Corona / Covid-19 and oral health

Very few people look forward to a visit to the dentist or find it pleasant. This makes it all the more
understandable that many of them have canceled or delayed unnecessary treatments or unloved checkups following the emergence of the coronavirus and the lockdown in spring 2020. Going to the dentist’s office was too unsafe, they said. Maybe someone infected with the virus sat in the chair before me? Or is sitting next to me in the waiting room? No, I’d rather not go to the dentist until after the pandemic. Unless I’m in pain, in which case I go immediately.

Many patients who canceled or missed their appointments in the first lockdown faced a different problem at the end of the year: the stamp in the bonus booklet was still missing! And so they went to the dentist after all, sat down in the waiting room and in the treatment chair – in the middle of the second wave of the pandemic that hit Germany and the rest of the world harder than the first.

This begs the question: Is there even a “after the pandemic”? And why only go to the dentist when there are complaints?

Your oral health is an important part of your overall health!

A large part of the population still believes that a visit to the dentist is only necessary in case of acute pain. Yet, it was proven decades ago in a wide variety of studies that oral health has a major influence on general health. Interactions between periodontal diseases (i.e. diseases of the periodontium) and cardiovascular diseases, diabetes mellitus and Alzheimer’s disease are just a few examples. A classic sign of periodontal disease is bleeding gums, for example.

However, periodontal disease can be very well controlled and even stabilized with regular, twice-yearly check-ups and professional dental cleanings. Furthermore, a recent study has shown that in patients suffering from SARS-CoV-2 (COVID-19), a particularly high concentration of the virus was detected in periodontal gum pockets.

In other words, periodontal pockets are a popular stomping ground for the coronavirus. Of course, this does not mean: no gum pockets, no virus. But they do have a major impact on oral immunocompetence – and thus your overall health.

How does the virus work?

Primarily, SARS-CoV-2 is transmitted via droplet infection. The droplets are produced when you talk, sneeze or cough and are continuously released into the air. Therefore, if you wear a mouth-nose protection in the correct manner (nose and mouth are covered), the droplets you emit cannot be released into the surrounding air. Additionally, if you keep the recommended minimum distance, you also reduce the risk of infecting other people or yourself. The droplets in the air will sink to the ground before they reach you.

Furthermore, since this is a virus that can only survive longer on mucous membranes, mere contact with the virus (e.g. on the hand) is harmless. Only when mucous membranes are touched with the hand (for example by rubbing the eyes), the virus can enter the body. Regular, proper hand washing (at least 20 seconds) or disinfection already kills a large part of the viruses.

If the virus does enter the body, the first contact is often with the oral mucosa. Relatively soon after the virus appears, it was found that it binds to a specific enzyme (angiotensin-converting enzyme II, or ACE 2 for short). This enzyme is not found on the surface of the skin, but mainly on blood vessels in the lungs. However, the enzyme ACE 2 is also present in large quantities in the oral cavity. A large proportion of viruses are therefore bound in the oral cavity before they reach the lungs and are fought off by the immune defense system. This explains, for example, why some infected people suffer from loss of taste.

Good oral health is important – not only in the fight against the coronavirus

This is where so-called oral immunocompetence comes into play – with a decisive role. It has been shown that especially in high-risk patients, more severe courses of disease can be prevented by good oral immunocompetence. However, oral immunocompetence can only act effectively when oral health is in balance. Parondotal disease, on the other hand, leads to an imbalance. Gum pockets are the ideal breeding ground for pathogenic (harmful) germs. Their overabundance keeps the immune system permanently active and deprives it of valuable energy that it would actually need for the immune response to the SARS-CoV-2 virus. However, deep gum pockets cannot be adequately cleaned during everyday oral care at home. Many germs remain behind. In such cases, only professional dental cleaning or even deep gum treatments (periodontal treatments) can help.

In addition to the early diagnosis of periodontal disease and, of course, cavities, the regular check-ups also have other functions, such as cancer screening. Quite a few benign and malignant tumors originate in the head and neck region. Tumors can also originate from the oral mucosa. Here it is important that patients with full dentures also come for a check-up at least once a year. The examination of the head and oral mucosa is often not considered by many patients, but it is an essential part of every visit to the dentist.

In principle, it can be stated that the dentist should not only be visited for the treatment of acute pain. Modern, holistic dentistry extends far beyond the oral cavity – even in times of a pandemic. Caries and other diseases do not pause. On the contrary. Left untreated, the long-term consequences can be fatal.

Hygiene at your dentist

The German Society of Oral and Maxillofacial Medicine published a new hygiene guideline at the beginning of the pandemic and has updated it regularly since then. In it, reinforced hygiene measures were established. These include the permanent wearing of mouth-nose protection by practice staff and patients, obligatory hand washing on entering the practice, sufficient ventilation between individual treatments and, of course, observance of the minimum distance. In addition, German hygiene standards for disinfection of surfaces and sterilization of instruments are already significantly higher than in other European countries.

Sufficient protection of your health is therefore ensured.

All these strict requirements make your visit to the dentist a safe affair. No one, neither patients nor practice staff, wants to expose themselves to the risk of a SARS-CoV-2 infection. The vaccinations that are now beginning will again provide a sense of security. But no one knows how long the vaccination protection will last. Or whether the next virus is already waiting in the wings.

Regular check-ups and professional dental cleanings are therefore just as essential as wearing a mask, washing your hands properly and keeping your distance.

After the pandemic is before the pandemic. Protect yourself and your health.

Author: ZA Patrick Krug