Clinical dental practice exposes the dental team and patients to infectious airborne disease agents, due to the close contact during clinical care, and the infectious aerosols from most dental procedures. The U.S. Centers for Disease Control and Prevention (CDC), the American Dental Association (ADA) and other organizations developed recommendations to address the specific risk profile of SARS-CoV-2 transmission, adding additional protective measures to established standard precautions. When deciding on re-opening of dental services it is important to remember that so far, no reliable data on work-related infection risk for dental personnel are available. Combined with other uncertainties it seems prudent to follow four key principles: 1) All patients should be considered as potentially infectious; 2) procedures generating aerosols should be avoided, limited or closely managed; 3) infection control should be increased according to recommendations; 4) PPE measures should be maximized. Dental teams must follow ethical principles in providing the best possible and safe dental care. Yet, as business owners, they are facing existential impacts from reduced patient visits and loss of income resulting from service limitations. Reconciling the conflict of risking their life or their livelihood under the COVID-19 pandemic is not a welcome or easy choice. Decisions must be based on best possible evidence, and need to be revisited as the pandemic, and economic conditions change. COVID-19 also unmasked the challenges of access and financial coverage for dental care in the U.S. Sustainable preparation for future pandemics should consider reforms towards a more equitable system with better coverage.

Objective. To assess the methods used and results found in two surveys, one conducted in 1984 and the other in 1995, that indicated a large reduction in the prevalence and severity of dental caries among children in Jamaica, with special attention focused on methodological differences between the two surveys and the biological factors that may explain the large reduction in caries. Methods. In 1984 a modified "pathfinder" methodology was used to measure the prevalence and severity of dental caries in 6-, 12-, and 15-year-old children in Jamaica. A similar survey was conducted in 1995. A comparison of the two surveys showed an 84% reduction in the severity of dental caries at age 12. Both surveys used the same diagnostic criteria and clinical procedures, but the 1984 survey included a higher proportion of rural residents than did the 1995 one. Results. The data show an epidemiological transition between 1984, when dental caries was highly prevalent and severe, and 1995, when the disease was less prevalent and was concentrated in a smaller proportion of the population. Conclusions. Most of the reduction in dental caries between 1984 and 1995 is attributable to the introduction, in 1987, of salt fluoridation. While the 1995 survey included fewer rural areas than the 1984 survey did, that does not invalidate the observed reduction in dental caries. The use of fluoride toothpaste and dietary fluoride supplements as well as access to dental health promotion and preventive and curative services do not seem to be major contributors to the reductions observed.

Objetivos. Evaluar los métodos utilizados y los resultados obtenidos en dos encuestas realizadas en 1984 y 1995 que mostraron una gran reducción de la prevalencia y gravedad de la caries dental en niños jamaiquinos, prestando especial atención a las diferencias metodológicas entre las dos encuestas y a los factores biológicos que podrían explicar la gran disminución de la caries. Métodos. En 1984 se utilizó una modificación de los métodos de encuesta exploratoria de la Organización Mundial de la Salud para determinar la prevalencia y gravedad de la caries dental en niños jamaiquinos de 6, 12 y 15 años. En 1995 se realizó una encuesta similar. Resultados. Las dos encuestas emplearon los mismos criterios diagnósticos y procedimientos clínicos, pero la de 1984 incluyó una mayor proporción de residentes rurales que la de 1995. La comparación de ambas encuestas reveló una reducción del 84% en la gravedad de la caries dental a los 12 años de edad. Los datos muestran una transición epidemiológica entre 1984, cuando la caries dental tenía gran prevalencia y gravedad, y 1995, cuando ambas habían disminuido notablemente. Conclusiones. La reducción de la caries dental entre 1984 y 1995 es atribuible en su mayor parte a la introducción en 1987 de la fluoración de la sal. Aunque la encuesta de 1995 abarcó menos áreas rurales que la de 1984, esto no invalida la reducción de la caries dental que se observó. El uso de dentífricos fluorados, los suplementos dietéticos de fluoruros y el acceso a los servicios curativos, preventivos y de promoción de la salud dental no parecen haber contribuido de forma importante a la reducción observada.