Science

The Dentist Will See You Now: But Will You See the Dentist?



Mary Lyn Koval did not want to go to the dentist. A marketing communications consultant in upstate New York, Koval works from home and felt she was staying safe during the coronavirus pandemic. One of her childhood fillings had broken, however. “I put off going for two weeks. But I was afraid that if I’d exposed a cavity, it would devolve into a series of root canals” instead of a simple filling replacement, she says. Dental offices were then still closed by state order. Yet urgent and emergency procedures were allowed. Should Koval have chosen to delay treatment and risk a root canal—or worse, a tooth extraction? Or should she have risked exposing herself to COVID-19 at the dentist’s office? These questions are all part of the new pandemic calculus.

All states have now allowed dental practices to resume elective procedures (New York started doing so on June 1). Yet dentists know many patients remain scared of coming in. Indeed, many dentists and hygienists are afraid, too. “It’s such a high-risk profession,” says Grant Ritchey, a dentist with a private practice in Tonganoxie, Kan. “You’re in people’s mouths. You’re 18 inches from their faces. You’re creating aerosols.” Aerosols are tiny droplets that hang in the air and can contain the coronavirus. They can be produced when a dental worker uses compressed air and water in your mouth. Ritchey says he has adopted the mindset that “everyone is infected.” Even before he had to close his office, he started taking extra precautions, such as having patients wait in their car instead of the waiting room and taking everyone’s temperature—although not all people infected with the coronavirus have a fever. Upon reopening, he has ramped up gradually—seeing fewer patients than usual, spacing out appointments and disinfecting surfaces more frequently.

When Koval finally called her dentist about her tooth, she asked about the safety protocols in place. And when she went in, she thought the staff followed precautions very carefully. “I was repeatedly asked if I felt comfortable,” she says. “They were explaining the protective procedures as we went along.”

Dentists are taking extra care. But a lot of these measures are simply extensions of their normal regimens. “At dentist offices, we were doing universal protections—such as disinfection and PPE [personal protective equipment]—before it was cool,” says Matthew Messina, a consumer adviser and spokesperson for the American Dental Association. Access to PPE was the main limiting factor for Messina in reopening his Columbus, Ohio–based practice when the state gave the green light. In recent months, many dentists have donated much of their supply of protective gear to medical workers treating coronavirus patients on the front lines.

Ritchey says the association has been doing “a phenomenal job under trying times.” It has put out guidelines for reopening. And it has held frequent briefings to keep members updated on new research, as well as recommendations from the U.S. Centers for Disease Control and Prevention and the World Health Organization.

There are still plenty of unknowns about coronavirus transmission. And those uncertainties are playing out in dentists’ offices across the North American continent. In Ontario, a dispute is brewing between dentists and dental hygienists over the necessity of wearing highly protective N95 masks, according to the Canadian Broadcasting Corporation. The hygienists say N95s should be required for any task that might produce aerosols, while the dentists assert that surgical masks are sufficient.

And the pandemic itself is causing dental problems. Michelle Augello, a dentist in Buffalo, N.Y., has noticed an uptick in people complaining of issues such as headaches and jaw pain since the pandemic started. “In the morning, they practically have to force their mouth open, to unclench,” she says. “Or they feel like there’s an imprint of teeth on the side of their tongue”—from pressure through the night.

There is no one-size-fits-all treatment for jaw pain, because a spectrum of things can cause it. Augello ticks through the various approaches: ibuprofen and icing, stress management, jaw exercises, and myofascial massage. A night guard worn in the mouth can help with teeth grinding and jaw clenching. Sometimes a more serious jaw joint problem is revealed.

Melissa Leebaert had her own set of calculations to make. Leebaert, a voice-over professional in Bethesda, Md., had had a hip-replacement surgery postponed because of the pandemic. Doing so could have further delayed a routine dental cleaning, because she had been told she would have to wait at least three months after surgery to see the dentist. Both procedures would increase the risk of infection, and the wait would mitigate that risk. So Leebaert decided to get her teeth cleaned sooner rather than later, after Maryland allowed dental practices to reopen on May 7. “It was important—not like going for a pedicure,” she says.

Messina agrees. “Proper oral health is an integral part of overall health,” he says. During a routine visit, he explains, dentists are, of course, looking for cavities and gum disease. But they are also screening patients for oral cancers and other conditions. “Most people see their dentist more frequently than their doctors,” Messina says. Tartar buildup—that stuff the hygienist scrapes off your teeth during a cleaning—can lead to inflammation of the gums, which can worsen inflammatory conditions such as diabetes, arthritis and cardiovascular disease. “Having your teeth cleaned can lower the inflammatory load on the body,” he adds.

Ritchey, who has written about the lack of hard scientific evidence for the standard six-month cleaning, is sympathetic. “Some patients are not ready,” he says. “They may be concerned for their own health, or they’re caring for an elderly relative, or they are fearful. They’re erring on the side of caution.” Ritchey’s appointment scheduler is working through the backlog, calling patients who are due for a cleaning. If they decline, she slides them down the list to call in another couple of months. People who are fairly healthy may safely delay a routine dental cleaning, Ritchey says. If you have no gum disease and little decay, you can put off your cleaning for up to six months with low risk because most dental problems progress slowly. If you regularly have dental issues or are not otherwise healthy, however, dental problems can progress more quickly, he says. A three- to six-month delay can mean that instead of a filling, you need a crown—or that instead of a crown, you need a root canal or an extraction.

Beyond routine checkups, if you have any pain, swelling or bleeding, you should call your dentist. “We can help you determine if yours is an emergency, an urgency or not a big deal,” Messina says, adding that several of his patients have sent him photographs of their problems—which he calls “tooth selfies.”

If you do not have a regular dentist, you can still get a consultation and care. Many dental offices take emergency patients. And those who do can often be found by searching online for “emergency dental services.”

Koval, who got her tooth repaired during New York’s shutdown, is still wary and plans to put off her next routine cleaning. Although the number of COVID-19 cases in New York is declining, unlike those in many other states, she says she worries about a possible spike. “I’m going to wait and see for now,” Koval says.

Read more about the coronavirus outbreak from Scientific American here. And read coverage from our international network of magazines here.



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