MedPPE Blog May 3

Now is Not the Time to Neglect Oral Health

A recent scientific study published in the Journal of Clinical Periodontology found that patients with periodontitis, the most severe form of gum disease, were at least three times more likely to experience virus complications, including the need for assisted ventilation, ICU admission, and death.

 

The study published in Clinical Periodontology dealt with patients who have a severe form of gum disease which may not be prevalent, but up to 47% of North American adults experience some form of periodontal disease and, as the population ages, prevalence is predicted to increase. So it is vitally important that Canadians continue to see their dentists and hygienists at least every six months, especially during the pandemic. Dental appointments should not cause anxiety or concern during this period as dental professionals have established protective equipment protocols that are intended to keep everyone safe from germs, bacteria, disease and virus transmission.

Dentists across North America are now seeing the results of missed pandemic appointments in a surge of patients with cracked or damaged teeth, a phenomenon some believe may be related to an increase in jaw clenching and grinding due to stress. In fact, some dentists say they have seen a noticeable uptake in unique forms of dental issues during the pandemic. 

Dentists have not figured largely in the panoply of health care providers during the pandemic, but truth be told, dentists have been working hard and taking care of patients throughout the pandemic. A few offices may have closed early on, for a short period, but many re-opened after only a few short months of lock down. Dentists have found it just as difficult to maintain their practices and safeguard their staff, but that has not kept them from performing essential and potentially life-endangering work requiring personal protective equipment (PPE). Because when a patient needs oral care, a dentist is always there to help.

 

Common pandemic oral problems

Edmonton dentist, Hernandez-Kucey recently told Global News that “We are seeing more joint problems, people arriving (in the clinic) saying: ‘I’m not sleeping well, I’m waking up, my face hurts.’ Furthermore,” Dr. Hernandez-Kucey continued, “tension and anxiety, whether a patient is aware of it or not, can cause teeth grinding and clenching. That might cause a fracture or complication to the nerve health of the tooth.” 

Canadian dentists are also seeing a lot of patients suffering from something referred to as “mask mouth.” “Some people when they wear masks, they tend to breathe through their mouth. So this can cause dryness in the mouth, and dryness can enhance gum diseases or encourage inflammation.” Dr. Liran Levin, Professor and Head, Division of Periodontology, Department of Dentistry at the University of Alberta, told Global News.  

“Make sure you’re brushing or cleaning your teeth even more than on a regular basis because this dryness can help the bacteria create inflammation,” said Levin. He recommends that Canadians “Drink more water and try to breathe through your nose while you’re wearing a mask.” 

Dentist Hernandez-Kucey also pointed out that mask-wearing has benefits besides just the obvious one of protecting you from disease. Dr. Hernandez-Kucey said “If you smell your own bad breath—or halitosis—that can be a sign of potential infection, something you might not have noticed otherwise until it’s more advanced.

A Winnipeg dentist, Dr. Ken Hamin of Reflections Dental Health Centre, told Station 680 CJOB, that his office is seeing an unprecedented number of patients complaining of the same problem: “It’s the first time in probably 30 years that I’ve seen a trend—and the only thing I can account it towards is the stress of the virus,” said Hamin. “We’ve seen a huge increase, probably three to four patients a week, coming in and saying, ‘I’ve started clenching or grinding’, or ‘I’ve got headaches.’ ” Dr. Hamin recommends a night guard that may help patients reduce their teeth grinding during asleep.

 

Your dentist and dental hygienist want you to stay healthy, here’s how:

Everyone hates to get that “furry” feeling on their teeth when it’s been a while since your last cleaning. Here are ways recommended by dentists, oral specialists, dental hygienists and Dental Hygiene Canada to keep your mouth, teeth and tongue healthy.

Watch your diet. What you eat can have a huge impact on your oral health. For example, carbohydrates, when combined with the bacteria that live in your mouth, produce acid that attacks your teeth, increasing your risk for cavities. So limit your food and drinks intake to no more than 3 meals and 2 snacks daily and make water your beverage of choice. Include a protein or fat each time you eat and choose healthy snacks like apples, raw vegetables or plain yogurt.

Use an electric toothbrush. Electric toothbrushes accomplish superior plaque removal. According to a study entitled: “Manual Versus Powered Toothbrushing for Oral Health”* “brushes that worked with a rotation oscillation action removed more plaque and reduced gingivitis more effectively than manual brushes.” 

The Canadian Dental Association (CDA) recommends just about any Oral-B model because it removes plaque and prevents gingivitis. When buying an electric toothbrush make sure it’s easy to hold and easy to use. 

Brush your teeth regularly. According to the Canadian Dental Association, regular brushing is very important in preventing tooth decay and gum disease. Brushing removes the bacteria that promote tooth decay and the plaque that can cause gum disease. If you can, brush after every meal, because bacteria can attack your teeth just minutes after eating. At the very least, brush in the morning and before going to sleep. 

Brush at a 45º degree angle to your teeth, directing the bristles to where your gums and teeth meet, using a gentle, circular, massaging motion, up and down. Don’t scrub. Gums recede as a result of brushing too hard. Clean every surface of every tooth. Take your time and spend at least two to three minutes. Brushing your chewing surface, the cheek side, and the tongue side. Use a soft brush with rounded bristles and the CDA recommends you replace your toothbrush every three months.

Floss regularly. According to the Canadian Dental Association, flossing removes plaque and bacteria that cannot be reached with a toothbrush. If you don’t floss, you’re missing more than one-third of your tooth surface. 

Plaque is the main cause of gum disease. It is an invisible bacterial film that develops on your teeth every day and within 24 to 36 hours, plaque hardens into tartar that can only be removed by professional cleaning. Floss at least once a day, and plaque never gets the chance to harden into tartar. 

See your dentist regularly. Regular dental exams and professional cleanings are the best way to prevent and detect problems before they get worse.

Also, it’s time to call your dentist’s office immediately if you experience any of the following issues:

  • A damaged tooth: Whether cracked or chipped, you need to see a doctor right away. With a severe or jagged break you may risk cuts to your tongue or inside cheek which can be painful or become infected.
  • Pain: Dental pain is a sign that something is wrong—it could be caused by an infection or cavity but it requires immediate attention. 
  • Swelling:  Swelling in your mouth, gums or jaw could signify infection or an abscess. Bacterial infections are serious and often require antibiotics before treatment. 

 

Sources:

Global News Network of Canada

https://globalnews.ca

Canadian Dental Association

https://www.cda-adc.ca/

Dental Hygiene Canada https://www.dentalhygienecanada.ca/dhcanada/DHCanada/Preventive_Oral_Care/Oral_Health_During_COVID19.aspx

Association between periodontitis and severity of COVID19 infection: A case–control study by: Nadya Marouf, Wenji Cai, Khalid N. Said, Hanin Daas, Hanan Diab, Venkateswara Rao Chinta, Ali Ait Hssain, Belinda Nicolau, Mariano Sanz, and Feleh Tamimi CLINICAL PERIODONTOLOGY: 01 February 2021

https://doi.org/10.1111/jcpe.13435

The Canadian Academy of Dental Hygiene

“An Introduction to PPE for Students in Dental Assistant Training”

 https://www.canadianacademyofdentalhygiene.ca/admission/intra-oral-dental-assisting

*“Manual versus powered toothbrushing for oral health,” independent study, by M. Heanue, S.A. Deacon, C. Deery, P.G. Robinson, A.D. Walmsley, H.V. Worthington and W.C. Shaw, National Library of Medicine

https://pubmed.ncbi.nlm.nih.gov/12535436/#:~:text=Brushes%20that%20worked%20with%20a,%2D0.72%2C%20%2D0.15).