This article was originally published in our Fall 2020 print issue.
The COVID-19 pandemic has slowed down general healthcare checkups. People are scared, or rather cautious, to visit doctors , dentists, or optometrists. However, the negligence in addressing health problems, especially those due to poor oral health, can lead to a new public health concern. Unfortunately, there is a limit to the number of people allowed in small, confined spaces, like dental offices. Therefore, it is important, especially during pandemics, to recognize the importance of reprioritizing procedures, affordable care, and innovation in oral health.
Oral diseases are a public health concern throughout the world as they are extremely prevalent and often ignored by patients. According to a study done by World Health Organization affiliated scientists, there are a wide range of oral health diseases from cavities to mouth cancers. Fortunately, most of these oral diseases are largely preventable. By detecting them early, dentists can treat the condition before it turns into a painful problem. However, they are ignored due to the high treatment cost until the pain becomes unbearable. The negligence with recognizing oral diseases creates a compounding public health issue as it leads to a plethora of economic and personal issues due to missing work, large dental bills, and a reduction in the quality of life. During a pandemic, these largely preventable diseases are even more likely to be ignored, leading to more chaos and pain.
Due to the COVID-19 pandemic, daily visits to dental offices are low and 198,000 dental offices have closed. According to Dr. Elizabeth Bertz, a Professor of preventative and restorative dental sciences at the University of California, San Francisco, the coronavirus has “impacted every aspect of the care delivery system.” In particular, dental offices that closed during the beginning of the pandemic have struggled in opening back up. At the beginning of the pandemic dentists donated Personal Protection Equipment (PPE) to hospitals, and as they tried to reopen they faced a shortage of PPE. Additionally, according to Dr. Bertz, there has been an issue with bringing back dental office workers, especially hygienists. With 98% of hygienists being women and a lot of schools doing distance learning, many hygienists have chosen to remain home despite some dental offices open back up. With social distancing guidelines decreasing the number of patients allowed in dental offices, and dental offices having issues opening up due to issues procuring PPE and rehiring staff, appointments have become harder to get. Therefore, for some people the lack of available appointments is preventing them from getting oral health checkups.
In some places where appointments are available, patients themselves are hesitating to go to the dental offices due to the virus and public health protocols. This decrease in daily visits leads to people not realizing they have cavities until the emergence of a severe toothache. However, simply encouraging people to go back to dentists is not a solution as this can spread the coronavirus; cleaning teeth during the pandemic is a huge safety challenge as a lot of aerosols are released during cleaning procedures. Some dentists have been utilizing tele-dentistry to substitute physical visits. However, according to Dr. Bertz, there are issues with telehealth. First of all, it may be difficult for some patients to learn how to use new telehealth technology. Additionally, many health insurance companies do not cover tele-dentistry calls. Therefore, some patients are unwilling or unable to get oral health checkups via tele-dentistry.
The solution to the neglect of dental health during the pandemic comes in multiple parts. First, dental offices can mitigate the spreading of the virus by prioritizing non-aerosol releasing, more important procedures, including root canals, oral exams, and x-rays, versus teeth polishing and removing scales). As more people start coming back to dental offices, support from state and federal governments by expanding Medicaid can help get more people treated. An expansion in health insurance, even a temporary one, can help cover more people and encourage dental visits. Covering tele-dentistry can help some people get virtual checkups. Additionally, more public health messaging, reassuring people on safety measures being taken by dental offices, can encourage more dental checkups. Other federal guidance that would help provide a better framework to fight the public health issue could start with improving communication between federal, state, and local governments. Consistent messaging about the importance of oral health checkups and reinforcing safety standards will help improve oral health in the country. While COVID-19 is a pandemic with massive repercussions, ongoing public health issues, like dental health, should not be ignored.
New vaccines are being made for the coronavirus and predictions being made on the end of the coronavirus pandemic, but the issues with dental health will continue. With many people skipping visits to the dentist, an uptick in oral health issues has been predicted during the post-corona era. Therefore, more messaging on the importance of oral health and more coverage with regards to insurance will help fix the oral health epidemic.