Times of crisis call for creative solutions, and that’s never been more evident than during the COVID-19 pandemic. Innovative dentists have sought to adapt many aspects of their practices, but especially those involving the most vulnerable segment of our population: older adults.
New challenges for seniors’ oral health
For many seniors, even before the advent of COVID-19, physical limitations, systemic disease, cognitive decline and dependence on caregivers could all lead to an overall decline in oral health. What’s more, the pandemic worsened many of these same problems while presenting new ones.
“COVID-19 laid bare weaknesses in our elder care system,” said moderator Stephen K. Shuman, DDS, MS, in a webinar on pandemic-related disruptions in oral health care hosted by the Gerontological Society of America.
Some of the challenges in oral health care for seniors during the pandemic have included:
- Reduced access. Early in the pandemic, many dentists’ offices shuttered, and even when they reopened, fear of COVID-19 led many older adults to delay or entirely forego visits to the dentist’s office. Nearly half of U.S. adults reported delaying dental care due to the COVID-19 pandemic during the spring of 2020, and the increased risk posed by COVID-19 to seniors likely exacerbated the problem among older adults.
- Reduced care. In long-term care facilities, daily brushing, flossing and other routine care tasks were sometimes put on the back burner as COVID-19 diverted staff members to provide more urgent care to those affected or at risk. Proper oral care could also be challenged by staff members’ fears about the potential for oral transmission of COVID-19. Staffing shortages in facilities and on oral care teams made the situation worse. Georgia and Minnesota reported staffing shortages in long-term care facilities of more than 25% during the pandemic, and a recent poll from the ADA Health Policy Institute found that more than 80% of owner dentists who are currently hiring consider recruitment of dental hygienists and assistants to be extremely or very challenging at this time.
- Psychosocial problems. The loneliness, anxiety and depression caused by shelter-at-home orders could themselves worsen oral health among older Americans.
Solutions in oral health care for seniors during the pandemic
Just as the COVID-19 presented new problems, it also created potential for positive long-term change.
Teledentistry and teletriage
Through necessity, many dentists began refining techniques for the use of teledentistry and teletriage.
Some companies began implementing or built up their existing “pandemic teledentistry.” Teams used cloud-based electronic health records and taught long-term care facility staff how to take useful images of patient mouths and send them to centrally located dentists.
At the height of the pandemic, 24.8% of responding dentists reported they were conducting remote problem-focused evaluations through virtual technology or telecommunications, according to polling from the American Dental Association’s Health Policy Institute.
Some innovative dentists used what they referred to as assisted, or guided, oral hygiene during the pandemic. They used the latest audio and video technology to guide a patient or caregiver as they carried out oral hygiene on a regularly scheduled basis. Some caregivers, such as Michael J. Helgeson, DDS, of Apple Tree Dental, saw the technology as a key way to maintain dental health care for seniors during the pandemic when in-person care wasn’t possible.
While the pandemic restricted mobile care in some cases, its primary advantage of reducing the need to transport at-risk seniors also caused it to emerge as another possible solution.
Many dentists were already accustomed to setting up mobile units in long term care facilities even before the pandemic. Mobile dentistry helps reduce the potential for stress and confusion caused by moving older patients or those with dementia. With the latest mobile equipment deployed to long-term care facilities, dentists are able to perform simple extractions, restorative work and more in a timely manner. As in many dental offices, mobile units often add an external dental suction that uses ultraviolet light and filters to remove pathogens from the air.
How to support your senior patients through the pandemic
COVID-19 presented extraordinary challenges to your senior patients. The new solutions that helped maintain health care for older adults during the pandemic are likely here to stay.
To support your senior patients throughout the pandemic:
- Communicate with patients. Oral health care should never be placed on the back burner, and maintaining good communication with your patients is one of the most crucial keys to emphasizing the importance of oral health. As always, keep in mind the systemic relationship between oral health and overall well-being. Use empathic listening and compassionate care to encourage the maintenance of oral hygiene routines among your senior patients throughout the pandemic.
- Consider adopting new approaches. Teledentistry can now connect oral health care providers with older adults remotely when patients are unable to visit a dental clinic or if there are restrictions on dental providers visiting residential facilities. The use of mobile dentistry during the pandemic likewise bodes well for its future implementation as a solution for the needs of seniors in long term care facilities for whom transport is an issue.