Provision of dental care by public health dental clinics during the COVID-19 pandemic in Alberta, Canada

Abstract

Objectives: This study aims to describe dental services provided to a low income population in dental public health settings during the first wave of COVID-19 pandemic in Alberta, Canada. Methods: Routinely collected clinical data were recorded by dentists in electronic medical record files at Alberta’s two Public Health Dental Clinics (PHDCs). Patient contact was via teledentistry or in person, respecting phased provincial pandemic restrictions. A descriptive analysis of data relating to all patients contacting PHDC with dental problems between 17 March - 31 October 2020 was undertaken and compared to equivalent pre-COVID 2019 data. Results: In the period examined, 851 teledentistry consultations and 1031 in person visits were performed. Compared to the same period in 2019, 46% fewer patients were treated, representing a decrease in dental procedures: tooth extractions (17%), silver diamine fluoride applications (17%), endodontic treatments (82%) and fillings (84%). By contrast, prescriptions increased by 66% overall; representing 76%, 121% and 44% in antibiotics, non-opioid analgesics, and opioid analgesics respectively. In both years, antibiotics were the most prescribed drugs (66% in 2019 versus 62% in 2020) followed by non-opioid analgesics (28% in 2019 versus 33% in 2020); opioids accounted for the remainder (6.5% in 2019 and 5% in 2020). The largest drug prescription increases occurred during April-May 2020, when access to care was most restricted: antibiotics and non-opioid analgesics were 300% and 738% higher than the same time in 2019. Conclusions: Teledentistry and pharmacotherapy were used to triage and organise dental patients accessing care during the early stages of the pandemic. However, teledentistry did not replace definitive in person dental treatment, particularly for low income populations with high incidence of toothache and odontogenic infection. Reduced provision of dental procedures was accompanied by an increase in drug prescribing. Expedient access to care must be provided to address the dental needs of this population avoiding risks of further complications associated with infection and overprescribing antibiotics and opiates.

Evaluation of Post-Translation Control Mechanisms (Mirnas) In Type 1 Diabetic Patients with and Without Cardiac Autonomic Neuropathy

“…Lack of statistical significance on proportionate episodes of prescribing antibiotics to overall visits over the pre-Covid-19 and years with Covid-19 milieu could be attributed to overall reductions in visits during lock down scenarios that included emergency visits as well. This finding was supported by other research on emergency dental visits of children [16] as well as adults in Covid-19 lock-downs [24][25][26]. Moreover, our data did not include toddlers and children who visited the Emergency Treatment Unit (ETU) of National Dental Hospital.…”

“…Furthermore, Covid-19 crisis has increased the burden of AMR with the occurrence of co-infection with bacteria and fungi resistant to antimicrobials whilst causing disruptions to antibiotic stewardship programmed across the globe [43][44][45]. Antibiotic over-use is a well-known driver for AMR yet became an inevitable outcome of Covid-19 induced health system modifications and health care use, where oral health care became no exception [14][15][16]18]. However, it is not clear to what extent Covid-19 impacted on use of antibiotics among paediatric dental patients presented with dento-alveolar infections especially in the context of preventive oral health care provision.…”

“…Pulpitis, apical periodontitis, draining sinus tract, abscess, and acute facial swelling of dental origin need rational use of antibiotics to ensure antibiotic stewardship given the rise of antibiotic resistant microorganisms and adverse drug reactions and interactions [23]. However, studies reported increased dental antibiotic prescribing in oral health care provision during Covid-19 global pandemic for low income populations with high incidence of toothache and odontogenic infections in Canada [24], National Health Service (NHS) in the UK [25] as well as in the Australia under the Australian Pharmaceutical Benefit scheme (APBS) [26]. The global public health threat of antimicrobial resistance (AMR) attributed to surge of multidrug resistant microbes is well-known [27].…”

Understanding the impact of COVID-19 on dental antibiotic prescribing across England: 'it was a minefield'

“…7 Even larger increases have been reported in primary dental care in Scotland (49%) 13 and in the public health dental clinics of Alberta, Canada (76%). 14 By contrast, reductions in dental antibiotic prescribing at the start of pandemic restrictions were reported in primary dental care in Australia (20%) 15 and in Qatar, only 7% of patients managed remotely with teledentistry were prescribed antibiotics. 16 In France, a similar increase (17%) was experienced in 2020 compared to 2019.…”

Teledentistry use during the COVID-19 pandemic: Perceptions and practices of Ontario dentists

“…In the US, researchers sought to increase patient acceptance of mobile dentistry platform that uses intraoral cameras to provide virtual oral examinations, oral health management and treatment planning [13]. In Alberta, Canada, teledentistry was used to triage dental patients and determine whether patients' odontogenic infections could be delayed with drug prescriptions or not during early stages of pandemic [14]. In British Columbia, Canada, teledentistry was used to establish guidelines regarding taking acceptable intraoral photography for screening and triaging of potentially malignant oral lesions in home settings as opposed to clinical settings [15].…”