June 25th, 2021
Good oral health is an important factor to overall health.
Just one year ago, the unknown nature of the COVID-19 virus necessitated a halt in elective dental procedures, namely routine and preventive care. Societally, many experienced a novel increase in stress, anxiety, depression, loneliness, and poverty. Historically, socioeconomic conditions have a strong causative relationship to oral health conditions like erosion, caries, periodontal (gum) disease, bruxism (grinding of the teeth due to stress) and temporomandibular joint disorders. The necessary halt in preventative care, in conjunction with the economic and mental stresses of the novel pandemic, has had large ramifications on our community’s oral health, especially among populations that have already been underserved by the dental community.
One condition exacerbated by the pandemic is dental caries, commonly known as tooth decay or cavities. Dental caries start from childhood and continue into adulthood, aggravated by mood fluctuations, socioeconomic status, and other external factors. This process can be arrested and/or prevented with regular exams, cleanings, dental sealants, and fluoride applications. Just last year, these services were not safely available. Minor instances of dental caries have turned into complicated cases in the last 15 months.
Hispanics, Non-Hispanic Blacks, American Indians, and Alaska Natives are the populations who disproportionately suffer with poor oral health in the United States. The lack of pre-existing outreach and dental infrastructure for these populations, has often necessitated traveling long distances to receive affordable and quality treatment. Conditions arising from this systemic lack of quality care are now coupled with the halt of preventive care necessitated by the pandemic. Hope Dental Clinic has proudly worked to fill the gap in services for the underserved in the Twin Cities. However, an unprecedented increase in the number of patients needing our care has coincided with other challenges brought forth to the clinic during the pandemic. Due to the need for additional funds and volunteer clinicians has left us at a critical need for increased community support to continue to serve during the pandemic.
Instances of poor oral health extend to even the youngest patients in the Twin Cities area. The ongoing pandemic caused the postponement of preventive dental care in children, as only 4% of families with private dental insurance secured an appointment for their children. As a result, Hope Dental is now seeing many children in need of extractions that would have needed only restorative care had they been seen sooner. Early extraction of primary teeth causes malocclusions (improper bite), improper dietary habits, and psychological and emotional trauma, aggravating dental office fears. Dental pain and anxiety in pediatric patients leads to school absences and lower grades, and these issues are now superimposed over pandemic-related issues including changes in household finances, familial stress, and lack of adequate nutrition without the benefits of free and reduced lunch programs as schools shift to remote-learning.
Data released by the CDC shows that most patients who were admitted into hospitals with COVID-19 were suffering from chronic health diseases as underlying comorbidities. Populations with low socioeconomic status and low literacy rates are the most affected with chronic conditions like diabetes and cardiovascular diseases, which periodontal disease is closely linked with. Much of Hope Dental Clinic’s patient base is comprised of those with little to no higher education and fall below the Federal Poverty Line. The patient demographic we serve is sitting at a dangerous precipice of declining oral and overall health, which the pandemic has only worsened.
Human bodies have two main mechanisms of immunity which build their overall immune systems. Humoral mechanisms fight free-flowing infection in the body, while cellular mechanisms fighting infections from within the cell body itself to build immunity. Both healthy and immunocompromised patients who became ill with COVID-19 showed dysregulated humoral and cellular mechanisms, impacting their oropharyngeal (neck and mouth) health. Some symptoms included decreased salivary flow causing rapid spread of dental decay, changes in taste, ulcerations, gingivitis, and opportunistic fungal infections, all resulting in poor oral hygiene.
The underlying reason could be the cytokine storm SARS-COV-2 causes, where the body begins to attack itself. Blood flow becomes disrupted during this process, and the oral cavity is richly supplied with blood vessels. Poor performance of these vessels results in ulcerations and patchy areas in mouth. The multi-drug strategy and Interferons used as treatment for COVID-19 are among the most popular causes of dry mouth. Dental problems can be seen continuing even in fully recovered patients. Close monitoring of oral health, especially during transition from hospital to other settings, is now necessary.
Proper, quality oral healthcare has always been lacking for the underserved. Their low socioeconomic standing, coupled with the pre-existing lack of satisfactory outreach by the dental community has made them particularly vulnerable to the COVID-19 pandemic. Eventually, and as quickly as possible, there should be a push for dental facilities to provide proper preventative and emergency treatment to patients who have slipped through the cracks of our current healthcare system. Especially patients who have tested positive for SARS-COV-2 and now require post-care that includes consistent monitoring of oral health.
Hope Dental Clinic is experiencing an unprecedented need for our services as more Minnesotans lose their dental insurance and income from unemployment, and last year’s safety measures have left many patients waiting for care as their oral health worsens. The demand for our services coincides with a decrease in volunteers and funds from the pandemic as many fear for their own wellbeing. Hope Dental Clinic now rests at a critical point, requiring action from our community to help us continue to bridge the gap for good oral health to our neighbors in need.
Researched and Authored by Deepthi Nambala
Additional Editing by Jessica Flotterud and Kylee Mattson