Opinion: An Increase in Severe, Late Dental Complications Might Result From Reliance on Home Dental Remedies During the COVID-19 Pandemic

The global pandemic resulting from the coronavirus disease of 2019 (COVID-19) outbreak has caused significant limitations in the public's access to routine dental and medical care. The availability of appointments at private medical and dental practices, especially on the East Coast, have been severely curtailed as practices have shut their doors and laid off workers in response to stay-at-home orders and reduced clinical volume.¹ Even larger academic practices have been forced to close for all but the most severe emergencies.^{2 , 3} Despite this, routine dental issues have continued to occur. Data from Google Trends have shown that although United States searches for “dentist appointment” are at a 1-year low, searches for “dental emergency” are at a 1-year high (Fig 1 A). This has also coincided with a massive spike in interest for the terms “COVID-19” and “stay at home,” and the growing awareness of COVID-19 in the United States (Fig 1B). However, routine dental conditions can rapidly evolve into emergencies if not promptly treated, and these data suggest that although patients have been decreasingly searching for dental appointments, they have been increasingly using Internet searches to determine whether their dental condition is an emergency to avoid leaving their house. Patients have even attempted to treat themselves at home in extreme circumstances.⁴

Figure 1.

A, Graph of Google trends for previous 12 months showing an appreciable increase in search interest for “dental emergencies” and a decrease in searches for “dentist appointment.” B, Graph of Google trends for previous 12 months showing an appreciable increase in search interest for “COVID-19” and “stay at home.”

Clinically, the consequences of this are becoming increasingly apparent. At our hospital system, we have begun to see increasing numbers of late dental complications, specifically Ludwig's angina, an end-stage infection of the floor of the mouth that often results from untreated mandibular infections or trauma.⁵ This condition has become exceedingly rare in the age of modern dentistry; therefore, this increase is alarming. We believe this increase might be the direct result of decreased routine dental care, because patients have begun to ignore signs of increasingly severe dental conditions in an effort to remain home. We believe this has likely resulted from a failure to directly communicate to patients the circumstances under which they should seek dental care despite the COVID-19 pandemic. In cases of severe dental pain, persistent oral bleeding, or increasing difficulty with breathing or swallowing, patients should still be urged to seek dental care. Although the risks associated with COVID-19 are significant, the risks of untreated dental emergencies could prove more immediately life-threatening. As such, it is our belief that when public agencies and policy makers communicate the situations under which citizens are allowed to leave their residences, greater emphasis should be placed on non–COVID-19–related medical and dental emergencies.