Dentistry will struggle to return to normal says professor

Dentistry will struggle to return to normal says professor

Dental surgeries are ’coronavirus heaven’ Professor Mike Lewis warns it will be ’very difficult to return to normal’. He said he does "not foresee" a return to normal any time soon. He also said that maintaining good oral hygiene could help prevent the spread the virus, a view echoed by Prof Martin Addy.

Professor Lewis, who is a dentist and professor at Cardiff University and works at the emergency clinic at University Hospital of Wales Dental Hospital, was speaking in an interview with ITV Wales.[i] He said: "The dental environment is coronavirus heaven because it is present in saliva and a lot of the dental equipment like a drill or an ultrasonic scaler create what are called aerosols and that’s spraying the virus, if it’s present, into the room’s atmosphere. It will stay present for many hours".

He described it as "an absolute nightmare" in terms of trying to keep safe while treating patients. "It’s like sneezing a thousand times over. The community dentist is still providing advice, pain relief and antibiotics but there will come a time when the teeth will need to be extracted," said Professor Lewis. "There are more teeth being taken out now than if we were would be if we had full access to a full range of dental treatment. I do not foresee an early return to normal dentistry."

In a separate interview he said maintaining good oral hygiene could help prevent the spread of coronavirus. Most toothpastes and mouthwashes contain detergents with anti-viral qualities, similar to those in hand sanitisers, which could impact the ability of the virus to spread. Spending four minutes a day on cleaning your teeth "has never been so important. Research has demonstrated that poor oral hygiene is an important factor that could influence occurrence of respiratory infection. This is especially relevant at this time of the Covid-19 pandemic. The public needs to appreciate the benefit of good oral hygiene (tooth brushing, inter-dental cleaning and mouthwash).

He continued: "At the time of lockdown people have adequate time to spend just two minutes twice daily cleaning their teeth. This has never been so important. Covid-19 spreads via saliva and this is the basis of the need for social distancing. Toothpastes and mouthwashes contain substances, similar to those in hand sanitizers, that have antiviral actions and these could also impact the ability of the Covid-19 to spread which is obviously an additional benefit of a good oral hygiene regimen. So everyone please wash your hands and clean your teeth."

His words were echoed by Professor Martin Addy, an emeritus professor at the University of Bristol, who said that the use of toothpaste could play a significant role in preventing coronavirus infections – and is urging fellow industry colleagues to inform their patients. He said: ‘The possibility even probability that tooth brushing with toothpaste could play a significant beneficial role in the spread of and infection by coronavirus is based on three fundamental points.

Prof  Addy continued: ‘Firstly, hand washing with soap and or hand washing gels to limit the direct or indirect spread of infectious diseases. This includes COVID-19 and is based on sound scientific principles. Secondly, like many respiratory diseases, the infective microorganisms, including coronavirus, are spread in salivary droplets expelled from the mouth. This can be via coughing, sneezing or even talking. Thirdly, toothpastes, almost from their conception contain detergents, notably sodium lauryl sulphate. These are found in many antimicrobial hand washes recommended against coronavirus.’

In addition, he says the antimicrobial action of toothpaste in the mouth persists for a few hours. As a result, if the dental profession’s recommendation of brushing twice a day for two minutes is adhered to, the viral load in saliva will be reduced. He believes dental professionals have a crucial part to play in spreading these messages. The dental profession therefore has a key role in in the control of COVID-19 at this time. They should be reaffirming twice daily oral hygiene practices via patient contact in practices, clinics and hospitals.

‘The profession can also play an additional role by extolling simple oral hygiene messages, some already known. For example, after brushing, spit out residue and do not rinse. With much of the population in lockdown, one of the brushings should be before leaving home for shopping, exercise etc. This is to increase their exposure of the mouth to toothpaste. An additional dose of paste on a finger rubbed over the teeth and mucosa should be considered. Nurses, dentists and medics should brush their teeth before donning PPE.’

He added: ‘Finally, for those dental practitioners seeing urgent or emergency patients or working in urgent care centres, the advice should be that they themselves follow good oral hygiene practices. This could be regular brushing with toothpaste whilst in the surgery – and perhaps brushing more frequently. When possible, patients about to attend a clinic or practice should be asked to brush immediately before attending. If this is not possible, toothpaste could be made available in the waiting room for application on the patient’s finger immediately before being seen.’

[i] https://www.itv.com/news/wales/2020-04-29/dentist-says-surgeries-are-closed-because-the-dental-environment-is-coronavirus-heaven/

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