The COVID-19 Pandemic and Your Dental Health

​​​I will share some thoughts about how the COVID-19 pandemic may ​impact dental health and also how to maintain your dental health during this time.

While I do have some important information to share, I am torn on whether there is any room for keeping the article a little lighthearted? 

There is nothing funny about this Coronavirus. The deaths and serious illness it is causing among patients and front-line healthcare workers are horrific. The economic toll it is having on Canada and throughout the world is like nothing we have ever seen. Various levels of government in Canada are helping Canadians weather this storm. I hope, if you live outside of Canada, your government is doing the same. 
   
There are a few shreds of good news. If you do contract the virus it is thought that once you are well, you are unlikely to catch it again as your body will have developed immunity against it. As well, there will, in time, be a vaccine for the virus. So parents,  you will not be in lockdown with your teenage children forever and vice versa.  
     
Please note: I do mention a few products and services by name in this article. I have no financial interest in any  mentioned whatsoever. 
     
I am a dentist in Toronto, Canada, where like many places, all non-essential businesses have been ordered closed to reduce the transmission of the virus. Dentists here are allowed to provide emergency and urgent care to their patients but have been ordered to stop any routine treatment, to help diminish the spread of the virus through the community. It is unknown how long this will be the case but it could be for some time. As a result of the pandemic, the delivery of dental care and the practise of dentistry have been turned upside down in many ways.

Finding a Dentist During the Pandemic 
Finding a dental office that is treating emergencies at this time could be a challenge.  Many dental offices in Toronto have shut down temporarily during the pandemic. If you have an urgent dental problem you can read my previous article on how to deal with dental emergencies during the pandemic by clicking here. 

In my own practice, I am on call for emergencies from Monday to Friday 8 am until noon. I would be interested to hear from you, whether you live in or outside of Toronto  regarding your experience of trying to access dental care during this time. I have read online, for example, that patients in England are having a very difficult time accessing emergency dental care.

Cavities will have to wait to be filled until dentists have been given the okay to resume routine treatment unless the cavity is causing you pain. Even then, dentists have been advised to repair teeth in the simplest manner possible. Repairs that ideally involve little or no drilling are advised. This is because high-speed drilling can produce aerosol spray around the tooth. Patients who present to the dentist may unknowingly be infected with the coronavirus, as in the early stages you can be symptom-free. If the infected patient is then treated by the dentist and an aerosol is produced, this spray can project virus particles in the direction of dentist and their assistant. So, dentists need to modify their treatments in order to minimize aerosols, use high volume suction to suck up the bulk of the aerosol spray if any is produced, and wear N95 masks, face shields and gowns if aerosols are going to be produced in order to avoid contracting the virus.

​Maintaining Your Gum Health During the Pandemic 
Dental cleanings are also on hold. Many people with a history of gum disease get their teeth cleaned every three to four months, so a delay in their professional dental cleaning is not ideal. However, we don’t want thousands of patients passing through dental offices for dental cleanings, potentially spreading the virus.
     
To help maintain gum health during the pandemic, you need to be diligent about your home care routine.  If you have a history of gum disease you could benefit from using a Waterpik twice daily in addition to your regular tooth brushing. This can help flush out debris and bacteria from under your gums and in between your teeth. The Waterpik website has some good, short videos on how to use the device (www.waterpik.com). Mouth rinses such as Listerine (available at most supermarkets and pharmacies) and Periactive (online order only:www.izunoralcare.com) can also help reduce gum inflammation.

The Pandemic and the Orthodontic Patient



​People with braces will need to be extra careful to brush well around brackets and other orthodontic hardware  as they won't be getting dental cleanings for the time being. With many people home from work and school, there may be a tendency to snack more frequently on pop, juice, coffee with sugar, chips, candy, etc. This can promote the start of cavities around brackets if they are not kept clean. ​So brush well. I am a big believer in using an electric toothbrush to keep teeth with braces cavity-free.

Will the Pandemic Drive Up Cavity Rates? 
With the pandemic, many people are either working from home or sadly, laid off. As well, students are still home on a March Break that never ended. With more people being at home, there may be a  greater opportunity for frequent snacking as mentioned in the section above. 

As a result, it would not surprise me if there is a surge in cavities in the aftermath of the pandemic. This is because frequent snacking on foods containing fermentable carbohydrates found in cookies, chips, pop, juice and candy provides a food source for the bacteria (plaque) that live on our teeth. Dental bacteria thrives if fed lots of carbohydrates (sugars) found in the above foods. They ingest the carbohydrate and convert it to acid which softens tooth enamel and can lead to cavities.

​To prevent cavities, instead of grabbing the snack foods and beverages mentioned above, try foods such as nuts, seeds, cheese or veggies. These foods will not cause cavities. 

If you usually put sugar in your tea or coffee and sip on it for hours a day, this can promote cavities. Try to drink your coffee or tea down quicker (i.e.ten minutes) rather than prolonged sipping. The longer teeth are bathed in a sugary solution of tea or coffee, the more likely they are to decay. This is also true for sipping on juice, pop or milk for long periods of time. Have these beverages with a meal and don't sip them in between meals. Tap water is the best drink to have between meals. See if you could learn to  enjoy coffee or tea without sugar. Or if you need a sweetener try Splenda. It is a natural sweetener that won’t cause cavities. Note:  Splenda is sweeter than sugar so use less  in your beverage than you would table sugar.
     
Fresh fruit in moderation will not promote cavities, whereas dried fruit, while having some health benefit in moderation, is sweet and sticky and can promote cavities if eaten too often.  

Low Mood and Dental Health During the Pandemic
 
Depression, low mood or anxiety caused by the pandemic may make some people feel less inclined to take care of themselves, including their teeth.
I have met patients who, because of depression, stopped brushing their teeth for many years. Yes, years. I have also met young patients i.e. preteens and teens who don't see the importance of brushing. Bleeding gums and cavities, unfortunately, result from this neglect. 

I am hoping people will continue to use those few minutes a day to brush even if they don't feel enthused about it. It can save your teeth and thousands of dollars in dental fees down the road... just a few minutes a day.

Flossing and the Pandemic

​In good times it is difficult to get people to floss. So in difficult times will flossing fall by the wayside? Or could the pandemic be a big game-changer in flossing habits? Maybe it will!  Caution: Only deluded dentists and dental hygienists will probably agree with the following: If you are working from home, or are home schooled (is that happening?) you are not spending time commuting to work or school. That frees up at least three minutes a day, which is the time it takes to floss, time that a lot of people never seem to have.

Note: I am fully sympathetic to the fact that even if you are working from home or laid off at home, you may have even less free time now than before the pandemic, if you are trying to home-school kids, cook, look after or keep tabs on  older parents, etc.) 

But getting back to flossing for a minute, and this is the inspirational part of this article, maybe YOU can be an agent of change during the COVID-19 Pandemic. 
It has been said that two proven ways to achieve a goal are first, commit to it publicly i.e. tell those around you: "I am going to run a marathon," or "I am going to start flossing once a day!” and second, find someone to share in the pursuing the goal. Having a running buddy in the case of marathon training can make you less likely to skip your long training runs, and having a "flossing buddy" could make you more likely to floss once a day. 
I know you are thinking that have a “flossing buddy” might be difficult in this time of social distancing. However, enter the latest and greatest pandemic communication tool, Zoom.  www.Zoom.us

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Zoom is a free online video conferencing app that will allow you to get-together with friends, family, or acquaintances online each night and floss together! You can also discuss your favourite brands of floss, waxed versus unwaxed, floss on a stick versus old-school (freehand) flossing. I am told that Zoom could have other uses as well?

​A Pandemic Flossing Disclaimer

There will be at least one person who reads this article, and decides after years of not flossing, to floss again. Then they will promptly pull out a piece filling at their first flossing attempt. So here is my response: If your teeth are in good health and your fillings (if you have any) are in good shape, then you will not pull a filling out when you floss your teeth. However,  flossing indeed can pull out a piece of loose or defective filling. (You can have a cracked or loose filling and be completely unaware of it).

I have always maintained that it is better to pull out a loose piece of filling by flossing rather than let remain in the tooth. This is because bacteria can get in around a loose filling or seep through a cracked filling. Some of the biggest cavities I have seen can start around loose or defective fillings. So if a piece of filling pops out while you floss, at least you know you need to see your dentist. 
But not so fast. Remember, there is a pandemic out there so that tooth will need to wait to be repaired. Which leads us to….

​What Should You Do If You Lose a Filling During the Pandemic? 
If a piece of filling comes out of a tooth, whether through flossing or eating, it is not an emergency. Do not panic. 
The tooth could be sensitive to touch, cold, or chewing after the filling comes out but this may very well subside within a day or two. If you are in significant pain, however, call your dentist. 

Now the consolation is that if you pulled out a filling while flossing, it means you are now a flosser! So you can keep up your daily flossing. It won't do further harm to the tooth and it could help keep food from getting packed in the place where you lost the filling.  Food compacting can cause the gums to become tender, so brush that spot where you lost the filling. If it is sensitive to cold water then try brushing with warm water.

​Foods to Avoid (Especially) During the Pandemic
 
​​A further tip that will serve you well during this pandemic and all through your life involves caramels, toffees and how long you want your dental work to remain in your mouth. 
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If you have crowns and/or bridges and especially if you have temporary crowns or bridges, I highly recommend you do not eat toffee or caramels. You might be best to avoid candy apples and caramel apples as well. All of these foods are excellent crown and bridge removers. Even crowns and bridges that are in perfectly good condition can be pulled out with these sticky foods. During a pandemic, you don't want to have to start searching for a dentist who can re-cement your crown and bridgework. An ounce of prevention is worth a pound of cure.

​Children’s Dental Health and the Pandemic​

​If routine dental care is withheld too long it could adversely affect the dental health of children more so than that of adults. Cavities tend to progress quicker in baby teeth than in permanent teeth.
  
The enamel that covers a  baby tooth is thinner and weaker than the outer enamel layer covering a permanent tooth. So an early to a medium-sized cavity in a baby tooth could progress to the point of needing emergency treatment sooner than the same sized cavity in a permanent tooth. 

We are still in the early days of this pandemic. It has only been a little under four weeks since dentists in Toronto (and maybe where you live) were advised to stop providing routine care. However if this pandemic is long and drawn out it might make more sense to treat children with large cavities (place fillings) before they have to endure more complicated emergency dental treatment. This is a tough issue that dental regulating bodies may have to look at. We will have to monitor this situation closely.

​Well, I will stop there. I do have other thoughts that I will share another day. Let's hope this pandemic is brought under control sooner than later. Let's also hope there will not be further pandemics in our lifetime but if there are, that what we learn from this one will lessen the  the effect of future ones.
 
The incredible thing about pandemics is that at least, in theory, they are preventable, However, that would take massive, worldwide public health and economic initiatives that are beyond the scope of this article. But there is always hope that this important goal can be pursued by countries, cooperatively throughout the world.

If you have a question or comment, please feel free to use the comment section below.
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Sincerely,
Jeff Shnall