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Dentistry's Role in Combating Bioterrorism
To develop a consensus on a potential role for dentistry in dealing with bioterrorism, the American Dental Association (ADA) called together experts in bioterrorism issues and representatives of key organizations for a Workshop on the Role of Dentistry in Bioterrorism. Convening in June 2002, attendees included representatives from organized dentistry, government, the military, and academia.
Workshop panelists concluded that dentistry has assets in personnel and facilities that could be of great value in responding to a major bioterrorist attack.
- Dentists may be called on to play a role in education. With knowledge of scientifically based information about disease agents that may be used in bioterrorism, dentists can educate patients and correct misinformation that may be circulating throughout the general public. Further, dental workers are well-versed in infection control procedures; they can apply their knowledge in reducing the spread of infections.
- In diagnosis, surveillance, referral, and treatment, dental workers can detect characteristic intraoral or cutaneous lesions if they are present and report them to public health authorities. Dentists can refer suspicious cases to the appropriate specialists, collect salivary and/or nasal swabs for laboratory testing, and prescribe or dispense chemotherapeutic or chemoprophylactic medications for the public.
- Many dentists may be able to augment and assist medical and surgical personnel in providing treatment for victims of bioterrorist attacks. Dentists who have hospital experience may be especially well-suited to provide services that require a close working relationship with physicians.
- In the event that rapid inoculation or vaccination of the public is required to prevent the spread of infection by a biological agent, dentists may be recruited to assist in a mass inoculation program.
- Local dental societies are encouraged to develop a dental response plan that can be integrated into each community's mass disaster response plan.
- Educational programs for dentists should be developed to prepare them to provide services they may be recruited to perform in an emergency.
- In a major bioterrorist attack, traditional medical resources will be overwhelmed. The ADA predicts that it will fall to nonphysicians to provide many services ordinarily supplied by physicians (e.g., triage, dispensing medications, and providing general medical support). As hospitals become filled, alternate sites for the provision of health care may be required. Located throughout any given community and equipped with many resources that hospitals have (sterilization equipment, air and gas lines, suction equipment, radiology capabilities, instruments, needles), dental offices may be called on to serve as local "minihospitals" when local hospital facilities become overwhelmed or when the concentration of patients is to be avoided, as in attacks involving contagious agents.
In his presentation at the 143rd ADA Annual Session in October 2002, OSAP Board Member Louis DePaola, DDS, MS, presented an educational session on "Bioterrorism: Dentistry's Role." In summation:
- Dental practitioners should be familiar with the signs and symptoms of mass-destruction biological agents because some have oral-facial manifestations.
- The role of dental practitioners includes recognizing bioterrorist disease signs.
- It is essential that oral health and other professionals know about the various diseases, and the systemic oral-dental manifestations of naturally occurring and bioengineered infectious agents.
- If the unthinkable should occur, oral health providers could play a key role in the early identification and subsequent control of a bioterrorist attack.
Dr. DePaola advises practitioners to have a high level of suspicion, keep bioterrorist agents in their differential diagnoses for patients with unusual symptoms and be aware of unusual clinical presentations.
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