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A COVID stimulated wake-up call for dental prevention

Perio_COVID A wake up for dental prevention, COVID is worse for patients with periodontal disease.

We are all (well most of us!) now actively involved in prevention and risk assessment. 

We stay at home, keep our distance, wash our hands and wear masks.  We know some people are at higher risk of serious complications and death from COVID than others, so we shield the elderly and those who are clinically vulnerable, and we require our medics, dentists and care workers to wear PPE and engage in comprehensive disinfection routines to protect them and their patients from the close contact they have to have in their essential work.  Our vaccination programmes have initially been targeted at those who, by nature of their inherent risks or lifestyle risk factors, are in most danger. 

It is the coming of age of risk assessment and prevention, a time when the public accept that the inconveniences of doing the right thing are essential to ensure a better future.

I strongly believe that NHS dentistry post-COVID will take on this challenge: the one that says prevention comes first, and to prevent you must first to know your susceptibility and what you personally can do to protect your health.  Treatment is a fix, not a cure and whilst essential to get patients out of pain, should not be the focus of a modern health service.  Advanced restorative treatment on an unhealthy periodontium should not be paid for out of the public purse. 

A study has just been published from Qatar on the impact of perio disease on COVID outcomes.  Qatar has electronic health records containing medical and dental data (definitely something for the NHS to aspire to!) which facilitated the analysis of confounding factors.  To quote the press release here:

 The case control study of more than 500 patients with COVID-19 found that those with gum disease were 3.5 times more likely to be admitted to intensive care, 4.5 times more likely to need a ventilator, and almost nine times more likely to die compared to those without gum disease.

Blood markers indicating inflammation in the body were significantly higher in COVID-19 patients who had gum disease compared to those who did not, suggesting that inflammation may explain the raised complication rates.

Professor Mariano Sanz, one of the study’s authors, noted that oral bacteria in patients with periodontitis can be inhaled and infect the lungs, particularly in those using a ventilator.

“The results of the study suggest that the inflammation in the oral cavity may open the door to the coronavirus becoming more violent,” said Professor Lior Shapira, EFP president-elect. “Oral care should be part of the health recommendations to reduce the risk for severe COVID-19 outcomes.”

Causality, which is very difficult to prove, is not claimed here, and as always, whilst confounding factors have been adjusted for, those with perio disease often also have other health issues. Maybe the periodontitis is just a manifestation of a tendency to inflammation, and the COVID response simply results from that.   However, the evidence for periodontal disease raising your risk for other systemic diseases is indisputable and growing.

The crunch is this:  gum disease is the easy part to deal with: it is not invasive, expensive or harmful.  When you can stop the disease in its tracks, why risk COVID complications?  Why accept the heightened discomfort and dissatisfaction with your teeth, and the tooth loss that results from periodontitis?  Knowing that gum disease is associated with diabetes, CVD, kidney disease, dementia etc, why would the susceptible patient not choose health over bleeding?

Now is the time to talk prevention: to explain to the susceptible periodontal patient how they are more vulnerable than others in the population; to identify and share the lifestyle factors which put them personally at risk of the disease; to explain the potential impacts on their systemic health, and persuade the patient that it is up to them to take the decision to work with you to take charge of their future. 

Liz Chapple

OHI Ltd, UK provider of PreViser and DEPPA technology

www.previser.co.uk

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