Global health threats are also oral health threats

Abstract

If you were to select a global health threat, what would come to your mind first? It would likely be a pandemic like COVID-19 or Ebola fever or other highly infectious diseases that do not stop at borders. In 2019, the World Health Organization (WHO) put together a list of 10 health threats to highlight their dangers to the global community.1Ten threats to global health in 2019. World Health Organization.https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019Date accessed: December 30, 2022Google Scholar The 10 threats were selected because of their potential to cause significant illness, death, societal disruption, and public health impact as well as considering their likelihood of occurring. They require increased attention from governments, health care professionals, communities, and stakeholders in all countries, irrespective of their level of health system public health capacities. The 10 threats selected indeed comprise infectious diseases like influenza, Ebola, HIV, and dengue fever as well as high-prevalence diseases and broader risks to population health such as noncommunicable diseases or climate change and air pollution. Although not mentioned explicitly, all 10 of WHO’s global health threats are relevant for oral health and oral health care, directly or indirectly (Table). We discuss 3 global health threats in more detail: high-threat pathogens, antimicrobial resistance (AMR), and weak primary health care. Each issue is an independent threat, yet all 3 are interlinked.Oral health care professionals might take false comfort in assuming that their daily clinical work is far away from global health threats.TableTen global health threats as defined by the World Health Organization in 2019 and their relation to oral health∗Source: World Health Organization.1GLOBAL HEALTH THREATORAL HEALTH IMPLICATIONS1. Air Pollution and Climate ChangeOral health care has a significant environmental footprintMeasures to reduce waste and carbon emission2. Noncommunicable DiseasesOral diseases are the most common noncommunicable diseasesBidirectional relationship of oral and general healthCommon risk factors of oral diseases are shared with other noncommunicable diseases3. Global Influenza PandemicOral health care providers at increased infection riskCounseling at-risk patients to get vaccinatedImportance of being a role model for vaccination and infection control4. Fragile and Vulnerable SettingsOral health care among the most vulnerable health services, particularly in humanitarian emergencies, war, or disaster situationsRefugees and immigrants disadvantaged in accessing oral health care services5. Antimicrobial ResistanceOral health care providers contribute substantially to antibiotic prescribingCompliance with prescription guidelines neededImportance of infection control measures6. Ebola and Other High-Threat PathogensHigh infection risk for providers and patients (especially airborne and bloodborne infections)Oral health care service disruption with limitations of accessing oral health care as a consequence7. Weak Primary Health CareOral health care services are not generally part of primary health care in all health systems worldwideThe essentiality of oral health care services makes it mandatory to strengthen primary health care by making oral health care an integral and universally available element8. Vaccine HesitancyPromote all recommended vaccinations for children and adultsOral health care professionals lead by example9. Dengue FeverGingival bleeding may be an intraoral symptomNo elective oral health care during a dengue infection recommended10. HIV Infection32 million people worldwide living with HIV; more than 1 million new infections in 2021Significant oral manifestations of an HIV infectionOral manifestations can be early infection symptoms and indications of compliance with antiretroviral therapy∗ Source: World Health Organization.1Ten threats to global health in 2019. World Health Organization.https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019Date accessed: December 30, 2022Google Scholar Open table in a new tab Oral health care professionals might take false comfort in assuming that their daily clinical work is far away from global health threats. High-threat pathogens (called high-consequence pathogens by the Centers for Disease Control and Prevention) are highly contagious or lethal “viral, bacterial, [fungal,] prion, and related infections and diseases of unknown origin.”2Division of high-consequence pathogens and pathology. Centers for Disease Control and Prevention.https://www.cdc.gov/ncezid/dhcpp/index.htmlDate accessed: December 30, 2022Google Scholar It is a core public health function to protect populations from such threats, and more than 250 Centers for Disease Control and Prevention experts work in this area. Much has been said and written about the COVID-19 pandemic and its impact on oral health care. The uncertainty of transmission risks during the early parts of the pandemic led to unprecedented disruptions of oral health care services. Among all of the health services, oral health care was the most affected by partial or full service closures worldwide.3Beltrán-Aguilar E. Benzian H. Niederman R. Rational perspectives on risk and certainty for dentistry during the COVID-19 pandemic.Am J Infect Control. 2021; 49: 131-133Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar, 4Pulse survey on continuity of essential health services during the COVID-19 pandemic: interim report, 27 August 2020.https://www.who.int/publications/i/item/WHO-2019-nCoV-EHS_continuity-survey-2020.1Date accessed: December 30, 2022Google Scholar, 5Continuity of essential oral health services during the COVID-19 pandemic in the WHO African region: results of a member state survey and policy recommendations, January 2021. World Health Organization Regional Office for Africa.https://www.afro.who.int/sites/default/files/2021-01/CONTINUITY%20OF%20ESSENTIAL%20ORAL%20HEALTH%20SERVICES%20DURING%20THE%20COVID-19%20PANDEMIC.pdfDate accessed: December 30, 2022Google Scholar, 6Panchal N. Wolff M. The profound impact of COVID-19 on the dental profession.Compend Contin Educ Dent. 2021; 42: 272-277Google Scholar Reassuringly, the principles of universal infection control, measures against airborne transmission, adaptations of service management, and the rapid availability of effective vaccines made it possible to resume oral health care services completely. Just as the pressure from COVID-19 started to ease, another high-threat infection, mpox, emerged outside of the known endemic areas in Western and Central Africa.7Samaranayake L. Anil S. The monkeypox outbreak and implications for dental practice.Int Dent J. 2022; 72: 589-596Crossref Scopus (23) Google Scholar,8Wenham C. Eccleston-Turner M. Monkeypox as a PHEIC: implications for global health governance.Lancet. 2022; 400: 2169-2171Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar To date, more than 83,000 cases have been reported from 110 countries, with close to 30,000 cases in the United States. The WHO still classifies mpox as a public health emergency of international concern. Despite clear infection risks in dental settings and oral symptoms in those infected, the impact of mpox on oral health care has not reached COVID-19 levels.9Zemouri C. Beltrán E.O. Holliday R. Jakubovics N.S. Allison J.R. Monkeypox: what do dental professionals need to know.Br Dent J. 2022; 233: 569-574Crossref Scopus (2) Google Scholar All WHO-listed global infection threats underscore the crucial need for constant vigilance and alertness. Existing and approved infection control measures need to be regularly reviewed and updated to ensure safety for patients and staff members. This includes action in 5 key areas: the policies, guidelines, and protocols in place; patient screening when seeking oral health care; adaptations and modifications of oral health care facilities; compliance with measures for personal protective equipment; and infection control measures, including hand hygiene and selection of procedures for appropriate management of aerosols.10Benzian H. Beltrán-Aguilar E. Niederman R. Systemic management of pandemic risks in dental practice: a consolidated framework for COVID-19 control in dentistry.Front Med. 2021; 8644515Crossref Scopus (3) Google Scholar Infection control is equally central to addressing AMR. Antibiotic-resistant bacteria can cause a range of illnesses, from mild to life threatening. Each year, more than 2 million people in the United States are infected with antibiotic-resistant bacteria, and at least 23,000 people die from these infections.11Antibiotic resistance threats in the United States, 2019. Centers for Disease Control and Prevention.https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdfDate accessed: December 30, 2022Google Scholar Infections caused by antibiotic-resistant bacteria are more difficult to treat and require expensive and complex medications, and sometimes none are effective. Prevention is critical to combating AMR. Antibiotics must be prescribed correctly and only when needed, and patients need encouragement to finish their course of antibiotics. The US National Action Plan for Combating Antibiotic-Resistant Bacteria outlines 4 key areas to address the threat from AMR: prevention, surveillance and tracking, response, and research and development.12National action plan for combating antibiotic-resistant bacteria, 2020-2025. US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation.https://aspe.hhs.gov/reports/national-action-plan-combating-antibiotic-resistant-bacteria-2020-2025Date accessed: December 30, 2022Google Scholar The FDI World Dental Federation, the American Dental Association, and many other professional organizations around the world have issued guidelines for antibiotic use in dental practice and advocate for stewardship of oral health care professionals in addressing AMR,13Lockhart P.B. Tampi M.P. Abt E. et al.Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: a report from the American Dental Association.JADA. 2019; 150: 906-921.e12Abstract Full Text Full Text PDF PubMed Scopus (76) Google Scholar,14Thompson W. Rios L.E. Fedorowicz Z. Dailey Y. Douglas G. I’ve got toothache, I need antibiotics: a UK perspective on rational antibiotic prescribing by dentists.Braz Dent J. 2018; 29: 395-399Crossref Scopus (1) Google Scholar including guidance on prophylactic use of antibiotics for patients at risk who are undergoing invasive procedures.15Sollecito T.P. Abt E. Lockhart P.B. et al.The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints: evidence-based clinical practice guideline for dental practitioners—a report of the American Dental Association Council on Scientific Affairs.JADA. 2015; 146: 11-16.e8Abstract Full Text Full Text PDF PubMed Scopus (149) Google Scholar,16Antibiotic prophylaxis prior to dental procedures. American Dental Association.https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/antibiotic-prophylaxisDate accessed: December 30, 2022Google Scholar In this context, the concept of One Health, highlighting the interconnections between human, animal, and environmental health, becomes increasingly relevant.17Baroni de Carvalho R. Shick E. Dye B.A. The One Health initiative and its importance to oral health.JADA. 2022; 154: 187-190https://doi.org/10.1016/j.adaj.2022.11.006Abstract Full Text Full Text PDF Scopus (0) Google Scholar,18Antimicrobial resistance. World Health Organization.https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistanceDate accessed: December 30, 2022Google Scholar Framing weak primary health care as a global health threat may seem unexpected. Yet a functioning primary health care system is crucial in preventing and responding effectively to any of the global health threats listed and in ensuring continuity of essential services during a public health emergency. At least one-half of the world’s population lacks access to essential health and oral health care services.19Reframing primary health care: a 21st century challenge. Editorial.EClinicalMedicine. 2021; 40101177Google Scholar,20Global oral health status report: towards universal health coverage for oral health by 2030. World Health Organization.https://www.who.int/team/noncommunicable-diseases/global-status-report-on-oral-health-2022Date accessed: December 30, 2022Google Scholar Through providing a first point of contact for people and communities, primary health and oral health care are the foundation to improving access. Primary health care is also the basis of universal health coverage, one of the central health goals of the United Nation’s Sustainable Development Goals. Oral health care needs to be part of universal health coverage.21Listl S. Quiñonez C. Vujicic M. Including oral diseases and conditions in universal health coverage.Bull World Health Organ. 2021; 99 (407-407)Crossref Scopus (7) Google Scholar,22Benzian H. Beltrán-Aguilar E. Mathur M.R. Niederman R. Pandemic considerations on essential oral health care.J Dent Res. 2021; 100: 221-225Crossref PubMed Scopus (28) Google Scholar Oral health care professionals might take false comfort in assuming that their daily clinical work is far away from global health threats. Global pandemics have propelled global health threats to the forefront of media, public, political, and professional awareness. They also exemplified that oral health care is not shielded from such global threats. Oral health is part of global health, oral health care is an essential part of health care systems, and oral health care professionals are integral to the health care workforce. If there is anything that health care systems or health care professionals can do to address global health threats, then oral health care systems and oral health care professionals must be involved in such actions. It is important that we all sharpen our awareness, strengthen our vigilance, and act responsibly to protect the safety of patients, staff members, and communities at large.