A preparedness model for the provision of oral health care during unfolding threats: the case of the covid-19 pandemic

As of May 1 2021, the COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2), has spread to more than 200 countries and territories, caused over 3 million deaths, and infected more than 150 million people worldwide [1, 2]. Also by May 1 2021, a third wave of infections was experienced by a number countries, some caused by more infectious genetic SARS-CoV-2 variants [3], even in the wake of mass inoculation efforts made possible by the fastest development of a vaccine ever seen in modern history [4]. Nonetheless, the pandemic continues to lead to social unrest [5] and economic and educational pitfalls [6]. The pandemic has also negatively impacted the provision of health care, and in particular oral health care, due to the close face-to-face proximity of professionals to patients’ face [7]. As the virus that causes COVID-19 can be found in saliva droplets and aerosols, the practice of oral health care is said to be at the highest risk for transmission of the virus [8, 9] even more so in light of a strong evidence for airborne spread as discussed by Greenhalgh and colleagues [10]. 

Use of Toothpaste and Toothbrushing Patterns Among Children and Adolescents — United States

Fluoride use is one of the main factors responsible for the decline in prevalence and severity of dental caries and cavities (tooth decay) in the United States (1). Brushing children’s teeth is recommended when the first tooth erupts, as early as 6 months, and the first dental visit should occur no later than age 1 year (2–4). However, ingestion of too much fluoride while teeth are developing can result in visibly detectable changes in enamel structure such as discoloration and pitting (dental fluorosis) (1). Therefore, CDC recommends that children begin using fluoride toothpaste at age 2 years. Children aged 3 years should use no more than a pea-sized amount (0.25 g) until age 6 years, by which time the swallowing reflex has developed sufficiently to prevent inadvertent ingestion. Questions on toothbrushing practices and toothpaste use among children and adolescents were included in the questionnaire component of the National Health and Nutrition Examination Survey (NHANES) for the first time beginning in the 2013–2014 cycle. This study estimates patterns of toothbrushing and toothpaste use among children and adolescents by analyzing parents’ or caregivers’ responses to questions about when the child started to brush teeth, age the child started to use toothpaste, frequency of toothbrushing each day, and amount of toothpaste currently used or used at time of survey. Analysis of 2013–2016 data found that >38% of children aged 3–6 years used more toothpaste than that recommended by CDC and other professional organizations. In addition, nearly 80% of children aged 3–15 years started brushing later than recommended. Parents and caregivers can play a role in ensuring that children are brushing often enough and using the recommended amount of toothpaste.

Mindful Dentist

Dental anxiety challenges patients and providers alike, creating barriers to care, increasing pain perception, and increasing the time and effort required to complete treatment. While patient-centered dentistry invites us to care for the person attached to the teeth, many dentists feel ill-equipped to handle the many emotions that arise during dental treatment. Mindfulness and the practices that cultivate it are invaluable to the provision of patient-centered care in four respects: 1) it provides balance to the dental professional during stressful times, 2) it cultivates the qualities of a patient-centered health care provider 3) it guides actions necessary to meet a patient’s needs, 4) it provides techniques that patients can themselves use to find balance during stressful times. All of these fruits of mindfulness practices are demonstrated in three true vignettes of fearful patients who were treated by the author. Video footage of the three stories is also provided.

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