Professor Martin Addy talks about ways dental teams can reemphasise hygiene messages to protect the vulnerable from COVID-19.
Few people, if any, have experienced anything similar to the UK measures helping to stop COVID-19. These measures are based on sound scientific advice and include: hand washing, staying at home, social distancing, for example.
The basis for these measures is the mode of virus transmission, which is direct or indirect via physical contact. This could be by the hands or directly by saliva droplets expelled from the mouth on coughing, sneezing and even talking.
The frontline medical professions, including dental, have had years of experience of hand washing and the donning of protective equipment to shield themselves and their patients from infections.
This now includes COVID-19. Carers for the elderly – which can be family members, community nurses at home or nurses in residential homes – have had less access to protective equipment, until recently, with very poor infection outcomes.
Based on the effectiveness of detergent-based hand washing products against coronavirus and because toothpaste contains the same detergents, dental professionals have got behind the suggestion to reaffirm tooth brushing for two minutes at least twice a day.
These brushings should be before leaving home – particularly if using public transport. For the medical professions, including dentistry, tooth brushing should be performed before donning protective equipment. Increasing the exposure to toothpaste by the general public without the need to brush could be the application of toothpaste on a finger rubbed around the mouth.
This is a recommendation which can easily be made by all members of the dental team for their patients and even themselves.
The dental team may be handicapped, however, in getting the oral hygiene message to certain groups notably the elderly. This population is large and, by age alone, is more susceptible to COVID-19.
Additionally, they may have medical conditions, making them even more vulnerable. They may also have cognitive or physical problems, limiting oral hygiene practices. In turn, they become reliant on others for all hygiene procedures whether at home or in residential care.
Protect the elderly
Nevertheless, the number of dental professionals in the UK is large. They have family, friends, patients and even contact with residential homes through which to reaffirm the oral hygiene and toothpaste messages.
Finally, and very much related to the preceding comments is the role of the dental team in denture care. The percentage of adults without teeth has fallen dramatically from the 33% of the 1960s. However, there are still large numbers of individuals in the UK with full or partial dentures, many of whom are elderly.
For these individuals the dentures act as a fomite for infectious microbes including coronavirus. As such the dental team need to reaffirm denture hygiene practices. For example, dentures should be removed during sleeping hours and thoroughly cleaned.
Here is not the time or place to debate commercial denture cleaning products. At this time, the focus is on the destruction of coronavirus possibly on the prosthesis. This can be simply achieved by brushing with toothpaste or soaking overnight in a detergent solution.
This could be with water-diluted hand wash or indeed washing up liquid, simply rinsing with water before reinsertion. For the edentulous, tooth brushing with paste is not feasible. Here, the finger delivery of toothpaste is eminently suitable.
In summary, the dental team – even the government in the fight against COVID-19 – should adopt the slogan: Stay Alert, Wash Your Hands and Brush Your Teeth.
As the time for relaxing lockdown approaches, this message becomes even more pertinent.
Professor Martin Addy is an emeritus professor at the University of Bristol.
