In the 21st Century there are tons of things to talk about. Especially about the current pandemic and where this will lead us into, understandably so. But let’s don’t forget about our mouth.
On one hand, without our mouth, we would not be able give voice to our feeling, enjoy the delicious multicultural cuisines, kiss our loved ones and many other essential tasks in life, for which the mouth is absolutely necessary.
And on the other, there is substantial evidence to show that having poor oral hygiene, especially active gum diseases (formally known as periodontal diseases) can lead to development of severe complication during COVID19 illness.
You would be surprised to realise how important is oral health during this pandemic!
Why we tend to forget about looking after our mouth?
When my patients’ sit on my dental chair and discuss oral hygiene regime, the answer is always the same, time, busy schedule, taking the kids to school or to bed etc.
I am a human too, and I understand that in today’s modern society, life has become ever so busy, for both men and women. Every task takes its time, and time is what we don’t have.
However, at the end we always agreed that if we incorporate oral hygiene as part of our daily routine, it become easier to have a healthy mouth.
Now, you might think that tooth brushing is enough. Well allow me to tell you that is not enough. Brushing alone would not give you a healthy mouth, there are many other factors that contribute to good oral health, but before we get to those, let’s explore the drawbacks of poor oral hygiene.
What are the side effects of having poor oral hygiene?
- Tooth decay → bad breath → tooth ache → severe pain → tooth extraction
- Gum diseases → bad breath → swollen gums → painful gum → tooth loss
- Bad bread → people will avoid you → loneliness → mental health issues
- Unstable systemic diseases (such as cardiovascular diseases and diabetes) → Feeling unwell → tired → poor quality of life
- Risk of developing a secondary infection in the lungs during COVID19 infections, such as pneumonia
There are several studies demonstrating that an increase of oral bacteria in the mouth could increase the risk of developing secondary respiratory infections, during COVID19 sickness.
What happened when a person is taken to intensive care units (ICUs) due to COVID19 infection?
Various studies have shown that people receiving ventilation support in ICUs develop pneumonia, this been largely related to the bacterial load accumulated in their mouth which travel along the tubing system, which then settles in the lungs and causes severe illness such as pneumonia. This specific illness is known as Ventilator- Associated Pneumonia (VAP). Pneumonia is well known to be a life-threatening disease/ fatal, cause by bacteria and some cases by a virus too.
Who is at risk of developing VAP?
- People who received mechanical ventilation for over 10 days
- People with increased number of bacteria responsible for gum diseases (active and/or severe periodontal diseases)
For example, a positive COVID19 person could potentially develop a secondary infection in their lungs, such as pneumonia. Now, can you imagine a human body trying to deal with two deadly infections ate the same time! Absolutely devastating…
Dental hygiene appointments
When it comes to active gum diseases, dental hygienist or therapist are the experts!
The treatment for active gum diseases are:
- Education on gum diseases, the cause, how can this be managed and prevented
- Professional mouth debridement, means the removal of plaque and calculous deposits in your mouth
- Oral hygiene coaching, this involve finding a suitable oral hygiene routine tailored to your needs
- Set a recall dental hygiene appointment, this will help you to maintain good oral hygiene and have the professional support you need
Dental hygiene treatments are recommended to everyone to maintain good oral health, not just for people with active gum diseases, some children may need this treatment too. Some people will need more appointments per year than others, the reasons are multifactorial, depending on each individual needs.
Manual or electric?
I always recommend an electric toothbrush!
Electric toothbrush has proven to be better at removing more plaque the manual toothbrush, clinically and scientifically. However, some of my patients have an impeccable oral hygiene by using manual toothbrush too.
Manual tooth brushing is technique sensitive, so if your technique is perfect then there is no need to change to an electric toothbrush. The person who can assess this would be your dental hygienist, therapist or dentist.
In my clinical experience, the electric toothbrush has greatly improved the oral hygiene of many of my patients, some have moved from poor oral hygiene to good oral hygiene, and some from good to excellent. I guess there is always a room for improvement!
Interdental cleaning means to clean in between your teeth. This can be achieved my using floss or floss-picks (a floss with a handle) this its normally recommended for teeth which are very close together. As for interdental brushes, this is more suitable for people with larges gaps in between their teeth. Interdental brushes are colour-coded, each colour have a size, so the colours you would need depends of the size of the gaps in between your teeth.
You might think why do I need to clean in between my teeth!
Well plaque sit all around each tooth. Tooth brushing clean the front, the back and the top of the teeth, but cannot remove the plaque sitting in between the teeth, hence interdental cleaning is also essential to have healthy gum and teeth.
So, what does Tooth Loving Care and Healthy Gums means to you?
This means that by making toothbrushing and interdental cleaning a daily routine, you will have healthy gums and teeth for life, it will also prevent the development of gum diseases, and more importantly it will prevent you from developing secondary infections of COVID19 illness, if you become infected. And last but no least, your dental hygiene appointments are crucial to receive the professional support you need to have good oral health.
My ultimate satisfaction is for you to have a health mouth. Find me on my Instagram page if you need more help @smileofpearls.
Cibas Almondes, Camila Maria, et al. Relation between Periodontal Status and Ventilator-Associated Pneumonia. Journal of International Academy of Periodontology, 2017, file:///C:/Users/nnera/Downloads/JIAP%20October%202017%20-%20Relationship%20between%20Periodontal%20Status%20and%20Ventilator-Associated%20Pneumonia%20(1).pdf. Accessed 11 November 2020.
Yang, Li-Chiu, et al. “The Association of Periodontal Treatment and Decreased Pneumonia: A Nationwide Population-Based Cohort Study.” International Journal of Environmental Research and Public Health, vol. 17, no. 1, 5 Jan. 2020, pubmed.ncbi.nlm.nih.gov/31948027/, 10.3390/ijerph17010356. Accessed 11 November 2020.
Cox, Michael J, et al. “Co-Infections: Potentially Lethal and Unexplored in COVID-19.” The Lancet Microbe, 24 Apr. 2020, www.sciencedirect.com/science/article/pii/S2666524720300094?via%3Dihub, 10.1016/S2666-5247(20)30009-4. Accessed 11 November. 2020.
Sampson, V. “Oral Hygiene Risk Factor.” British Dental Journal, vol. 228, no. 8, 1 Apr. 2020, pp. 569–569, www.nature.com/articles/s41415-020-1545-3, 10.1038/s41415-020-1545-3. Accessed 15 November 2020.
Molayem, S. and Cruvinel Pontes., The mouth-Covid Connection : Il-6 Levels in Periodontal Disease — Potential
Role in COVID-19-Related Respiratory Complications. [online]Mouthcovid.com. Available at: http://www.mouthcovid.com Accessed 15 November 2020
Pitones-Rubio, V., Chávez-Cortez, E., Hurtado-Camarena, A., González-Rascón, A. and Serafín-
Higuera, N., 2020. Is Periodontal Disease A Risk Factor For Severe COVID-19 Illness?. Elsiever Public Health Emergency collection 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303044/. (Pitones-Rubio et al., 2020) Accessed15 November 2020
NHS. “Coronavirus (COVID-19).” Nhs.Uk, 30 June. 2020, https://www.nhs.uk/conditions/pneumonia/. Accessed 15 November 2020
Wu, Y., et al. “Effect of Aging on Periodontal Inflammation, Microbial Colonization, and Disease Susceptibility.” Journal of Dental Research, vol. 95, no. 4, 1 Apr. 2016, pp. 460–466, www.ncbi.nlm.nih.gov/pmc/articles/PMC4802783/, 10.1177/0022034515625962. Accessed 11 November 2020.
Goh, Ken Junyang, et al. “Preparing Your Intensive Care Unit for the COVID-19 Pandemic: Practical Considerations and Strategies.” Critical Care, vol. 24, no. 1, 11 May 2020, 10.1186/s13054-020-02916-4. Accessed 11 Novemeber 2020.
“A Third of Covid-19 ICU Patients ‘Do Not Recover.’” BBC News, 14 May 2020, www.bbc.co.uk/news/uk-scotland-52653192. Accessed 11 Novemeber 2020.
Scannapieco, Frank A. “Role of Oral Bacteria in Respiratory Infection.” Journal of Periodontology, vol. 70, no. 7, July 1999, pp. 793–802, 10.1902/jop.19126.96.36.1993. Accessed 10 Nov. 2020.
AlJehani, Yousef A. “Risk Factors of Periodontal Disease: Review of the Literature.” International Journal of Dentistry, vol. 2014, 2014, pp. 1–9, 10.1155/2014/182513. Accessed 12 November 2020.
British Society of Periodontology 2 www.bsperio.org.ukCopyright. The Good Practitioner’s Guide to Periodontology. 2016.
CDC. “Coronavirus Disease 2019 (COVID-19) – Symptoms.” Centers for Disease Control and Prevention, 14 Mar. 2020, www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html. Accessed 15 November 2020.
Munday, Polly. “Delivering Better Oral Health: An Evidence-Based Toolkit for Prevention.” Vital, vol. 5, no. 1, Mar. 2008, pp. 13–13, assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/605266/Delivering_better_oral_health.pdf, 10.1038/vital731. Accessed 15 November 2020.
“Powered/Electric Toothbrushes Compared to Manual Toothbrushes for Maintaining Oral Health.” Www.Cochrane.Org, 17 June 2014, www.cochrane.org/CD002281/ORAL_poweredelectric-toothbrushes-compared-to-manual-toothbrushes-for-maintaining-oral-health. Accessed 15 November 2020.
Phua, Jason, et al. “Intensive Care Management of Coronavirus Disease 2019 (COVID-19): Challenges and Recommendations.” The Lancet Respiratory Medicine, vol. 8, no. 8-506–17, Apr. 2020, 10.1016/s2213-2600(20)30161-2. Accessed 15 November 2020.
Straub, Rainer H., and Carsten Schradin. “Chronic Inflammatory Systemic Diseases.” Evolution, Medicine, and Public Health, vol. 2016, no. 1, 27 Jan. 2016, pp. 37–51, www.ncbi.nlm.nih.gov/pmc/articles/PMC4753361/, 10.1093/emph/eow001. Accessed 11 November2020.