Coronavirus: shaping the practice of dentistry and oral care

Covid-19

20 April 2020

COVID-19 has devastated global communities and drastically changed the operation of almost every domain of society, culminating in a radical transformation of everyday life as we know it. As alarming ICU footage and eye-opening exponential curves began to take the world by storm, notions of “quarantine” and “self-isolation” began to enter our vernacular and routines, followed by a subsequent wave of politicians concluding that, after careful consideration of letters from distressed local children, the Tooth Fairy and Easter Bunny (two dangerous potential superspreaders) would be exempt from travel and social-distancing restrictions. In the face of extreme change and uncertainty, dentists’ initial panic surrounding the threat of rapidly diminishing and exorbitantly expensive mask and sanitiser supplies was swiftly surpassed by grave concerns for public safety, with the subsequent closure of many clinics being accompanied by donations of remaining PPE to our medical colleagues on the frontline.

Of course COVID-19 has not been a crisis of oral health specifically, but the reporting of global events, policy decisions, individual behaviours and celebrations of community precipitated by the virus have prompted my reflection on dental practice and our responsibility to our patients and the wider community. In the midst of this pandemic, we all have a unique opportunity in isolation for reflection, self-development and to contribute meaningfully by applying ourselves in the absence of our beloved handpieces.

Evidence-based decision making and communication strategies

Influencers and misinformation take a range of forms in contemporary society, many with insidious implications for our patients’ health. In an era in which Instagram models espouse celery to be the cure for COVID-19, and people panic-buy hydroxychloroquine after prominent politicians proclaim that it does the same, the spread and internalisation of ‘fake news’ is almost as contagious as the virus itself. In our professional lives, it is our responsibility to unfurl the web of untruths that might be guiding the health practices of the individual, as well as to support the oral and general health of the community as a whole. Similarly, we should be applying the same level of critical thinking in our own careers - from our assessment of the literature that shapes our evidence-based practice to the ways in which we can tend to areas of clinical weakness to optimise our performance as dentists. In such situations that require artful communication and up-to-date knowledge and skills, we should equip ourselves with an armamentarium of techniques. If we do not possess the necessary skills at present, we need to empower ourselves, both through self-motivation to embrace innovation and refresh the basics, and engagement with our professional networks. This drive has manifested recently as a series of webinars and online CPD and I sincerely hope that this trend of productivity continues to punctuate our quests to look after ourselves and our loved ones in this turbulent time.

Prioritising oral health in self-care regimes

While most basic hygiene products are flying off supermarket shelves as the world prepares for an apocalypse, why aren’t empty oral care aisles the ones making the news headlines? It is clear that self-care has become a priority for many, as facemasks, yoga and bubble baths have turned into daily rituals to pass time in our iso-igloos after the 9-5 WFH commitments are ticked off. At-home workouts are trending to offset the effects of our incessant snacking, but oral health is less represented in this balancing act. In the context of healthcare, Australian regulatory bodies have sensibly agreed that most dental treatments are not essential, but oral health certainly is, especially now in the absence of easily accessible dental care. While now is a time of information overload, I would relish in seeing more oral health messages alongside reports of singing solidarity from balconi to punctuate the reports of death and devastation that inundate our newsfeeds. Now is the time to really tend to our own health and for parents to maximise time spent at home to really instill sustainable oral health and dietary habits in the next generation.

Infection control

The COVID-19 crisis has been a wake-up call to ensure that we abide by meticulous standards of infection control. It wasn’t until I saw a COVID-inspired video of gloves being painted by each hand-washing step that I truly understood the rationale for following the hand-washing protocol through which our muscle memory guides us every day in practice. Many of us tuned into Prof Laurie Walsh’s webinar, but, for those who missed it, the ADA guidelines are always a go-to.

Consideration for vulnerable patients and remote care

With hope coming from initiatives to support elderly and immunosuppressed friends and neighbours with their activities of daily living, and supermarkets designating seniors’ shopping times to save them from the chaos of those fighting to stockpile supplies, COVID-19 has prompted reflection on how best to support our more vulnerable patients. We too have a duty to this demographic, so is telehealth the solution for risk-minimisation in the face of current restrictions? As the pioneers of teledentistry, the American Dental Association has published guidelines and webinars to keep its members informed, with Australian practice to follow. Having created a novel teledentistry-specific item number, Australian Dental Association branches are currently in discussions with health insurance providers to make rebates for the provision of remote care a reality. Perhaps, in future, this movement will be to the advantage of Australia’s rural and remote communities for whom dental care is often inaccessible.

All of this has come as a truly surreal, dystopian dream from which we most likely won’t wake for months to come. My intent has not been to fixate on the doom and gloom of the situation, but to celebrate the innovation that has been born from catastrophe and to appreciate the unique opportunity that has arisen from a break in routine to reflect on our practice and use the time ahead to become the best clinicians that we possibly can.

About the Author:
Emma Turner is a final year Doctor of Dental Medicine student at the University of Western Australia and Past President of the Australian Dental Students’ Association. She is passionate about contributing to the future of oral health through dental education, community engagement and research. Emma is a contributing writer for the Colgate Advocates for Oral Health Editorial Community.