By Genni Burkhart
Even before the pandemic, the healthcare system that serves rural America was in decline.
A 2015 report by the Pew Charitable Trusts found that people in rural areas often have to travel long distances to go to the dentist, face workforce shortages in healthcare, are less likely to have fluorinated water, and are less likely to have dental insurance. Additionally, a study by the U.S. Department of Health and Human Services found a dental shortage will occur over the next decade across America.
The impact of COVID-19 on rural dentistry has compounded problems that have existed for years. Before the pandemic, rural populations faced lower dentist-to-population ratios, restricting access to care due to geographic isolation. Patients in rural areas are more likely to have missing teeth and untreated tooth decay. With the pandemic, rural patients have further postponed routine preventative oral care, exaggerating existing oral health problems only to face greater health consequences later on.
But there are solutions, and thinking “outside the box” is helping to serve rural dental patients during the age of COVID-19.
Teledentistry Offers Hope for Rural Patients
One of the rising trends for rural dental care includes the use of teledentistry. Teledentistry is currently being considered as a way to resume dental practice during the pandemic. This is one avenue to allow for an application that can complement existing dental systems during the pandemic. A study by the Elsevier Public Health Emergency Collection found that the benefits of teledentistry include remote triaging of suspected COVID-19 patients for dental treatment, and lowering the unnecessary exposure of healthy patients through limiting visits to dental offices and hospitals.
For rural patients, teledentistry shows great promise as it limits excessive travel and allows for consultations with dentists, regardless of where you live. Teleconsultations can allow rural patients to continue their therapy without having to travel, even during the pandemic. Technology plays an important role in the adoption of telediagnosis. Using smartphones as a detection system can aid in screening for oral lesions through dental photography and limit close contact during the pandemic. Telemonitoring can also play an important role in monitoring the progress of treatment, as this allows for rural patients to have a level of care more similar to that of their urban counterparts. A recent pilot study during the pandemic found telemonitoring to be useful for remote monitoring of surgical and non-surgical dental patients, leading to reduced costs and waiting times for rural patients.
Could Dental Therapists Offer A Solution?
According to the CDC, more than 49 million US residents live in areas designated by the Health Resources and Services Administration as professional dental health shortage areas. Many of these patients have put off necessary dental visits during the pandemic, driving greater demand for preventative care, especially as COVID-19 limits access to dental providers.
A strategy utilized by a growing number of states is the licensing of Dental therapy. Dental therapists provide a legitimate way to increase access to midlevel providers in the dental healthcare system where dentists are in short supply. Like physician assistants in medicine, dental therapists provide preventive and restorative care in dentistry. According to the Rural Health Information Hub, which is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services, dental therapists have made great strides in improving access to dental healthcare in rural communities.
Alaska has lead the way in the useful utilization of dental therapists since 2005. Dental Health Aide Therapists (DHATs) have been helping to meet the needs of Natives in some of the most remote Alaskan villages. Alaska requires DHATs to be trained in a two-year, post-high school educational preventive and clinical strategies program based on a competency-based, primary care curriculum. DHATs are under the general supervision of dentists. Program evaluations in Alaska have shown that DHATs are fully competent in treating patients while under the supervision of dentists, much like the relationship of physician assistants to physicians.
Other states are looking to improve access to rural dental care with the use of dental therapists as well. In 2009, Minnesota authorized dental therapists to practice in “underserved areas” of the state. In Minnesota, dental therapy is classified into three programs: Oral Health Care Practitioner (OHCP) Master's degree program; Bachelor's and Master's level Dental Therapy degree; and Master's degree in Advanced Dental Therapy. According to an updated 2016 report, Maine, Arizona, Michigan, and Vermont have since passed legislation authorizing the practice of dental therapists in an effort to increase access to rural dental healthcare.
Rural populations, even before the COVID-19 pandemic, face multiple challenges due to their geographic isolation and lack of access to dental providers. Many rural patients have further put off going to the dentist due to COVID-19, only to compound their preexisting conditions. Thus, thinking of innovative solutions to solve the problem of access to rural healthcare is more important than ever. There is rising support for the use of teledentistry by dentists, and the introduction of training dental therapists to work under a dentist to meet the needs of patients in isolated or hard to reach rural areas. COVID-19 will continue to impact how patients access healthcare, but the flip-side could be that 15 percent of the population or the 46.2 million people currently living in rural communities could find greater access to quality dental care long after the outbreak of the COVID-19 pandemic.
About the Author: With over 10 years as a published journalist, editor, and writer Genni Burkhart’s career has spanned across politics, healthcare, law, business finance, and news. She resides on the western shores of the Puget Sound where she works as the Editor in Chief at DOCS Education out of Seattle, WA.