When Covid-19 began to spread like wildfire in the U.S. this past March, some of the first professional establishments to close their doors were dental offices. Once the basics of how coronavirus was spread via respiratory droplets was understood, the notion of such excessive exposure with an open mouth, sprayed oral irrigations, suctions, drilling, picking, brushing and flossing were off limits. All of these procedures are called AGP’s, or aerosol-generating procedures, which have been found to be the highest spreaders of viral particles. The vast majority of dentists, oral surgeons, and orthodontists around the country and across the world were handling most of their work by telemedicine, and seeing in-person visits for emergencies only.
As PPE (personal protective equipment) and more aggressive office supply cleaning practices, use of disposable instruments, and minimizing procedures requiring excess spray of secretions became more the norm, offices began to open. By June 2020, most practices were back to various levels of non-urgent visits. Many have limited the number of patients in waiting rooms, require pre-entry health questionnaires, temperature screening, and some have required pre-visit Covid-19 testing, especially where a more extensive procedure may be involved.
Just as pediatricians were seeing significant delays in routine, albeit necessary, care, especially with regards to infants and toddlers falling behind on their vaccine schedules, dentists have been seeing consequences in delayed dental care. As reported by the New York Times on September 8, 2020, Dr. Tammy Chen, a dentist in New York City, saw a dramatic uptick in dental trauma. No, not from fights over masking debates, political scuffles, or coronavirus vaccine safety. These were self-inflicted traumas, from clenching, grinding, poor posture while chronically on a screen, and even poor sleep. These can all lead to dental injuries, primarily cracked teeth, jaw pain, and even worn down molars from tooth grinding. This combined with months of missed dental care, stress-induced dental issues became a mainstay of practice.
An August 2020 recommendation published by the World Health Organization (WHO) strongly advised to offer remote consultations for dental issues, as well as to significantly curtail aerosol-generating procedures (AGP’s), which have been found to increase the risk of Covid-19 spread. Such procedures were described as follows:
“Definition of aerosol generating procedures (AGPs) in oral health care: All clinical procedures that use spray-generating equipment such as three-way air/water spray, dental cleaning with ultrasonic scaler and polishing; periodontal treatment with ultrasonic scaler; any kind of dental preparation with high or low-speed hand-pieces; direct and indirect restoration and polishing; definitive cementation of crown or bridge; mechanical endodontic treatment; surgical tooth extraction and implant placement.” (WHO).
The American Dental Association (ADA) issued a response statement to this, with ADA President Chad P. Gehani stating: “Oral health is integral to overall health. Dentistry is essential health care. Dentistry is essential health care because of its role in evaluating, diagnosing, preventing or treating oral diseases, which can affect systemic health.”
While the WHO later clarified that, indeed, routine dental care should continue as long as safety guidelines are followed, many individuals have indefinitely postponed routine visits, leading to more issues with dental pain and tooth fractures. Not all, however, have had this experience. Dr. David Kitada, a dentist in practice in West Los Angeles, has noticed a different scenario than what’s been seen in Manhattan. Now that many restrictions have been lifted, he remarked “We have noticed something completely different with our patients. Many of them are hanging around and chatting much more… Some are even saying how coming in for a routine dental hygiene appointment is about the only thing they feel ‘normal.’ They even get to take their masks off! It made us realize how fortunate we are to have made just a few changes to our practice and that we get to interact with several people each day when others are feeling so isolated working from home.”
And there you have it. As many of us do love and respect our dentists, we are at the point in this pandemic where going to the dentist is the highlight of one’s week. Or month. Don’t forget to floss.
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