Dental care during covid 19
- 1. Dental care provision during COVID-19 pandemic and post infection measures Presented by Dr.Narmatha Namachivayam, BDS,MDS OMRD Specialist
- 4. • Begins to show wear-and-tear • If you've used it for three months • After recovering from a cold - reinfection THM : Soft-bristled brush with a proper grip in your favorite color
- 6. https://www.medicalnewstoday.com/articles/322577#how-to-choose Check for ADA approval Toothpaste must •contain fluoride •contain active ingredients to improve oral hygiene •be free from flavoring agents •have scientific evidence to support that it is safe and effective
- 7. COVID - 19 • Coronavirus disease 2019 (COVID-19) / Coronavirus / COVID • Contagious disease - Caused by severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) • The first known case was identified in Wuhan, China, in December 2019 • The disease has since spread worldwide, leading to an ongoing pandemic • Usual onset – 2-14 days (typically 5) from infection • Diagnostic method – RT – PCR ,CT chest scan
- 8. Contd…
- 10. SARS-CoV-2 transmission and dental treatment Dental clinics - allowed to reopen But should you rush in making an appointment, or is it better to wait it out a little bit longer?
- 11. • The oral cavity - entry portal for several pathogens - SARS-CoV-2 - isolated - saliva of COVID-19 patients • Salivary gland epithelial cells - infected by SARS-CoV - major source of the virus in saliva • High viral load in saliva - beginning of infection , titres - reduce with disease resolution Barzon et al., 2016, Zuanazzi et al., 2017 D. Chen et al., 2020
- 12. Loss of taste and smell • Human ACE2 - main host cell receptor for SARS‐CoV‐2 – widely expressed by respiratory epithelial cells and in the oral cavity, mainly in the tongue • related to injuries in the peripheral nervous system • direct transmission of the virus to the brain • secondary to olfactory problems or nasal obstruction • changes in salivary flow and composition - changes in taste perception • Show improvement within a few weeks in parallel with the improvement of other Covid‐19 symptoms
- 13. Now, due to COVID-19, there are additional safety precautions in place, many of them recommended by the Ministry of Health & Family Welfare (MoH & FW) itself and with the newly enhanced safety precautions, the dental clinics are, therefore, safe to visit
- 14. When Should I Visit a Dentist? If you notice any of the following conditions
- 15. • Issues such as teeth cleaning, whitening of teeth, mild sensitivity, or a small chip in the tooth can all be treated at a later point in time • However, it is advisable to call up your dentist and let them decide if a visit is required or not Contd …
- 16. - Look into nearby dental clinics, - Avoid long distance travel - Family practitioner - Make appointment through phone/online - Have RT-PCR,CT report if possible - Avoid attenders unless necessary - Have your past dental/medical history How to reach dental office
- 17. Do I Need a Prior Appointment? In the present circumstances, it is advisable to take a prior appointment before visiting a dental clinic for the following reasons: •To minimize the number of patients in the waiting area, hence, ensuring social distancing •To minimize waiting time for the patient •Since the time taken to prepare the dental operatory has increased because of the elaborate safety protocol to be followed, a prior appointment is encouraged
- 18. What are Dental Clinics Doing to Protect Patients and Staff from COVID-19? •Appointments: Telephonic screening •Screening: • The temperature and pulse oximeter reading • Medical and travel information • Eliminating shared spaces • Increasing sanitation • Personal Protective Equipment (PPE) • Changing procedures to avoid aerosols
- 19. What Precautions Should I Take While Visiting a Dental Clinic? •Participate in pre and post-appointment screenings •Wear a mask whenever possible •Avoid using the restroom •Washing your hands is important after leaving •Adhere to the appointment time •Avoid getting an attendant •Avoid wearing a wristwatch, jewellery, and any other additional accessories or bags •Online payments
- 20. What Can I Do in the Meantime? •Brush twice daily •Use Fluoride toothpaste •Flossing, interdental brushes(food impaction, periodontal problems) •Avoid sticky, too hot, cold ,carbonated foods •Drink lots of water
- 21. Pain management Paracetamol/acetaminophen/Dolo 650 • 500 mg • Safest • No specific interaction except alcoholics • Caution – liver disease not to exceed 2g Ibuprofen -200 mg ,400mg • 1-0-1 • Not to exceed 5 days • Caution – asthma, peptic ulcer, BP, kidney, liver disease • In BP patients – interaction ,monitor BP • Replace with paracetamol Antibiotic prophylaxis • Amoxycillin 500mg 1-1-1 • Amoxycillin ,clavulanate – 625 mg – 1-1-1 COVID
- 23. In pregnancy and breast feeding patients Acetaminophen/Paracetomol • safer option for pain or fever in pregnancy • safe for use in lactating women https://www.uspharmacist.com/article/otc-medication-use-in-pregnancy-and-breastfeeding
- 24. TREATMENT OF MOUTH ULCERS •Apply pain relief ointments like Orajel or Anbesol •Apply ice or use cold water •Placing old tea bags on the sores •Drink cool chamomile tea •Milk of magnesia - good option and is advised to place on Mouth Ulcers HOW TO AVOID MOUTH ULCER? •Eat a healthy and balanced diet •Avoid spicy and acidic food and beverage •Brush gently •Drink plenty of water •Adopt means to reduce stress •Have a proper sleep
- 25. Topical preparations - 2% viscous lidocaine hydrochloride, 0.5% dyclonine hydrochloride(Ora jel /orabase/ Anbesol) ADULTS: used as a rinse CHILDREN : applied with a cotton swab Swallowing - contraindicated Children’s formula – diphenhydramine hydrochloride elixir does not contain alcohol Used before meals Meticulous oral hygiene - mandatory Brush and floss their teeth after meals ,soft toothbrush that has been soaked briefly in hot water to further soften the bristles
- 26. Contd… Nonsteroidal Agents Rx: Amlexanox oral paste 5% Disp: 5-g tube Sig: Dab on affected area four times a day until healed Rx: Orabase Soothe-N-Seal Protective Barrier (OTC) Disp: 1 package Sig: Apply according to the package directions every6 hours, when necessary For mild to moderate relief
- 27. Mouthwash Antiplaque solution (peridex) Sig: Take 3 tsp (15 mL), swish for 3 minutes, gargle, and expectorate three times a day for 2 weeks; then use daily as needed for maintenance
- 28. CHAPPED OR CRACKED LIPS For maintenance, frequent application of lip care products e.g., Blistex, Chap Stick, Vaseline, cocoa butter
- 29. Dry mouth • Sip cool water frequently - every 10 minutes - all day long • Allowing ice chips to melt in your mouth is comforting • Artificial salivas (e.g., Moi-Stir, Salivart, Xero-Lube, Orex) • Keep the lips lubricated
- 31. TASTE DISORDERS Zinc deficiency - associated with a loss of taste sensation For zinc replacement Rx: Ora zinc capsules (OTC) Sig: Take 1 capsule with milk three times a day for at least 1 month Rx: Z-Bec tablets (OTC) Disp: 60 tablets Sig: Take 1 tablet daily with food or after meals
- 32. Management of Medically compromised patients High Blood Pressure Elective dental care should be deferred for patients with severe, uncontrolled hypertension - blood pressure of ≥180/110 mm Hg
- 33. Contd … Care of Teeth and Gums 1. Floss your teeth after each meal. Be careful not to cut your gums 2. Brush your teeth after each meal - Use a soft, even-bristle brush and a bland toothpaste containing fluoride (e.g., Aim, Crest, Colgate) If a toothbrush is too irritating, cotton-tipped swabs (Q-Tips) or foam sticks (Toothettes) can provide some mechanical cleaning. 3.Nutrition Adequate intake of nutrition and fluid 4. Maintenance Have your oral health status evaluated at regularly scheduled intervals by your dentist E. Supportive A humidifier in the sleeping area will alleviate or reduce nighttime oral dryness
- 34. Post Covid 19 infection measures How COVID-19 can spread via toothbrush? • COVID-19 - spread through toothbrush and tongue cleaners • These items belonging to an infected person - significantly have high concentration of SARS-CoV-2 • Continued use of these items - lead to re-infection or fresh COVID-19 infection in others • If someone in a household has contracted coronavirus then it is advisable that the toiletry items (toothbrush, tongue cleaner etc.) used by the infected person should be thrown out
- 35. • Change your toothbrush and tongue cleaner after 20 days of getting the first symptoms • As a prevention - mouthwash and betadine gargle - helps in reducing build-up of virus/bacteria in the mouth. • If a mouthwash is not available, rinsing the mouth with warm saline water also works fine. Apart from this, one must maintain oral hygiene and brush twice a day
- 37. Why are COVID patients prone to mucormycosis infection? • Patients with comorbidities • taking immunosuppressant medications • diabetic - under strong immunosuppressant medications - develop fungal infections. • poor blood glucose control - encourage the fungi to thrive in the body • industrial grade oxygen, tap water in humidifiers, reused masks, antibiotic overuse • Moisture in the environment, • unclean environment in which patients are treated and oxygenated - big source of infection. • The organism lives with us and acts up when we are immunocompromised.”
- 38. How to prevent or minimize the spread of fungal infections? • While in most severe COVID-19 cases, steroid is a common medication prescribed by most doctors • "Indiscriminate steroid use harms in two ways - first it reduces your immunity; second, it raises your blood sugar levels. • Both of these predispose you to getting infected with mucor • avoid the usage until and unless a doctor prescribes it
- 39. Symptoms to watch out for………….. If in case a person has developed mucormycosis infection, it is important that you pay attention to the symptoms, so as to prevent the complications that may follow. - Headaches and swelling in the forehead - Swelling in the one side of the face - Black crusts around the nose - Blurred vision or vision loss - Pulmonary complications such as nosebleeds, nasal blockage, reduction in facial sensation - Respiratory complications such as chest pain, cough, shortness of breath
- 40. ‘Wards of Covid Warriors’ Bachelor of Surgery(MBBS) and Bachelor of Dental Surgery(BDS) seats for the academic Year 2020-21.
- 41. How Oral Hygiene Can Decrease the Risk of COVID-19 Complications “Could there be a link between oral hygiene and the severity of SARS-CoV-2 infections” CONCLUSION Inadequate oral hygiene can increase the risk of inter-bacterial exchanges between the lungs and the mouth, increasing the risk of respiratory infections and potentially post-viral complications”. Luckily, you may be able to decrease the risk of developing COVID-19 complications by simply practicing proper oral hygiene.
Editor's Notes
- #19: Safety is of utmost concern, especially now, as dentists enter the new COVID-19 world. Dental clinics today are taking extra precautions, which are also recommended by the MoH&FW:Telephonic screening of all patients is done prior to giving them an appointment. Appointments are staggered with more time allotted for each patient to reduce the number of people in the clinic at any given time to ensure social distancing among patients. The temperature and pulse oximeter reading of anyone entering the clinic is recorded for screening purposes. A detailed medical and travel information is being taken from all patients regarding COVID-19 along with other diseases in general, and treatment is rendered only after the assessment of risk.
- #25: Mouth Ulcers do not need treatment as they go away with time. But if the ulcers are large and extremely painful please visit your dentist for treatment options:
- #26: Symptomatic relief of painful conditions can be provided with topical preparations such as 2% viscous lidocaine hydrochloride or 0.5% dyclonine hydrochloride. Topical anesthetic may be used as a rinse in adults but should be applied with a cotton swab in children so they do not swallow the medication. Swallowing these anesthetics is contraindicated, in part because they may interfere with the patient’s gag reflex. Symptomatic relief also can be attained by mixing equal parts of diphenhydramine hydrochloride elixir and magnesium hydroxide or aluminum hydroxide. Children’s formula diphenhydramine hydrochloride elixir does not contain alcohol. Sucralfate suspension also may be used before meals. The diphenhydramine mixture and the sucralfate coat the ulcerated lesions, allowing the patient to eat more comfortably. Meticulous oral hygiene is absolutely mandatory for these patients. Mucosal lesions that contact bacterial plaque present on the dentition are more likely to become secondarily infected. Patients should be seen by a dentist or the hygienist for scaling and root planing, with use of local anesthesia when necessary, in all cases in which oral hygiene is suboptimal. Patients must be encouraged to brush and floss their teeth after meals in a gentle yet
- #38: Patients with comorbidities taking immunosuppressant medications to fight off environmental pathogens are most likely to bear the ills of the fungal infections. That said, critical COVID-19 patients, who are either diabetic or due to their severe conditions, are under strong immunosuppressant medications, may develop fungal infections. Not only do uncontrolled blood sugar levels make it easier for patients to contract severe illness, but poor blood glucose control may also encourage the fungi to thrive in the body. industrial grade oxygen, tap water in humidifiers, reused masks, antibiotic overuse "Moisture in the environment, unclean environment in which patients are treated and oxygenated can be a big source of infection. The organism lives with us and acts up when we are immunocompromised.”