Posted: December 2nd, 2022

Oral Health and COVID-19

Oral Health and COVID-19

Introduction
The COVID-19 pandemic has impacted the world in various ways. The highly infectious disease has affected patients who cannot visit clinics for oral health services. Oral healthcare services increase the risk of transmission of viral disease (Kranz et al., 2021). On March 16, 2020, the American Dental Association recommended that all dentists postpone elective dental care. The association recommended that only emergency dental care due to the prevailing risk of transmission of the virus. According to the association, the dental care professionals could resume oral health services earliest April 6 (ADA, 2020). The recommendation led to a postponement of the dental care services until a later date when the virus’s risk would subsidize. Lack of access to healthcare services reduces the risk of dental complications.
What are the themes inferred from the results of the studies?
Dziedzic et al. (2020) found that oral health should be considered an essential part of overall health. The study shows that the pandemic has led to a decline in access to healthcare services such as dental care because dental care plays a significant role in patients’ health with comorbidities. Continuous support is necessary for vulnerable patients during the coronavirus pandemic. Similarly, Hajek et al. (2021) acknowledge decline is attributed to the postponement of dental visits.
Brian and Weintraub (2020) examined the issue of oral health and the pandemic. The findings suggest that there is a need to improve prevention and access to oral healthcare services. The scholars indicate the need to adopt non-aerosolizing, prevention-centric approaches to treat oral diseases during the pandemic. The study finds 76 percent of dental clinics were closed while 19 percent were completely closed, and 5 percent saw a low volume of patients.
Crawford and Taylor (2020) examine the effectiveness of e-dentistry in the treatment of oral diseases. The findings indicate the need for a virtual approach to managing emergency consultations, treatment, multidisciplinary clinics, and handling new patients.
Giudice et al. (2020) investigate the value of teledentistry in monitoring patients during the pandemic. The study describes the value of teledentistry in dental practice during the COVID-19 pandemic. The findings suggest teledentistry allows monitoring of patients, reduces human contact, reduces cost, and reduces coronavirus infection risk. Mathivanan et al. (2020) emphasize that teledentistry is the future of the dental practice.
Hajek et al. (2021) examine the postponement of dental visits during the pandemic. The findings indicate that 20 percent of the patients postponed checkups and regular examination. According to the study, postponement increases the risk of deterioration of oral health. Similarly, Kranz et al. (2021) acknowledge postponement can pose a threat to dental health.
Kranz et al. (2021) examine the delay of dental care visits among the American population. Nearly 46.7 percent of the respondents reported delaying their dental care visits during the pandemic. The findings correlate with Hajek et al. (2021) that the dental care visits reduced due to the fear of coronavirus infection.
Luzzi et al. (2020) examine the impact of the pandemic on dental care. The findings suggest a change of strategy since remote interactions require quality communication skills to sustain dental care provision during the pandemic.
Mathivanan et al. (2020) indicate that teledentistry is the future of the dental practice. Findings suggest that 90 percent of dentists agree that teledentistry will improve healthcare services among the rural population. The study relates to Brian and Weintraub (2020) that teledentistry can enhance access to care.
Sirin and Ozcelik (2021) examine the relationship between the pandemic and dental damage. The results indicate the relationship between the dental damage stage and the pandemic is remarkable. 75% of patients in dental damage stage three were hospitalized with over 11.6 days of hospital stay.
Yang et al. (2020) indicate that healthcare services should distinguish between emergency and non-emergency healthcare services. The incidence of pediatric emergencies (40.1%) was lower than non-emergencies (59.9%). Prioritizing the cases will improve the provision of care for emergency conditions.
Meta-analysis
Four of 10 studies discussed teledentistry (Crawford, 2020; Giudice, 2020; Mathivanan, 2020; Yang, 2020), Three of four studies (Crawford, 2020; Giudice, 2020; Yang, 2020) directly evaluated e-dentistry or teledentistry during COVID-19 pandemic to assess that teledentistry can enhance patients’ access and monitoring during the COVID-19 pandemic, their studies showed teledentistry has a possibility of improving the provision of care during the pandemic, They concluded that although e-dentistry is not the solution for providing complete oral services, it can provide good results in selected patients and improving the ability to monitor dental conditions especially for those people who are at risk with a specific health condition.
Crawford et al., 2020 pointed out that pandemic offers dental care professionals an opportunity to shift to non-aerosol-generating procedures, prevention-centric approaches, and limit surgical interventions. One of the four studies ( Mathivanan et al., 2020) evaluated dentists’ knowledge about teledentistry; the study did not point out directly during the COVID-19 pandemic; the article mentioned that the need for oral health is increasing in countries with a large rural population and difficult access to oral care, and although few dentists have elaborate knowledge about teledentistry, the technology can increase access to dental care and minimize the negative effects of lack of access to a regular dental office, so dentists should know this method; the study showed only 73 of 200 dentists were aware of teledentistry, and only 50% of general dentists had knowledge about teledentistry; however, more than three-quarters of the dentists’ population believed that teledentistry could be an acceptable form for providing medical services and dental exam in rural areas, In contrast, more than 90% of the dentists believed that teledentistry could violate the patient’s privacy.
Two studies of 10 studies evaluated postponed dental care visits (Hajek, 2021; Kranz, 2020). The public started taking extra measures to avoid the risk of infections. While some canceled their monthly or regular visits, others postponed them until the conditions subsidized. Government measures to execute lockdown measures put the public’s fear that going out to public places was a risk to their health. For example, the government asked people to avoid going out if necessary or doing a morning run. Some of the services the government termed as non-essential were closed. For example, gyms, schools, beauty, and barbershops were closed. Hajek et al. (2021) evaluated 974 participants, and the finding shows that 22 percent of the respondents postponed dental care visits. Among the 22 percent, 72 percent of the participants postponed regular dental care examination while 19.6 percent postponed planned therapy.
The study by Kranz et al. (2021) suggested that nearly 50 percent of American adults postponed their dental care due to the COVID-19 infectious virus. They pointed out that because populations at risk for most chronic diseases are similar to those at higher risk for oral disease, oral health, and regular dental visits can reduce respiratory disease progression. It is important because older people and people who have other medical condition such as chronic lung disease, diabetes, a heart condition, or kidney disease are at higher risk for developing severe illness due to COVID-19 infection; postponed dental care can cause poor oral health and increase the risk of adverse health outcomes and also increase developing the same medical conditions, therefore, improving oral health may reduce the morbidity of COVID-19.
In contrast, The American Dental Association issued a declaration to close the dental care facilities to avoid infection risk. One of the factors contributing to this decision was that dental care services include aerosol-generating procedures that increase virus transmission risk. The dental care professionals closed their facilities to fear getting infected with the virus from a patient or a co-worker.
According to Ahmed et al. (2020), of 650 dental care professionals across 30 countries,87 percent of dentists were afraid of getting infected with a patient’s virus, 72% of respondents reported that they feel nervous when talking to patients in close vicinity. The study showed that 66 percent of the respondents wanted to keep their clinics closed.
American Dental Association, Health Policy Institute (2020) launched an ongoing biweekly poll to understand better the impact of the COVID-19 pandemic on dental practices. The poll indicated that in the week of March 23, %76 dental centers were closed, and they saw emergency patients only. After the association announced that the dental care clinics would reopen gradually in May, patients did not immediately resume their planned visits. Dentists continued to see the majority of patients with emergency cases, unlike scheduled visits or routine visits to treat oral diseases; the data collected in the biweekly poll in the week of May 4, 2020, indicated that dental offices had 59% fewer patients compare to what was typical in their practice.
While eight of 10 studies evaluated adult patients, two studies evaluated pediatrics oral health during the COVID-19 pandemic (Luzzi, 2020; Yang, 2020); Luzzi et al. (2020) argued that pediatric oral health is at risk due to the pandemic. The failure of parents to take children for dental care increases the risk of adverse outcomes. Pediatricians indicate that children are high-risk transmitters of the virus, and thus dentists are shy to accept non-emergency pediatric dental care services during a pandemic. Luzzi et al. (2020) developed consultation and orientational tool on operative protocols in pediatric dental practices during the COVID-19 pandemic to manage and limit infection spread in the pandemics. Yang et al. (2020) demonstrate that consultation for regular and emergencies and pediatric dentistry management can increase when dentists embrace the online approach.
Yang et al. (2020) evaluated a total of 474 online consultations of pediatric dentistry in 59 days to analyze the dental health status of children during the COVID-19 pandemic and introduce the principle of dental treatment priorities in emergencies. The incidence of pediatric emergencies (40.1%) was lower than non-emergencies (59.9%); the study also showed even some of the most affected areas respond with creative measures to avoid the risk of treatment during the provision of care. The study also confirmed that new facts would comprise the adoption of teledentistry to facility access and reduce the virus’s risk of transmission.
One of 10 studies (Sirin & Ozcelik, 2021) examined the relationship between dental stage damage and the symptoms associated with COVID-19. The study used 137 patient records (20-65 years ) based on oral examination records and panoramic X-rays referred to the University of health sciences, Sultan Abdolrahman Han training and research hospital, and outpatient dental in Turkey. Among the respondents, 1,516 COVID-19 patients had positive real-time PCR COVID-19 tests. They developed new scoring for dental damage, indicating a remarkable relationship between the risks of COVID-19 with the dental damage stage. The relationship demonstrates that the population’s oral health deteriorates with regularly visiting the dental care clinics. According to the classification, there was a correlation between the dental damage stage and the morbidity and mortality of COVID-19 disease. The mortality rate due to COVID-19 disease was significantly higher in patients in the dental damage stage 2 3.
Synthesis of the Literature
The dental care crisis requires a proactive approach to improve the health of the population. According to Brian and Weintraub (2020), the public should eat healthy diets, avoid fluoride exposure, and take dental sealant to improve health quality. Brian and Weintraub (2020) campaigns for prevention measures and increase access to dental care services. One of the suggestions of enhancing access is to examine the populations at risks, such as minority groups, low-income families, low literacy individuals, and the elderly. Dziedzic et al. (2020) argue that taking care of the population embraces continuous care for vulnerable populations. Some of the vulnerable people affected by poor access to dental care services include minority groups, low-income families, low literacy individuals, and the elderly. The provision of care for the vulnerable populations needs to match with the new reality.
The pandemic offers dental care professionals an opportunity to shift to non-aerosol-generating procedures, prevention-centric approaches, and limit surgical interventions. According to Crawford and Taylor (2020), the effective use of e-dentistry service during the COVID-19 pandemic can increase the response measures against the virus. Studies suggest that e-dentistry or teledentistry is one way to improve access to healthcare services and reduce the risk of transmission. The study shows that a virtual office approach is critical in overcoming the barriers related to dental care during the pandemic. A virtual office approach can increase access to healthcare services related to dental care. Crawford and Taylor (2020) show that healthcare workers can provide dental services and prescribe medication to patients without physical contact. Video conferencing increases the opportunity of boosting access to healthcare services for people across a wide geographical area. According to three studies (Crawford, 2020; Giudice, 2020; Mathivanan, 2020; Yang, 2020), teledentistry can enhance patients’ access and monitoring during the COVID-19 pandemic; the studies emphasize that dentists should align their healthcare delivery with the new reality; the new fact will comprise the adoption of teledentistry to facility access and reduce the virus’s risk of transmission.

References
American Dental Association, Health Policy Institute (2020). COVID-19: Economic impact on
dental practices, retrieved from https://surveys.ada.org/reports/RC/public/YWRhc3VydmV5cy01ZWQ2NjRiNzBhNzI3MTAwMGVkMDY2ZTQtVVJfNWlJWDFFU01IdmNDUlVO
Brian, Z & Weintraub, J.A. (2020). Oral health and COVID-19: Increasing the need for
prevention and access, Preventing chronic disease, DOI: http://dx.doi.org/10.5888/pcd17.200266
Crawford, E. & Taylor, N. (2020). The effective use of an e-dentistry service during the
COVID-19 crisis. Journal of Orthodontics 47 (4), 330-337. DOI: 10.1177/1465312520949557
Dziedzic, A., Tanasiewicz, M., & Tysiac-Mista, M. (2020). Dental care provision during
Coronavirus disease 2019 (COVID-19) pandemic: The importance of continuous support for vulnerable patients. Medicine (Kaunas, Lithuania), 50 (6), 294. DOI: 10.3390/medicina56060294
Giudice, A., Barone, S., Muraca, D., Averta, F., Antonelli, A. & Fortunato, L. (2020). Can
teledentistry improve the monitoring of patients during the Covid-19 dissemination? A descriptive pilot study. International Journal of Environmental Research and Public Health, 17 (10). p 3399. https://doi.org/10.3390/ijerph17103399
Hajek, A., De Bock, F., Huebl, L., Kretzler, B. & Konig, H.H. (2021). Postponed dental visits
during the COVID-19 pandemic and their correlations. Evidence from the nationally representative COVID-19 snapshot monitoring in Germany (COSMO). Healthcare, 9 (1), 50, https://doi.org/10.3390/healthcare9010050
Kranz, A.M., Gahlon, G. Dick, A.W. & Stein, B.D. (2021). Characteristics of U.S. adults
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Luzzi, V., Lerardo, G., Bossu, M. & Polimeni, A. (2020). Pediatric oral health during and after
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Mathivanan, A. Gopalakrishnan, J.R., Dhayanithi, A., Narmatha, M., Bharathan, K., & Saranya,
(2020). Teledentistry: is it the future of rural dental practice? A cross-sectional study. Journal of Pharmacy & Biogllied Sciences, 12 (suppl 1), p 304-307. DOI: 10.4103/jpbs.JPBS_91_20
Sirin, D.A. & Ozcelik, F. (2021). The relationship between Covid-19 and the dental damage
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Yang, F., Yu, L., Qin, D., Hua, F. & Song, G. (2020). Online consultation and emergency
management in paediatric dentistry during the COVID-19 epidemic in Wuhan: A retrospective study. International Journal of Pediatric Dentistry, 31 (1), 5-11, https://doi.org/10.1111/ipd.12722

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