COVID-19 pandemic

Dental care in times of Covid

Dental care in times of Covid

Dr HS Chawla

Ever since the emergence of Covid-19 in Wuhan, China, it has spread across the world and become a global pandemic.

The present situation is a relatively new infliction as not everything is known about Covid. One aspect, which is widely accepted, is that it spares no one and fast spreads through contact with oral (mouth) fluids, nasal (nose) secretions and/or eye secretions. Droplets, apart from spreading through coughing and sneezing, also fall from mouth during normal talking, which we generally ignore. Many of us may have noticed small droplets of saliva/spit dribbling out of one’s own or somebody else’s mouth. There are many such instances where such accidents, like clearing throat with slight cough, happen and are not in one’s control.

Large droplets, which are visible, fall just a few feet away from us, whereas small particles, which are not seen with naked eye, float around in the air to longer distance.

This is why social/physical distancing and covering mouth is important to avoid getting infected with Covid-19. Besides, spitting on road should be completely discouraged.

It is also important to maintain oral hygiene. The real problem is how to keep mouth clean and free from at least bacterial infections? A cleaner and healthy mouth may be less prone to viral infections as it is well known that a healthy body is less prone to get any other infections. The bacteria lives in everyone’s oral cavity, predominantly sticking on the teeth, the top surface of the tongue and below the visible margin of the gum that touches the tooth. So, it is important to thoroughly brush teeth concomitantly using the following three methods: i) short horizontal, ii) small clock-wise & anti-clockwise, and iii) vertical strokes from gum downwards for upper teeth and gum upwards for lower teeth on both sides of the teeth, that is, cheek and tongue sides of all teeth. The tooth has two more surfaces i.e. sides in-between teeth, which remain unattended by many of us. To clean these surfaces, use dental floss and interdental brush.

The main aim of tooth brushing is to reduce the number of bacteria in the mouth. First brush without toothpaste i.e dry brushing, which would dislodge bacteria settled on the teeth and gums. The bacteria gets dislodged by frictional action of bristles on the teeth. After brushing, the bacteria will float in the mouth mixed with saliva. It is natural to spit out the dislodged material. It takes about 5-8 minutes to reasonably clean the teeth if done properly. Next, brush with toothpaste for 30 seconds to one minute. This is followed by flossing and interdental brushing to dislodge bacteria from the sides of the teeth. Finally, it is important to brush once again with toothpaste. This sequence is very important to achieve optimal cleaning of teeth.

To check if one has effectively cleaned the teeth, one should run finger on last teeth; if it feels greasy/slippery then there is a need to brush once again thoroughly. Since the oral and food passage to stomach is in continuation, bacteria from the oral environment would influence the tonsillar health and teeth inversely. Tonsils are considered as a line of defence, preventing the infection to spread. The remnants of food often stick to the tonsillar area, more so in cases where tonsils, which have small crypts or pits in them (follicular tonsillitis). The tonsillar health also contributes to bad breath. In order to keep tonsils healthy and to ward off any bacterial and viral attack, we should keep the tonsillar area clean by frequent gargling with warm water preferably saline water at least after major meals and at night time after brushing.

The third important factor is the hygiene of nasal passages. This also influences oral cleanliness. The nose harbours bacteria, Staphylococcus species being predominant. For the nasal hygiene measure, one should clean the nasal passages at night. This is achieved by taking some warm water or saline warm water from one (right) nostril and blowing it out from the same nostril. Repeat the same with the other (left) nostril. People who are familiar with ‘jal neti’ can also follow the same for cleansing the nasal passage. The posterior nasal discharge is a known phenomenon and is likely to influence the throat.

These three methods (cleaning of teeth, gargles for tonsils and nasal health) if followed together and properly, would guarantee long-lasting oral health and could also contribute towards total health and combat the infliction of bacterial and hopefully viral infections. It is expected to lessen the viral load in this period of Covid-19 susceptibility.

The writer is former Head, Oral Health Sciences Centre, PGI


Maintain oral hygiene

  • First brush your teeth without toothpaste. This would dislodge bacteria settled on the teeth and gums. The bacteria gets dislodged by frictional action of bristles on the teeth. After brushing, the bacteria will float in the mouth mixed with saliva. It is natural to spit out the dislodged material. It takes around 5-8 minutes to reasonably clean the teeth if done properly. Next, brush with toothpaste for 30 seconds to one minute. This is followed by flossing and interdental brushing. Finally, it is important to brush once again with toothpaste.

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