Since the pandemic started, we have seen a parallel in COVID-19 and oral health disparities, due to social determinants of health. The most vulnerable groups are people in lower socioeconomic positions, racial/ethnic minorities and older aged individuals. We have also seen correlations with lower literacy, living in rural areas and lack of insurance. People who identify as Black, Latino, American Indian, or Alaska Native are at especially high risk of COVID-19–related infection and death, and have poorer oral health, according to the Centers for Disease Control and Prevention (CDC). COVID-19 has compounded existing oral health disparities for three main reasons:
1. People are delaying care. This is happening most places in the world. Many people have not seen a dentist in nearly two years. Job loss and lack of insurance can make going to the dentist a lower priority or even impossible — especially if expensive care is needed. This dilemma started years before COVID-19, but it has escalated during the pandemic. In the past 10 years, there has been a 10% decline in the use of oral health care among low-income adults, mainly because many states have restricted or eliminated access to Medicaid dental benefits. People also are having difficulties finding dentists who accept Medicaid or CHIP (Children's Insurance Health Program), which account for about 39% of dentists nationally. As COVID-19 costs take up more state budgets, these trends may worsen.
2. People are changing their oral hygiene routines at home. Anecdotally, and in qualitative research, parents have reported giving their children sugary foods and treats as a reward for good behavior or as a substitute for not being able to play with their friends. Changes in daily life and schedules because of remote schooling and work have caused some parents to change their family’s and children’s normal routines, which had included tooth brushing with fluoridated toothpaste. Social scientists and epidemiologists currently are investigating these oral hygiene changes and their long-term effects.
3. People still believe going to the dentist is dangerous because of COVID-19. The dental profession was a leader in infection control and prevention long before COVID-19. Like all healthcare professionals, dentists take several precautions to prevent the spread of infectious diseases like COVID-19, including wearing personal protective equipment (PPE): surgical masks, eye protection, face shields, protective clothing, and gloves. Nationally, U.S. dentists reported high use of PPE and rather low COVID-19 infection; for example, six-month cumulative prevalence rates were ten times lower for dentists than frontline healthcare providers. At UCSF dental clinics, zero COVID-19 transmission cases have been linked to patient care — and our clinics have remained open since the pandemic started. There are no indications that going to the dentist increases a person’s risk of COVID-19, even with the new Delta variant. However, it is very important for patients and healthcare workers to stay home if they experience any COVID-19 symptoms. The growth of teledentistry has made it possible for some patients to access oral health care when they need it, despite the pandemic.
— Stuart Gansky, DrPH, Associate Dean for Research, Lee Hysan Chair of Oral Epidemiology in the School of Dentistry and Director of the UCSF Center to Address Disparities in Children's Oral Health (CAN-DO)
