Pandemic pause

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COVID lockdowns and oral health
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Well-run dental practices are busier than ever, but there are concerns about the oral health of those for whom COVID lockdowns meant skipping dental treatments. By Cameron Cooper

Given a perfect storm of COVID-19 lockdowns, rising inflation and cost-of-living pressures, it is not surprising that some patients are rethinking their dental care.

The Australian Dental Association’s annual Consumer Survey of 25,000 Australians highlights a worrying trend, with a key finding indicating that one in three people had postponed dental treatments since the start of the pandemic.

ADA president Dr Mark Hutton is concerned that this practice may lead to more serious dental problems for some patients. “Missed dental appointments through the pandemic means that early disease may not have been diagnosed early,” he says. “The evidence is clear that when oral disease is untreated for an extended period of time, it is more challenging to restore it to a healthy state.”

Of those who delayed their dental consultations, 21 per cent felt the postponement had adversely affected them. Dr Hutton says ADA members report seeing more signs and symptoms associated with bruxism such as cracked teeth and loss of tooth structure, possibly caused by stress and anxiety associated with the pandemic. “Others believe that the periodontal condition of their patients and teeth needing restorative treatment may have deteriorated,” he adds.

The main reason for delaying treatments, as cited by survey respondents, is they felt their dental problem was not urgent (26 per cent). Seventeen per cent were concerned about catching COVID-19 at the dental clinic (or en route), and 16 per cent reported not being in a suitable financial position to afford dental care.

A problem for the ages

Of the subset of respondents who delayed treatments, 23 per cent were aged 18 to 24, rising to 41 per cent of those aged 65 to 74. More women than men put off appointments across all age ranges. 

Dr Sarah Raphael is Engagement & Advocacy executive at the ADA’s NSW branch and general manager of Filling the Gap, a charity that seeks to provide pro bono dental treatment for vulnerable people. 

She says it is clear that some sections of the elderly community are especially exposed as a result of delaying visits to the dentist, or being unable to access appropriate care in aged care facilities. Poor oral care leaves the aged at risk of malnutrition and aspiration pneumonia, yet the ADA survey indicates that 66 per cent of respondents are unaware that poor oral health could have an impact on other medical conditions.

“We know that if your oral health is poor at that beginning point of entering aged care that it will go downhill very quickly,” Dr Raphael says. “So at least if you can start that end stage of your life having had regular dental visits, the maintenance that’s required is much less.”

In addition to the elderly, Dr Raphael says many “working poor families” are struggling to afford proper dental care as a result of the pandemic and associated unemployment and cost-of-living issues. They slip into the gap between those who are eligible for public oral health services and those who can afford private health insurance.

“I don’t like the term ‘working poor’, but there are families out there that are working hard just to make all the other pieces of their life function—getting groceries and putting a roof over their head—and accessing private oral health services is low down on their list.”

Profession powers on

Patients aside, the past two years have also placed enormous strains on dentists and their staff.

Lockdowns hurt dental practice cashflow in the earlier phases of the pandemic, while ongoing outbreaks of COVID-19, influenza and respiratory syncytial virus have made it difficult to manage staff rosters.

However, the ADA survey points to some positives for dentists, with many Australians not planning to delay dental treatments for long. At the time the survey was conducted (November to December, 2021), 54 per cent of respondents indicated they would go to the dentist in the next one to three months, and 22 per cent planned to book within three to 12 months.

“It is very difficult to predict future patient loads,” Dr Hutton says. “While patients delaying treatment in the past may mean that dentists are busy for some time, the slowing down of the economy and the increase in living costs now occurring might dampen demand.”

As the year unfolds, Dr Raphael believes dentists are set for strong patient inflows. 

She says the key for ongoing success is to run their practices by always putting the patient first and communicating clearly and frequently with their patients about the overall health benefits of regular dental visits. “In decades past, many dentists didn’t need to do any marketing, or to be especially good at running a business—it ran itself. Those days are gone.”

One of the challenges will continue to be recruiting and retaining quality staff, according to Dr Raphael. She notes that a mandatory vaccination policy at the height of the pandemic led to an exodus of dental assistant and administrative staff at some clinics.

“They’re settled in to their new jobs now and are not really coming back to dental practices.”

The Medicare factor

While some critics have called on government to include full dental cover as part of the Medicare scheme in a bid to encourage greater affordability of care, Dr Hutton says such a move will have to wait.

“The ADA does not support dental in Medicare in the short term as most governments will see it as an expensive option and it limits the services that are available through such a scheme,” he says. “It is more preferable, the ADA believes, to see the introduction of access to targeted comprehensive dental schemes for those in real need.”

This includes setting up the Seniors Dental Benefits Schedule along the same lines as the Child Dental Benefits Schedule (CDBS). It would be available to those in receipt of a commonwealth benefit payment—and extend over time to adults on low incomes who earn above the threshold for public dental care.

“Right now, though, we need to increase awareness of the CDBS as utilisation rates remain at 38 per cent uptake,” Dr Hutton says. “That means over 60 per cent of families whose children are eligible for $1026 worth of dental treatment over every two-year period until the age of 18 are missing out.” The ADA wants the government to better promote this scheme.

For those not eligible for these schemes, the ADA suggests that patients save for their own dental care, and shop around for the best extras cover with private health insurance. In addition, many dentists have payment plans available to assist their patients. 

“The best insurance policy of all, however, is prevention,” Dr Hutton says. “Patients will benefit most by attending dental appointments regularly and getting regular examinations and treating those small issues before they become bigger, more painful and more expensive ones.” 

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