key: cord-0911441-rpnrcmyx
authors: Porter, Stephen; Carneiro Leão, Jair; Cohen Goldemberg, Daniel; Fedele, Stefano
title: Look back to assure a better future
date: 2020-07-24
journal: Br Dent J
DOI: 10.1038/s41415-020-1925-8
sha: 3f723eb3e465dba735345d73e2035359f3038c94
doc_id: 911441
cord_uid: rpnrcmyx

nan

Undoubtedly lookbacks should focus upon strategies to enhance the delivery of acute care of plaque-induced dental disease as these are the dominant oral disorders of children and adults in the UK and across the globe. Nevertheless each specialty area will have had specific challenges that may warrant -or provide -solutions. For example, consideration must be given to the probable reduction in the identification and treatment of oral malignancies, 1 any worsening of immunologically-mediated disease 2 and any increases in numbers of individuals with facial pain secondary to psychological distress. 3 Within oral and maxillofacial surgery it is probable that injuries due to contact sports, road traffic accidents or violence have fallen but, as highlighted by Coulthard and colleagues, injuries due to domestic violence may rise. 4 Of concern, the combination of psychological stress due to prolonged social isolation and alcohol consumption 5 may have created a burden of facial injuries that is presently completely unknown to healthcare professionals or reflected within the rise in injuries due to falls/trips within homes or the reports of facial injury due to deliberate self-harm. 6 The present examples are the tip of an iceberg of possible health burden. There is the potential for repetition with any further COVID-19 outbreaks but there may be lessons to learn (for example triage, training and timetabling) that may help -even in the absence of any further pandemic. We urge leaders of the different specialties of oral healthcare in the UK and around the globe to undertake meaningful lookback analyses that will inform the roadmap for oral healthcare in the twenty-first century. There will be limited, if any, funding opportunities for appropriate analyses hence proposed studies must be methodologically sound to identify where, even simple, change will positively impact upon oral healthcare.

Aligned to this we propose that future public health strategies recognise the worth of primary dental healthcare providers to monitor COVID-19 community infection. The great majority of dentistry is delivered in readily accessible practices by staff skilled in the examination of the mouth and potentially the upper airway. If practices are unable to deliver the usual care (for example due to regulatory concerns of increased transmission due to aerosol generating procedures containing COVID-19) it is highly likely that they would be able and willing to become local test centres to monitor outbreaks -perhaps also using the facilities of community pharmacies -to assure rapid identification of pockets of new infection. 7 Change requires strong vision, leadership, willpower, resources and pragmatism. It is our view that with an appropriate well-resourced roadmap, informed by the solutions of the recent past, all oral healthcare providers, whether generalists or specialists, have much to contribute to lessen the burden of any future, or indeed continued, outbreaks of COVID-19 infection. 8 

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Correlates of symptoms of anxiety and depression and mental wellbeing associated with COVID-19: a cross-sectional study of UK-based respondents

COVID-19, domestic violence and abuse, and urgent dental and oral and maxillofacial surgery care

Covid-19 and alcohol-a dangerous cocktail

Provision of Emergency Maxillofacial Service During the COVID-19 Pandemic: A Collaborative Five Centre UK Study

Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2)

Preparing for a challenging winter 2020/21

The BDJ Upfront section includes editorials, letters, news, book reviews and interviews. Please direct your correspondence to the News Editor, Kate Quinlan at k.quinlan@nature.com. Press releases or articles may be edited

2 Daniel Cohen Goldemberg 3 and Stefano Fedele 1,4 1 UCL Eastman Dental Institute