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| EDITORIAL |
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| Year : 2021 | Volume
: 11
| Issue : 1 | Page : 1-3 |
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COVID-19 and dental health fallout: Time to take the bull by the horn
Sharat Shetty
ProSmile Dental Clinic and Implant Centre, Dr L H Hiranandani Hospital, Mumbai, Maharashtra, India
| Date of Submission | 21-May-2021 |
| Date of Acceptance | 23-May-2021 |
| Date of Web Publication | 10-Jun-2021 |
Correspondence Address:
Dr. Sharat Shetty
ProSmile Dental Clinic and Implant Centre, Dr L H Hiranandani Hospital, Mumbai, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdi.jdi_9_21
How to cite this article:
Shetty S. COVID-19 and dental health fallout: Time to take the bull by the horn. J Dent Implant 2021;11:1-3 |
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Ever since the first reports of the COVID-19 breakout in China in December 2019, its rapid worldwide spread has resulted in humungous health problems, and there is neither an absolute cure in sight nor is complete control of transmission. Although the infection has not been severe in most infected individuals, death of over 3 million is dreadful and many still need moderate-to-intense hospital care. Most countries are not able to provide the supportive and corrective therapies due to their unpreparedness to handle a pandemic of such magnitude and speed. But, even after a year, the second wave saw a huge surge at least in India where urban areas with better medical facilities and more resources showed better recovery rates and patient mobility. Rural regions were unfortunately the bigger victims. Also, a third wave is predicted, and the viral variants are suspected to influence its infectivity and recoveries.
Shifting goalposts
Since virus travels through air to infect, an early theory was postulated with just observational conclusions of many infected zones that droplets and fomites were responsible for most transmission. This led to frantic guidelines sometimes controversial coming from reputed national and international agencies of complete lockdowns and restricted movements with protection. The solutions implemented then were spontaneous and with helplessness but now current evidence-based modifications are warranted and need to be implemented accordingly. But, many sectors have fallen victims and have suffered heavily. Sadly, there has been exploitation too. Herd immunity seems to be the key to reduce the demonic effects of the virus. Global vaccination still is a herculean and demanding task, and there is pandemonium among countries as some can produce or buy the stocks and most are at the mercy of donor countries. Besides, the manufacturing pace, acceptance of the different types of vaccines, storage and transport, efficacy and effectiveness numbers, costs, and sharing diplomacies add to challenging times.
Changing oral health status
Oral health mirrors many underlying general health conditions, and many times, oral health deterioration can aggravate them. Inadequate care of periodontium and tooth structure can lead to irreversible changes brought about by inadequate home and professional care. COVID-19 has resulted in oral care hesitancy and changing routines of people restricted to home such as inadequate oral home care, increased snacking, indefinite postponement of pediatric and orthodontic interventions, and not availing of basic to complex periodontal and restorative solutions, leading to increase in avoidable complications. Besides, the behavioral changes have resulted in increased parafunctional manifestations on oral and associated tissues. There is a proven connection between oral and general health and hence it is imperative to continue the same oral care even in these pandemic times to maintain patient's well-being and good overhealth. Dental practice has changed tremendously ever since the pandemic started outside China in January 2020, and it is going to stay that way for a long time. Fears persist with many misplaced and unproved views doing the rounds. Most of them were structured possibilities and not evidence based and may change with more studies corroborating or contradicting the hypothesis after finding the truth behind them. Some may go away, but the positive changes are welcome.
Patient's views
Unfortunately, patients too perceive the unproved threats as real and are reluctant to visit dental office unless compelled with unresponsive home care. An overload of self-medications has been on the rise and many comfort themselves with teledentistry and no actual dental procedures are initiated in spite of the fact that most dental diseases are irreversibly damaging unless intervened at the earliest. Many are waiting for explicit medical breakthroughs for controlling the COVID-19 forever to avail of routine dental therapies. Till then, the anxiety and fear will linger.
Dental perspective
It had been postulated that the dental profession will see the maximum surge in transmission of COVID-19 disease as compared to other health professionals as dental procedures have always been identified for its high aerosol-generating procedures capable of rapid transmission of disease. In the early days of pandemic in 2020 (so-called first wave), dental practices and institutions did see a great fall in delivery of dental treatments due to COVID-related anxiety and fear and lack of available and accepted protective guidelines and gears. The recommendations included emergency care only, use of personal protective equipment, frequent sanitization of dental equipment, floors, room furniture, and air, and the use of preprocedural mouthwashes. Many practices were also closed in the whole of 2020 and there was partial opening when the case fatalities were less starting 2021. The second wave and current lockdowns are seeing the same results again. This led to increased deterioration of oral health and many on the irreversibility path. The first wave events appear unwarranted retrospectively and may not be needed in future.
Fears of dentists
Small time dental practices with less-visible safety features are seeing a downward trend in patient numbers. Dentists too have developed severe anxiety. Many attributes are responsible such as no previous exposure to pandemics, fear of personal health morbidity and mortality and transmission to family members, reduction in income due to closures and/or prolonged reduction in patient volumes in practices in turn less desire to spend on newer regulations and recommendations, inability to prevent staff attrition and their distress, and importantly reduced investments in continuous professional developments.
Welcome findings
Dental clinical practice had already been stringent as compared to other disciplines taking good protection cares to avoid the transmission of many microorganisms originating from mouth and transmitting them. It is heartening to note that not one COVID-19 transmission has a dental origin across the globe pointing to the robust care system in place. Nevertheless, there are more lessons to adapt to and put proven systems in place for more safety. Good environmental practices have been recommended with specific guidelines, but there is no sturdy correlating evidence about air change frequencies, air-conditioning needs, or air filtration protocols, though adequate ventilation appears to be rationale.
High-volume suction equipment can evacuate the aerosols quicker and efficiently from and around oral cavity reducing far spreads. Use of ultrasonic devices, air turbines, and polishing agents has been suspects. Many studies pointed out the contamination model in and around the mouth and even at 1 m radius but whether this will amount to transmission is suspect. Literature is replete with data suggesting that coughing, sneezing, and talking for longer periods can generate and dispense droplets further as compared to routine dental procedures. Recent evidence is pouring, in which says that dental unit waterlines contain more microorganisms than saliva and are found predominantly in the contaminated droplets and splatter. And if both salivary and dental unit water-borne organisms are controlled using adequate antimicrobials, the potential transmission from these procedures can be reduced significantly.
Of course, with the confirmed high concentration of the contamination around the mouth, adequate protection is mandatory, and most were in place, except there is an added need for eye protection and face shield/visors considering the serious nature of coronavirus infection and its transmission and affinity to mucous membranes (abundant angiotensin-converting enzyme 2 receptors).
Current recommendations for healthy quality of practice in today's context
Dental offices should see every patient to be asymptomatic but a potential carrier but provide dental attention by understanding the disease transmission and putting maximal transmission-protection protocols. These include:
- Reopening or reorganizing dental practices providing safer centers with all safety-ridden guidelines in place driven with the current epidemiological evidence. These include safe physical distances with proper appointment systems, continuous use of face masks, eye protection and visors, hand and respiratory hygiene measures, standard instrument sterilization protocols, and recommended environmental disinfection strategies
- Encourage teledentistry, triage, surveillance, and infection-controlled procedures including preprocedural oral rinses with no delay in timely dental interventions
- In-office saliva-based diagnostics whenever introduced should be done for early detection and to halt the rapid spread of virus and even management. Even early detection of oral signs suggestive of COVID-19 such as dysgeusia and anosmia should be routine inquiry
- Motivating the public of the preventive oral care regimen and strategies and to avail routine care under better and safe conditions. Multiple models of digital communications are suggested to allay the fears and anxiety
- Undertake effective continuous professional learning of potential postCOVID eventualities such as the current mucormycosis, characteristic COVID-19-associated oral signs and symptoms, and newer pharmacological agents
- Overcome vaccine hesitancy and advocate immunization to all
- Address psychological issues of all dental staff (anxiety, depression, anger, hope, and motivation) and ensuring their vaccination and constant well-being.
“The potential in many environmental issues is that if you undertake corrective action without appropriate understanding of the problem, then you wind up doing more harm than good”.
-Hugh Ross
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