Pandemic Disrupts Oral Healthcare Among Older Adults

Dentistry Today


The disruptions in long-term care facilities caused by the COVID-19 pandemic have created opportunities for positive long-term changes in this setting, according to a report from the Gerontological Society of America (GSA), “Pandemic-Driven Disruptions in Oral Health: 10 Transformative Trends in Care for Older Adults.”

The report calls attention to transformative trends with the potential to improve oral healthcare for residents based on webinars developed by GSA’s Oral Health Workgroup and presented by nationally recognized speakers under the theme of “Geriatric Oral Health and COVID-19: Old Problems, New Challenges.”

“During many years of dealing with oral health barriers, it always seemed to me that oral health had wound up somewhere near the top of Maslow’s hierarchy of needs in long-term care,” said Stephen K. Shuman, DDS, MS, professor of dentistry at the University of Minnesota and chair of the GSA Oral Health Workgroup.

“When COVID-19 was added to the bottom of the pyramid, it bounced oral health completely off the top. And that’s what moved the GSA Oral Health workgroup to plan these webinars,” Shuman said.

The report noted that the pandemic’s disruption can produce permanent transformation.

“COVID-19 gives us the chance to accelerate the change we want to see,” said Terry Fulmer, PhD, RN, president of the John A. Hartford Foundation. “We have a mandate—ethical, moral, and clinical—to get things right moving forward.”

COVID-19 also will change nursing homes, the report said. The pandemic presents an opportunity to reimagine the role of nursing homes and healthcare for older adults, Fulmer said, in the areas of staffing, infection prevention, personal protective equipment, social and physical isolation of residents, and racial/ethnic inequities.

Additionally, the report noted workforce and dental coverage challenges caused by the pandemic as practitioners are aging and better coverage options are needed for older adults.

Chronic oral health problems need to be better managed as well, the report said. Conservative approaches should be used earlier to treat caries in frail and functionally dependent older adults, said Leonardo Marchini, DDS, MSD, PhD, of the University of Iowa College of Dentistry and Dental Clinics.

The report also recommends implementing teledentistry and tele-triage. Michael J. Helgeson, DDS, of Apple Tree Dental said oral health services were “on the back burner” during the early months of the pandemic, and his company was able to use teledentistry and tele-triage to provide care while convincing administrators and clinicians of the need to restart in-person care.

Mobile dentistry can be used to serve patients with dementia as well, the report said. Onsite services are highly preferred for patients with dementia, the report said, as they avoid the need for transport and care by unfamiliar individuals.

Jeffrey E. Dodge, DMD, a general dentist in Woonsocket, Rhode Island, who also provides mobile dentistry services to long-term care facilities as lead dentist with CareLink, described innovations in mobile dentistry used during the pandemic to address acute problems and unfinished care.

The report also recognized that dentists could serve as vaccinators and as health professionals on the frontlines of care during the pandemic, which will lead to important new roles for oral healthcare providers and collaborative care.

Plus, closer cooperation and collaboration among dentists, other oral health practitioners, and medical and allied health professionals has the potential to improve care in nursing homes and in other underserved areas such as rural and inner-city locations, the report said.

The report also noted the role of state laws and long-term care regulations. During the pandemic, Samuel Zwetchkenbaum, DDS, MPH, of the Rhode Island Department of Health, collaborated with providers and deployed to facilities, learning new ways of stopping the spread of influenza and future pathogens.

Finally, the biological, social/behavioral, health service use, and policy areas are fertile with COVID-19-related queries, said Bei Wu, PhD, Dean’s Professor in Global Health at the Rory Meyer College of Nursing at New York University. Solutions identified will go far in helping to leverage COVID-19 experiences to address the oral health challenges faced by older adults, the report said.

GlaxoSmithKline Consumer Healthcare provided support for the report.

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