Oral Health Care during the times of COVID 19

 The face is the index of the mind. Likewise, the oral health is an indicator for the general health status of an individual. Oral health problems constitute a major public health issue in developing countries. This is amplified by a skewed dentist-patient ratio owing to clustering of dental professionals in urban areas.

In times like these, when a virus is dangerously rearing its head, oral health definitely has taken a back seat. This could be due to fear of COVID superimposed on the fear of the dental drill, closure or reduced hours of dental practices, increasing costs due to additional preventive and safety measures imposed and economic crisis derailing the patient’s interest for non-emergency dental procedures.

Now that many dental practices have re-opened with full vigour, all has not been lost. This pandemic has provided an opportunity to rethink the future of dental practice.

Dentistry has so far had a main stake on 2 highly useful, but aerosol generating devices;  the high-speed handpiece used for drilling teeth for fillings and the ultrasonic scaler used remove hard deposits on teeth. These procedures are done to treat the 2 most common dental diseases, the dental caries known to common man as tooth decay and periodontal or gum disease.

We as dentists have been forced to go back in time and take a leaf out of history books  to re-orient oral health care towards a prevention based approach.

Prevention measures go hand in hand with awareness campaigns. If the population is made aware of the ill effects of a particular disease and shown the ways and means to prevent its occurrence, it is automatically equipped to handle it better.

Preventive practices in dentistry that are already in place in different communities include –

Fluoride supplementation to vulnerable population – through Community water and salt fluoridation

• Topical fluoride application to children in the growing ages relative to tooth eruption schedules
• Diet counselling and formulation for high caries risk individuals
• Pit and fissure sealants for susceptible pits and fissures
• Reinforcement of oral hygiene procedures with proper maintenance protocol
• Reduction of tobacco and alcohol usage
• Preventive and Interceptive procedures to combat developing mal-occlusion

These have to be ramped up and made easily accessible / available to all populations.

Minimally invasive surgical techniques that could replace the aerosol generating procedures include –

• Nonsurgical caries management using hand instruments, resin sealants,  fluoride releasing glass ionomer cements (Atraumatic Restorative Technique)
• Oral hygiene procedures sans the ultrasonic scalers.

In recent times, the concept work-from-home has become the new normal. Although dentists are one of the few professionals who definitely can’t work from home, the “online” platform can be used as a suitable medium to convey oral health related information.  

Tele dentistry can be used for education, consultation, and triage, allowing dental professionals to advise patients whether their dental concerns constitute a need for urgent or emergency care, whether a condition could be temporarily alleviated at home, or whether treatment could be postponed. This would provide effective solutions to minor dental needs and make the patient visit the clinic for definitive surgical procedures.

This essentially reduces chair-side time, travel and appointment / waiting-time, rising cost concerns of the patient and simultaneously prevents the dentist from inadvertent exposure to the virus, reduces the costs of running the dental practice with additional safety measures and mandatory testing kits.      

Online learning can also be used to facilitate access to preventive services and oral health education when dentists can provide such services in community settings, such as schools, without onsite presence.

Thus, the dental team must work in unison with public health professionals to clearly communicate the importance of oral health to general health and put forth the steps being taken to ensure patient and provider safety whilst promoting prevention and non-aerosol generating procedures.

Prevention is always better than cure!