Is there an upside to COVID-19 for dentistry?

Legend has it that as Sir Winston Churchill sought to build postwar alliances near the end of World War II, he uttered this phrase: “Never let a good crisis go to waste.” He recognized the opportunities that were ahead, even in the darkest periods of world history.

The COVID-19 pandemic has become an international crisis of historic magnitude. The United States, as with nearly every other nation on Earth, is facing one of the most critical public health challenges in modern memory.

Dentistry has not been exempt from the harsh realities of pandemic-era life and practice. But over the last several months, the American Dental Association (ADA) has put forth extraordinary effort to lead dentistry’s response to COVID-19, which is caused by the novel SARS-CoV-2 coronavirus.

The results of our activities—designed to support and inform the profession, patients, and the public through these novel, unparalleled circumstances—have been phenomenal. In the first year of our current strategic plan, Common Ground 2025, we have already exemplified the ADA’s multifaceted objective to strengthen our profession and advance public health, although we never imagined that a global health crisis would be the impetus.

The ADA’s COVID-19 team (with staff members from the Practice Institute, Science and Research Institute, Government Affairs, Integrated Marketing and Communications, and Legal Division among many others) created a robust suite of useful content to answer many of the questions our members had. The ADA Coronavirus (COVID-19) Center for Dentists—a Web page dedicated to keeping our community informed of pandemic-related issues—was launched.

Keeping the public informed with facts and advice during an uncertain time was also central to our response. To date, there are thousands of news stories, including top-tier outlets such as National Public Radio, CNN, and the Today Show, that cite the ADA as a source with a cumulative audience reach in the billions.

The ADA Division of Government and Public Affairs has contributed to a multitude of pandemic relief legislation proposed and passed in our nation’s capital. Among a slew of priorities, the ADA has raised its voice to ensure, for example, increased production of personal protective equipment (PPE) and beneficial modifications for Paycheck Protection Program loans.

In addition, a series of digital events and weekly “Power of Three” calls with leaders across the tripartite were among the various channels through which the ADA delivered information. Communication was paramount in our effort to help members and constituent societies survive a period of practice restrictions and thrive during reopening.

The ADA’s Advisory Task Force on Dental Practice Recovery, with support from the Practice and Science teams, developed interim guidance (including the Return to Work Interim Guidance Toolkit, Interim Mask and Face Shield Guidance, and a hazard assessment tool) to help dentists return to work more safely. The group continues to create content that meets the evolving needs of our members and profession.

The ADA’s Health Policy Institute has continually surveyed dentists and analyzed COVID’s economic impact on US dental practices, providing their insight to the profession and news media.

Although dentistry has been cautious on its path to recovery after nationwide reopenings, there have been direct impacts on the provision of care. With changes in patient scheduling and potentially decreased procedure volumes, our practices may see decreased revenues. Enhanced safety measures will increase overall costs, something many industries are also experiencing.

The pandemic will likely continue until a vaccine has been developed and administered broadly. If successful, prevalence of COVID-19 may not be significantly reduced until late in 2021, if then. Most dental practice modifications and enhanced infection control protocols (including modifications to PPE, patient scheduling and screening, social distancing, and procedure selection) will continue into the foreseeable future.

Yes, it has been a difficult year. But as a practicing dentist and the newly installed 157th president of our Association, I recognize that there are some silver linings in dentistry’s season under the cloud of COVID-19. Here are few.

Better Preparation for the Future

To those who think that we will not have challenges like this in the future, the H1N1 pandemic of 1918 would like to have a word. History can offer a glimpse into the future, and we have learned that what has happened today can happen a century from now or much sooner. We are responsible for taking what we have learned (given the speed and breadth of the ADA’s current comprehensive response) and setting the stage for when we face a new superbug.

Additional Layers of Safety for Our Patients and Staff Members

Our profession has an excellent history for providing safe care, and we will get better. The moves we have made in response to the immediate needs of our staff members and patients are those indicated by the ADA’s work to prioritize a culture of safety in dentistry. A resolution passed by the 2019 ADA House of Delegates created a framework for seeing this through; we are already walking our talk. Lessons learned during our response to COVID-19 will enable safety improvement in other areas of dental practice as well.

Our profession has an excellent history for providing safe care, and we will get better.

Expedited Research

This pandemic has generated a body of literature exploring the potential unique airway-aerosol risks dentists face. I believe that this research will be expedited in the near future, providing reliable and valid data to guide subsequent patient care recommendations.

Technology-Assisted Patient Interaction

The use of teledentistry has risen substantially during this pandemic. With increased adoption, we are also seeing improvement to hardware and software, leading to a growing list of advantages gained by practices seeing patients remotely. Triage, monitoring, and postoperative care can easily be done to limit the need for direct patient interaction. Distant evaluations used by trained dental team members can further enable efficient patient interactions but also expand access to rural communities. Group interaction through technology-enabled, Web-based education can expand oral health literacy in schools and interprofessional settings. For example, group prenatal education programs organized by obstetricians could include oral health care education.

A Reminder of Dentistry’s Essential Role in Overall Health Care

The ADA recommended that dentists focus only on urgent and emergency care when the acute nature of the pandemic was first noted in the United States. At the time, knowledge of SARS CoV-2 was very limited, but the magnitude of this new respiratory disease in other countries was obvious. The pause in nonurgent and nonemergency clinical care provided time necessary to gain knowledge and create resources for the dental profession while preserving PPE for acute care facilities. Emergency care provided by dentists kept patients out of emergency departments. The essential role of oral health care has been acknowledged and must be emphasized going forward.

The essential role of oral health care has been acknowledged and must be emphasized going forward.

Alternative Approach to Oral Health Care

Until science clarifies the true risk of aerosol-producing procedures to dentists and the dental team, we are incentivized to reevaluate options to these procedures. We have a renewed opportunity to emphasize prevention and to promote indications for noninvasive caries management.

Insight for Improving the Dental Education and Licensure Process

COVID-19 prevented live patient examination which, in turn, generated multiple issues encountered by graduating students, dental schools, and state boards of dentistry with graduation, examination, and licensure. As we grappled with the challenges in the system, and with this summer’s launch of the Dental Licensure Objective Structured Clinical Examination, we are now much better equipped to continue improving the process.

A Case for a Fair and Seamless Dental Benefit System

The cost of providing care has increased. In both private practice and public health, we must ensure appropriate reimbursement. This pandemic and the changes brought about by it have illustrated the resources necessary for viable dental practice. The government, patients, and patient advocates call for care. All parties understand this, and the time is right for legitimate data-driven, resource-based revision of oral health care reimbursement. Along with this, we should continue to advocate for administrative simplification.

Innovation in Dental Industry

They say that necessity is the mother of invention. I like to think that a pandemic can spur innovation just the same. I certainly expect new products and technology will improve patient care and team member safety in ways we could not have fathomed even a few years ago.

COVID-19 has totally disrupted dentistry’s world and that of the others whose products, services, and resources are key to the provision of optimal oral health care.

The ADA has made notable strides in supporting its community in the present. We must also recognize that in crisis, opportunity exists to improve our profession long after the pandemic is behind us. Let’s not waste it.