Public Health, Penn Pandemic Diary Penn Pandemic Diary, Entry #35: Dentistry is an Essential Service

Tim T. Wang, a Perry World House Graduate Associate, is a DMD candidate at the School of Dental Medicine, a MPH candidate at the Perelman School of Medicine, and an Associate Fellow at the Leonard Davis Institute, all at the University of Pennsylvania.

The COVID-19 pandemic is as disruptive as it is unprecedented, fundamentally changing the ways that healthcare is delivered in the United States. Since March 2020, many state governments have mandated postponement of elective medical procedures to conserve medical resources for essential procedures. While certain medical procedures are unambiguously critical, the line between essential and elective procedure is not always clear cut. It is in this gray area where many dental procedures fall. This naturally begs the question: is dentistry essential?

Unfortunately, oral health has been considered an auxiliary or low-priority part of wellbeing in low-, middle-, and high-income countries. Even nations with universal public healthcare are no exception: dental work is one of the few medical services that require a co-pay in the United Kingdom’s National Health System. Meanwhile, in the United States, dental care is not covered by Medicare, which insures adults over the age of 65, and is incompletely covered by Medicaid which insures low income individuals.

Over the last few months, the pandemic has severely affected the dental field. An overwhelming majority of dental offices closed operations. Only certain providers remained open for emergency procedures, such as trauma, dental infections, and root canals. COVID-19 has have further limited access to dental care, especially in low income populations, exacerbating many of the structural inequalities already plaguing oral healthcare.

Dentists have actively responded to the challenge. They’ve modified patient flow to minimize waiting time, implemented protective barriers to minimize aerosol transmission, and mandated N95 respirator usage for staff. There has also been an increase in telehealth services, especially for triaging and following up with patients. However, dentistry is an inherently hands-on form of healthcare, so teledentistry can only augment rather than replace services.

One example demonstrates the challenges of pandemic dentistry: triaging patients with large facial swellings due to tooth infections and abscesses. In the short term, dentists can prescribe antibiotics and anti-inflammatory analgesics, though this is only a temporary solution. Eventually, either a root canal must be performed or the tooth must be extracted to solve the problem permanently. There is a similar dilemma with crowns, dental implants, and dentures, which many patients require to chew and speak properly. Without adequate care, they are at risk of afflictions such as malnutrition and psychosocial damage.

The ramifications of COVID-19 on dentistry and our society are still developing and will undoubtedly be long-lasting. However, this pandemic should serve as a wakeup call to dispel any notions that dental care is a luxury and can be dispensed with during times of hardship. Because oral health is an essential component of physical health, it is key to move dentistry from its conceptual silo and integrate it with other medical services. Only with this fundamental shift in how we view dentistry can we have meaningful conversations and design effective policies that sustainably protect the oral health and wellbeing of all Americans.

The views expressed in the Penn Pandemic Diary are solely the author’s and not those of Penn or Perry World House.