Editor’s Note: This is the second in a two-part blog on COVID-19 and health equity. The first blog can be found here.
A less well-publicized health consequence of the COVID-19 pandemic is the impact it is having on oral health and dental access. During the pandemic, most dental practices offer only emergency services or are temporarily closed. Some practices are employing or looking into teledentistry in order to maintain access for patients. The dental profession is intensely trying to determine what the future practice of dentistry will look like. Due to the close-contact nature of providing dental care, new ways to address infection control (personal protective equipment, modified patient flows, enhanced sanitation processes, mitigating effects from aerosol-generating procedures, etc.) and other protective measures will change the future practice of dentistry. As dental practices redesign the way they operate, it will be important that access to care is not adversely affected, especially for historically underserved populations who are already disadvantaged. Even prior to the pandemic, the oral health literature is replete with information showing large segments of the United States population are already experiencing poor access to dental care. Not surprisingly, this includes racial and ethnic minority populations that also have some of the worse oral health indicators in the country.
Due to the severe economic impact of the pandemic, states will face significant financial pressures to cut costs. However, to ensure access to dental services, it will be important to maintain public oral health coverage under Medicaid, including adult benefits. In the short term, federal subsidies may be necessary to stabilize the financial positions of state budgets for this to happen. Redesigning dental practices to ensure patient and staff safety or to add teledentistry tools and other changes will increase costs for practice groups. Office efficiencies, patient flow patterns and the proportions and types of procedures performed may change. As teledentistry and other innovations become more prominent in practices, policies and regulations must be in place to authorize their use, delineate scopes of practice, and clarify reimbursement procedures.
Some ideas to address anticipated higher costs and safety concerns include employing a more cost-effective workforce (hiring less costly providers as part of the dental team), adopting less invasive treatments, and reimbursing for more prevention services. The additional costs and associated administrative requirements and burdens related to changes and redesign may prompt some practitioners to leave dentistry or sway people away from the profession. This would have a negative impact on an already inadequate oral health workforce, especially from the perspective of traditionally underserved populations. There are also concerns that some practitioners may feel the economic pressure to recoup losses and extra costs by serving more patients that can pay at higher rates and seeing less or avoiding public insurance and low income uninsured patients. These economic drivers of change do not bode well for populations with historically poor access to dental services. As the dental profession seeks to right itself in the midst of powerful forces for change, equity advocates and consumers must ensure that enacted policies and programs support a future oral health system that undeniably meets the needs of everyone and not just the privileged.
The COVID-19 pandemic has painfully demonstrated (again) the need to aggressively strengthen and reinforce the health equity movement in order to eliminate health disparities that continue to plague so many in this country. It is not acceptable to go back to business as usual. There is the opportunity and a calling for sustained concerted efforts and collective action among advocates, champions and the general public to create the necessary momentum and the political will to achieve health equity for all.