Routine hygiene is important during a pandemic

Should I be seeing my dental hygienist for routine care during the COVID Pandemic?   

6 out of 10 Canadians have not received dental hygiene care since March 2020.  About 26% of these have stopped visiting the office due to financial strain or loss of dental insurance.  Another 32% have concerns about safely of appointments and 37% are putting off all non-essential appointments.   Of the Canadians who have seen their dental hygienist 90% have reported feeling safe and 92% have reported receiving the same or better care.(1)

Is it Safe?

The Canadian Dental Association and the Canadian Dental Hygienist’s Association have worked together to provide clear guidelines on how to operate safely during the pandemic.   If you visit your dental office you will notice small changes, from pre-screening patients to plexiglass barriers, to air purifiers and more frequent cleaning of the waiting areas.  The dental industry has been on top of infection control for decades so it has only needed slight modifications to account for an airborne virus.  All the disinfection, sterilization, glove and mask wearing was already routine.   

You will however, find visiting your dental hygienist is a little different.  For example for most people your hygienist will only hand scale and not polish the teeth.  The use of a Cavitron and polishing create aerosols (which are believed to contain the virus) so they are only done when deemed essential.  To date the Canadian Dental Hygienist’s Association has reported that there has been NO transmission of COVID-19 from operator to patient or vice versa.

Is it worth the risk?

Oral health is essential to overall health.   Poor oral health is associated with health conditions such as diabetes, aspiration pneumonia, chronic obstructive pulmonary disease, heart disease and immune-mediated inflammatory diseases.(2)  52% of Canadians 65 and older suffer from periodontal disease, which untreated can negatively impact health.(3)  The novel coronavirus COVID-19 poses a significant risk to people living with pre-existing conditions that impair the immune response including diabetes, hypertension/cardiovascular disease, and obesity.   These multifactorial diseases are also associated with altered oral biofilms and periodontal disease.  Similarly periodontal disease is an inflammatory disease, and increases the overall inflammatory load on the body.(4-8)  It is therefore thought that there is a link between poor oral health and COVID-19 complications.  In fact patients in ICU (from COVID-19) have been found to exhibit an exceptionally high bacterial load of many well-known periodontal disease  pathogens.(9-10)   Essentially a “healthy periodontium can help decrease the severity and complications related to COVID-19”(9)

Do I Have Periodontal Disease?

If you are unsure if you have periodontal disease here are some indications that you probably do.  You have lost 1 or more teeth due to  bone loss or mobility.   You have been told you have pockets or recession.   You have been told you should see the hygienist every 3-4.5 months.  Not sure, ask your Dental Hygienist!

1. www.cdha.ca/dentalhygienduringcovid 
2. Lavigne SE, Forrest JL. An umbrella review of the evidence of a causal relationship between periodontal microbes and respiratory diseases: Position paper from the Canadian Dental Hygienists Association. Can J Dent Hyg 2020;54(3):144-155. Available from https://files.cdha.ca/profession/journal/2735.pdf 
3. Government of Canada. Prevalence of Chronic Diseases and Risk Factors among Canadian Aged 65 Years and Older (Internet). c2020 (cited 2020 Dec 3). Available from: https://www.canada.ca/en/services/health/publications/diseases-conditions/prevalence-chronic-disease-risk-factors-canadians-aged-65-years-older.html 
4. Chiappetta S, Sharma AM, Bottino V, Stier C. COVID-19 and the role of chronic inflammation in patient with obesity.  International Journal of Obesity (2020) 44:1790-1792
5. Wng T, Du Z, Zhu F, Cao Z, An Y, Gao Y. Comorbidities and multi-organ injuries in the treatment of COVID-19. Lancet. 2020;395;e52
6. Yang X, Yu Y, Xu J, Shu H, Xia, J, Liu H. et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8:475-81
7. Guan WJ, Ni ZY, Hu Y, Liang WH, OU CQ, He JX. et al.  Clinical characteristics of Coronavirus disease 2019 in China. N Engl J Med. 2019;382;1708-20
8. Zhang JJ, Dong X, Cao YY, Yaun YD, Yang YB, Yan YQ et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020; 
9. Molayem S, Pontes CC.  The Mouth-COVID Connection. IL-6 Levels in Periodontal Disease-Potential Role in COVID-19 Related Respiratory Complication.  J Calif Dent Assoc. 2020;48(10):485-499 Available from: https://issuu.com/cdapublications/docs/cdapubs_journal_2020_october
10. (10)https://www.news-medical.net/news/20200630/oral-hygiene-and-severity-of-COVID-19-e28093-the-connection.aspx