Basic precautions for oral hygiene maintenance during and post COVID pandemic

1. Dental care provision during COVID-19 pandemic
and post infection measures
Presented by
Dr.Narmatha Namachivayam, BDS,MDS
OMRD Specialist

4. • Begins to show wear-and-tear
• If you've used it for three months
• After recovering from a cold - reinfection
THM : Soft-bristled brush with a proper grip in
your favorite color

6. https://www.medicalnewstoday.com/articles/322577#how-to-choose
Check for ADA approval
Toothpaste must
•contain fluoride
•contain active ingredients to improve oral hygiene
•be free from flavoring agents
•have scientific evidence to support that it is safe and effective

7. COVID - 19
• Coronavirus disease 2019 (COVID-19) / Coronavirus / COVID
• Contagious disease - Caused by severe acute respiratory syndrome coronavirus 2 (SARS-
CoV-2)
• The first known case was identified in Wuhan, China, in December 2019
• The disease has since spread worldwide, leading to an ongoing pandemic
• Usual onset – 2-14 days (typically 5) from infection
• Diagnostic method – RT – PCR ,CT chest scan

8. Contd…

10. SARS-CoV-2 transmission and dental treatment
Dental clinics - allowed to reopen
But should you rush in making an appointment, or is it better to wait it out a little bit longer?

11. • The oral cavity - entry portal for several pathogens - SARS-CoV-2 - isolated - saliva of
COVID-19 patients
• Salivary gland epithelial cells - infected by SARS-CoV - major source of the virus in
saliva
• High viral load in saliva - beginning of infection , titres - reduce with disease resolution
Barzon et al., 2016, Zuanazzi et al., 2017
D. Chen et al., 2020

12. Loss of taste and smell
• Human ACE2 - main host cell receptor for SARS‐CoV‐2 – widely expressed by respiratory
epithelial cells and in the oral cavity, mainly in the tongue
• related to injuries in the peripheral nervous system
• direct transmission of the virus to the brain
• secondary to olfactory problems or nasal obstruction
• changes in salivary flow and composition - changes in taste perception
• Show improvement within a few weeks in parallel with the improvement of other Covid‐19
symptoms

13. Now, due to COVID-19, there are additional safety precautions in place, many
of them recommended by the Ministry of Health & Family Welfare (MoH & FW) itself and
with the newly enhanced safety precautions, the dental clinics are, therefore, safe to visit

14. When Should I Visit a Dentist? If you notice any of the following conditions

15. • Issues such as teeth cleaning, whitening of teeth, mild sensitivity, or a small chip in
the tooth can all be treated at a later point in time
• However, it is advisable to call up your dentist and let them decide if a visit is
required or not
Contd …

16. - Look into nearby dental clinics,
- Avoid long distance travel
- Family practitioner
- Make appointment through phone/online
- Have RT-PCR,CT report if possible
- Avoid attenders unless necessary
- Have your past dental/medical history
How to reach dental office

17. Do I Need a Prior Appointment?
In the present circumstances, it is advisable to take a prior appointment before visiting a dental
clinic for the following reasons:
•To minimize the number of patients in the waiting area, hence, ensuring social distancing
•To minimize waiting time for the patient
•Since the time taken to prepare the dental operatory has increased because of the elaborate safety
protocol to be followed, a prior appointment is encouraged

18. What are Dental Clinics Doing to Protect Patients and Staff from COVID-19?
•Appointments: Telephonic screening
•Screening:
• The temperature and pulse oximeter reading
• Medical and travel information
• Eliminating shared spaces
• Increasing sanitation
• Personal Protective Equipment (PPE)
• Changing procedures to avoid aerosols

19. What Precautions Should I Take While Visiting a Dental Clinic?
•Participate in pre and post-appointment screenings
•Wear a mask whenever possible
•Avoid using the restroom
•Washing your hands is important after leaving
•Adhere to the appointment time
•Avoid getting an attendant
•Avoid wearing a wristwatch, jewellery, and any other additional accessories or bags
•Online payments

20. What Can I Do in the Meantime?
•Brush twice daily
•Use Fluoride toothpaste
•Flossing, interdental brushes(food impaction,
periodontal problems)
•Avoid sticky, too hot, cold ,carbonated foods
•Drink lots of water

21. Pain management
Paracetamol/acetaminophen/Dolo 650
• 500 mg
• Safest
• No specific interaction except alcoholics
• Caution – liver disease not to exceed 2g
Ibuprofen -200 mg ,400mg
• 1-0-1
• Not to exceed 5 days
• Caution – asthma, peptic ulcer, BP, kidney,
liver disease
• In BP patients – interaction ,monitor BP
• Replace with paracetamol
Antibiotic prophylaxis
• Amoxycillin 500mg 1-1-1
• Amoxycillin ,clavulanate – 625 mg – 1-1-1
COVID

22. For pediatrics/children

23. In pregnancy and breast feeding patients
Acetaminophen/Paracetomol
• safer option for pain or fever in pregnancy
• safe for use in lactating women
https://www.uspharmacist.com/article/otc-medication-use-in-pregnancy-and-breastfeeding

24. TREATMENT OF MOUTH ULCERS
•Apply pain relief ointments like Orajel or Anbesol
•Apply ice or use cold water
•Placing old tea bags on the sores
•Drink cool chamomile tea
•Milk of magnesia - good option and is advised to place on Mouth Ulcers
HOW TO AVOID MOUTH ULCER?
•Eat a healthy and balanced diet
•Avoid spicy and acidic food and beverage
•Brush gently
•Drink plenty of water
•Adopt means to reduce stress
•Have a proper sleep

25.  Topical preparations - 2% viscous lidocaine hydrochloride, 0.5%
dyclonine hydrochloride(Ora jel /orabase/ Anbesol)
 ADULTS: used as a rinse
 CHILDREN : applied with a cotton swab
 Swallowing - contraindicated
 Children’s formula – diphenhydramine hydrochloride elixir does
not contain alcohol
 Used before meals
 Meticulous oral hygiene - mandatory
 Brush and floss their teeth after meals ,soft toothbrush that has been
soaked briefly in hot water to further soften the bristles

26. Contd…
Nonsteroidal Agents
Rx:
Amlexanox oral paste 5%
Disp: 5-g tube
Sig: Dab on affected area four times a day until healed
Rx:
Orabase Soothe-N-Seal Protective Barrier (OTC)
Disp: 1 package
Sig: Apply according to the package directions every6 hours, when necessary
For mild to moderate relief

27. Mouthwash
Antiplaque solution (peridex)
Sig: Take 3 tsp (15 mL), swish for 3 minutes, gargle, and expectorate three times a day
for 2 weeks; then use daily as needed for maintenance

28. CHAPPED OR CRACKED LIPS
For maintenance, frequent application of lip care products
e.g., Blistex, Chap Stick, Vaseline, cocoa butter

29. Dry mouth
• Sip cool water frequently - every 10 minutes - all day long
• Allowing ice chips to melt in your mouth is comforting
• Artificial salivas (e.g., Moi-Stir, Salivart, Xero-Lube, Orex)
• Keep the lips lubricated

30. Gingivitis
Rx:
Chlorhexidine gluconate (Peridex) 0.12%

31. TASTE DISORDERS
Zinc deficiency - associated with a loss of taste sensation
For zinc replacement
Rx:
Ora zinc capsules (OTC)
Sig: Take 1 capsule with milk three times a day for at least 1 month
Rx:
Z-Bec tablets (OTC)
Disp: 60 tablets
Sig: Take 1 tablet daily with food or after meals

32. Management of Medically compromised patients
High Blood Pressure
Elective dental care should be deferred for patients with
severe, uncontrolled hypertension - blood pressure of
≥180/110 mm Hg

33. Contd …
Care of Teeth and Gums
1. Floss your teeth after each meal. Be careful not to cut your gums
2. Brush your teeth after each meal - Use a soft, even-bristle brush and a bland toothpaste containing fluoride
(e.g., Aim, Crest, Colgate)
If a toothbrush is too irritating, cotton-tipped swabs (Q-Tips) or foam sticks (Toothettes) can provide some
mechanical cleaning.
3.Nutrition
Adequate intake of nutrition and fluid
4. Maintenance
Have your oral health status evaluated at regularly scheduled intervals by your dentist
E. Supportive
A humidifier in the sleeping area will alleviate or reduce nighttime oral dryness

34. Post Covid 19 infection measures
How COVID-19 can spread via toothbrush?
• COVID-19 - spread through toothbrush and tongue cleaners
• These items belonging to an infected person - significantly have high concentration of
SARS-CoV-2
• Continued use of these items - lead to re-infection or fresh COVID-19 infection in others
• If someone in a household has contracted coronavirus then it is advisable that the toiletry
items (toothbrush, tongue cleaner etc.) used by the infected person should be thrown out

35. • Change your toothbrush and tongue cleaner after 20 days of getting the first symptoms
• As a prevention - mouthwash and betadine gargle - helps in reducing build-up of
virus/bacteria in the mouth.
• If a mouthwash is not available, rinsing the mouth with warm saline water also works
fine. Apart from this, one must maintain oral hygiene and brush twice a day

37. Why are COVID patients prone to mucormycosis infection?
• Patients with comorbidities
• taking immunosuppressant medications
• diabetic - under strong immunosuppressant medications - develop fungal infections.
• poor blood glucose control - encourage the fungi to thrive in the body
• industrial grade oxygen, tap water in humidifiers, reused masks, antibiotic overuse
• Moisture in the environment,
• unclean environment in which patients are treated and oxygenated - big source of
infection.
• The organism lives with us and acts up when we are immunocompromised.”

38. How to prevent or minimize the spread of fungal infections?
• While in most severe COVID-19 cases, steroid is a common medication prescribed by most
doctors
• "Indiscriminate steroid use harms in two ways - first it reduces your immunity; second, it
raises your blood sugar levels.
• Both of these predispose you to getting infected with mucor
• avoid the usage until and unless a doctor prescribes it

39. Symptoms to watch out for…………..
If in case a person has developed mucormycosis infection, it is important that you pay
attention to the symptoms, so as to prevent the complications that may follow.
- Headaches and swelling in the forehead
- Swelling in the one side of the face
- Black crusts around the nose
- Blurred vision or vision loss
- Pulmonary complications such as nosebleeds, nasal blockage, reduction in facial
sensation
- Respiratory complications such as chest pain, cough, shortness of breath

40. ‘Wards of Covid Warriors’
Bachelor of Surgery(MBBS) and Bachelor of Dental
Surgery(BDS) seats for the academic Year 2020-21.

41. How Oral Hygiene Can Decrease the Risk of COVID-19 Complications
“Could there be a link between oral hygiene and the severity of SARS-CoV-2 infections”
CONCLUSION
Inadequate oral hygiene can increase the risk of inter-bacterial exchanges between the lungs
and the mouth, increasing the risk of respiratory infections and potentially post-viral
complications”.
Luckily, you may be able to decrease the risk of developing COVID-19 complications by
simply practicing proper oral hygiene.