and more sustainable patient care. However, self-care alone is insufficient without organizational and systemic support.

Moving Beyond Symbolic Support to Real Protection

Public displays of gratitude, such as applause or symbolic rewards, offer short-term recognition but do little to address the root causes of distress. Framing healthcare workers as “heroes” may even discourage help-seeking by reinforcing expectations of invulnerability.

What is needed instead are evidence-based prevention and intervention strategies, including:

• Psychological first aid during crises

• Accessible mental health services and self-help programs

• Telemedicine platforms that reduce workload and isolation

• Mindfulness-based stress reduction and resilience training

• Peer support, reflective practice groups, and structured debriefing

Interventions such as WHO’s Self-Help Plus (SH+) demonstrate that scalable, non-diagnostic approaches can significantly reduce psychological distress in high-adversity settings.

Leadership, Culture, and Organizational Responsibility

No mental health strategy will succeed without a supportive workplace culture and leadership. Healthcare leaders must actively reduce stigma, normalize mental health discussions, and foster environments of trust, empathy, and inclusion.

Effective organizational measures include:

• Reasonable limits on shift length and workload

• Mandatory breaks and protected recovery time

• Access to confidential mental health services

• Non-punitive responses to medical errors

• Trauma-informed leadership and supervision

Leadership that acknowledges moral dilemmas and supports ethical reflection plays a critical role in preventing moral injury.

Towards Systemic Change in Healthcare Systems

The pandemic exposed how fragile mental health systems are at precisely the moment they are needed most. Health systems must be redesigned to balance efficiency with humanity, and productivity with sustainability.

Global guidance emphasizes:

• Whole-of-society approaches to mental health

• Investment in long-term mental health infrastructure

• Integration of healthcare workers’ voices through co-production

• Addressing stigma as a systemic issue, not an individual failing

Making mental health a priority requires embedding well-being into policy, financing, workforce planning, and professional standards.

Policy Actions to Make Mental Health a Priority

Evidence supports the following actions:

• Implement long-term, evidence-based mental health programs for healthcare workers

• Ensure adequate staffing levels and fair compensation

• Normalize help-seeking and protect confidentiality

• Actively combat stigma within healthcare institutions

• Involve frontline workers in policy design and decision-making

• Invest in digital and innovative mental health solutions

• Expand research on preparedness and long-term impacts

Conclusion: A Test of Global Commitment

Healthcare workers have carried societies through one of the most disruptive global crises in modern history. Protecting their mental health is not an act of gratitude; it is a responsibility.

Making mental health a priority for healthcare workers strengthens care quality, safeguards patients, and helps health systems withstand future crises. Failure to act carries personal, societal, and economic costs that no system can afford.