key: cord-0695467-sxh68foc authors: Marchini, Leonardo; Ettinger, Ronald L. title: COVID‐19 pandemics and oral health care for older adults date: 2020-05-11 journal: Spec Care Dentist DOI: 10.1111/scd.12465 sha: fa4e4c7876183378b25d9012f0126ee5269e2feb doc_id: 695467 cord_uid: sxh68foc nan aerosols. [13] [14] [15] Another issue was to limit the use of personal protective equipment (PPEs) by dentists, as they were required for hospitals and were in short supply globally. 13, 16 Older adults with multiple comorbidities have been identified as the highest risk group for fatal COVID-19 clinical outcomes. 9 ,17 A significant number of older adults are prescribed angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers to manage diabetes, hypertension, and chronic kidney disease, and these medications put the patients at an increased risk of infection by SARS-CoV-2. 17 Not surprisingly, a number of long-term care facilities (LTCFs) have become outbreak hot-spots for COVID-19 infection, because they provide care for older adults with multiple comorbidities. This problem may be exacerbated by the fact that LTCFs have close living quarters, undertrained staff, and a shortage of PPEs. 18 The earliest outbreak of COVID-19 in the United States was in a LTCF in Washington State, which had a high fatality rate. 18 Despite all the risk, older adults unfortunately have not been in the focus of the international health care debate during this current pandemic. 19 Unfortunately, oral health care has been halted in most LTCFs as part of the recommended measures for isolation, 20 and there is no predictable date when oral health care will be part of the protocol in LTCFs again. Additionally, older adults with multiple comorbidities living in the community are less likely to seek oral health care. This may be caused by a combination of the fear of being exposed to high-risk aerosol generating procedures and knowing that older adults have a higher risk of getting infected and not surviving COVID-19. Currently, recommended triage and treatment procedures when treating older adults, particularly those with dementia, are hard to follow safely. For older adults with dementia (about 48% of the American LTCFs population 18 ), following COVID-19 best practices, such as using facial masks in the reception area and using preoperative mouth rinses, 15 can be anywhere from challenging to impossible. Even for community dwelling older adults, many of them presenting with hearing and vision problems, communicating from a social distance and/or wearing a N95 mask with a full face shield can prove to be challenging. Even providing urgent and emergent oral health care, and following recommended flowcharts for triage can be a challenge, as some questions (e.g., "What is your pain level on a scale of 1 to 10?") 13 can only be estimated for patients with cognitive impairment. Older adults with dementia are sometimes treated under general anesthesia (GA), depending on their level of cognitive impairment, their behavior, and the type of oral health treatment they need. Access to operating rooms to use GA is now even more restricted due to the pandemic, and will be for the near future. In a proposed system for prioritization, only urgent oral health care is included. 21 It is important to notice that the restrictions for accessing oral health care due to the COVID-19 pandemic are not unique. These problems are in addition to the multitude of barriers faced by older adults in accessing oral health care, which has been often previously reported, 22,23 especially for the most vulnerable groups, like individuals living in LTCFs, 24 the homebound, 25 and older adults with dementia. 26 Inevitably, these COVID-19-related barriers are likely to further reduce the already poor access to oral health for frail and functionally dependent older adults. As a consequence, even poorer oral health outcomes might occur among vulnerable older adults in the near future. Therefore, the small 27 but proactive group of oral health providers dedicated to geriatric dentistry will be facing new and greater challenges as the world rebuilds after this current COVID-19 pandemic crisis. 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