There are early indications that the pandemic is taking a serious, and potentially long-lasting, toll on our oral health. In September, even before the winter coronavirus surge in the United States, an American Dental Association survey found that more than half of the dentists who responded were seeing an increase in stress-related conditions among patients. These included teeth grinding, cracked and chipped teeth and symptoms of temporomandibular joint dysfunction, like jaw pain. More than a quarter of the dentists reported an increase in cavities and gum disease — quite likely a result of changes in people’s diets and hygiene. Americans have also had difficulty accessing dental care: A report last month by the CareQuest Institute for Oral Health, a nonprofit research and advocacy group, found that six million adults had lost their dental insurance because of the pandemic, and more than one in 10 had delayed getting care because of cost, lack of insurance, fear of exposure to the virus or a combination of those factors.
A major challenge for providers is that routine dental procedures generate aerosols, which increase the risk of viral transmission. How much is unclear. (“There are currently no data available to assess the risk of SARS-CoV-2 transmission during dental practice,” according to the C.D.C., which offers guidance for dental settings on its website.) As precautions, many clinics have added space and time between appointments, reducing the number of patients they can see. That and other issues have worsened longstanding disparities in who receives oral health care: By mid-April, almost 60 percent of private practices were operating at full capacity, compared with roughly 35 percent of their public counterparts, according to A.D.A. polling.
But the pandemic has also inspired remote adaptations — ones that could help address these inequities. “We had to start thinking differently about how we were going to meet the needs of those children and families” who couldn’t come to a clinic or be treated at a school or other community site, says Antonina Capurro, the Nevada state dental health officer, “and how we were going to reach them.”
Throughout the history of modern medicine, the mouth has, rather strangely, been viewed as separate from the rest of the body. Preventive visits to a dentist typically are not covered by health insurance, unlike annual visits to a primary-care physician. Only within the past few decades have researchers begun to appreciate the extent to which oral health is inextricable from a person’s overall physical, emotional and psychological well-being. Gum disease has been linked to a wide array of disorders, including diabetes, Alzheimer’s disease, cardiovascular disease, premature birth and even respiratory infections. Along with tooth decay, it is also associated with poor socioeconomic outcomes. Children who have cavities, for instance, tend to miss more school days and fare worse academically than those who don’t.