Only history will be able to fully measure the impact of the 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 products 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 stressors and decreased oral hygiene related to isolation-induced depression.
Also, increased pro-inflammatory food consumption and increased xerostomia raise the risks for dental caries and periodontal disease alike. Tooth sensitivity appears to be at an all-time high as well, likely as an indirect response to increases in acidic dietary choices, bruxism, and alcohol consumption.
How Can You Assist Your Patients?
Patients may or may not be aware of all of the direct and indirect impacts of COVID-19 on their oral health. Therefore, clinicians need to become private detectives during routine examinations to identify all of the direct and indirect impacts the pandemic may have already had. Intervention can help relieve hypersensitivity, increase oral hydration, remineralize tooth structure, and decrease inflammatory response.
Prior to each visit, review each patient’s records to find previously identified increased risks for periodontal diseases and dental caries. Prioritize thorough 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 additional therapy or treatments they have not experienced in the past.
Dental professionals should be equipped to provide as indicated:
- Wise counsel to reduce pro-inflammatory dietary food and beverage choices such as sugary or acidic beverages and starchy carb snacks
- Coaching to adopt simple but thorough oral hygiene routines to offset increased risks from pandemic stressors
- Identification of decreased salivary flow and evidence of xerostomic tissues
- Identification of demineralized surfaces and/or hard and soft tissue evidence of bruxism
- Identification of inflammatory responses and diagnosis of gingivitis and/or periodontitis for early diagnosis and treatment
- Product recommendations specific to each patient’s needs to offset xerostomia, remineralize tooth structure, increase salivation, prevent sensitivity, and reduce plaque biofilm
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.
Also, 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 Your 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. Patients should be intentional about drinking water, through a straw, if necessary, to maintain adequate 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 become a label detective, intentionally avoiding or limiting products with high sugar content and/or 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 in between their teeth daily. They should maximize 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 variants of the SARS-CoV-2 virus that have been shown to reside at higher viral counts in nasal passages.
Of course, 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 spit out excess toothpaste, but allow a bit of the residue paste to coat and remain on the tooth surfaces for maximum protection.
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.
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.
Karen Davis, RDH, BSDH, practices clinically in Dallas, Texas and is founder and owner of a continuing education company named Cutting Edge Concepts. Her background as a clinician, consultant, and speaker enable her to identify with challenges facing dentistry and offer innovative solutions vital to success in today’s marketplace. Dentistry Today has recognized Karen as a “Leader in Continuing Education” since 2006. She is an independent consultant to Philips Oral Healthcare.