ADA 'respectfully yet strongly disagrees' with WHO guidance recommending delay of dental care

ADA graphic

The American Dental Association released a statement Aug. 12 stating it "respectfully yet strongly disagrees" with the World Health Organization's interim guidance recommending that "routine" dental care be delayed in certain situations because of COVID-19.

Photo of Dr. Chad P. Gehani
Dr. Gehani

"Oral health is integral to overall health. Dentistry is essential health care," ADA President Chad P. Gehani said. "Dentistry is essential health care because of its role in evaluating, diagnosing, preventing or treating oral diseases, which can affect systemic health."

The ADA Board of Trustees adopted an ad interim policy stating dentistry is essential health care during a video call July 27, and the House of Delegates will consider it as a resolution during its virtual meeting in October.

As U.S. COVID-19 cases began to rise in March, the ADA called for dentists to postpone all but urgent and emergency care in order to understand the disease and consider its effect on dental patients, dental professionals and the greater community, Dr. Gehani said.

Both the ADA and Centers for Disease Control and Prevention then issued interim guidance for dental professionals related to COVID-19, calling for the use of the highest level of personal protective equipment available, such as masks, goggles and face shields. To minimize aerosols, the ADA guidance also recommended dental professionals use rubber dams and high-velocity suction whenever possible and hand scaling instead of ultrasonic scaling when cleaning teeth.

"Millions of patients have safely visited their dentists in the past few months for the full range of dental services," Dr. Gehani said. "With appropriate PPE, dental care should continue to be delivered during global pandemics or other disaster situations."

In its interim guidance, released Aug. 11, WHO recommends that "routine" oral health care be delayed until COVID-19 transmission rates decrease from community transmission to cluster cases or according to official recommendations at the national, subnational or local level.

"Most of the media coverage of the WHO interim guidance missed that the guidance did not intend to override 'official recommendations at [the] national, sub-national or local level,'" said Dr. Christopher H. Fox, CEO of the International Association for Dental Research and American Association for Dental Research. "The ADA and the CDC have clear interim guidance for the safe delivery of oral health care. However, IADR and AADR would respectfully disagree with the WHO interim guidance that defines preventive oral health care as nonessential health care."

WHO Chief Dental Officer Benoit Varenne, Ph.D., also expressed concerns about media coverage of the interim guidance in an Aug. 13 email to global dental leaders.

"Unfortunately, a number of media headlines intentionally or not — when they are referring to the WHO guidance, did not mention that the recommendation to delay routine oral health care is only suggested in an intense uncontrolled community transmission scenario. A scenario that [does] not fit with the current situation of [most countries] around the world," Dr. Varenne said. "So please be aware of the missing information sometimes disseminated by the media that could increase fear and concern of patients seeking oral health care. I think we have all to play a part in sharing with the public, national dental associations and health authorities the full story provided in the guidance document."