In March and April 2020, the use of dental services fell by 75% and 79% respectively, compared to the same months the year before, according to a Fair Health study, and most practices didn’t recover significantly until the following year. As a result, 46% of dentists reported revenue drops that had major impacts on their practices due to the pandemic.

But many dentists have been seeing a surge of patients come back this fall and winter, especially as the deadline to use flexible spending account (FSA) money for 2021 is almost here. So if you’re looking to schedule an appointment, you should do so sooner rather than later.

At One Manhattan Dental in New York City, the practice saw the lowest dip of appointments in January 2021. Once patients started getting vaccinated in the late winter and spring of 2021, there was a very dramatic increase in patients coming back, and this has continued for the entire year.

“This has been in all areas of our practice. Hygiene appointments, whitening, cosmetic procedures, and elective treatments,” says Dr. Rob Raimondi, a cofounder of One Manhattan Dental. “Patients are more interested in doing definitive care and being extremely proactive to treat degenerative issues.” Raimondi adds that there has also been a large number of new patients to the practice, another trend that has been consistent the entire year. Many of the new patients are coming as spouses, entire families, friend groups, and groups of coworkers.

Dr. Raimondi says this trend seems to be continuing into the new year of 2022, also. Over the last three to four months of 2021, patients are scheduling larger treatments to get started in January and February.

Going to the dentist has never been a popular activity—and there are a significant number of adults who are downright scared of it—so it’s not hard to imagine that people would put off this mundane but necessary errand. Not to mention keeping your mouth open and unmasked for long periods of time in someone else’s face during pre-vaccinated times also sounds harrowing. A survey by the North American Dental Group found that 71% of patients have been hesitant to visit their dentist during the pandemic for a non-time-sensitive dental procedure, and 54% said they would only do so in the case of an emergency.

While many dental practices did see an uptick in seeing patients via telehealth portals in 2020 and 2021, virtual visits cannot fully replace the kind of nitty-gritty information provided by X-rays or a dentist seeing a patient’s teeth up close. The American Dental Association suggests recovery began around February 2021, when patient volume reached 81% of pre-COVID levels, on average.

Among patients who have not been in for a checkup in the past year (or two), Raimondi says that he has seen two very different extremes. First, there are patients who have dramatically increased their home care and healthy habits, paying more attention to their overall health. “We have seen conditions like periodontal/gum issues improve in these people,” Raimondi notes. The second group has had an increase in dental caries (cavities), periodontal (gum) disease, and tooth grinding. And these patients have had to go through extensive dental treatment to correct these issues.

And worse yet, among patients who have tested positive for COVID-19, Raimondi notes that the practice has increasingly been seeing worse hygiene among the patients who suffer from long COVID and brain fog. A Nature Medicine study published in March 2021 examined how COVID infects cells in the mouth, which could explain why some patients experience symptoms like loss of taste, dry mouth, and blistering. The study also found that saliva is infectious, indicating the mouth might transmit the virus deeper into the body, as well as to others.

Beyond basic dental hygiene, there was also a lot of chatter during the pandemic lockdown months of 2020 about more people grinding their teeth. Raimondi agrees that there have been more patients with this problem.

“This must be caused from the increased stress people are under because of the pandemic and the associated issues,” he notes, explaining this has resulted in more cracked teeth and more chipped teeth. “The cracked teeth sometimes need to be extracted and replaced with a dental implant. Teeth that can be saved have needed crowns, onlay, or fillings to repair them.”

The grinding itself can be treated by wearing a night guard to protect one’s teeth, the temporomandibular joint (TMJ; there is one on each side of the jaw), and further extending muscles of the jaw. For this, dentists strongly recommend a professional custom-made hard night guard. There is no over-the-counter solution that is effective.

Entering the new year, some people often make the resolution to give up sweets (at least temporarily), which is always good for dental health. But there are other easy measures people can implement, and hopefully retain year-round, to improve their dental health. Dr. Raimondi outlines them clearly: Drink more water, stay hydrated, floss prior to brushing daily, and brush your teeth two to three times daily. And this last one is overlooked but crucial: tongue brushing. Bacteria can accumulate on the tongue easily, and brushing will combat both the bacteria as well as bad breath.