Part 2: Oral Health and Healthcare during COVID-19: Lessons from India, Kenya and the United States

Oral health services have been severely impacted by the COVID-19 pandemic. As healthcare systems struggle to cope with an increasing number of COVID-19 patients, there has been a decline in the provision of elective and non-emergency oral healthcare at both the public and private levels. This has impacted access to and utilization of dental services, training and education of dentists and dental students, and community-based outreach and programming. In collaboration between Columbia Global Centers | Mumbai and Columbia Global Centers | Nairobi for a two-part series, we discussed lessons learned from India, Kenya and the United States in finding innovative ways to provide in-person and virtual clinical and outreach services in dental healthcare delivery during this pandemic.

Program Moderator:

Kavita P. Ahluwalia – Associate Professor and Program Director, Postdoctoral Program in Dental Public Health, Columbia University College of Dental Medicine (CDM)

Panelists:

James B. Fine – Professor and Associate Dean of Postdoctoral Programs, Columbia University College of Dental Medicine (CDM)

Victor Badner – Associate Professor and Chair, Department of Dentistry and Oral Maxillofacial Surgery, Jacobi Medical Center

Regina Mutave James – Professor and Dean, School of Dental Sciences, University of Nairobi, Kenya

Vikrant Mohanty – Associate Professor and Head, Public Health Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi 

Webinar Highlights:

James B. Fine – Although as many of our speakers last week have pointed out in the state of New York we have stopped anything but dealing with dental emergencies for about 15 weeks, the emergency clinics that actually direct patient care had to be ongoing consistent and much of it was provided by our hospital dental residents. (Time frame from minute 10:04-10:27)

James B. Fine – So three groups that we wonder provide education: There are residents assigned to the hospital [New York Presbyterian] and to the Dental School, our post graduate students are assigned to the Dental School, and our faculty are assigned both to the hospital and the Dental School. (Time frame from minute 11:11-11:27)

James B. Fine – Our residents always function under the supervision of our faculty and treated both outpatient and inpatient. What are out key educational focus for our particular residents? One, managing pain, and this is extremely important during these 15 weeks from most of the patients presenting to the emergency clinic. Two, managing infections. Three, actually practicing infection control at the highest level. And finally, identifying patients potentially at risk for COVID-19 virus. (Time frame from minute 11:29-12:06)

James B. Fine – The faculty also treated patients and supervised residents. So the faculty had to step in where our dental students were no longer on the premises in helping handle the volume emergencies coming through. And they treated both outpatients and inpatients for these dental emergencies. (Time frame from minute 12:08-12:29)

James B. Fine – Our post graduate students: They did not provide direct patient care, but they did manage their patient rosters, which is their student practices, to identify those needing potential urgent care for referral to the emergency dental clinic. And this was very important. We wanted to make sure we stay in front of any dental emergencies and minimize it. (Time frame from minute 13:41-14:05)

Regina Mutave James – Since 2010, Kenya has a devolved healthcare system with 47 devolved units managing healthcare together with the national government. (Time frame from minute 27:36-27:48)

Regina Mutave James – The School of Dental Sciences trains about 30 undergraduate bachelor of dental surgery students every year and has serious limitations of infrastructure and staff. And as I probably shared last week, with COVID-19, this number is likely to push lower down because there is the requirement for personal protective equipment to make sure that there’s protection of the dentists, the trainees, and faculty. There’s additional safety measures in a clinical setting that presents a serious challenge. (Time frame from minute 29:05-29:54)

Kavita P. Ahluwalia – I know that in the United States, we are working quite hard to integrate dental and medical education but I don’t think we have gotten as far as you [Regina] and we certainly have not gotten medical practitioners to say they would like more time and more education. (Time frame from minute 39:18-39:38)

Victor Badner – There is a program at Jacobi Medical Center in the system in New York called “Helping Healers Heal.” That’s when medical or dental providers have struggled psychologically with their patient care and we tried to help the healers take care of themselves. Support is given and offered ahead of time as well as throughout our efforts to prevent and deal with PTSD and difficult things people are dealing with. (Time frame from minute 47:36-48:08)

Victor Badner – We did off-site work including research and contact tracing and triage calls. We did inpatient support services. We did specialized COVID care such as general surgery and our step-down ICU. And we also were the only service taking care of our Maxillo-facial trauma. It used to be shared with plastic surgery and laryngology, but we took all of it and performed a drive-thru testing. (Time frame from minute 50:05-50:37)

Vikrant Mohanty – We started off by providing pre-screening since way back in 18^th of March 2020 when the world was just gearing up to respond to the outbreak of COVID. So over the last 100 days, we have screen more than 7,500 patients and treated nearly 42% of them by providing some sort of immanency and urgent/comprehensive care. (Time frame from minute 1:02:41-1:03:08)

Vikrant Mohanty – During COVID-19, the government of India took a very strong step where they actually banned the use of tobacco across the country. That means, with the last survey, we had around 266 million people using tobacco. In one shot, the whole of India had a lockdown, not only on the population activities, but also on tobacco use. So that puts a huge burden mainly on the users but also it gave a window of opportunity for healthcare providers to reach out to these users. (Time frame from minute 1:04:06-1:04:37)

Vikrant Mohanty – The objective [D-Shot, Dental School Health Orientation and Training Program] is to orient and prepare teachers towards dental emergencies and oral health during COVID-19. Teachers were made responsible so they could sensitize school children regarding oral health during this COVID-19 times. We developed a referral system through teleconsultation to target parents and children. We organize oral health promotional events and activities. We develop special-targeted oral health materials and circulation through various worldwide channels and also look at conducting research to implementing these strategies. (Time frame from minute 1:10:23-1:10:56)