key: cord-0880474-8m74chjn authors: Tong, Nicholas; To, Shunhau; Wyatt, Chris C.L. title: Impact of the COVID‐19 pandemic on the University of British Columbia Geriatric Dentistry Program: Clinical education and service date: 2021-09-27 journal: Gerodontology DOI: 10.1111/ger.12591 sha: ea6959da9dc5dad66b71a78f80babf5adc1306ae doc_id: 880474 cord_uid: 8m74chjn BACKGROUND AND OBJECTIVE: In Canada, the COVID‐19 pandemic was associated with significant morbidity and mortality in older adults, particularly those in long‐term care (LTC). Access to oral health services was limited during the pandemic due to public health restrictions. The aim of this paper was to describe the impact of the pandemic on the clinical education and service of the University of British Columbia (UBC) Geriatric Dentistry Program (GDP), which provides care to LTC residents. METHODS: Data were collected from UBC GDP AxiUm dental software records, including number of dental appointments in 2019 and 2020. Data on revenue in 2019 and 2020 based on clinical production were collected through financial summary reports. Data on the number of educational rotations were collected from summary reports from scheduling software. RESULTS: In 2020, significant reductions in clinical service, revenue, and productivity were observed in the UBC GDP relative to 2019. The number of GDP appointments for June‐December 2020 was lower by 68%. The clinical productivity reduced by 67% for the same period. Expenses were slightly reduced. The overall number of LTC clinical rotations for students were only slightly lower for undergraduate students in 2020 than in 2019, and it increased for graduate students. CONCLUSION: The COVID‐19 pandemic and associated public health restrictions had a negative impact on the clinical service and productivity of the UBC GDP in 2020 relative to 2019. However, clinical educational rotations to LTC were slightly increased in 2020 relative to 2019. Dental care for LTC residents can be provided if rigorous administrative controls, engineering controls and personal protective equipment are employed. March 2020, COVID-19 was classified as a global pandemic by the World Health Organization. 1 COVID-19 is a disease caused by the novel coronavirus SARS-CoV-2 and is characterised by fever, cough, shortness of breath, fatigue, loss of appetite and loss of smell and/or taste. 2 In Canada, a robust public health response was employed to respond to the pandemic, including physical distancing, enhanced hand hygiene, respiratory etiquette and other measures. 2 Despite the public health measures, the morbidity and mortality associated with the pandemic in older adults was high, particularly in those residing in Long-Term Care (LTC) facilities. 3 In Canada, the majority of COVID-19 related deaths occurred among LTC residents. 3, 4 In LTC settings, public health authorities recognised the higher risk of morbidity and mortality and mandated a reduction in visitors and the temporary suspension of non-essential services during the early phases of the pandemic. 2, 4 As a result, routine dental care provided in LTC facilities or in outpatient dental clinics was limited. Data published from a European, university-based dental clinic dedicated to the treatment of dependent older adults reported an 81% reduction in clinical activity in 2020 relative to an equivalent period in 2019. 5 LTC residents are at higher risk of oral disease and face numerous barriers to receiving oral health care. 6 This is of increasing importance as Canada's population is ageing, with the number of older adults over age 65 expected to grow by 68% over the next 20 years. 7 This group of older adults is retaining more of their natural dentition as they age than previous generations, and oral diseases remain prevalent in this cohort. 8 While most older adults are functionally independent, a substantial proportion are frail or functionally dependent due to multimorbidity, functional decline and cognitive decline 9,10 with many requiring advanced support and care in a protective environment such as LTC facilities or Assisted Living (AL) facilities. 8, 4 While LTC residents have higher rates of caries and other oral diseases than their community dwelling peers, Programs providing comprehensive dental care in LTC have been shown to improve oral health. 11, 12 The University of British Columbia (UBC) Geriatric Dentistry Program (GDP), as part of the UBC Faculty of Dentistry, has a mandate to provide clinical service, research, and education in geriatric dentistry, with a focus on frail and functionally dependent older adults residing in LTC facilities. The UBC GDP supports clinical geriatric dentistry education activities for undergraduate, graduate and post-graduate dental students in the Faculty of Dentistry. It provides clinical services to frail and functionally dependent older adults in 27 LTC facilities across two health authorities in British Columbia (BC). This dental care occurs at dental clinics housed within LTC facilities or on referral to the outpatient Oral Health Centre (OHC) geriatric clinic at the UBC Faculty of Dentistry. The aim of this paper was to describe the impact of the COVID-19 pandemic on the clinical education and service of the UBC GDP. We also aim to describe the phased approach taken by the UBC GDP upon reopening of clinical educational rotations and clinical services to allow for the safe provision of dental care for frail and functionally dependent older adults in LTC. Data were collected from UBC GDP AxiUm dental software records. AxiUm is an academic dental management software used in numerous North American dental schools for clinical documentation, student management, and financial record-keeping. 13 The numbers of dental appointments in 2019 and 2020 were identified through In 2020, reductions in clinical service, revenue, and productivity were observed in the UBC GDP relative to 2019. During the public health-mandated shut down, the number of dental appointments with the UBC GDP in April and May 2020 was reduced by 100% compared to 2019 for both LTC clinics and the outpatient OHC clinic (Table 1) . Upon re-opening with public health restrictions in June-December 2020, the number of dental appointments at LTC clinics was reduced by 72% relative to the same period in 2019. The number of dental appointments from June to December 2020 at the outpatient OHC clinic was greater by 30%. Overall, the number of UBC GDP appointments for June-December 2020 was lower by 68%. The clinical productivity for the UBC GDP in April-May 2020 was 60% lower than the same period in 2019 (Table 2) . Clinical productivity was lower for June-December 2020, with a reduction of 67% relative to the same period in 2019. Expenditures for 2020 did not significantly change compared to 2019. The overall number of clinical educational rotations in LTC for dental students from the UBC Faculty of Dentistry were only slightly decreased for undergraduate dental students and dental hygiene students in 2020 relative to 2019 and increased for graduate and postgraduate dental students (Table 3) year. In GDP rotations, DMD students, graduate prosthodontic specialty students, and GPR residents provide supervised direct patient care for LTC residents in teaching dental clinics at two LTC facilities and in the outpatient geriatric clinic at UBC. Each clinical rotation has one to two dental students present at a time, with a supervising faculty member and dental assistant. The in-house teaching clinics in LTC have one dental operatory, equipped with an overhead sling for transfer of non-ambulatory patients and provides no-cost care for residents of the facility. The UBC GDP experienced reductions in clinical service and productivity in 2020 relative to 2019 due to the COVID-19 pandemic. The reductions in clinical productivity are similar to those reported in a European geriatric dental clinic. 5 This was expected, as public health measures were similar worldwide, with a focus on reducing the risk of viral transmission especially among older adults. This study provided a broad overview of the impact of the COVID-19 pandemic on the service and educational arms the UBC GDP. One weakness of this study is that it did not examine changes in oral health status of GDP patients related to the pandemic. Furthermore, this study did not characterise the types of dental procedures provided in 2020 relative to 2019. Dental care for frail and functionally dependent older adults, such as those residing in LTC, continues to be an important service to optimise quality of life. 6, 11, 12 The goals of treatment in this group are to eliminate oral sources of pain and odontogenic infection, control inflammation and maintain a level of comfortable oral function. 8 Providing these services in dental clinics housed within LTC facilities, at bedside, or in a specialised ambulatory clinic increases access to care. 11 This is important because a lack of mobility and functional dependency are one of many barriers to care for older adults. 14 During the COVID-19 pandemic, many Canadian LTC facilities faced challenges with regards to adequate staffing, which may have contributed to decreased care hours per patient. 3 Decreased frequency of oral hygiene assistance for dependent LTC residents over the pandemic may be linked to an increase in biofilm-mediated oral diseases and rapid oral health deterioration. 15 Furthermore, decreased access to dental care for LTC residents during the pandemic was noted as many facilities enacted strict rules preventing residents from leaving facilities. The presence of LTC dental clinics would eliminate the need for residents to leave the facility for dental care and greatly improve access to dental services. In Canada, geriatric dentistry is recognised as an important component of dental and dental hygiene Programs and many educational Programs have dedicated clinical and didactic time allocated in their curricula. 16 Exposure of dental students to older adults, specifically those in LTC, is a valuable clinical training opportunity allowing for the acquisition of knowledge and skills needed to treat frail and functionally dependent geriatric patients. 17, 18, 19 Future studies should investigate whether changes in oral health status of LTC residents occurred due to pandemic-related restrictions and its after-effects and how geriatric dental services should prepare for potential future pandemics to avoid reductions in service as experienced in 2020. In response to the COVID-19 pandemic, the UBC GDP took a fourphased approach to reopening clinical service and clinical education rotations in alignment with guidelines from the Provincial Health Officer, provincial dental regulatory authority, UBC, multiple health authorities, and individual LTC facilities (Table 4) . 20 controls, and personal protective equipment. 20, 22 In early June 2020, the UBC GDP, adopting these published guidelines, was requested to return to the provision of in-house dental services by one LTC facility that had a long-standing clinical educational affiliation. The ability to examine, prevent, and treat oral diseases for LTC residents without the need for patients to leave the facility was beneficial with regards to risk mitigation related to COVID-19. The initial reopening of clinical services in LTC was limited to one facility where one hospital dentistry resident in the GPR Program, Phase IV of the provincial public health plan is conditional on global availability/administration of a vaccine and/or treatment, a process that began in late 2020 in BC. 4 Of those first to receive the vaccine in BC were health care workers and residents/staff of LTC facilities, similar to other jurisdictions around the world. The UBC Geriatric Dentistry Program, which serves frail and functionally dependent older adults in LTC, experienced reductions in clinical service and productivity in 2020 relative to 2019 due to the effects of the COVID-19 pandemic. However, clinical education rotations for dental students attending in-house LTC facility dental clinics were increased in 2020 compared to 2019, due to the judicious employment of administrative controls, engineering controls, and personal protective equipment. 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Assisted Living & Independent Living Facilities Impact of the COVID-19 pandemic on the University of British Columbia Geriatric Dentistry Program: Clinical education and service The authors declare that there are no conflicts of interest. NT designed the study, performed data analysis, and wrote the manuscript. CW designed and critically revised the manuscript. ST collected data for this study. All authors approved the final version of the manuscript. https://orcid.org/0000-0002-7628-1203