Oral Health and COVID-19: Increasing the Need for Prevention and Access

Zachary Brian, DMD, MHA; Jane A. Weintraub, DDS, MPH

Disclosures

Prev Chronic Dis. 2020;17(8):e82 

In This Article

Abstract and Introduction

Abstract

Populations disproportionately affected by coronavirus disease 2019 (COVID-19) are also at higher risk for oral diseases and experience oral health and oral health care disparities at higher rates. COVID-19 has led to closure and reduced hours of dental practices except for emergency and urgent services, limiting routine care and prevention. Dental care includes aerosol-generating procedures that can increase viral transmission. The pandemic offers an opportunity for the dental profession to shift more toward nonaerosolizing, prevention-centric approaches to care and away from surgical interventions. Regulatory barrier changes to oral health care access during the pandemic could have a favorable impact if sustained into the future.

Introduction

On March 11, 2020, the World Health Organization declared the global spread of coronavirus disease 2019 (COVID-19) a pandemic.[1] Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new virus with no vaccine or treatment, and the population currently has no immunity. The virus is primarily transmitted by direct or indirect personal contact through airborne respiratory droplets from an infected person.[2]

On March 16, 2020, the American Dental Association (ADA), the nation's largest dental association, recommended that dental practices postpone elective dental procedures until April 6, 2020, and provide emergency-only dental services to help keep patients from burdening hospital emergency departments.[3] Because of the rise of infections, this recommendation was updated on April 1, 2020, when the ADA advised offices to remain closed to all but urgent and emergency procedures until April 30 at the earliest. As a result, access to dental care substantially decreased. During the week of March 23, 2020, an ADA Health Policy Institute survey indicated that 76% of dental offices surveyed were closed but seeing emergency patients only, 19% were completely closed, and 5% were open but seeing a lower volume of patients.[4]

In addition to the lack of widespread COVID-19 testing, point-of-care testing in dental offices also was not available. Because of the inability to test all patients and the fact that asymptomatic or presymptomatic patients could be infectious, ADA guidance shifted in mid-April 2020 as state and local government policies varied regarding criteria for reopening different types of services, including dental services.[5] Questions remain about how soon patients will prioritize and resume nonemergency dental care amid other delayed health care services. The full extent of pandemic-related financial strain and loss of dental insurance is not yet clear and will dramatically affect dental care utilization.

In this commentary, we explain why oral health care should be a public health priority in the response to the pandemic and discuss the aspects of dental care that make it challenging to accomplish this. We will also provide opportunities for improvement, such as focusing more on prevention and nonaerosolizing dental procedures and the means by which to increase access to affordable, more equitable care for vulnerable populations.

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