Call for Global Public Health Leaders: Provision of Safe Dentistry for All
The Need of Safe Dentistry
The Shanghai Declaration reaffirmed health as a universal right and essential resource for everyday living, a shared social goal, and a political priority for all countries during the Ninth Global Conference on Health Promotion.1 The United Nations Sustainable Development Goals (SDGs) also call for investing in health to assure universal health coverage and to reduce health inequitites.1 While timely access to healthcare should be provided for populations in need, the quality and safety of healthcare must be assured regardless of differences among health care settings worldwide to achieve the basic principle of health care: do no harm. The United States (US) National Academies of Sciences, Engineering, and Medicine defined quality for health care using six components in its report, “Crossing the Quality Chasm”: safe, effective, patient-centered, timely, efficient, and equitable.2 At a fast pace in recent years, public and private sectors have been introducing innovative models of health care workforce and delivery vehicles. It is critical to diligently assure the quality and safety of such models.
Universal oral health care provision is an essential goal in public health; there is great need to increase safe and timely oral health care for all. The oral health profession was the front-runner for safe delivery of clinical care. For example, the oral health profession adopted hepatitis B virus vaccinations for all clinical personnel ahead of other health professions in the early to mid-1980s.3 However, it is time to revisit the safety in various oral health care settings globally that may have different types of infrastructure and levels of resources.
Infection Control and Prevention in Dental Settings
Breakdowns in infection prevention and control may occur when proper sterilization and monitoring fail. In 2003 and again in 2016, the US Centers for Disease Control and Prevention released guidelines for infection control practices in dental offices nationally and globally to provide direction for the public, dental health care personnel, and policymakers.4,5 While these knowledge resources are available free online with mobile apps and other communication tools, many health professionals may not be able to follow these recommendations due to limited practical resources to achieve safe dentistry. A major published review of infection control and prevention in oral health care facilities showed that the resources for infection control and prevention are limited in developing countries.6 The scope of infection control and prevention practice ranges from autoclave sterilization with biomarkers in highly developed countries to boiling water sterilization without individual pouch and multiple re-uses of disinfectant in developing countries. The studies in developing countries also indicate serious shortcomings in education and training for infection control and prevention in oral health care facilities.6 Cross-contamination with digital technology and inadequate hand washing are other major concerns in a technology-driven dental practice model in countries with electronic health record systems.
Availability and Affordability of Infection Control in Dental Settings
While knowledge resources are available for safe dentistry, implementation of safe practice will only happen with coordinated efforts and with political support to subsidize the cost of supplies and equipment for infection control and prevention, especially for low-income countries. Dental extraction is a common procedure and may be the only treatment option where resources are scarce. Basic necessities for achieving safe extraction include disposable needles, lidocaine carpules, gauze, sterilized syringes and forceps, safe needle recapping devices, disinfectant wipes, an autoclave machine and sleeves, clean water, and compensation for health care workers. Based on a supply price list of a US manufacturer, disposable items for a single tooth extraction can cost more than US $1.90, and this amount exceeds daily earnings or wage for more than 10 per cent of the world’s people.7
Global Charter and Safe Dentistry
The World Federation of Public Health Associations (WFPHA) developed the Global Charter for the Public’s Health in 2016 to adapt public health to its global context today in the light of and in conjunction with the United Nations’ Sustainable Development Goals.8,9 Framers of the Global Charter designed it to be a comprehensive public health framework that can be applied in varied global settings. It clearly points out that financing for health care and communicable disease control are essential elements for attaining health promotion and protection through appropriate advocacy and good governance. After the World Congress on Public Health in Melbourne in 2017, WFPHA also adopted a policy resolution “Exempt Tax on Dental Supplies and Equipment for Infection Control and Prevention.”10 It emphasized the need for financing policies to support procurement of dental supplies and equipment for infection control and prevention and suggested tax exemption or subsidization as sources for new investments in health and well-being. WFPHA has also presented this resolution to the 70th World Health Assembly in a statement providing health ministers and organizations with a potentially effective financing model.11
Oral health is an integral part of general health and overall well-being. Fiscal policies for safe dental practice through tax exemption and subsidization can serve as essential elements of a public health financing model for safe practice and control of communicable diseases in communities around the globe with limited resources and infrastructure. This call for global public health leaders, public health organizations, and local and national governments to assure safe dentistry will promote the basic principle of health care: do no harm, but do good.
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