"Impact of Corona on Oral Health"
Impact of Corona on Oral
Health
Introduction
What might be the effect of the COVID-19 on oral health? According to recent report the Mouth COVID
connection there may be a link between Gum Disease and SARS-COV-2. Severe Acute
Respiratory Syndrome Corona Virus 2 (SARS-COV-2) is the virus responsible for
Coronavirus disease 2019. The World Health Organization declared a global
pandemic on 11 March 2020. Cornavirus, beginning from Wuhan city, China have
developed into a foremost challenging Public Health Crisis around the world. By
the time of this writing over 180 million person have been infected and
approximately 4 million persons have lost their lives worldwide. India braces
for the COVID-19 pandemic, Dental Surgeon are particularly vulnerable to
COVID-19 disease. It is a new strain discovered in 2019 which was not found
previously in humans.
The coronavirus is primarily transmitted by direct or indirect personal contact through airborne respiratory droplets from an infected person. COVID-19 can manifest with a range of symptoms, from mild flu like symptoms of fever, dry cough, fatigue, muscle pain and Diarrhoea to severe pneumonia progressing to Adult Respiratory Distress Syndrome. In 2000, the first and only Surgeon General's Report on oral health made clear that oral health is part of overall health and well being.
Coronavirus
and field of Dentistry
Among all health
care professionals, Dental Surgeons are at the highest risk of contracting and
transmitting the coronavirus. Dental services due to their unique nature like
generation of aerosol, sharp handling and Dental Surgeon's nearness to the
oropharyngeal region of the patient can be attributed to these risks. The
Dental Clinics can most likely expose patients to cross contamination, if ample
safety measures are not engaged.
Only history will be able to fully measure the impact of COVID-19 pandemic. But
many Dental Professionals are already seeing a direct or indirect impact of
increased stressors with patients seeking routine care. Among the obvious
evidence:
- Increased accumulations of hard and soft deposits on
patients' teeth due to longer than ideal timeframes between preventive
care
- Increased evidence of wear facets
- Abfraction lesions and fractured teeth due to stress
related bruxism
- Increased xerostomia due to mask-wearing throughout the
day, which tends to decrease hydration and increases mouth-breathing
- Increased evidence of demineralized surfaces due to
increased snacking and consumption of alcohol and sugary product as a
result of a work environment at home
Indirect evidence clinicians are seeing of the impact of COVID-19
on oral health includes increased inflammatory response due to heightened life
stressers and decreased oral hygiene related to isolation-induced
depression. Tooth sensitivity appears to be at an all-time high as well, likely
as an indirect response to increase in acidic dietary choices, bruxism and
alcohol consumption.
COVID-19 causes Stress and Stress is bad for Oral Health
Coronavirus effect on oral health include Ageusia and
case reports of vesiculobullous lesions and Necrotising Periodontal Disease.
Coronavirus causes stress which is bad for oral health. Many people grind their
teeth in their sleep when they are stressed. This cause cracked and chipped
teeth as well as wearing down our enamel. Teeth can crack under the pressure of many things. Patients
that are holding tension in their jaw or neglecting their oral hygiene can
suffer from a cracked tooth. Without
treatment the issue can get worse and worse. That's why Dental Surgeon
recommends use of mouth guard while sleep.
Dry
Mouth
In a dry mouth, the body is unable to produce saliva which protects the mouth from bad bacteria, other pathogens and aids the process of digestion. The patient may feel dryness or stickiness in the mouth and the saliva may become thicker. As per studies, Xerostomia happens when the virus attacks the oral linings and muscle fibres,During pandemic peoples are wearing masks very much this leads to Dry Mouth. Dry Mouth can lead to an increase in both caries and infections as a consequence. Evidence indicates that Mouth Breathing will desiccate oral tissues which causes bad breath and an increase in the unhealthy bacteria in mouth. Studies have shown that these receptors are also present in salivary gland cells which are believed as one of the first SARS-CoV-2 target cells. Since xerostomia could occur before the common symptoms are noticed, it is possible to use this condition for early diagnosis, treatment, and isolation of the individual thereby preventing further transmission.
COVID Tongue
According
to the American Academy of Oral Medicine (AAOM), COVID tongue is an
inflammatory disorder that usually appears on the top and sides of the tongue.
Affected tongues typically have a bald, red area of varying sizes that is
surrounded by an irregular white border. According
to a research letter published in the British journal of Dermatology, a
significant number of COVID-19 patients are experiencing bumps on their tongue,
along with inflammation and swelling. In this condition, the tongue may start
to appear white and patchy. The body fails to produce saliva that protects the
mouth from bad bacteria. People with this symptom may find it difficult to chew
and speak. COVID tongue can also change the tongue's sensation as well as
cause muscle pain caused by chewing due to persistent ulcers. However, in many cases, this disorder is due to alterations in the
quality of saliva, while the quantity of saliva does not vary much.
Many research regarding the link between Gum Disease and
COVID-19 indicated that those with gum disease are more likely to experience
severe COVID-19. The study of more than 500 patients with COVID-19 found that
those with gum disease were 3.5 times more likely to be admitted to
intensive care, 4.5 times more likely to need a ventilator and about 9 times
more likely to die compared to those without gum disease. Blood markers
indicate inflammation in the body were significantly higher in COVID-19
patients who had gum disease compared to those who did not, suggesting this
inflammation may explain the raised complication rates. Periodontitis causes
the Gum Disease, if left untreated, inflammation can spread throughout the
body. COVID-19 is associated with an inflammatory response that may be fatal.
Oral Ulceration
Evidence indicated
that COVID-19 causes damage to the blood vessels within our body, which include
the blood vessels that supply the mouth. This results in an increase in oral
ulcerations and gingival breakdown. Patients with high levels of CRP have been
shown to have a worse prognosis with COVID-19.
Patients may or may not be aware of all of the direct and
indirect impacts of COVID-19 on their oral health. Dental Surgeons should
identify all of the direct and indirect impacts the pandemic may have already
had. Intervention can help relieve hypersensitivity, increased oral
rehydration, remineralize tooth structure and decrease inflammatory response.
Prior to each visit, review each patients' records to find
previously identified increased risks for periodontal diseases and dental
caries. Prioritize through screenings and risk assessments for these patients
as well as for all patients with underlying health concerns such as cancer,
heart disease, diabetes, obesity and autoimmune diseases as well as for any
patient who is immunosuppressed.
Depending on how long the interval has been between dental
hygiene visits, and on contributing risk factors that influence oral health,
some patients who had been at low risk of disease prior to the pandemic may
receive an unexpected diagnosis of gingivitis, periodontitis, or dental caries.
Adequate time for education and information on risk reduction is imperative for
these patients. Many will need to return for treatments
they have not experienced in the past.
Dental professionals should be utilizing teledentistry and
social media to communicate prevention and intervention messages to alert
patients that increased attention to their oral health is critical during a
pandemic.
However, periodontal disease may be an influencing factor
contributing to a more severe COVID-19 outcome, once infected, primarily due to
the increase in pro-inflammatory cytokines based upon recent published data
from the British Dental Journal. This is of particular importance with some
patients experiencing longer intervals between dental care during the pandemic.
What Can Our Patients Do?
Knowledge is power regarding choices we make for our health.
Once your patients are equipped with knowledge that risks may be higher than
they have previously experienced for oral disease, they can proactively take
steps to reduce risks and prevent adverse outcomes in their oral health.
First, advise your patients to drink more water than they
think they need. The more a person is masked, the easier it is to reduce
hydration. No one should wait until
they are thirsty to hydrate.
Next, patients should be told to increase their antioxidant
consumption daily with multiple servings of green leafy vegetables and bright
colored fruits and vegetables to provide necessary nutrients and minerals to
oral tissues.
Third, tell each patient to intentionally avoiding or limiting products with high sugar content and high
acidic content. They should revamp how they snack, for example, choosing carrot
sticks with almond butter instead of chips or candies.
Also, patients should be advised to select a convenient time
to devote at least two minutes to thorough brushing and another minute for
cleaning their teeth daily. They should use of power
brushes such as the Philips Sonicare for optimal results and power devices
such as the AirFloss for ease and effectiveness of cleaning between teeth.
Patients additionally should experiment with
over-the-counter products to alleviate dry mouth. Products that contain Xylitol
such as Spry mints, gum and spray, or Xylimelts can be very beneficial in
stimulating saliva and hydrating tissues. So can antioxidant products such as
Periosciences AO Provantage gel, toothpaste, and mouth rinse, as well as
products that contain arginine and calcium carbonate such as Basic Bites. Oral
probiotics such as Probiora Pro can help repopulate the oral cavity with
beneficial bacteria during sleep when salivary flow is reduced.
Furthermore, xylitol nasal sprays such as XLEAR can help
maintain clear nasal passages and potentially could be preventive
against SARS-COV-2 virus that have been shown to reside at higher
viral counts in nasal passages.
Patients should be told to utilize fluoridated
toothpaste daily to offset acidic attacks to the enamel and help strengthen it,
but they should also avoid rinsing immediately after brushing. Patients should
simply allow a bit of the residue paste to coat
and remain on the tooth surfaces for maximum protection.
Conclusion
A study conducted in Germany showed maintaining good oral
health may prevent a severe course of the disease. Our patients may not be
aware of potential adverse effects to their oral health related to the COVID-19
pandemic. But with simple strategies, we can assist them in protecting their
beautiful smiles and preserving their oral health. Finally, patients
should not delay in seeking preventive dental care. Increased protective
layering of infection control strategies due to the pandemic make dental
offices a safe place to receive preventive and therapeutic treatments.
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Nice infarmation
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