Perspectives from the Pandemic

Given the upheaval that dentistry has experienced over the last year, it is important to assess what we have learned from the pandemic and how those lessons may be applied to our future practice.

Dental Healthcare Workers are Essential Health-care Workers. Early in the pandemic, dental healthcare providers (DCPs) were identified as a key group of highly trained healthcare workers who could screen patients to assess risk, administer COVID-19 testing, and provide additional supportive care for front-line workers.^7,8 Emergency authorizations in hard-hit areas, such as New York and Washington, requested that DCPs volunteer to aid an overwhelmed healthcare infrastructure.^8,9 Further, as vaccine development produced promising vaccine candidates, three of which have received emergency use authorization (EUA) as of this writing, DCPs came into focus as individuals who could potentially deliver some of the hundreds of millions of doses needed to achieve herd immunity in the US.¹⁰ Several states have approved dentists and/or dental hygienists to deliver vaccine doses.¹¹ Furthermore, the US Centers for Disease Control and Prevention (CDC) designated dental healthcare workers, including dentists, dental hygienists, and dental assistants, in the highest priority tier to receive vaccinations, based upon the essential nature of dental healthcare and its impact on public health.¹²

Use of Enhanced Infection Control Practices Served to Keep COVID-19 Transmission Low Among Dental Healthcare Professionals.Initial assessment of occupational risks placed DCPs in an extremely high risk category based upon their close proximity with patients, their exposure to aerosols during the delivery of patient care, and the potential for asymptomatic and presymptomatic patients to shed virus and cause infection.¹³ Assessment of the incidence of COVID-19 infection in both dentists and dental hygienists demonstrated that, despite these initial concerns, DCPs had high rates of compliance with enhanced infection control and prevention protocols and significantly lower incidence of COVID-19 infection than those seen in other healthcare providers and/or within the communities.^14,15 This news is comforting to DCPs and patients alike, but it is not necessarily surprising given the near-universal adoption of infection control practices in dental offices, even prior to the pandemic.^14,15 These data continue to be monitored but they are certainly reassuring that the dental office is a safe environment in which to work and receive care.

Oral Inflammation is Related to Overall Health. One of the puzzling features of COVID-19 is the spectrum of clinical presentations seen in patients infected with the SARS-CoV-2 virus.^16,17 Initial data indicated that many patients who suffered from serious COVID-19 symptoms (often resulting in hospitalization and/or death) had other comorbidities, particularly those that were related to chronic inflammatory conditions and/or immunocompromised status.¹⁸ Given these findings, it was initially hypothesized that oral chronic inflammatory conditions, particularly periodontitis, could contribute to a hyperinflammatory state and worsen COVID-19 symptoms, particularly those associated with severe disease and a cytokine storm.¹⁹ A recent publication found that in patients hospitalized for COVID-19, periodontitis was a significant risk factor for more severe disease and increased the risk of death by nearly nine times.²⁰ The pandemic has highlighted the importance of overall wellness for many people, and this emerging evidence suggests that the identification of periodontal disease along with treatment and maintenance may be critical to reducing risks of high-consequence infectious diseases for patients.

A year ago, it would have been difficult to predict the journey that all of us have been on, but it has also shown us how resilient dentistry is as a profession and how critical the dental care we deliver is to patients and our communities.