Remember the movie Contagion back in 2011? Movie-goers caught a glimpse of a biological apocalypse; a deadly virus infecting millions worldwide with quarantines imposed and people growing afraid of each other. Sounds familiar? Back then, there was no sense of foreboding of a pandemic of such scale. Of course, we all remembered the more recent ones like SARS and H1N1, but ‘Movement Control Order’, and ‘Lockdowns’ were unheard of. While the pandemic has brought about the collapse of many non-essential industries such as tourism, and even education, certain aspects of our most essential healthcare sector have also taken a beating. One in particular is the dental health care. So how has COVID-19 affected and changed this sector? What are the crucial guidelines that citizens have to abide by?
What Is COVID-19?
By now, indubitably, most of us are familiar with the COVID-19 virus. We all came to know it as a nefarious virus that cripples our respiratory system. Though detailed comprehension of the virus is still in its infancy, here is what scientists and researchers have gathered so far. While many will assume that COVID-19 is the actual name of the virus, it actually stands for Coronavirus disease 2019. The virus’s actual name is SARS-CoV-2 virus. Basically, this is the third introduction of the highly infectious coronavirus after SARS-CoV and MERS-CoV.
So how does the virus infect our body? It enters our body cells through respiratory droplets and close contact with an infected person. It then replicates before being released from the host cell to infect other parts. Along the way, various immune responses are triggered in our body, inducing a cytokine storm. These are pro-inflammatory mediators and chemokines released in large amount, causing deadly uncontrolled systematic inflammatory response. This particular storm causes Acute Respiratory Distress Syndrome (ARDS) and multiple organ failure.
The Growing Concern In Dental Health Care
As of 17 May 2020, the number of infected persons in Malaysia stands at 6,894 cases. How do these numbers affect the orthodontic and dental services? Think of it like a domino effect. Our bodies are potential host to this virus and a source of infection to others. To stop the chain, quarantine, lock downs and social distancing become life-saving methods. As a consequence, this has brought about disruptions to patient schedule, appointments and treatments.
One of the concerns amongst aligners patients is what happens after they have used their last set of aligners. While some orthodontics in the USA have advised patients to continue wearing the last aligners until office re-opens, the question of how long remains uncertain. Moreover, there is also a growing fear of complications arising from treatment delays and lack of supervision. Some of the problems that could potentially arise are root resorption and gum inflammation.
Curbing The Infection In Dental Clinics
The importance of hand hygiene, social distancing and the use of PPE has already been ingrained in our minds. While we are doing our part by practising all of the above in the confines of our home, how does it actually differ in hospitals and clinics? To reduce the risk of COVID-19, treatment at these facilities are now only restricted to emergency cases. What is categorised as an emergency? It has to be a life-threatening condition requiring immediate treatment. Below is the list of emergency conditions according to subspeciality.
|Subspeciality||Types Of Emergencies|
|Primary dental services||– Toothache (pain score > 4)|
– Tooth extraction due to infection
– Fractured restoration/appliance/broken
– Injury to mouth/tooth due to trauma
– Trigeminal neuralgia
– Facial cellulitis/abscess
– Mouth lesions and malignant tumour
– Post extraction complications (bleeding,
infection and dry socket)
|Orthodontic specialist services||– Fractured wire/bracket/appliances|
|Periodontic specialist||– Abscess management|
|Dental restorative specialist||– Endodontic emergencies such as acute pulpitis, cellulitis and swelling|
– Removal of crown/bridge that is loose/mobile
and re-cementing, without reconstruction
|Dental specialist services in hospitals||– Biopsy cases|
– Trauma cases
– Cancer cases
– Abscess cases
– Acute facial/dental pain
Source: Malaysian Dental Association
‘Less Is More’
Remember the days when a visit to a hospital was like a scene out of a carnival? During visiting hours, the cubicles are swarmed with relatives and clinics are filled with both patients and family members. While it shows a great support system, the downside is the unknowing transmission of diseases. And when a pandemic comes in full force, masses and numbers are our biggest enemy. So in times of crisis, it is important to limit the number of caregivers or family members to a maximum of two when accompanying a patient to the hospital/clinic. Think of the adage ‘Less Is More’ during this pandemic.
Owning Up To Your Own Dental Health
When the going gets tough, the tough get going. During difficult times like this, it is important not to slack in oral hygiene. We now know of the growing concern amongst those whose dental problems are not considered urgent. So what are some of the basic things we can do to maintain good oral hygiene and avoid complications?
1. Keeping Your Aligners Clean
Rinse your aligners with cold water when you remove them. Never use hot water as this will deform the plastic. Some might think that using toothpaste is the correct way to clean aligners. On the contrary, antibacterial soap is the apt choice as toothpaste can be abrasive against plastic. Also, soak your aligners in a CLEAR retainer or denture cleaner. Soaking it in coloured solutions may cause staining.
2. Keep Your Teeth And Hands Clean
Always remember to brush and floss your teeth regularly before you wear your aligners. More importantly, sanitise and wash your hands thoroughly before and after handling the aligners.
3. Say No To Being A Sweet Tooth
The sweet-tooth life is irresistible but when it comes to oral care, it is a big NO, NO! Sugary food and drinks can cause tooth decay as well as teeth staining. For those wearing braces, do avoid hard and sticky food which can increase the risk of broken braces.
And Then There Was Light…
May your choices reflect your hopes, not your fears.Nelson Mandela, The late president of south africa
It seems like an insurmountable task, containing an invisible enemy that knows no boundaries. Every sector of industry has been brought down to its knees save one. There is an old saying by Josh Billings, an American humourist, ‘Health is like money, we never have a true idea of its value until we lose it.’ True enough, this pandemic has taught us just that. We were certainly not ready for a pandemic of such scale, but the right choices we are making now certainly reflect our hope; the survival of the human race and our future generations. By practising these simple yet restrictive measures; good hygiene and social distancing, this is a war that can be won. Remember, the darkest hour is just before the dawn.
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