The Pandemic Drags On. HIV Folks, Are You Taking Care of Your Teeth?

But what about my deep cleaning?

That’s what I was asking myself all spring and summer as the COVID-19 pandemic dragged on. As a person living with HIV for nearly 20 years, I try to maintain every aspect of my health, including my oral health. The past few years, I’ve been going for my dental care to the esteemed New York University (NYU) College of Dentistry here in New York City. It was one of the few places I could find under my very limited Obamacare dental plan that would cover the numerous fillings and other work I needed. So, warily but gratefully, I went.

Turns out I liked it! I spent much more time at NYU College of Dentistry than I would at a private office, because it’s not just a care center but a learning environment. Some visits, frustratingly, my teeth would only be assessed and discussed among teachers and students, not even worked on. (Thankfully, I work from home and have a flexible schedule.) But I also liked the fact that I was getting a meticulous audit of my teeth, in some ways learning right alongside the students, with no shady profit motive of the sort that makes private providers tell you that you need $5,000 worth of work that you don’t really need.

So I stuck with it, befriended the nice young dental students who worked on my teeth, and got about half of the extensive work I needed done—all for a rock-bottom $15 a visit! My teeth were very appreciative.

Then COVID hit. Right before, in addition to some pending fillings, I’d been scheduled to have a deep cleaning, the kind they need to “numb you up” for so they can get down below your gumlines. But, like health centers nationwide, and also because it’s a school, NYU shut down.

The COVID spring and summer dragged on, and I started to worry about my teeth, as much as I assiduously kept up on my brushing and flossing (and as much as I hate flossing). NYU did not reopen. So, once dental offices in my neighborhood unshuttered, with lots more air filtration and PPE for the practitioners than ever before, I made an appointment at one of them and shelled out $100 for a cleaning.

“It’s not a deep cleaning, but it’ll hold you until you can have one,” said the nice young dentist, who’d gone—get this!—to NYU! That was a few months ago now, and I can still feel the ridges of my back lower teeth, which I hope means that they’re still relatively plaque-free. Yay!

Then I read this New York Times story saying that dentists nationwide are seeing an epidemic of bruxism—a fancy word for teeth-grinding, both while awake and asleep—because people are stressed out from COVID, and that it’s leading to tooth cracks and fractures.

Were dentists who treat us folks with HIV seeing the same thing? Yep! That’s what I was told by three dental directors who see significant numbers of people with HIV—J.P. González-Torres, D.D.S., at New York City’s Callen-Lorde clinic, Amar Trivedi, D.D.S., at Houston’s Legacy Community Health, and Heather Crockett-Miller, D.D.S., M.P.H., at Columbus, Ohio’s Equitas Health.

“I’m definitely seeing that and having to make a lot of nightguards for people to wear to bed to protect their teeth,” said Crockett-Miller, adding that if patients can’t get in to see her right away, she suggests they go to a pharmacy like CVS and buy a ready-made nightguard. González-Torres and Trivedi gave the same advice. The Times piece also urged people to make sure that, at least during waking hours, their upper and lower teeth are not touching. Let your jaw hang slack!

All three dentists I spoke to also said that their offices had significantly stepped up safety, with new ventilation and filtration systems, stronger suction straws to prevent aerosolized saliva, and full-on PPE including eye goggles, N95 face masks, and clear face shields, gowns, and gloves.

“It’s a little less personal than it used to be,” said Crockett-Miller. But hey—we’re in an epidemic!

They also said that, unless you’re severely immunocompromised (if, say, you’re not on HIV meds for some reason and/or your CD4 count is 200 or below) and thus at high risk for COVID—and, we should point out, it appears so far that folks with well-managed HIV are not in a COVID high-risk category—you should be going back to the dentist for routine care such as cleanings or sub-urgent care, like my cavity fillings. Without being able to speak for all dental offices, they said, most of them by now have stepped up their safety standards in the ways mentioned above.

“The fear factor around going to the dentist has mostly subsided,” said Trivedi, “but now it’s more about, ‘Hey doc, I just can’t afford that crown right now,’” due to COVID-induced economic hardship. (If you find yourself in this situation, reach out to your local HIV-serving health center or service organization; if you qualify for ADAP, the federal-state treatment assistance program for people with HIV, you may find that it covers extensive dental work, as it often does at places like Legacy.)

In New York City, González-Torres said that he and an assistant alone are helming Callen-Lorde’s dental clinic, which usually has a staff of about 14. He said he’s been doing a lot of assessments via a FaceTime-like telehealth portal, often urging patients to buy an over-the-counter Play-Doh–like temporary tooth filling at the drugstore for crowns or fillings that fall out, until they can come in for work. He also said that the clinic was holding off on certain procedures that heavily aerosolize, or blast into the air, oral particles.

All three dentists said that, amid the upheavals and stressors of COVID, some patients have slacked on at-home dental hygiene, such as by not brushing or flossing as much, but that it’s absolutely critical that we keep up the good work at home. In addition to brushing twice and flossing once daily, they gave the following pro tips for good at-home care:

  • Use an ultrasoft toothbrush, and brush very softly, in a circular motion, at an angle, so as not to wear down gums. An electric toothbrush, even a cheap battery-powered one, is even better.
  • Try not to rinse after brushing your teeth, because leaving the fluoride on them is good for them. If you hate the grittiness of that, use a fluoride rinse. Also, see if your insurance will cover PreviDent, a prescription high-fluoride toothpaste.
  • Eat cheese! Studies show that it helps balance the pH in your mouth. On the flip side, sugary sodas, coffee, and even lemon water—currently often touted as a health hack—will wear down your teeth, so drink them sparingly—and quickly. Better to chug them than sip them all day long.
  • Rinsing with warm saltwater can help minor mouth infections, but anything serious or sustained needs to be looked at by a dentist. Same with any lump, bump, or sore that doesn’t heal in two weeks. Get it looked at—it could be oral cancer, which is easily removed if caught early but not pretty if left unattended.
  • If you are or were a drug user, don’t let stigma keep you from going to the dentist. “You’d be amazed at what we can do these days to save what we can and make your teeth look better,” Crockett-Miller said.

As for me, I just called NYU Dental. They’re back in business, they told me, and they’ll be calling all their old patients to set up appointments for all that unfinished work. I’m so excited for my deep cleaning! Now, that’s something I never thought I’d say—but these are some strange COVID times!

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