Many South Dakotans have put off needed dental care during the COVID-19 pandemic, increasing the risk of gum disease, tooth and bone loss or other serious health issues related to poor dental care, which can include heart attacks and diabetes.
Patients with acute dental problems and those who undergo routine dental care have stayed away from dental offices due to concerns they may be susceptible to COVID-19 during office visits.
Members of the state dental industry, who have taken a financial hit due to lack of appointments, say they may need a full year to overcome the backlog of delayed care resulting from COVID-19.
“The ‘COVID hangover,’ that’s going to go on for a while,” said Paul Knecht, director of the South Dakota Dental Association. “We are finding ourselves needing to do a lot of extra work there.”
Research links poor dental health — especially periodontal gum disease — to heart attacks, diabetes, mental health issues and other serious problems. About 40 percent of American adults over age 30 have periodontitis, which is advanced gum disease that enables bacteria to build up in pockets around the teeth and which can then spread to the bloodstream, according to the Centers for Disease Control and Prevention.
Experts say those hit hardest by delaying needed dental care include those who have the most difficulty accessing dental care and those most vulnerable to future complications — children, the elderly, minorities and people with disabilities.
About one in five South Dakota residents currently admits they will delay dental treatment if they are not in pain, according to research by NextSmileDental.com. The website, which provides resources on dentures, recently conducted a survey of 4,500 patients. Parents who were surveyed also reported their children were eating more sugary treats. Children are especially vulnerable to tooth decay and other problems from delayed care.
Data collected by the South Dakota Dental Association has found that 15 percent of the state population will not return to a dental office until they have been vaccinated against COVID or until the pandemic subsides.
“There’s no social distancing in dentistry,” said Dr. Rick Fuchs, an orthodontist who serves patients in Mitchell and Huron. “You’re working 18 inches from an open mouth.”
Modern general dentistry relies on high-speed drills cooled by water, which raises splatter issues and COVID-19 concerns, Fuchs said.
South Dakota dentists are now operating at 70 to 80 percent of normal appointment schedules. For the year, they’re down 20 percent, although the pace of business has fluctuated greatly.
For dentists, as for everyone else, the COVID crisis brought a worry and constantly evolving guidelines and shifting priorities.
At St. Francis Mission Dental Clinic, on the Rosebud Indian Reservation in south-central South Dakota, the pandemic prompted the clinic to cancel all health events starting in March 2020, said manager and dental hygienist Marty Jones. Most of the patients served at the clinic are Native Americans. Jones said people often stop her in town to ask when services will return.
Her first dental health clinic will take place in March 2021, and Jones is unsure if she is fully prepared for an onslaught of patients.
“I’m scared to even put it on the radio that they can call for an appointment,” she said. “We’re going to be overrun.”
Mitchell dental hygienist Patricia Aylward said residents at a nursing home she serves have received no dental care beyond emergency services for the past year.
“All of these people are elderly and have more dental needs than most,” she said, “and they have not been able to leave for dental treatment.” Dentists have also not been able to visit them.
Beginning in March 2020, every week brought another hurdle. Challenges included shutting offices down, reopening them safely, vaccinating staff, obtaining scarce personal protective equipment, and applying for federal aid.
At all times, Knecht said, dentists have followed CDC and American Dental Association guidance.
In mid-March, the American Dental Association advised all practices to shut down until early April. It later extended the shutdown. Exceptions were made for emergency cases, which mostly included cases involving serious pain.
Recognizing the potential for harm to patients, dentists scrambled in May to reopen safely. Dentists worked out ways of decontaminating surfaces and eliminating aerosolized particulates. Barriers to isolate airflow were erected, or schedules were changed to allow particulates to settle.
In January, office schedules began returning to what they had been in July and August, Knecht said, although it varied by practice makeup and location.
Karisa Hart, office manager of Hart Dental in Mitchell, said delayed maintenance for periodontal patients can be especially detrimental. Periodontal treatment requires a large initial investment.
“If you don’t maintain it,” she said, “you’re back to square one.”
Across the state, the office closures and slowed schedules created concerns over dental practice finances as well as for patient safety. Federal COVID-19 emergency assistance helped, Knecht said, but it will be harder to get full compensation for the year’s overall decrease in productivity. The effects could become apparent during the second quarter of this year, he said.
Addressing the backlog among low-income patients presents additional challenges.
Dental offices must contend with lost dental insurance among regular patients who lost jobs due to the pandemic. Hart said a patient in her office struggles to eat because of a broken bridge.
“They’re now living on one income,” Hart said. “There are things like that we probably aren’t even aware are happening.”
On the other hand, she added, some people have used stimulus funds to address longtime problems. “Some come in ready to do major work,” Hart said.
Finances also will be an issue for dentists who serve Medicaid patients. In South Dakota, the state and federally funded program for the impoverished caps dental care at $1,000 per year with only a few exceptions, Knecht said.
Jayme Tubandt is a hygienist at Falls Community Health & Dental in Sioux Falls. As a federally qualified health center, Falls receives cost-based funding to better serve the poor.
Under federal purview, the clinic never struggled to access personal protective equipment or N95 masks.
For 13 weeks, Tubandt said, the clinic treated only those with severe pain or swelling, and it eventually reopened for routine care.
