Oral health and access to care under siege during COVID-19 pandemic

29 June 2020 Healthcare

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A good oral hygiene routine, regular dental check-ups and a healthy lifestyle are crucial for protecting oral health and maintaining general health. Oral diseases, if left untreated, not only impact the mouth, but can also impact every aspect of life. The COVID-19 pandemic has severely impacted oral health around the globe: in addition to fueling unhealthy eating and drinking habits[1], the pandemic has also severely disrupted dentistry services and access to care.  

Unhealthy commodity industries capitalize on a new normal at the expense of oral health

During the pandemic, tobacco, alcohol, and processed food and drink companies have been pushing their products, which are detrimental to oral health. Ultra-processed food such as sodas have been used to brand COVID-19 testing, while fast food and doughnuts have been promoted as donations to food banks and frontline workers[2].

Sales of alcohol have also increased in several countries and companies have adapted to meet consumer demand by developing delivery services. In the United Kingdom, one alcohol company started promoting its ‘through the letterbox’ cocktail delivery service, without completing age verification[3].

Excessive alcohol drinking can lead to injury, often to the mouth and teeth, and can cause dental caries due to the high sugar content of alcoholic drinks. Acidity is linked to dental erosion and many alcoholic beverages are quite acidic, with a pH level around 4.

“Alcopops” (drinks relatively low in alcohol but often high in sugar) are the most damaging for the teeth, as they include the erosive potential of alcohol and of the sugar in soft drinks or fruit juices[4]. Along with tobacco, excessive alcohol use increases the risk for cancers of the mouth, contributes to poor oral health and increases the risk of heart disease.

Covid-19 continues to wreak havoc on dental services

Routine dental care was largely unavailable during the pandemic, as many dental practices were forced to close.

While more and more practices worldwide are re-opening, many warn that a return to normal is not yet possible, as there are numerous concerns about the availability of dental services and ensuring the safety of dentists and dental teams.

The continuing operation and long-term survival of many dental practices is also threatened by the economic and social challenges arising due to care restrictions, practice closures and shortages of personal protective equipment (PPE), as well as the need of investing in new types of PPE and technology.

In this BBC piece[5] about dentists returning to work in the UK, British Dental Association Principal Executive Committee Chair and FDI Dental Practice Committee member Dr Mick Armstrong says, “anyone expecting dentistry to magically return [to normal] will find only a skeleton service.” Dentistry continues to suffer from the effects of the pandemic, even as many countries are reopening. 

Studies[6] [7] have shown that there is a significant change in the distribution of dental problems and the patient’s willingness to seek dental care. While this could result in increasing numbers of late dental complications and untreated dental emergencies, it is also contributing to a rise in home dental remedies, or “DIY dentistry.” According to Dr Armstrong, “whenever access problems emerge, people with toothaches take matters into their own hands”[8].

FDI Council’s official statement on COVID-19 outlines key principles for dental practice and oral health promotion during the pandemic.

FDI continuously emphasizes oral health as an essential public service and calls for oral health professionals to be included in the decision-making process regarding regulation of and guidance on health care delivery during the pandemic.

FDI has also put together a library of resources for members, health authorities and dental teams to respond to the challenges posed by COVID-19.

 

References

[1] Abbas AM. Dietary habits in adults during quarantine in the context of COVID-19 pandemic.Obes Med. 2020;19.

[2] NCD Alliance. Map of Examples of Unhealthy Commodity Industry Responses to COVID-19. Available from: https://ncdalliance.org/why-ncds/covid-19/map-unhealthy-industry-responses [Accessed 22 June 2020].

[3] NCD Alliance. Map of Examples of Unhealthy Commodity Industry Responses to COVID-19. Available from: https://ncdalliance.org/why-ncds/covid-19/map-unhealthy-industry-responses [Accessed 22 June 2020].

[4] Peycheva K, Boteva E. Effect of Alcohol to Oral Health. Acta Medica Bulgarica. 2016;43(1): 71-77.

[5] Edgington T. Coronavirus: No return to 'business as usual' for dentists. BBC. 5 June 2020. Available from: https://www.bbc.com/news/health-52913826 [Accessed 22 June 2020].

[6] Yakubov D, Ward M, Ward B, Raymond GF, Paskhover B. Opinion: An Increase in Severe, Late Dental Complications Might Result From Reliance on Home Dental Remedies During the COVID-19 Pandemic. J Oral Maxillofac Surg. 2020; May.

[7] Guo H, Zhou Y, Liu X, Tan J. The impact of the COVID-19 epidemic on the utilization of emergency dental services. J Dent Sc. 2020. Available from: doi.org/10.1016/j.jds.2020.02.002.   

[8] Steussy L. People are pulling their own teeth while dentists are on coronavirus lockdown. New York Post. 21 April 2020. Available from: https://nypost.com/2020/04/21/people-are-pulling-their-own-teeth-with-dentists-on-lockdown [Accessed 22 June 2020].