Oral health matters for vulnerable populations

September 6, 2020. The Daily Reflector. By Victoria Long.

Victoria Long,
2021-21 J. Bradley Wilson Schweitzer Fellow

“Only brush the teeth you want to keep” is common advice that dental professionals tell patients to maintain their oral hygiene. As social distancing measures continue to keep people at home or 6-feet away from each other, there is an unanticipated growing risk for elderly adults. Who is ensuring that this population, already at-risk for major health concerns, is getting the daily oral care that they need? 

The U.S. Centers for Disease Control and Prevention (CDC) recently published that those who are in long-term care and assisted care facilities “are at the highest risk of being affected by COVID-19.” For many, this has produced fear within these communities. Measures have included residents being secluded and nurse aids maintaining strict distancing procedures. Volunteers and family members are advised to stay home, away from residents. Being a highly infectious virus, COVID-19 presents an especially challenging hurdle for oral care due to its potential for airborne transmissibility. Assisting elderly residents, with brushing their teeth or removing their dentures has become understandably much riskier. At the same time, the CDC also recommends that older adults receive “continuity of regular care and medical services,” which includes aiding with oral hygiene. 

While many older adults are presumably more at risk for COVID-19, they are also more at risk for many preventable dental diseases. For those already needing additional help maintaining oral hygiene, stopping daily preventive strategies may lead to more emergent dental needs. Since March, the American Dental Association has recommended that dental offices only treat patients with urgent and emergent dental visits. As states are beginning to relax their stay at home orders, some dental offices are beginning to open their offices for routine dental care.  However, the ability to open offices depends on the level of Covid-19 cases within the region, the ability to safely treat patients following enhanced risk management guidelines, and the availability of personal protective equipment, such as surgical masks and face shields or N95 masks.  Consequently, individuals without dental insurance, those without a dental home, and those whose regular dentist may not be able to treat patients are seeking emergency dental care for pain and infection within hospital Emergency Departments at a time when vulnerable populations in the hospital are exactly what the world is trying to avoid. 

Nurses, nursing assistants, and others within assisted living and long-term care facilities that take care of the most vulnerable against COVID-19 are on the front lines of protecting from COVID-19 and other communicable diseases including oral diseases. With adequate PPE, caretakers should ensure their elder adults needing assistance with oral care are receiving adequate help. We all have a role to reach out to our community members in long-term care facilities to ensure oral health care strategies are in continual use for improved quality of life. Families are paying for their loved ones to be properly cared for in these facilities, and oral health is no exception. As a dentist in training, I see a large cohort of elderly patients in my clinical program, and it hurts me to know that these populations are being hit the hardest not only with COVID-19 but also with dental pain and infections at the same time.

The unfortunate reality is that decayed or missing teeth, poor oral care and/or ill-fitting dentures can cause difficulty in chewing, altered perception of taste of foods, and can lead to pain, infection, and further loss of teeth. Poor oral health can lead to a decrease in overall systemic health of the individual, such as risk for type 2 diabetes complications or cardiovascular disease. Preventive oral care practices can be forgotten in the vulnerable elderly with the lack of volunteers, absent family members and the stigma of getting too close during theCOVID-19 pandemic. Lack of prevention will likely increase oral health problems in these elder populations that we will see with increased care costs and patient morbidity.

Victoria Long

ECU School of Dental Medicine 

DMD Candidate | Class of 2022

2020-2021 J. Bradley Wilson Schweitzer Fellow