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Oral Health

Dr.SHARON.J.THOMAS
(Periodontist)

It was a few days ago that I observed how my parents were teaching my two year old son the story of the hare and the tortoise ,the conveniently forgotten truism that slow and steady wins the race.

The novel corona virus officially announced as the cause of COVID-19 on January 8, 2020, has curbed the monotonous, fast moving globe to an unpredictable halt. The origin of coronavirus disease 2019 (COVID-19) started from Wuhan, China, last December and have become a major challenging public health problem for not only China but also countries around the world.

The fluid nature of the pandemic, the uncertainty, inconsistent reporting, and overall anxiety will likely result in permanent changes once the pandemic is over. However a persistent, consistent and diligent fight with the virus can phase out the commotion, misery and the obscurity of life ahead.

The most common symptoms of COVID-19 are fever, dry cough, and tiredness. Other atypical symptoms include aches and pains, nasal congestion, headache, conjunctivitis, sore throat, diarrhea, loss of taste or smell or a rash on skin or discoloration of fingers or toes. Most people (about 80%) recover from the disease without needing hospital treatment. Older people, and those with underlying medical problems like high blood pressure, heart and lung problems, diabetes, or cancer, are at higher risk of developing serious illness.

However, anyone can catch COVID-19 and become seriously ill. People of all ages who experience fever and/or cough associated with difficulty breathing/shortness of breath, chest pain/pressure, or loss of speech or movement should seek medical attention immediately. If possible, it is recommended to call the health care provider or facility first, so the patient can be directed to the right clinic.

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PYORRHEA – CORONA CONNECTION

The oral cavity has often been referred to as the window of our health by health care professionals, as it can act as the source, the access point and diagnostic detectors of various general diseases. Studying the mouth can give dentists an insight into the overall health of the patient.

Currently with advances in scientific investigation methods and statistical analyses; and with improved understanding of periodontal diseases and associated systemic diseases, the field of the oral-systemic health connections has been a rapidly advancing area of research that has been gaining great interest not only by scientists and clinicians but also by the media and the public.

Gingivitis means inflammation of the gums, or gingiva caused by film of plaque, or bacteria, accumulates on the teeth. Gingivitis is a non-destructive type of periodontal disease, but untreated gingivitis can progress to periodontitis. Periodontitis or Pyorrhea is a chronic inflammatory disease of the oral cavity caused by specific microorganisms which can lead to periodontal pocket or gingival recession or both and can finally lead to tooth loss.

THE COVID IMPACT ON PERIODONTAL TISSUES

COVID-19 has strong impact on the gingival and periodontal tissues both pathologically and psychologically. The acute infection of COVID as well as its therapeutic measures has shown to affect the oral tissues. The effect of lockdown and the agony of the unpredictable future has aggravated stress and alterations in dietary, behavioural and oral hygiene practices. The table below enumerates the effect of COVID-19 on periodontal tissues.

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THE PERIODONTAL IMPACT ON COVID-19

Chronic systemic inflammation associated with periodontitis may presuppose a higher risk of increased severity of COVID-19 in periodontitis patients. Since inflammatory and microbial imbalance as well as comorbidities affect systemic health, it is possible that periodontal status indicates the risk of complication of COVID-19. There is enough evidence to propose that periodontal disease acts as a risk factor for COVID-19.

Periodontitis could be indicative of systemic health as it has been widely associated with several disorders such as diabetes, hypertension, obesity etc. Furthermore, these comorbidities and additional factors are common risk factors in patients with severe COVID-19 illness There are various shared risk factors among periodontal disease and COVID-19. Some of them include aging, male gender, diabetes, hypertension, cardiovascular disease, obesity, chronic obstructive pulmonary disease, asthma, smoking, stress, HIV, cancer, liver disease, rheumatoid arthritis etc.

ROLE OF PATIENT

Taking care of your oral health can make a huge difference in your well-being and quality of life, and that’s no less true during COVID-19.
1. Maintain proper oral hygiene – Regular brushing , flossing ,tongue cleaning, use of antiseptic mouthwash.
2. Time-sensitive dental care during  COVID-19: For dental situations like painful toothache, mouth or face swelling, broken tooth, broken filling, bleeding or swollen gums ,contacting a dentist quickly can help you find relief, prevent further long-term damage, and make care and recovery easier.
3. Proper and healthy diet.
4. Abstain from adverse oral habits like smoking, drinking and tobacco chewing
5. Stay safe from COVID -19 and follow government protocols strictly.

ROLE OF PERIODONTIST

In the present situation of lock down and quarantine where access to a dentist is not possible and safe, we should be champions of prevention and not just focus on treatment. This window of opportunity allows more time to primarily focus on oral hygiene instructions and could be rewarding in more ways than we think. There has never been a better opportunity to change the way we think and focus on patient education. Particularly with regards to disease progression, ways to control periodontal conditions at home, and the benefits it brings.

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Dental-care professionals must be fully aware of 2019-nCoV and other viral agent spreading modalities, how to identify patients with active infections and, most importantly, to prioritize self and patient protection. Several practical strategies to block virus transmission to provide a reference for preventing the transmission of 2019-nCov during dental diagnosis and treatment, including patient evaluation, hand hygiene, personal protective measures for the dental professionals, mouth rinse before dental procedures, rubber dam isolation, anti-retraction hand piece, disinfection of the clinic settings, and management of medical waste. Figure 1 shows a flowchart showing the management of dental problems during COVID-19 pandemic as given by Bhanushali et al, 2020.

 

For years, the dental profession has been aware of the direct connection between the mouth and the body. Many believe that the mouth is the mirror to one’s health. COVID-19 is a learning opportunity, not just for patients, but clinicians too. Highlighting the importance of prevention; by using the time for more than treatment alone, it will allow patients to engage and understand their periodontal condition and take ownership and responsibility for their disease management and prevention.