The COVID-19 pandemic represents an unprecedented global public health crisis. Oral health professionals, dental associations and regulatory bodies are facing diverse challenges to continue providing dental care and promoting the oral health of the population, while at the same time protecting patients and practitioners from the health threat posed by SARS-CoV-2.
This library contains guidance for oral health professionals and other resources relating to the COVID-19 pandemic issued by national and international bodies.
25 February 2021
COVID-19 continues to have a severe impact on global health, society and economies. Vaccines are essential in fighting the pandemic as they can protect people from getting ill and ease reliance on non-pharmaceutical public health measures, such as service closures and stay-at-home orders[i]. Several COVID-19 vaccines have been approved for use, having proven safe and effective in large-scale clinical trials. Over 200 other vaccine candidates are in various stages of development[ii]. As of late January 2021, nearly 100 million COVID-19 vaccine doses have been administered in over 50 countries, mostly to vulnerable populations such as the elderly and at-risk groups like healthcare workers[iii].
As countries begin implementing vaccination programmes, there is a need to highlight several considerations relating to dental services and the oral health workforce. Oral health is a fundamental component of overall health and wellbeing[iv],[v] and oral health care is an essential public service. Vaccination of dentists, their team members and other oral health professionals is important to contribute to continued access to care. Dentists are also highly trained professionals that have regular interactions with people about their health, and are therefore well positioned to support national vaccination programmes.
Considering these points, FDI Council asserts the following key principles related to dentistry and COVID-19 vaccination:
- Dentists, other oral health professionals and support staff are front-line providers of an essential health care service and should therefore be included in priority vaccination groups. They are in regular contact with each other and the patients who visit their healthcare facilities. If they contract COVID-19, it can result in practice or clinic closures. Including them in priority vaccination groups is therefore important for avoiding oral health workforce dropout and jeopardizing access to care.
- Equitable access to COVID-19 vaccinations is needed for the health of people globally, including vulnerable populations and healthcare workers. To this end, FDI Council fully supports initiatives to improve access to vaccines in underserved localities, such as the COVAX facility being co-led by GAVI, WHO and CEPI[vi].
- Efforts should be made to enable dentists to administer COVID-19 vaccines when possible within national legislation and regulations, and with minimal disruption to oral health care services. Several countries have already confirmed that dentists will be permitted to administer COVID-19 vaccinations, including in countries where dentists have not previously been permitted to give vaccines[vii].
- Dentists are well positioned to provide evidence-based information about vaccination and may receive questions from their patients about COVID-19 vaccines. Health authorities and National Dental Associations should ensure dentists, their team members, other oral health providers and dental students have access to accurate, up to date information on the vaccines available in their country or locality and the specificities of the vaccination programme in place.
- Given the expected large number of vaccine approvals and high population uptake in the near future, there may be a higher number of suspected adverse drug reactions than in normal times. Dentists can play an important role in pharmacovigilance programmes. Health authorities and National Dental Associations should ensure dentists are well informed of national pharmacovigilance systems and methods for reporting suspected adverse events.
FDI Council expresses its sincere thanks to all oral health professionals, National Dental Associations and other members of the global oral health community for their dedication in responding to the ongoing crisis.
Please visit the FDI COVID-19 RESOURCE LIBRARY for access to practical resources and more information on the outbreak.
[i] World Health Organization. Vaccines and Immunization: What is Vaccination? Available from: https://www.who.int/news-room/q-a-detail/vaccines-and-immunization-what-is-vaccination [Accessed 2 February 2021].
[ii] GAVI: The Vaccine Alliance. The COVID-19 Vaccine Race – Weekly update, 27 Jan 2021. Available from: https://www.gavi.org/vaccineswork/covid-19-vaccine-race [Accessed 2 February 2021].
[iii] Ritchie H, Ortiz-Ospina E, Beltekian D, et al. Coronavirus (COVID-19) Vaccinations. Available from: https://ourworldindata.org/covid-vaccinations [Accessed 2 February 2021].
[iv] Glick M, Williams DM, Kleinman DV, Vujicic M, Watt RG, Weyant RJ. A new definition for oral health developed by the FDI World Dental Federation opens the door to a universal definition of oral health. Int Dent J 2016 66: 322-324.
[v] World Health Organization. Oral Health: Achieving better oral health as part of the universal health coverage and noncommunicable disease agendas towards 2030. Report by the Director General. Executive Board 148th Session 2020. Available from: https://apps.who.int/gb/ebwha/pdf_files/EB148/B148_8-en.pdf [Accessed 5 February 2021].
[vi] GAVI: The Vaccine Alliance. COVAX Facility. Available from: https://www.gavi.org/covax-facility#what [Accessed 2 Ferbruary 2021].
[vii] In a survey of 57 National Dental Associations conducted by FDI in December 2020 and January 2021, 17% reported that their country has already confirmed that dentists are or will be permitted to administer COVID-19 vaccinations.
After its emergence in December 2019, COVID-19 has grown to pandemic proportions with over 5.7 million cases and 350,000 deaths confirmed in over 200 countries as of the beginning of June 2020. COVID-19 is not only negatively impacting people’s health, but also economies, education, productivity and the overall strength of health systems. The lack of effective treatment or vaccine means that infection control through non-pharmaceutical public health measures currently appear to be the only means to combat the pandemic1.
The outbreak is causing significant disruption to dental practice worldwide. Oral health professionals, dental associations and regulatory bodies are facing diverse challenges to continue providing dental care and promoting the oral health of the population, while at the same time protecting patients and practitioners from the health threat posed by SARS-CoV-2. Dental care is unique in that many procedures are performed with an average of around 35cm space between the patient’s mouth and the practitioner’s face2. Some dental procedures generate a large number of droplets and aerosols, therefore special attention and consideration are required in developing care guidelines and regulations during the pandemic3. The continuing operation and long-term survival of many dental practices is also threatened by the economic and social challenges arising due to care restrictions, practice closures and shortages of personal protective equipment (PPE), as well as the need of investing in new types of PPE and technology4.
As this is a new biological threat, there is a lack of knowledge and tools with which it can be fought. Evidence about how SARS-CoV-2 is spread and infects people is currently lacking and many of the public health decisions and recommendations in place are based on what is known about similar viruses. There is therefore a need to continuously review and update recommendations. Health professionals may need to update and change behaviours in-line with evidence as it evolves.
Guidelines and regulations to manage these challenges are being developed by appropriate national bodies, and oral health professionals are rapidly reviewing and implementing new guidance and requirements.
In view of this, FDI Council recommends some key principles for dental practice and oral health promotion during the current pandemic:
- Oral health is a fundamental component of overall health and well-being5, and oral healthcare is an essential public service that must be made as broadly accessible as possible. Authorities should ensure regulations do not unnecessarily impede access to oral healthcare and put measures in place to improve access where feasible, including tele-dentistry services, emergency clinics and oral health promotion initiatives.
- Oral health professionals and oral healthcare should be included in all discussions and decisions related to the regulation and guidance of healthcare delivery and health professionals during the pandemic.
- Where possible and relevant, authorities should provide appropriate financial and administrative support to dentists as business owners and liberal professionals, and implement appropriate fiscal measures, to reduce the financial burden on dental practices and ensure the continuation of adequate care during and after the pandemic.
- All regulations and guidance for oral health professionals and oral healthcare should take into account the current public health situation and needs of the country, and not only the individual infection risk of practitioners and patients.
- Oral health professionals must strictly follow all national guidelines and regulations in place, including those relating to personal protective equipment (PPE), treatment procedures and patient intake procedures.
- Authorities should ensure easy access to PPE at reasonable costs.
- Oral health professionals have a responsibility to assure emergency care whenever possible and as permitted by national regulations.
- Oral health professionals should take every opportunity to communicate and reinforce oral disease prevention messages to help reduce treatment need, avoidable dental visits and healthcare costs.
- Dentists/practice owners have a responsibility to protect the health and well-being of their staff and patients.
- Further research into SARS-CoV-2 and its transmission, including specific considerations for dental practice, is essential to allow appropriate guidance to be made.
FDI Council expresses its sincere thanks to the global oral health community for their dedication in responding to the ongoing crisis.
1 World Health Organization. Surveillance strategies for COVID-19 human infection: Interim Guidance 10 May 2020. Geneva: World Health Organization;2020. Available from: https://www.who.int/publications-detail/surveillance-strategies-for-covid-19-human-infection [Accessed 2 June 2020].
2 Wajngarten D, Garcia PP. Effect of magnification devices on dental students’ visual acuity. PloS one. 2019;14(3).
3 Thamboo A, Lea J, Sommer DD, et al. Clinical evidence based review and recommendations of aerosol generating medical procedures in otolaryngology – head and neck surgery during the COVID- 19 pandemic. J Otolaryngol Head Neck Surg 2020;49(1):28.
4 European Centre for Disease Prevention and Control. Safe use of personal protective equipment in the treatment of infectious diseases of high consequence. Stockholm: ECDC;2014; Izzetti R, Nisi M, Gabriele M, Graziani F. COVID-19 transmission in dental practice: brief review of preventive measures in Italy. J Dent Res. 2020; Apr 17.
5 Glick M, Williams DM, Kleinman DV, Vujicic M, Watt RG, Weyant RJ. A new defintion for oral health developed by the FDI World Dental Federation opens the door to a universal definition of oral health. Int Dent J 2016 66: 322-324
|COVID-19 recomendaciones para odontologia||
El Ministerio de Salud Argentina
|COVID-19 Special Edition||
African Journal of Conservative Dentistry (AJCD)
|COVID-19: Jak wykonywać procedury endodontyczne||
Polskie Towarzystwo Stomatologiczne
|COVID-19: Procedimentos em clínicas, consultórios ou serviços de saúde oral dos cuidados de saúde primários, setor social e privado||
Ministério da Saúde República Portuguesa, Serviço Nacional de Saúde, Direção-Geral da Saúde
|COVID‐19 dentistry‐related aspects: A literature overview. Vittorio Checchi, Pierantonio Bellini, Davide Bencivenni, Ugo Consolo||
International Dental Journal
|Dental care and coronavirus (COVID-19)||
Oral Health Foundation
|Dentistry and coronavirus (COVID-19): Moral decision-making. Paul Coulthard||
British Dental Journal
|Documento valutazione rischi COVID-19||
Associazione Nazionale Dentisti Italiani
|Documentos técnicos COVID-19||
El Ministerio de Salud y Protección Social
|Einschätzung der corona gefährdungslage und aktualisierte empfehlungen||