key: cord-1025118-w0pm33fs authors: Riad, Abanoub; Boccuzzi, Michela; Pold, Ave; Krsek, Martin title: The Alarming Burden of Non‐Communicable Diseases in COVID‐19 New Normal: Implications on Oral Health date: 2020-06-18 journal: Oral Dis DOI: 10.1111/odi.13491 sha: 4baa1d4d143d0603928183a5609287a5ccb944c5 doc_id: 1025118 cord_uid: w0pm33fs The coronavirus disease (COVID‐19) outbreak has triggered massive debates within dental professional organizations about prioritization of offered services, served groups, and required protective measures.(Volgenant et al., 2020) While navigating through the post‐outbreak era, we aim to demonstrate the importance of continuous global focus on the burden of non‐communicable diseases (NCDs) such as oral diseases. Oral diseases are the most prevalent NCDs worldwide consuming one‐fifth of out‐of‐pocket health expenditure and being recognized as the third most expensive condition to treat in Europe.(Peres et al., 2019) The World Health Organization (WHO) recommends prioritizing common risk factor approaches in all interventions targeting NCDs in order to draw attention to the multifaceted relationship between oral diseases and chronic conditions like diabetes, cardiovascular disease, and cancers.(Sheiham & Watt, 2000) The coronavirus disease outbreak has triggered massive debates within dental professional organizations about prioritization of offered services, served groups, and required protective measures. (Volgenant et al., 2020) While navigating through the post-outbreak era, we aim to demonstrate the importance of continuous global focus on the burden of non-communicable diseases (NCDs) such as oral diseases. Oral diseases are the most prevalent NCDs worldwide consuming one-fifth of out-of-pocket health expenditure and being recognized as the third most expensive condition to treat in Europe. (Peres et al., 2019) The World Health Organization (WHO) recommends prioritizing common risk factor approaches in all interventions targeting NCDs in order to draw attention to the multifaceted relationship between oral diseases and chronic conditions like diabetes, cardiovascular disease, and cancers. (Sheiham & Watt, 2000) NCDs have been recognized for long as the leading cause of mortality and disability worldwide; in addition, they are highly associated with the severity and fatality rates of COVID-19 indicating that prevention and control of NCDs are integral parts of the COVID-19 response. Unfortunately, the NCDs burden is predicted to rise in the next period due to the paradigm in prioritizing COVID-19 over NCDs. (Kluge et al., 2020) However being inevitable; non-pharmacologic interventions impose unprecedented risks to people living with NCDs. Physical distancing can enhance behavioural risk factors like smoking and physical sedentary. Reorientation of national health budgets will negatively impact the continuity of palliative care due to decreased supply of essential medicines and technologies and restricted access to healthcare workers. This increase in the levels of NCDs will create a vicious circle between the two pandemics-the NCDs and COVID-19-thus exacerbating health inequities. (Kluge et al., 2020) Besides the bidirectional relationship between periodontitis and diabetes, periodontal diseases is a risk factor of lung diseases, including chronic obstructive pulmonary disease (COPD). Periodontitis is strongly linked to hypertension with an array of pathophysiologic mechanisms, including pro-inflammatory cytokines. Chronic inflammation is recently suggested as the common factor in both periodontitis and cancers. (Cullinan et al., 2009; Yao et al., 2014) Oral diseases and major NCDs share common etiological factors, chronicity mechanisms, and control requirements, implying that the burden of oral diseases may unprecedentedly increase. A recent Cochrane review revealed that access to elective dental care may be substantially restricted during the COVID-19 "New Normal" period. This global ban on elective dental procedures will have a strong impact on public oral health, and patients' oral health-related quality of life.(COVID-19 Dental Services Evidence Review Working Group, This article is protected by copyright. All rights reserved 2020) The immediate increase in stress and anxiety levels in response to the COVID-19 outbreak, especially in patients with NCDs, can deteriorate adherence to health-promoting behaviours, including oral hygiene. (Horenstein et al., 2018) Public apprehension of infection may contribute to resistance to dental treatment; which in turn will increase the levels of dental anxiety. (González-Olmo et al., 2020) As pandemics hit the lower socio-economic groups the most, the financial recession will restrain millions of people from seeking dental treatments, including emergency interventions. To conclude, the burden of oral disease should be adequately investigated during the next months in order to avoid a surging demand for dental care that may collapse our limitedly operating facilities. Oral health promotion programs and tele-dentistry applications are now needed more than ever to stabilize the curve of oral diseases. Recommendations for the re-opening of dental services: a rapid review of international sources Periodontal disease and systemic health: Current status Perceived vulnerability to Coronavirus infection: impact on dental practice How does anxiety sensitivity increase risk of chronic medical conditions Prevention and control of non-communicable diseases in the COVID-19 response. Lancet Accepted Article This article is protected by copyright Oral diseases: a global public health challenge The Common Risk Factor Approach: A rational basis for promoting oral health. Community Dentistry and Oral Epidemiology Infection control in dental health care during and after the SARS-CoV-2 outbreak Association of periodontal disease with oral cancer: A meta-analysis The authors declare that there is no conflict of interest.