In the wake of Covid-19, the American Dental Association (ADA) advised dental practices to postpone elective dental procedures and limit service to emergency patients. Consequently, many patients have been denied access to routine dental care and prevention. The most affected groups are those who are most vulnerable to Covid infection as they have a high risk of developing oral diseases or lack access to oral health care services.
The Need to Focus on Oral Health
The most common oral diseases are dental caries and periodontal diseases. Dental caries affects around 32.7% of the US population, while periodontitis affects 42% of the adults aged 30 and above. Unchecked oral diseases cause pain and infections that require expensive treatments. Most oral diseases can be avoided or prevented from progressing through oral hygiene, fluoride exposure, dietary changes, public education, and dental interventions.
Covid-19 Puts Vulnerable Populations at Risk of Oral Diseases and Infection
Groups that are at a high risk of chronic diseases also tend to be vulnerable to oral diseases. Most of the risks such as poor diet, stress, poverty and substance abuse escalated during the pandemic. The populations most exposed to covid-19 and oral diseases include minorities, older adults, low socioeconomic groups, the uninsured and people in remote areas.
Covid Has Exacerbated Disparities in Access to Oral Health Care
Covid protocols have made it hard for populations at high risk of infection to get oral health care. People with covid symptoms are instructed to avoid non-emergency care, while providers are advised to delay dental services until the patient has recovered. Meanwhile, over 49 million US residents of areas with dental health professional shortages have been unable to access preventive dental services due to covid restrictions.
Poor and minority populations are disproportionately affected and are more likely to lack dental insurance than nonpoor and nonminority groups. Meanwhile, Medicaid beneficiaries have difficulty accessing care because only 20% of the practising dentists accept Medicaid. The situation will only worsen as states dedicate more resources to Covid prevention and containment measures.
Risk Of Covid-19 Infection From Aerosol-Generating Procedures
Oral health professionals are at a high risk of Covid-19 infection due to the nature of their practice. Most patients are unmasked and have their mouths open during treatment, increasing the risk of exposure to infectious particles. Further, aerosol-generating procedures put practitioners at a high risk of infection.
- Public health needs to shift focus from surgical interventions to prevention. More resources should be allocated to preventive measures such as promotion of healthy diets, combating substance abuse, community water fluoridation and promotion of oral health in the community.
- Oral health practitioners should embrace non-surgical interventions and avoid the use of aerosol-generating procedures in the prevention and management of caries. The options for non-surgical caries management and prevention include the use of dental resin sealant, sodium fluoride varnish and topical fluorides. These alternatives can reduce the risk of viral transmission.
- Providers and payers need to shift reimbursement from the current model that rewards tooth restoration and function to one that emphasized oral health. They should support the implementation of evidence-based prevention through a reimbursement model that focuses on prevention and oral hygiene.
- Public health agencies and dental associations need to intensify communication on the provider and patient safety. Practitioners should be advised to utilize PPEs during dental care. Public education on maintaining good oral health should target vulnerable communities.
- Currently, 33.6% of adults in the US have no dental insurance benefits. States need to expand Medicaid coverage to include dental insurance plans for adults and provide modified models to increase access to the most vulnerable groups.
- States also need to ease workforce restrictions and scope of practice policies to facilitate increased access to dental care.
- States should review legislative barriers to teledentistry, while payers should reform their reimbursement policies to accommodate telemedicine.
- Finally, oral health practitioners and advocates must lobby public health agencies to recognize oral health as important for overall well-being. They should propose policies to increase access and address inequalities and disparities.
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