This study is the first to our knowledge to quantify the individual dental procedures provided during the forced hiatus in dental care associated with the coronavirus pandemic from March to August 2020 compared to the same period the year prior in the states of New York and Georgia. Dentists in both states reported a statistically significant decrease in all dental procedures, in particular dental prophylaxis, during the COVID-19 pandemic. These findings in the United States differ from the reported 83.8% of Brazilian dentists who reported that their patients sought out elective care (prophylaxis and preventive procedures) during the pandemic (5). This contrast highlights the international inconsistencies in attitudes and management of the COVID-19 pandemic.
Despite NYSDA and GDA members having no statistically significant differences in the demographic makeup of respondents in this study, NYSDA members had a significantly larger decrease in prophylaxis, elective care, emergent care, and specialty procedures.
New York dentists were advised to reopen non-emergent dental care a month later than Georgia dentists, but the consistently greater decrease in dental care in New York over the 5-month period suggests other external factors at play. These results might reflect the increased general fear and COVID-19 impact felt by citizens and dental practitioners in New York, and New York City in particular, during the Spring of 2020. The CDC COVID-19 Response Team’s report of the cases, deaths, and incidences of COVID-19 across the United States from February 12th to April 7th showed that New York City and secondly New York State held the highest cumulative number of reported COVID-19 cases, the highest cumulative incidence, and the highest number of reported COVID-19-related deaths, while these metrics were much lower in Georgia (6). Such significant differences in the COVID-19 experience in New York State and Georgia may explain the consistently greater decline in dental care in New York. These findings may suggest an increased fear of reopening dental offices in New York for dentists and patients alike.
Dentists’ number of years of practice experience had no statistically significant impact on time of reopening in NY and GA. One could speculate that increased confidence gained through years of experience might have been counterbalanced by an increased fear of age-related COVID-19 morbidity and mortality among older, more experienced dentists. This finding differs from Faccini’s survey of dental care in Brazil in which a higher percentage of younger dentists continued routine dental treatment with less concern compared to older dentists (5). Further, the number of dentists in a group practice also had no significant impact on time of reopening in this study.
The only dental procedure that did not significantly differ from baseline 2019 levels or between New York State and Georgia was antibiotic prescription. It might have been anticipated that New York dentists, who had a greater decrease in in-person care, would prescribe more antibiotics to treat patients remotely, but the findings of this survey demonstrated a similar increase in antibiotic prescription to Georgia dentists. The explanation remains unknown, but New York patients’ readiness to reach out remotely for dental care due to COVID-19 fear could be a contributing factor.
Study Limitations:
The survey response rate of 5.06% for NYSDA and 4.89% for GDA raises the possibility that respondents may differ from nonrespondent dentists, diminishing the generalizability of these results. Correction and stratification of potential respondent bias could not be easily resolved, as the data was collected anonymously through the professional associations. Neither the New York State nor the Georgia Dental Association collects information on their membership’s years in practice, number of dentists per practice, nor whether they accept Medicaid. Without this baseline demographic information, the extent to which respondent dentists represent the broader membership of the dental associations is unknown. While this study’s results found 16% and 17% of NYSDA and GDA respondents’ practices accept Medicaid, respectively, the Health Policy Institute’s statistics found that 36.5% of dentists in New York State participate in Medicaid while 27.5% of dentists in Georgia participate in Medicaid (7). It is possible that Medicaid-accepting dentists are less likely to become members of these dental associations, but because this information is not collected by either dental association, respondent bias cannot be ruled out.
The survey sample might also be subject to recall bias, as all parties were asked to recount procedures and cancellations from months prior.
Finally, limitations may include erroneous responses to question #6, “How did the cancellation/rescheduling rate compare to your dental practice's usual rate when your office reopened after the COVID-19 dental hiatus?”. Results for this question had a very wide distribution that averaged close to 0% change, diminishing confidence in the interpretation by respondents, despite apparent success in the pilot testing. While NYSDA and GDA members felt COVID-19 exposure fear contributed to 37% and 52% of dental appointment cancellations, respectively, it might have been anticipated that the cancellation rate compared to normal would be a clear increase. It is possible that the dentists and their patients were more affected by other factors, although this cannot be determined from the present data.
This survey was conducted to take the first step in understanding the impact on oral public health of the unprecedented hiatus in dental care during the COVID-19 pandemic. The sample groups of dentists from New York and Georgia who accepted the invitation to participate in this survey were similar in terms of years in practice, size of practice, and acceptance of Medicaid.
Across the states of New York and Georgia, the provision of all dental procedures declined significantly during the COVID-19 pandemic. This decrease was significantly greater in New York than in Georgia, particularly with dental prophylaxis, direct restorations, crowns, and implants.