Ashley Middleton was scheduled for a teeth cleaning in June 2020 before the coronavirus pandemic caused dental offices to temporarily close their doors, delaying patient care.
By the time viral transmission concerns had dissipated, the Bay City native had slipped out of her routine. She got busy with a move, a job change, and now, a pregnancy, as a months-long delay for her bi-annual cleaning grew into a years-long one.
“I’m definitely worried I’ll be judged when they ask me the last time I had a cleaning,” Middleton said. “I do feel guilty about not going.”
The 29-year-old isn’t alone in letting her dental care routine slip. Dentists throughout the state reported seeing declines in patient volume during the heights of the pandemic, followed by increases in oral health problems, including more cavities.
Dr. Jehan Wakeem, a Macomb County dentist with more than 28 years in practice, said she’s still seeing patients who haven’t been back since the pandemic started. While that number is declining, those patients are often returning in worse shape.
Before 2020, Wakeem saw maybe one patient a month who needed extensive work including multiple fillings, a root canal, or tooth extractions. Now, she’s seeing those patients weekly.
“There are less and less people who I haven’t seen, but there are a lot of new people coming and they’re coming with a disaster,” she said. “By and large, I’m seeing more cavities than I’ve ever seen in my life. People are coming in with what we call a bombed out mouth, which is cavities on almost every tooth and more. I’ve never seen so many people need full-mouth extractions.”
Cavities are permanent damage that occur when bacteria and sugars cause a tooth to decay. Treatment can include clearing out and filling the cavity up until a certain point. If left to progress, however, it can worsen in a matter of months to the point of requiring a root canal or tooth extraction.
When coronavirus infections ramped up in 2020, Michigan put efforts in place to limit the spread, including closing many non-essential businesses for months at a time.
Dentist offices were closed for the better part of three months, recalled Dr. Vince Benivegna, president of the Michigan Dental Association and an oral surgeon in East Lansing. Even after re-opening for routine care, he said it’s taken the better part of two years to get through patient backlogs amidst a shortage of dental hygienists and assistants.
“I think dentists are maybe in the range of 80% to 90% capacity now compared to pre-COVID,” he said. “If there’s a shortage in hygienists, they might not be able to see you for a year. So there’s more gum disease, there’s more decay. Things are worse because of the backlog of appointments and people trying to get in who can’t in a timely manner.”
In 2021, an estimated 14% of Michigan children age 17 and younger had tooth decay or cavities, according to survey data from the Data Resource Center for Child & Adolescent Health. That’s higher than the national average (11.7%), and an increase from the 10% estimate Michigan reported five years earlier.
Michigan’s 39% increase in children with cavities between 2016 and 2021 was the largest increase nationwide during that time, and its 2021 rate ranked fifth behind only Louisiana, California, Mississippi, and Idaho, according to an analysis by QuoteWizard.
The data doesn’t surprise Dr. Elizabeth Ralstrom, a pediatric dentist in Clinton Township. Like others in the industry, she has noticed the increase in her patients.
“I’m still seeing kids coming in who haven’t been seen since before the pandemic, several of those kids a week,” Ralstrom said. “Almost 2.5 years. that’s enough time for a small problem to become significant.”
Treatment is often cheaper and less invasive when a problem is caught early. While a simple cavity might cost $150 to fix, a cavity allowed to grow and worsen for two years could mean a root canal and crown, which can cost $2,000 or more.
“Once a week I’ll have a patient who comes in who needs you know, $2,000 to $5,000 worth of dentistry,” Wakeem said. “Whether they follow through or not is up to them because, you know, there’s a financial aspect to it and there’s a fear aspect to it.”
Beyond cavities, dentists look for evidence of periodontal disease, which is the result of infection and inflammation of the gums and bone that surround and support the teeth. What starts as gingivitis can progress into periodontitis, meaning the gums pull away from the tooth, bone can be lost, and the teeth may even loosen or fall out.
According to the U.S. Centers for Disease Control and Prevention, 47% of adults 30 and older have some form of periodontal disease. That rate increases to 70% for adults 65 and older.
Signs of periodontal disease include bad breath, red or swollen gums, tender or bleeding gums, painful chewing, and loose and/or sensitive teeth.
Dentists recommend brushing and flossing every day to remove bacteria that causes gum disease, and to see a dentist once or twice a year beginning at age 1. Regular professional cleaning can help prevent and combat periodontal disease.
Professional dental care also can identify signs of other health conditions including heart disease, cancer, diabetes, skin conditions, gestural intestinal issues, and HIV/AIDS.
“We know the mouth is kind of like the gateway to the body,” Wakeem said. “There’s so much that we can see just by looking in the mouth, and having been in the field for so long, it’s very intuitive.
“We know the patient, especially when we see them on a regular basis. We know last time we saw you we saw this, and this time we see this, you know, what’s changed? The continuity of care is really important because it really does allows us to be able to catch whatever is going on. “
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