Changing Scenario in Dental Public Health Amid COVID-19 Pandemic

What a Public Health Dentist Can Do?

INTRODUCTION

George Santayana once said, “Those who cannot remember the past are condemned to repeat it.” Indeed so, travelling back in time to the Middle Ages, the black death – bubonic plague, smallpox, cholera, several influenzas, HIV/AIDS, etc., have caused the death of millions and had a massive blow on the economy and political systems of affected nations.[¹] In December, 2019, an outbreak of coronavirus disease (COVID-19) emerged that has challenged the state-of-the-art medical technologies even in developed countries and truly reflecting the “failure of success.” It was declared a pandemic on March 11, 2020, by the World Health Organization (WHO). Evidence suggests that SARS COV-2 is primarily transmitted by direct or indirect contact through airborne droplets by coughing or sneezing from an infected person. Countries across the world have customized their efforts for COVID-19 control according to local context and vaccination drive.[²]

The Occupational Safety and Health Administration designates the performance of aerosol-generating procedures on known or suspected COVID-19 patients as “very high risk.” These dental procedures have become problematic during the pandemic, providing an opportunity to shift to nonaerosolizing procedures and a greater focus on prevention.[³] The field of Public Health and Preventive Dentistry facilitates to understand the distribution and determinants of oral diseases and to educate, motivate, and promote oral health in diverse populations.[⁴]

Enough literature is available on the protective aspects and prevention of cross infection in a clinical dental setup.[^5,6] However, emphasis on integrating public health dentists into the various initiatives taken at international, national, and local levels is still lacking. This article aimed to provide an overview of the various roles an untapped dental public health specialist can play to curb the impacts of the COVID-19 in providing optimum oral health care to the masses.

HOW CAN PUBLIC HEALTH DENTIST PLAY THEIR PART?

The dental public health professional, with understanding of dental problems and competence in dealing with community activities, can facilitate appropriate COVID-19 preventive measures at the individual, institutional, and community levels set by government from time to time, which includes:

1. Health promotion
2. Support to medical health services and public health administration
3. Testing and tracking
4. Surveillance
5. Tobacco cessation.

HEALTH PROMOTION

It is widely documented that a healthy immune system is crucial for both prevention and protection from COVID-19, wherein zinc, Vitamin C, and Vitamin D supplements can be used for patient-based requirements.[⁷] Ayurveda and yoga can play a key role to boost immunity as per the mentioned guidelines of the AYUSH ministry.[⁸] Integrating the above schemes, a public health dentist can educate patients attending the dental outpatient department (OPD) and the community by promoting the agenda of “Fitness ka dose, 30 minutes har roj” through pamphlets distribution at the primary health centres (PHCs) and anganwadi centres and through COVID-19 tailored content using infographics targeting social media and digital platforms.

SUPPORT TO MEDICAL HEALTH SERVICES AND PUBLIC HEALTH ADMINISTRATION

Under the leadership of public health dentists, “the SMS approach” can be implemented, which includes social distancing of at least one meter, use of masks as respiratory etiquette, and sanitization for frequent hand hygiene. The awareness for widespread practice of SMS can be generated among the local population in collaboration with rural and urban local bodies, paramedical functionaries engaged in different roles for COVID-19 containment.

The prime minister's mantra on “Do gaj ki doori, mask hai zaroori” can be promoted at the community level by the Public Health Dentistry departments. Dental institutes can strictly follow thermal screening, adequate distancing in queues, and hand hygiene for patients and attendants. Few lines of brief advice can be printed in the OPD ticket on safety measures to be followed for COVID-19 prevention.

Since the economic collapse may have a greater consequences than the deaths by COVID-19, a proficient public health dentist can negotiate with the stakeholders, legislators, third-party payers, and advocate policymakers on the integration of dental insurance with health policies, while encouraging incentives for preventive, nonsurgical, and nonaerosol procedures that can be beneficial to the disadvantaged.

TESTING AND TRACKING

Testing, tracing, and treatment have been a major strategy in COVID-19 control. Public health dentists can facilitate the testing of suspected individuals and patients scheduled for invasive dental treatment at the institution, thus preventing the oral health-care service providers from contracting COVID-19. Active contact tracing of the individuals who interacted with positive patients can be done in collaboration with medical service providers. Besides, the practice of teleconsultation for patients can be adopted to lessen the burden of people seeking dental care under the supervision of public health dentists.

SURVEILLANCE

Surveillance of oral health needs as a result of delayed dental care due to pandemic through telephone, e-mail, web-based surveys, or mobile applications can be initiated, and national level data can be collected that could be invaluable to track the disease progression and predict possible oral health outcomes. The same can be used in setting priorities, considering the available resources and constraints for robust program planning to improve pandemic preparedness and response through evidence-based decision making to prevent and mitigate the existing social gradient for oral diseases. Likewise, facilitating further research on infection control measures, active monitoring of patient and provider safety with priority on testing existing personal protective equipment combinations, and COVID-19 tests at clinical settings are recommended for restarting a full-fledged safe practice.

TOBACCO CESSATION

Recent studies have revealed that there is a significant improvement in smoking cessation during this pandemic compared to before.[⁹] Authors have also suggested that fear of the pandemic and lockdown measures could be the possible reason for such outcomes.[¹⁰] An operational research study conducted in India to assess the impact of the pandemic and the lockdown on the behaviour of tobacco users has highlighted that awareness activities about the harmful effects of tobacco during the coronavirus pandemic have to be strengthened. Further, it has been emphasized that measures to motivate and support tobacco users to quit have to be provided through cessation services.[¹¹] Hence, a public health dentist can make use of this situation to plan vigorous smoking cessation counselling methods using quitlines, messaging reminders, especially targeting the marginalized populations.

WHAT COULD BE THE WAY FORWARD?

COVID-19 restrictions are being lifted gradually, which is not about returning to the prepandemic normal but about cautiously transitioning to a new normal, and for that, active community participation is the need of the hour. A public health dentist can take headship to sensitize the community through cost-effective means including messaging, radio programs, and television advertisements concerning the maintenance of good oral health and its role in overall health, especially during this crisis. In addition, dental curriculum should include competencies and additional training in pandemic and disaster relief for early detection of disease outbreak and prompt interventions. Continuing dental education on infection control measures should be organized to the postgraduates and general dentists for an effective best practice.

CONCLUSION

The COVID-19 pandemic presents several opportunities to shift toward preventive dentistry. Future research could include developing and testing minimally invasive approaches to reduce aerosol generation during dental procedures, teledentistry models, smoking cessation, and evaluating alternative financing schemes for preventive procedure. The saying “Prevention is better than cure,” which is often neglected, like the unheard voice of a public health dentist, is now being proven otherwise in the grim wake of the COVID-19 pandemic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.