Estimating the Within-Person Change in Dental Service Access Measures during the COVID-19 Pandemic in the United States

Abstract

Background. American adults delay dental care more than any other healthcare service. Unfortunately, the COVID-19 pandemic may have stalled efforts to address dental service delays. Early evidence has suggested substantial declines in dental service visits in the early phase of the pandemic; however, our study is among the first to measure within-person changes from 2019 to 2020 and conduct subgroup analyses to examine if changing dental patterns were mediated by exposure to the pandemic, risk of adverse COVID-19 outcomes, or dental insurance. Methods. We analyzed a National Health Interview Survey panel of individuals initially surveyed in 2019, with subsequent follow-up in 2020. The outcomes included dental service access measures and the interval of a most recent dental visit. By constructing a probability-weighted linear regression model with fixed-effects, we estimated the average within-person change from 2019 to 2020. Robust standard errors were clustered within each respondent. Results. From 2019 to 2020, adults reported a 4.6%-point reduction in the probability of visiting the dentist ( p < 0.001 ). Significantly higher declines were found in Northeast and West regions compared to Midwest and South regions. We find no evidence that declining dental services in 2020 were associated with more chronic diseases, older age, or lack of dental insurance coverage. Adults did not report more financial or nonfinancial access barriers to dental care in 2020 compared to 2019. Conclusions. The long-term effects of the COVID-19 pandemic on delayed dental care warrant continued monitoring as policymakers aim to mitigate the pandemic’s negative consequences on oral health equity.

Dilemmas and Opportunities in Dentistry in the Face of the Covid-19 Pandemic

“…12 There was an essential lag in this face-to-face treatment during the lockdown, and the dental treatment of children declined the most among all age groups. 13 The frequency of follow-ups and dental check-ups was also affected, limiting the prevention and promotion of oral health care for children. 8 Teledentistry provided remote diagnosis and oral care to children with dental issues in these situations most frequently.…”

“…The inability to do so may worsen the already existing oral health inequities. 13 The COVID-19 pandemic may also promote the adoption of advanced dental workforce simulations, such as dental therapists or hygienists who carry out at least three years of higher education and offer a restricted variety of services along with a dentist, including restorative and periodontal therapies. Studies have proved that dental therapists lessen total dental expenses and enhance access in indigenous and remote areas.…”

“…18 The current scenario should also prompt the researchers to do additional research applying the pandemic "shock" to dentistry to systematically explore how treatment delays affect dental health and overall well-being. 13 Research could further emphasise the importance and challenges associated with dental treatment as a tool for enhancing the standard of health and eliminating health inequities.…”