Learn how to emphasise gum disease prevention with your patients
A recent study conducted on 568 patients with Covid-19 shows that periodontitis plays an important role in the course of the disease.
Periodontitis, one of the most prevalent chronic inflammatory diseases around the world, was proven to be a significant player among the main risk factors associated with Covid-19. The worldwide pandemic-causing disease and its connection to the health of gums was a main subject of interest in several studies over the last year.
As the Covid-19 pandemic escalated in 2020, it was suggested by Dr. Sharma et al., that chronic periodontitis presents a major risk factor for increased Covid-19 severity and fatality. The possibility of a connection between oral health and aggravation of Covid-19 was also a subject of interest to other scientists. At the time there was not enough data to prove this hypothesis however, so further studies were needed.
Periodontitis affects the course of Covid-19 and increases risk of death
A recently published study conducted throughout the year 2020 (February to July) by Nadya Marouf et al., in Qatar, revealed that periodontitis is definitely associated with a higher risk of complications in Covid-19 patients, including both an increased severity of Covid-19 symptoms as well as a significantly higher risk of death. The study evaluated a group of 568 patients suffering from Covid-19.
Scientists observed that in patients who were concurrently suffering from periodontitis, the need for intensive care admission was 3.5 times higher, the need for assisted ventilation was 4.5 times higher, and the death rate was 9 times higher than in patients without periodontitis. Increased blood levels of biomarkers linked to worse Covid-19 consequences were also detected.
It is known that periodontitis leads to permanent damage of periodontal ligament and alveolar bone, and subsequent tooth loss thus develops due to pro-inflammatory cytokine production induced by periodontopathic bacteria. But what’s the connection between the oral disease and Covid-19?
Periodontopathic bacteria have an influence on dozens of diseases and conditions
Whilst the exact mechanism behind the relationship between gum inflammation and the course of Covid-19 is still unclear, researchers are already providing various possible explanations. One is based on the prospect that the periodontal bacteria influence the coronavirus or the ACE2 receptors.
Another hypothesis is that the bacteria trigger additional inflammation in the lungs, as it travels from the oral cavity, and especially periodontal pockets – which may serve as a reservoir for pathogens. The mechanism could also be explained as being the overreaction of the immune system in the cytokine storm that can be present in severe corona processes.
Also important in the connection with Covid-19 is the already-known fact that periodontopathic bacteria are also present in various respiratory diseases (for example aspiration pneumonia and chronic obstructive pulmonary disease), and other systemic diseases such as diabetes and cardiovascular disease. In fact, periodontitis has been linked with more than fifty diseases and conditions, including chronic kidney disease, Alzheimer’s Disease, rheumatoid arthritis and certain types of cancer. Patients with such-mentioned systemic diseases also have increased Covid-19 aggravation and mortality rates.
Take care of your patients’ gum health
According to the European Federation of Periodontology (EFP), around 40% of people suffer from periodontitis. It is estimated that around 70% of adult tooth loss is caused by periodontitis.
What advice to give patients in order to prevent gum disease?
According to the EFP:
- To brush the teeth carefully more than once a day, using a soft manual or powered toothbrush and gentle but efficient toothpaste.
- To clean between the teeth daily using an appropriate sized interdental brush (or floss if the gaps are too tight). The size in this case matters – it is important to choose the right size for the patients and teach them how to use the interdental brush properly.
- To use specific mouth rinses, toothpastes, or gels in addition to cleaning, in order to reduce inflammation. When choosing the right product, they should be focused on those containing fluoride, enzymes, hyaluronic acid, and those without SLS or plastic microparticles.
- To quit smoking, maintain a healthy weight, eat a balanced diet, exercise, and reduce stress. If they have diabetes, they should be under the supervision of a specialist and in good control of their blood sugar.
Therefore, the importance of proper home care and thorough cleaning of the teeth and gums should be distinctly stressed. It is important to educate patients repeatedly about the body-mouth connection so they can understand the immense importance of caring for their oral health by applying adequate prevention measures – the proper and regular cleaning of teeth and interdental spaces, but also understanding the importance of regular check-ups with a dental professional and avoiding smoking, since all of these are crucial for maintaining good oral health.
Proper home oral-care cheat sheet for your patients
Keep reminding your patients that only a toothbrush and toothpaste is definitely not enough. Here’s the best aids that will help them to prevent bleeding and gum disease.
You can choose whether to use a classic brush or powered brush. In both cases, it is important for the toothbrush’s filaments to be soft and dense. Change the brush regularly, and always after every viral or bacterial disease. Choose the right toothpaste – one that cleans, but does not damage your enamel or mucosa lining due to microparticles or aggressive whitening agents.
Cleaning of the back teeth
For this purpose the best help is a single brush. It allows you to reach the most hidden spaces in your mouth and clean them properly.
Cleaning between the teeth
The best instrument in this case is the interdental brush. Always choose the proper sized brush according to the actual size of your interdental spaces, measured by a dentist or dental hygienist. For the narrowest spaces use dental floss.
Supportive treatment of inflamed gums or gums after a dental procedure
If an inflammation occurs, you can help the healing process with various products (rinse, gel, toothpaste) that are efficient and gentle at the same time. They usually contain beneficial ingredients like plant extracts, xylitol, hyaluronic acid, cyclodextrine, sodium fluoride or chlorhexidine.