Rational perspectives on risk and certainty for dentistry during the COVID-19 pandemic

Resumo

Clinical dental practice exposes the dental team and patients to infectious airborne disease agents, due to the close contact during clinical care, and the infectious aerosols from most dental procedures. The U.S. Centers for Disease Control and Prevention (CDC), the American Dental Association (ADA) and other organizations developed recommendations to address the specific risk profile of SARS-CoV-2 transmission, adding additional protective measures to established standard precautions.

When deciding on re-opening of dental services it is important to remember that so far, no reliable data on work-related infection risk for dental personnel are available. Combined with other uncertainties it seems prudent to follow four key principles: 1) All patients should be considered as potentially infectious; 2) procedures generating aerosols should be avoided, limited or closely managed; 3) infection control should be increased according to recommendations; 4) PPE measures should be maximized.

Dental teams must follow ethical principles in providing the best possible and safe dental care. Yet, as business owners, they are facing existential impacts from reduced patient visits and loss of income resulting from service limitations. Reconciling the conflict of risking their life or their livelihood under the COVID-19 pandemic is not a welcome or easy choice. Decisions must be based on best possible evidence, and need to be revisited as the pandemic, and economic conditions change.

COVID-19 also unmasked the challenges of access and financial coverage for dental care in the U.S. Sustainable preparation for future pandemics should consider reforms towards a more equitable system with better coverage.