Article by A/Prof Chaminda Jayampath Seneviratne, Principal Investigator, Oral Health Academic Clinical Programme, National Dental Centre Singapore
The robust training of clinical medicine in dentistry has seen professional dentists come forward in voluntary medical engagements and services for COVID-19 control and spread. With their detailed understanding of head and neck anatomy, licensed dentists are eligible to administer COVID-19 diagnostic tests such as nasopharyngeal and oropharyngeal swabs.
Dental clinics that are well equipped with facilities to control aerosol spread of infections, such as negative pressure rooms and high-volume excavators, can offer help to augment the capacity for COVID-19 screening.
Dentists can also assist their medical counterparts in the inpatient setting. Such duties include patient triage, monitoring vital signs, administering oxygen and injectables, and writing prescriptions.
Dental fraternity at the global forefront during COVID-19
In Singapore, aggressive mass-scale testing for COVID-19 was implemented for foreign workers residing in dormitories. This major operation was supported by multiple government agencies, including the National Dental Centre Singapore (NDCS).
In this massive operation, NDCS staff worked collaboratively with colleagues across various professional backgrounds including clinicians, nurses, pharmacists, radiographers, and medical social workers. With the cohesive and coordinated effort across the medical fraternity, the considerable task to successfully establish and staff the field swab clinics was able to be done within a short period of time.
In the UK, dentists, dental support teams as well as clinical academics have played a vital role in supporting the NHS. It was reported that dental staff from Bath Health NHS Trust and QMUL Institute of Dentistry helped in maternity, critical care, and emergency units. Dental hospitals have undergone reconfiguration to support medical care.
In the US, dentist volunteers in states such as Virginia and California have responded to appeals to assist with critical emergency care needs, and have been redeployed to the frontlines. States such as California have also made changes to their law to allow greater flexibility in scope and licensure in the time of a catastrophic emergency. The law provides immunity from liability for care provided "in good faith" during an emergency for a person who "voluntarily and without compensation or expectations of compensation, and consistent with the dental education and emergency training that he or she has received, provides emergency medical care to a person during a state of emergency." This would be an important consideration for other countries to follow.
Dental education and training in the new COVID-19 normal
The strengthening of the training and curriculum in dental schools can also be another key aspect in the contribution of the management of COVID-19. Dental schools could revise and reinforce education on infection control measures in dental practice. Some areas where universal precaution protocols can be re-evaluated and strengthened include hand hygiene, donning and doffing of PPE, respiratory hygiene or cough etiquette, sterilization of instruments and devices and disinfection of workplaces.
Infection control practices could be re-examined and improved to prevent cross-infection in a dental setting, although recent attempts have been made to review the current literature on precautions when providing dental care during the current pandemic, and make recommendations for dental practitioners.
The curriculum in dental schools could also be expanded to include competencies in pandemic and disaster relief. Such exposure enables dentists and their dental auxiliaries to augment the existing medical professionals in response to declared medical emergencies.
Dentists have already been trained to undertake oral swab procedures and biopsies as part of oral cancer screening. However, in the wake of a pandemic outbreak, dental students could be additionally trained to perform nasopharyngeal and oropharyngeal swabs, as well as saliva sampling procedures.
Dentists can also be a part of an effective surveillance network by notifying public health authorities about unusual oral symptoms or clinical presentations detected in questionable frequency in a population. Thus, dentists can facilitate the early detection of a disease outbreak or bioterrorism attack, and prevent mass casualties by prompt interventions.
In addition, voluntary medical work should be made a part of the community dentistry curriculum. In dentistry, clinical outreach programs during undergraduate training are still at their infancy. Such programs can be quickly scaled up.
Some dental schools have already included community engagement programs as a part of the dental curriculum. Such engagements instill a sense of voluntarism and prepare dental graduates to contribute in future disease outbreaks. Students will have additional opportunities to see the complexities of social and cultural aspects of their future patients. In addition, students are likely to gain appreciation for alternative career paths in public health as well as volunteer work. These experiences also have a positive impact on their understanding of ethical and social issues related to oral health care.
A study by Stony Brook University's humanitarian dental mission to rural Madagascar found that all dental students who participated gained experience and confidence in their clinical ability and increased their speed in performing procedures under demanding conditions. Beyond medical training, such programs also nurture team work, communication skills and leadership qualities in young dentists.
In the new COVID-19 'normal' setting, there is a greater need for refresher courses on infection control for practicing dentists, in order to adjust with patients' apprehension. Dental authorities and dental schools should urgently look into this need and develop protocols and appropriate courses for dental practitioners.
Research on infection control in the dental setting needs to be advanced. In order to formulate best practices, new research should be conducted across all disciplines of dentistry covering all procedures and their respective infection control strategies.
The field of public oral health should find new research avenues on community oral health that can provide an insight on the perception and apprehension of patients during hospital visits. Such information would help to revive the financial viability of public hospitals and private clinics.
The COVID-19 outbreak as well as harsh lock down practices worldwide have created a stressful environment for many people globally. Such situations have been shown to lead to poor oral health. Oral healthcare professionals should consider developing online platforms to provide information on oral hygiene and oral health maintenance. Digitalized healthcare services can be implemented with a qualified team of dentists being available online to provide reliable oral healthcare solutions in an accessible, affordable and appropriate manner and allay patients' dental concerns during lockdown periods. Oral healthcare professionals can also engage in voluntary service for residents in community housing to promote good oral health.
The role of the dentist in a pandemic can be beyond dentistry. By virtue of their training and practical experience, dentists can provide services in various ways to reduce the strain on the healthcare sector.
Volunteerism in such a time also leaves a positive impact on the individual. Pandemics rarely occur, and practical experience gained will be a lifelong lesson for the volunteer. In fact, the fighting spirit of a volunteer working in risky operations instills a high moral esteem and self-confidence.
The rejuvenated personality of the volunteer can prove to be valuable in developing his dental career in future. The selfless voluntary service will be appreciated by the larger community and future generations. Together we will be able to pull through this crisis and emerge stronger than before.