COVID-19 and Inequities in Oral Health Care for Older People: An Opportunity for Emerging Paradigms

Abstract

Severe restrictions have been imposed in most countries for oral health care to the general population, allowing treatment only for emergencies, because of the generation of aerosols during clinical procedures and to ration personal protective equipment (PPE) during the pandemic. This article stresses the critical situation that affects oral health for older persons in the complex times of the COVID-19 pandemic. Older adults are at high risk for the viral infection, but neglected dental conditions may worsen their health, triggering infections that can lead to local and systemic complications, compromising general health. We propose that under current and possibly future scenarios, teledentistry and the minimal intervention dentistry approach may play a pivotal role in reshaping the profession. The already existent inequities in oral health care may be exacerbated due to the pandemic, especially in the developing world. More research along with a strong educational component in the dental curriculum must be emphasized. COVID-19 may be an opportunity to change canonical paradigms. The dental profession must reflect and take action to face future challenges. Knowledge Transfer Statement: This article provides an overview of the oral health situation imposed by COVID-19 and the minimal intervention alternatives to provide care to older people who are at risk and have reduced access to care.

Telehealth Use in Geriatrics Care during the COVID-19 Pandemic—A Scoping Review and Evidence Synthesis

“…Free communication platforms [44,59,[73][74][75][76] Readily available web-based training [77][78][79] Standardized documentation and real time reporting to improve quality of care [80] Digital photographs and asynchronous sharing to circumvent connectivity issues [77] Wearable devices, remote monitoring sensors and other technologies as early warning tools [59,81] Automatic speech analysis for diagnosis and monitoring of dementia [82] Enhanced integration of specialty expertise care of nursing home residents [70,83] Possibility of daily community collaborative rounds involving multiple services providers in nursing homes [84] Technology that is easy to understand pertaining to different interfaces, passwords, and maintenance [56,70] T-Threats Ambiguous/technical jargon for descriptive terms [85] Large variability of available telehealth platforms [70] Lack of sustained insurance reimbursement [11] Digital divide for some due to lack of equipment, limited literacy, and lack of assistance [56,63,72,[86][87][88][89][90][91][92][93] Ageism/stigma leading to de-prioritization of older people [94,95] Failure to include older people in standardizing telehealth [56] Lack of tested clinical tools for telehealth use [65,96] Technical failures and patient dropout …”

Impact of COVID-19 on the Knowledge and Attitudes of Dentists toward Teledentistry

“…During the COVID-19 pandemic, social isolation measures carried out by most countries around the world have restricted dental consultations to emergency or priority procedures only. Due to these restrictions, possible neglect of oral health among the population could occur during the COVID-19 pandemic, which could lead to eventual emergencies or cause patient distress and insecurity, as well as even affect their general health (León and Giacaman 2020). Because of this, TD is a valuable resource to face this critical situation now and in future crises.…”

La teleodontología como alternativa de atención durante la pandemia por COVID-19

“…Los adultos mayores quienes tienen un alto riesgo para la infección por el virus pueden beneficiarse del cuidado odontológico por medio de la teleodontología, brindándoles consejos e información sobre nutrición e instrucciones de higiene bucal. Adicionalmente, se recomienda complementar la asistencia con los procedimientos de odontología mínimamente invasiva como el tratamiento restaurador atraumático 20 .…”