How will Dental Clinic Practitioners Respond to the CoViD-19 Pandemic?

By late March, the United States Center for Disease Control and Prevention or US CDC recommended postponing all non-emergent dental clinics or services nationwide as part of the country’s Corona Virus Disease-19 (CoViD-19) efforts, matching regulations that were already released by the ADA or American Dental Association, departments of public health, and state organizations. By early April, at least 95% of services were entirely shut down or only open for emergency care.

Dental care changes during Corona Virus Disease-19 pandemic

The bad news is oral health issues will arise even when services or clinics are closed. Without access to palliative or preventive care, pain caused by periodontal infections or dental abscess may become more frequent. These kinds of emergencies comprise more than 1.5% of all yearly emergency clinic visits.

Tooth decay has been repaired with simple fillings that may deteriorate. It may require more stringent and costly treatment. These treatments are less likely to be covered by most insurance policies when services reopen. In response to the Corona Virus Disease pandemic, new federal and local policies allow dentists and other professionals related to the medical field to use off-the-shelf software, like online video chatting applications, to help conduct health visits through the Internet and screen patients for dental issues.

But ADA or the American Dental Association guidance when it comes to billing lists only six current terminology codes that professionals can bill through telehealth. Insurance companies can reimburse not all of these billings. These codes only cover diagnostic services and represent a fraction of some dentist’s care. Before the pandemic, only California’s state had enacted laws reimbursing professionals for the use of tele dentistry. It facilitated treatments by professionals with remote supervision.

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Lasting consequences of Corona Virus Disease on dental care

Most professionals are small business owners or own a startup clinic that operates independently or with partner dentists. The prolonged closure of their services is causing them financial strain similar to what the majority of small or startup businesses are experiencing during this pandemic. As of April, this year, at least 45% of professionals reported that they were not paying some, if not all, of their staff.

Although clinics are eligible for small business loans provided by the federal CoViD-19 Aid, and the Economic Security Act, limited access to PPEs, social distancing, and staff furloughs will most likely impede care services even after the government lifts restrictions. The average age of these professionals is 50 years old.

Most of them are practicing by themselves, and at least 40% of them are over the age of 55. If the pandemic shutdowns are prolonged, a lot of older practitioners may retire rather than resume their practice after a costly and prolonged gap in operations. As practitioners in the countryside or the rural areas tend to be a lot older compared to professionals operating in big cities, such closures could worsen the existing geographical disparities in the access of a practitioner, making oral health care less accessible for people living in these rural areas.

While only representing a minority of all practitioners, the number of professionals with more than ten employees, as well as the number of practitioners contracting with service organizations to streamline operations has been exponentially expanding. Substantial financial losses during the Corona Virus Disease pandemic may hasten consolidations of businesses under models that can weather economic uncertainty.

Two years ago, at least six million United States residents received dental services from a federally qualified health center. Because more or less 90% of clients in federally qualified health center earn more or less 200% of the federal poverty line and at least 22% of them lack medical or health insurance, federally qualified health center clinics are an essential access point for less-fortunate and vulnerable communities with a higher risk of unmet health needs.

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With programs already at limited margins responses to coronavirus disease-19 have included redeploying workers to triage roles and frontline testing or being forced to furlough them. The most significant economic consequences of this disease may also affect access to services. During budget shortfalls, benefits are usually among the first services that will be cut off from Medicaid budgets.

During the 2008 housing bubble, 19 states limited or removed adult services from the Medicaid programs. These programs are mandated by the government to offer pediatric dental benefits. Loss if these coverages for people with lower incomes resulted in low dental utilization and higher rates of emergency utilization for dental issues. Reduced Medicaid coverage for care minimizes their funding to help provide services.

Opportunities to help improve service delivery during CoViD-19 pandemic

Not all changes are negative. As people become accustomed to the accessibility and convenience of telehealth, it will be more likely to take more substantial roots in the industry as well. Current codes enable triage and evaluation of acute dental issues without in-person visits.

With increasing mobile phone camera quality, practitioners can use tele visits to accumulate additional diagnostic details. Although this method cannot substitute for dental clinic best practices for a lot of diseases, the growth of this method may benefit clients who face barriers to traditional care, like patients in the countryside or rural areas, residential facilities or nursing homes, as well as those with transportation or mobility limitations.

This pandemic can also hasten the adoption of electronic records on services. As of this moment, most records do not integrate with the hospital or medical records, representing potential safety risks or barriers to coordinated care.

As the testing capabilities to this disease expand, clinics may become a convenient site for walk-in screening, a move encouraged by the ADA. During the H1N1 (an Influenza A virus subtype) epidemic, practitioners authorized to administer vaccines. It can also occur once the Corona Virus Disease-19 vaccine is developed. These expansions in the professional’s scope of practice would require enhanced details sharing between dental and medical providers.

Traditionally separated from medicine, this industry has been mostly safe from a lot of changes happening in health care delivery. At this point, the industry has been affected by the pandemic and indirectly involved in the disease response. Nonetheless, care will emerge from this pandemic as altered as other public life in the United States.