COVID-19 has paralyzed the world as its rampant spread has claimed over 162,773,940 confirmed cases and 3,375,573 lives worldwide as of 12 May,2021 since December 2019 [1]. This far-reaching effect is because COVID-19 gets transmitted through air bound droplets and human to human contact [2].
How has this affected dental care?
Dental care involves generation of aerosol, splatter, and face to face interactions. These factors make dental care providers and patients susceptible to contracting COVID-19 [3].
As a result, dental care has been limited to emergencies only [4]. Use of teledentistry and video calls are becoming exceedingly popular as it reduces probability of spread of the virus [2].
Why dental care is important for the older adults (over 65 years)?
Given that the older adults often have multiple comorbid conditions, they are susceptible for contracting nosocomial infections. Given their health condition, they may often require dental care at the hospitals or at special are centers and visiting the dentist only when there is pain and discomfort exposes older adults to an increased risk of infection due to long appointments or unavoidable use of rotary instruments. Therefore, it is important to take extra precautions and prevent the risk of spreading the virus to them.
Compromised chewing performance, limited food choice, weight loss, impaired speech, low self-esteem and wellbeing are some of but not limited to the effects of poor oral health in older adults [5].
Adapting new strategies in dental care to help the older adults
Preventing older adults from contracting nosocomial infections is the challenge faced in geriatric dental care currently as underlying concomitant disorders make them susceptible. Literature suggests that, the dental care providers should adopt certain extra strategies for their own protection against infection [2].
Use of telecommunication and pre check triaging of the patients could be a valuable method to screen patients. Dental care providers have to prescribe chest CT scans and RT-PCR test for suspected patients or refer to physicians, can prevent them visiting the dental clinics [2]. Also installation of high volume suction, HEPA filters, UV filters and having negative pressure rooms to clear aerosols in the treatment room must be considered. Disinfection of the room and dental unit water lines’ as per American Dental Associations guidelines is a must [3].
Use of extra oral radiographs for diagnosis purposes, pre procedural mouth rinses, non-rotary hand instruments, chemo mechanical agents, cariostatic restoration materials and minimizing use of three way syringes are being encouraged [2, 3]. As aerosols remain hung in the air for over 24 h, some literature has suggested that treatments generating aerosols should be scheduled at the end of the day. For example, oral prophylaxis using scalers and curettes, steps involved in denture procedures, partial excavation of caries with slow speed hand piece and crown preparations can be scheduled as the last appointment in the day [4–6].
Dentists need to do, more than ever to stress on preventive care especially in the older adults, because visiting the dentist only when there is pain and discomfort exposes older adults to an increased risk of infection due to long appointments or unavoidable use of rotary instruments [4]. For the wellbeing of older adults, the medical and dental fraternities must work together to create awareness and formulate a preventive treatment plan to minimize the need for drastic dental intervention thereby reducing risk of contracting infectious diseases, like COVID-19.
Conclusion
Patients can opt for teledentistry to avail the initial visit to the dentist to prevent the spread of COVID-19.
Based on the urgency of the situation, the dentist can render treatment for the older adults, whilst following all the infection control protocols and measures.
In these COVID times, the older patients should maintain their oral hygiene by following simple practices of tooth brushing and regular oral rinses.
To formulate a preventive treatment plan to minimize the need for drastic dental intervention thereby reducing risk of contracting infectious diseases, like COVID-19.
Acknowledgements
Not applicable.
Abbreviations
- COVID-19
Coronavirus disease
- CT
Computed Tomography
- RT-PCR
Reverse Transcriptase—Polymerase Chain Reaction
- HEPA
High Efficiency Particulate Air
- UV
Ultraviolet
Authors’ contributions
RS, VD was involved in preparation and RM was involved in the editing of manuscript. RS, VD and RM were involved in literature search and refining of manuscript. The authors read and approved the final manuscript.
Funding
No funding sources.
Availability of data and materials
Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.
Declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors of this manuscript declare that they have no competing interests.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Contributor Information
Ramya Shenoy, Email: ramya.shenoy@manipal.edu.
Violet D’Souza, Email: violet.dsouza@mail.mcgill.ca.
M. Roma, Email: roma.m@manipal.edu
References
- 1.WHO Coronavirus (COVID-19) Dashboard. https://covid19.who.int/. Accessed 18 May 2021.
- 2.Meng L, Hua F, Bian Z. Coronavirus Disease 2019 (COVID-19): Emerging and Future Challenges for Dental and Oral Medicine. J Dent Res. 2020; 10.1177/0022034520914246 [DOI] [PMC free article] [PubMed]
- 3.Harrel SKS, Molinari J. Aerosols and splatter in dentistry. J Am Dent Assoc. 2004;135:429–37. doi: 10.14219/jada.archive.2004.0207. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Berlin-Broner Y, Levin L. “Dental Hierarchy of Needs” in the COVID-19 Era - or Why Treat When It Doesn’t Hurt? Oral Health Prev Dent. 2020;18(2):95. doi: 10.3290/j.ohpd.a44371. [DOI] [PubMed] [Google Scholar]
- 5.Mascarenhas RE, Pralhad S, Manaktala N. Pan-dent-emic: safety considerations for dental surgery in the era of COVID-19. Patient Saf Surg. 2021;15(16):1–7. 10.1186/s13037-021-00289-3. [DOI] [PMC free article] [PubMed]
- 6.Petersen PE, Kandelman D, Arpin S, Ogawa H. Global oral health of older people–call for public health action. Community Dent Health. 2010;27(2):257–68. [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.