Dental hygienists strained as COVID eases, patients return

Flossing is demonstrated on an oversized model of human teeth

June 29, 2021 5 AM PT

Dental hygienist Jeannette Diaz’s patients sometimes cry. Lately, she’s been crying with them.

It’s not just because so many people refrained from getting dental work during much of the COVID-19 pandemic, leaving her to scrape off more than a year’s worth of tartar and plaque. It’s not just because the labor of cleaning teeth can take a toll on hygienists’ bodies.

It’s also because the patients are unburdening themselves on her — describing the tragedies and heartaches that have bombarded them during the pandemic. Many tell her how the coronavirus took their loved ones.

Dental hygienists “work in such close proximity and cover so many aspects of [a patient’s] life in going over their medical history that grief and loss and depression come up as a topic of conversation,” Diaz said.

The start of the pandemic brought dentistry nationwide to a near standstill. Now, with COVID-19 vaccines readily available and new coronavirus cases down significantly in the U.S., patients are clamoring for teeth cleanings.

In April 2020, overall patient volume at private dental practices nationwide plummeted to 7% of the pre-pandemic baseline, said Marko Vujicic, who oversees American Dental Assn.’s policy research activities. As of this month, volume is back up to 88%, Vujicic said.

Diaz, who has her own practice and travels to patients’ homes across Los Angeles and Orange counties, has been seeing that resurgence. She said that each weekend, she sees about six patients and has to reject about four additional people who call her wanting appointments.

Before the pandemic, Diaz said, she would see patients for about an hour each, but now her visits can last twice as long. That’s because of the condition of the teeth and because patients often grab the chance to talk to her about their troubles.

“It can be emotionally exhausting and draining when you hear about what they are experiencing mentally and emotionally that leads them to … be unable to care for their oral hygiene,” she said.

Diaz said she sympathizes with patients who were scared to seek dental care when the coronavirus was running rampant in California. But when looking into a neglected mouth, she becomes sad.

“I wish I would have been able to see them sooner,” she said.

Similar concerns weigh on Raiza Parada, a hygienist at a dental clinic in Long Beach.

“Just knowing that my patient’s health is on the line … and I couldn’t really do anything about it” while the patient postponed appointments. “That’s kind of emotionally hard on me,” she said.

A hiatus in oral care can have lasting consequences.

Patients “could be seeing … gum disease, bleeding gums — which potentially can lead to tooth loss,” said P.J. Attebery, a clinic coordinator with the Los Angeles County Comprehensive Health Center.

Germs left to multiply in the mouth can also spread and cause trouble in other parts of the body. According to the Mayo Clinic, endocarditis, cardiovascular disease, pneumonia, and pregnancy and birth complications can be linked to oral health.

Cleaning those neglected mouths takes a heavier physical toll on hygienists too.

“The longer that the tartar … stays on the tooth surface, the more difficult it is to remove,” Parada said. “We have to strive to maintain good ergonomics and posture to prevent injury to our bodies, all while trying to clean teeth using sharp metal instruments in a very slippery environment, while making the whole experience comfortable for patients.”

She said she’s been experiencing more pain in her neck, shoulders, upper back and forearms. Cleaning the back teeth tends to be the hardest on her because that’s the area patients neglect most, she said.

Parada has offset some of the effects by doing strength training, getting massages, taking Epsom salt baths and using a foam roller to loosen the muscles in her shoulders and upper back. But it’s not magic.

“I’ve never had pain like this in my whole career. I’ve been a licensed hygienist since 2012,” she said.

Wearing layers of personal protective equipment, along with the pressure to do more cleaning during a regular-length appointment, also taxes Parada. “Wearing the gown makes me hot and sweat more than I used to, and I feel dehydrated,” she said.

Diaz worked in difficult conditions even before the pandemic: She said the equipment she carries into and out of each patient’s house weighs 43 pounds, and that doesn’t include an ergonomic patient chair.

“I end up seeing [patients] in their bed, on their couch, on the recliner,” she said. “I have to bend and twist into weird positions.”

When a patient has a heavy buildup of tartar, Diaz has to apply extra pressure, exacerbating the strain on her own body.

Dental care has been the most neglected healthcare service during the pandemic, according to an American Dental Assn. survey of U.S. households conducted in May.

But if you have a long history of lackadaisical oral hygiene at home, your hygienist won’t necessarily believe the pandemic is behind your current tartar situation.

“I’m used to … people making excuses for not being able to floss, but it’s interesting how [now] people would tie their excuses to the pandemic,” Parada said. “The narrative changed.”

It doesn’t really matter why your teeth are the way they are, Parada said: Just show up.

“It’s very important for patients to know that it is safe to come back to the dental office to get their teeth cleaned,” she said.