COVID-19 and orthodontics in Brazil: What should we do?

We are writing about the commentary published in the Litigation and Legislation section in the June 2020 issue of American Journal of Orthodontics and Dentofacial Orthopedics (Jerrold L. Exceptional circumstances. Am J Orthod Dentofacial Orthop 2020;157:852-5). A reader, weighing the risk of seeing patients during a pandemic vs the risk of not seeing them, asked “What is the standard of care in this situation?” (What is correct—to provide dental care or avoid seeing patients and staff? What are the risks we face? Are we putting our patients and families at risk?). A legitimate question came to our minds: What should we Brazilian orthodontists do? Our current situation is critical. Brazil has the second highest number of patients with coronavirus disease 2019 in the world, behind only the United States. The numbers are intimidating. On June 7, the Brazilian Ministry of Health counted 1382 deaths, the highest reported on a Sunday since the beginning of the pandemic.¹ If this trend is maintained, we will soon overtake the United Kingdom, and we will also have the second highest number of deaths. In addition, the contamination curve is still rising.

To complicate the situation, the President and his government are constantly giving divergent information regarding stay-at-home orders, restrictions, and reopening of nonessential activities. We have been without a Minister of Health for almost a month, and since the beginning of the pandemic, 1 Minister of Health was fired, and his replacement resigned after only 1 month. The last measure proposed by President Bolsonaro was the nondisclosure of complete data, including the number of infected people and deaths. This change in the publication of daily reports prevents monitoring of the disease progress in the country, leaving Brazilians confused and without official and reliable information.

By contrast, the paralysis of the economic activities in a developing country has had devastating effects that will cause a long-lasting recession.² To minimize the damage, several cities are gradually resuming nonessential business activities, reopening business offices, shopping malls, bars and restaurants, as well as dental offices and regular dental care.

How are we, orthodontists, dealing with this situation? We are thousands, with no market reserve, and struggling day by day to work with dignity and efficiency. At the beginning of the pandemic, the Federal Council of Dentistry of Brazil³ ordered the closure of dental offices, maintaining only urgent and emergency care; this was recommended in a quite different scenario, with far fewer cases of infection and death. Now, amid the chaos of rising infections rates, the gradual reopening of businesses, including dental clinics, is being promoted, and we, orthodontists, must ponder the health of our patients and team, as well as our financial health. Knowing that even with the use of personal protective equipment and enacting all the safety precautions to avoid coronavirus disease 2019 infection, there is still a risk of contamination during dental procedures owing to the proximity to patients and oral fluids, we must make the moral decision on whether to provide dental care to our patients. Paraphrasing Dr Jerrold, is there a standard of care that would apply to this situation?

What should we, Brazilian orthodontists, do? We are looking forward to safe, science-based guidelines so that we can move forward without harming our patients, our staff, and ourselves.