Demand for dental services has been known to be closely linked to dental insurance and disposable income. Widespread economic uncertainty and health systems changes due to the coronavirus disease 2019 (COVID-19) thus may have a significant impact on dental utilization.

Using de-identified dental practice management data in 2019 and 2020, we observed variations in dental utilization among insured patients since the COVID-19 outbreak (during the period of practice closure and after reopening) by patient age, procedure types, insurance type, practice size, geographic area, and reopening status. We examined whether the rebound in procedure volumes at dental practices can be explained by county-level characteristics using hierarchical regression models.

While dental utilization among privately insured individuals fully rebounded by August 2020, utilization still remained lower than the pre-pandemic level by 7.54% among the publicly insured population. Demand for teledentistry increased up to 60 times during practice closure. Geographic characteristics--such as median household income, percentages of rural or African American populations, and dental professional shortage designations --were significantly associated with the number of procedures performed at dental practices.

As a result of COVID-19, dental practices experienced substantial decreases in procedure volume, particular among patients covered by public insurance or residing in underserved areas. Practical Implications: During these economic downturns, state health officials would be encouraged to adopt policies to expand access to oral health care for vulnerable populations via oral health promotion strategies and increasing the supply of dentists or mid-level dental providers in underserved areas.