Oral Health Group

The Impacts of the Pandemic on Dental Practice: A Shift in the Oral Health Paradigm

May 10, 2021
by Gary Glassman, DDS, FRCD(C)

Over a year into the COVID-19 pandemic, dental practices continue facing unprecedented challenges on both personal and professional levels. We have had to cope with the universal concerns about health risks to our patients, families, and ourselves. Added to our concerns for physical wellbeing are those of fiscal health, as the uncertainty around the economic consequences of the pandemic on our clinic operations become more evident.

In an ADA COVID-19 impact poll, over half of the participating dentists reported an increase in bruxism and damaged teeth since the pandemic hit. Concurrently, approximately 30% of clinicians reported a rise in periodontal disease among their patients.1


Our goal is to keep our patients healthy as we work to reverse the upward trend of oral disease. The links between oral health, physical wellbeing, and a strong immune system must be forefront in our efforts to educate patients. Let’s look more closely at issues of concern and their solutions.

Depending on the location of the dental office, visits to the dental hygienist vary between being flat to down as much as 80 percent. Just the donning and doffing of PPE repeatedly, and the difficulty breathing through an N95 respirator are sufficient to give rise to physical and mental exhaustion. Conversely, the extra time now available can help our hygienists focus on patient education with regard to periodontal health and the importance of undertaking preventive care.

Social Isolation, Mental Wellbeing, and Oral Health
COVID-19 is having a negative impact on the mental wellbeing of us all. A study from the Centre for Addiction and Mental Health in Toronto shows that although we are “beginning to see a decrease in anxiety levels, the rates of depression and loneliness remain elevated.”2 Moreover, research has shown that there is a two-way connection between mental health and oral hygiene.3 During the lockdown, not only have Canadians had little or no access to professional oral care, but many have also been using substances such as alcohol, cannabis and tobacco,2 which may have negative consequences to one’s physical and mental wellness.

This is while individuals with pre-existing eating disorders such as bulimia and anorexia, with the attendant adverse oral effects, have experienced significant worsening of symptoms due to increased emotional strain and reduced access to treatment.4

Increased unhealthy eating habits (such as day-long snacking and sipping on soft drinks and fruit juice) to cope with the isolation-induced despair has lead to an increased incidence of dental erosion.

All told, the challenges to oral and physical wellbeing are mounting. It is well known that periodontal disease, one of the most common chronic inflammatory diseases, can wreak havoc on our patients’ systemic health over time, and in some cases, exacerbate the adverse sequela of patients with cardiovascular disease, diabetes and cognitive impairment.

The Solutions
We are still in a pandemic and our patients still need to achieve a healthy smile.

Compassion: Many patients are paying fewer or no visits to the dentist simply due to the cost. Some have lost their health insurances, others choose to spend their reduced budgets on family necessities. It is important to identify these patients, educate them on the long-term economic and health benefits of preventive care, be empathetic, triage treatment needs, and offer financial arrangements, when appropriate, so they can continue with their oral care.

Elevated Communication: Patient engagement can go a long way. As practices are experiencing challenges navigating the pandemic protocols and restrictions, it has become clear that patient communication is more important than ever, both prior to, and in between maintenance visits. It adds value to the patient experience and strengthens their relationship with the dental care team.
Many patients are still avoiding regular dental visits due to COVID-19 concerns. It is critical to educate these patients about the consequences of neglecting oral care, explaining the importance of maintenance visits and how these visits allow early detection of dental or periodontal disease.

Whether it is by an email, a text message or even a phone call, informing patients about the safety measures put in place, assuring them that it is safe to visit the dentist, and facilitating their navigation through pandemic protocols will encourage them to attend their appointments.

Patient outreach before visits can be the first step in the patient communication journey and continuing that connection between visits reinforces patients’ trust in a way that goes beyond their time in the chair. This is an important contributor to the success and survival of your dental practice. Extending appointments can help reduce team stress while allowing for increased time for patient education and most importantly, an opportunity to address fears and answer questions.

Present the Science and Emphasize Home Care:
Oral self-care has never been more important. All patients, regardless of their unique needs, look to us as dental professionals to guide them in achieving their Oral Fitness™ goals, be it primary prevention or reversing the effects of periodontal disease.

One way we can help our patients is by offering them clear, easy, and effective solutions, which includes placing evidence-based tools at the fingertips. For example, we know that electric toothbrushes with sonic and oscillating-rotating technologies are significantly more efficient in reversing gingivitis and removing plaque* than manual toothbrushes.5

Stannous fluoride (vs. sodium fluoride) dentifrices, such as Crest Gum toothpastes, are additional examples of oral care aids with a well-established effectiveness profile in biofilm management and improvement of gingivitis.6,7 Especially now, with the post-pandemic reduction in ultrasonic procedures, patients can be reminded that the toothpaste they use matters when it comes to achieving optimum oral health. This is particularly true in endodontically treated cases, especially if the treatment is followed by prostheses or subgingival direct restorations.

There are also programs that offer affordable and science-backed solutions designed for oral self-care at home, reminding us that getting patients healthy starts in our clinics, but continues at home. Online communication tools are available, which help improve our reach, considering most Canadian patients are between the ages of 25–59, and over half of all patients prefer digital communication to phone calls.8

Helping patients feel their best
Patients are always keen on improving their appearance to enhance their mental wellbeing, but we can only start talking about cosmetics when we are out of the woods with proper OralFitnessTM.

The pandemic has triggered an increased awareness of and interest in home self-care, and the upward trend of demand for effective, easy-to-use, versatile solutions are here to stay. Patients rely on us to educate them about the best products available to maintain their oral health and physical wellbeing.


  1. HPI poll: Dentists see increase in patients’ stress-related oral health conditions. https://www.ada.org/en/publications/ada-news/2020-archive/september/hpi-poll-dentists-see-increase-in-patients-stress-related-oral-health-conditions.
  2. Mental Health in Canada: Covid-19 and Beyond CAMH Policy Advice. Accessed February 28, 2021. https://www.camh.ca/-/media/files/pdfs–public-policy-submissions/covid-and-mh-policy-paper-pdf.pdf
  3. Sekulic´ S, John MT, Davey C, Rener-Sitar K. Association Between Oral Health-Related and Health-Related Quality of Life. Zdr Varst. 2020;59(2):65-74. doi:10.2478/sjph-2020-0009.
  4. Richardson C, Patton M, Phillips S, Paslakis G. The impact of the COVID-19 pandemic on help-seeking behaviors in individuals suffering from eating disorders and their caregivers. General Hospital Psychiatry. 2020;67:136-140. doi:10.1016/j.genhosppsych.2020.10.006.
  5. Ikawa T, Mizutani K, Sudo T, et al. Clinical comparison of an electric-powered ionic toothbrush and a manual toothbrush in plaque reduction: A randomized clinical trial. Int J Dent Hyg. 2021;19(1):93-98. doi:10.1111/idh.12475.
  6. Biesbrock A, He T, DiGennaro J, Zou Y, Ramsey D, Garcia-Godoy F. The effects of bioavailable gluconate chelated stannous fluoride dentifrice on gingival bleeding: Meta-analysis of eighteen randomized controlled trials. J Clin Periodontol. 2019;46(12):1205-1216. doi:10.1111/jcpe.13203.
  7. He T, Eusebio R, Goyal CR, Qaqish JG. Assessment of the Effects of a Novel Stabilized Stannous Fluoride Dentifrice on Gingivitis in a Two-Month Positive-Controlled Clinical Study. J Clin Dent. 2017;28(4 Spec No B):B12-16.
  8. Adam R, Grender J, Timm H, Qaqish J, Goyal CR. Anti-Gingivitis and Anti-Plaque Efficacy of an Oral Hygiene Routine Including Oral-B IO Oscillating-Rotating Electric Toothbrush, Stannous Fluoride Dentifrice, CPC Rinse and Floss: Results from a 12-Week Trial. P&G Data on File.
  9. Data Driven Dentistry Archives. Oral Health Group. https://www.oralhealthgroup.com/publication/data-driven-dentistry/

*Oral-B oscillating-rotating technology confirmed for superior benefits in plaque and gingivitis (Cochrane 2014).

About the Editor

Dr. Gary Glassman graduated from the University of Toronto, Faculty of Dentistry in 1984 and from the Endodontology Program at Temple University in 1987 where he received the Louis I. Grossman Study Club Award for academic and clinical proficiency in Endodontics. Widely published, Dr. Glassman lectures globally on endodontics and is on staff at the University of Toronto, Faculty of Dentistry. Gary is a fellow of the Royal College of Dentists of Canada, Fellow of the American College of Dentists, endodontic editor for Oral Health dental journal, endodontic editor for Inside Dentistry, Faculty Chair for DC Institute and Chief Dental Officer for dentalcorp. He maintains a private practice, Endodontic Specialists in Toronto, Ont. Visit his personal/professional website at drgaryglassman.com or his practice website at rootcanals.ca. He can be reached at gary@rootcanals.ca.

Oral Health is pleased to present the voices of our Editorial Advisory Board members in this forum, which allows writers to share their personal thoughts, opinions, viewpoints and experiences. We want to ensure our tradition of serving our readers the very best in clinical and editorial content continues and we thank all the members of our Editorial Advisory Board for their efforts in making this happen. We welcome your comments and feedback. Feel free to share your thoughts with us through letters to the editor (amy@newcom.ca).

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