Dental hygienist Jeannette Diaz’s patients sometimes cry. Lately, she cried with them.
It’s not just because so many people abstained from seeking treatment for much of the COVID-19 pandemic, leaving her scratching over more than a year of tartar and plaque. It is not only because the work of cleaning teeth can harm the body of hygienists.
It’s also because patients are venting on her – describing the tragedies and heartaches that have bombarded them during the pandemic. Many tell him how the coronavirus took their loved ones.
Dental hygienists “work so close together and cover so many aspects of [a patient’s] life by reviewing their medical history that grief, loss and depression are a topic of conversation,” Diaz said.
The onset of the pandemic virtually paralyzed dentistry across the country. Now, with COVID vaccines readily available and new coronavirus cases down significantly in the United States, patients are clamoring for tooth cleanings.
In April 2020, the overall volume of patients in private dental practices nationwide fell to 7% of the pre-pandemic baseline, said Marko Vujicic, who oversees policy research activities at the American Dental Association. Since this month, the volume is back up to 88%, Vujicic said.
Diaz, who has her own practice and visits patients’ homes in Los Angeles and Orange counties, has seen this resurgence. She said that every weekend she sees about six patients and has to turn down about four more people who call her for appointments.
Before the pandemic, Diaz said, she saw patients for about an hour each, but now her visits can last twice as long. This is because of the condition of the teeth and because patients often take the opportunity to talk to him about their problems.
“It can be exhausting and emotionally draining when you hear about what they’re going through mentally and emotionally that causes them to…be unable to take care of their oral hygiene,” she said.
Diaz said she sympathized with patients who were afraid to seek dental care when the coronavirus was rampant in California. But looking into a neglected mouth, she becomes sad.
“I wish I could have seen them sooner,” she said.
Similar concerns hang over Raiza Parada, a hygienist at a Long Beach dental clinic.
“Just knowing that my patient’s health is at stake…and I really couldn’t do anything about it” as the patient rescheduled his appointments. “It’s a bit emotionally tough for me,” she said.
An interruption in oral care can have lasting consequences.
Patients “could see … gum disease, bleeding gums — which can potentially lead to tooth loss,” said PJ Attebery, clinic coordinator at the Los Angeles County Comprehensive Health Center.
Germs left to multiply in the mouth can also spread and cause problems in other parts of the body. According to the Mayo Clinic, endocarditis, cardiovascular disease, pneumonia, and complications of pregnancy and childbirth can be linked to oral health.
Cleaning these neglected mouths also has a heavier physical impact on hygienists.
“The longer tartar…stays on the surface of the tooth, the harder it is to remove,” Parada said. “We must strive to maintain good ergonomics and posture to avoid bodily injury, while trying to clean teeth with sharp metal instruments in a very slippery environment, while making the experience comfortable for the patients.”
She said she felt more pain in her neck, shoulders, upper back and forearms. Cleaning the back teeth tends to be the hardest for her, as it’s the area patients overlook the most, she said.
Parada offset some of the effects by doing weight training, getting a massage, taking Epsom salt baths, and using a foam roller to relax the muscles in his shoulders and upper back. But it’s not magic.
“I’ve never had pain like this in my entire career. I have been a registered hygienist since 2012,” she said.
Wearing layers of personal protective equipment, as well as the pressure to do more cleaning during a regular-duration appointment, also tax Parada. “Wearing the gown makes me hot and sweat more than before, and I feel dehydrated,” she said.
Diaz worked in harsh conditions even before the pandemic: She said the equipment she carries in and out of each patient’s home 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 in weird positions.”
When a patient has a heavy build-up of tartar, Diaz has to apply extra pressure, exacerbating the strain on his own body.
Dental care has been the most neglected health care service during the pandemic, according to an American Dental Association survey of American households conducted in May.
But if you have a long history of nonchalant oral hygiene at home, your hygienist won’t necessarily believe the pandemic is to blame for your current tartar situation.“I’m used to…people making excuses for not being able to floss, but it’s interesting to see how [now] people would tie their apologies to the pandemic,” Parada said. “The narrative has changed.”
It doesn’t matter why your teeth are the way they are, Parada said: Just show up.
“It’s very important for patients to know that it’s safe to come back to the dental office to have their teeth cleaned,” she says.
