Provision of dental care by public health dental clinics during the COVID-19 pandemic in Alberta, Canada

Abstract

Objectives: This study aims to describe dental services provided to a low income population in dental public health settings during the first wave of COVID-19 pandemic in Alberta, Canada. Methods: Routinely collected clinical data were recorded by dentists in electronic medical record files at Alberta’s two Public Health Dental Clinics (PHDCs). Patient contact was via teledentistry or in person, respecting phased provincial pandemic restrictions. A descriptive analysis of data relating to all patients contacting PHDC with dental problems between 17 March - 31 October 2020 was undertaken and compared to equivalent pre-COVID 2019 data. Results: In the period examined, 851 teledentistry consultations and 1031 in person visits were performed. Compared to the same period in 2019, 46% fewer patients were treated, representing a decrease in dental procedures: tooth extractions (17%), silver diamine fluoride applications (17%), endodontic treatments (82%) and fillings (84%). By contrast, prescriptions increased by 66% overall; representing 76%, 121% and 44% in antibiotics, non-opioid analgesics, and opioid analgesics respectively. In both years, antibiotics were the most prescribed drugs (66% in 2019 versus 62% in 2020) followed by non-opioid analgesics (28% in 2019 versus 33% in 2020); opioids accounted for the remainder (6.5% in 2019 and 5% in 2020). The largest drug prescription increases occurred during April-May 2020, when access to care was most restricted: antibiotics and non-opioid analgesics were 300% and 738% higher than the same time in 2019. Conclusions: Teledentistry and pharmacotherapy were used to triage and organise dental patients accessing care during the early stages of the pandemic. However, teledentistry did not replace definitive in person dental treatment, particularly for low income populations with high incidence of toothache and odontogenic infection. Reduced provision of dental procedures was accompanied by an increase in drug prescribing. Expedient access to care must be provided to address the dental needs of this population avoiding risks of further complications associated with infection and overprescribing antibiotics and opiates.