The dental office and its importance in dealing with the pandemic
Attending to people who have suffered from symptomatic COVID-19 in any of its phases of severity will be frequent in dental consultations.
Many people with one or more chronic diseases come to a dental practice, the number and severity of which increase with age. We have been working for years with different medical societies on the early detection of these conditions or their risk factors in dental consultations, as well as on the management of periodontal diseases when they act as another risk element in the development of these processes, as is the case with atherosclerotic cardiovascular pathology or the bilateral relationship demonstrated in the case of diabetes mellitus.
At this time of the pandemic, dental offices will not be uncommon see people who have been symptomatic of COVID-19 in any of its severity phases. Given this reality, the essential role that dental consultations can and should play in the field of disease prevention and health promotion, the close link between periodontal health and general health, and the importance of having a good overall health status to face possible SARS-CoV-2 infection with more excellent guarantees, places a high value on oral care at this time.
An important and unresolved problem is the uncertain future that awaits patients who have managed to defeat the coronavirus. In this context, it is considered that dental teams can contribute to the oral care of patients, maintaining healthy mouths to prevent complications that can be expensive in the post-COVID-19 phase.
Health Promoting Dental Practice
The role of periodontitis as a risk factor for atherosclerotic cardiovascular disease (expressed clinically as coronary ischemia, stroke, or peripheral vascular disease), diabetes mellitus, and certain forms of pneumonia has been widely demonstrated. All these diseases are complications that can develop after infection by the SARS-CoV-2 virus.
Therefore, now more than ever, it is essential to incorporate into the simple consultations procedures and protocols necessary for early detection of cardiovascular risk (including high blood pressure), as well as pre-diabetes or diabetes, and to establish appropriate measures to prevent and treat periodontal disease in its earliest forms. The ultimate goal is to reduce the overall risk of systemic pathology, especially in older patients with previous chronic conditions or who have suffered coronavirus infection with its possible sequelae.
Coronavirus sequelae in oral health
On the other hand, the consequences of SARS-CoV-2 infection persist after the patient's discharge from the hospital, especially in the most severe cases, and the risk of suffering from significant pathology over time increases considerably. For example, patients who have suffered from pneumonia, especially in its more severe form and associated with painful inflammation processes ("cytokine storm"), may be at greater risk of future diseases such as coronary ischemic disease, stroke, and kidney failure. In 2015, analyzing previous epidemics of coronavirus, it was concluded that the risk of heart disease was four times higher in people who had suffered from pneumonia.
The situation is especially controversial in the group of older patients, who often have one or more of the most common chronic conditions in humans in surrounding countries. They have a higher and proven risk of being infected by the SARS-CoV-2 coronavirus in its most severe form and a higher mortality rate. Thus, for example, preliminary series with patient data in China showed that mortality was clearly associated with age, with a higher rate in those over 85 years (10-27%), followed by patients between 65-84 years (3% to 11%), patients between 55 and 64 years (1 to 3%) and people aged 20-54 years (< 1%).
Other non-negligible problems in coronavirus patients, especially those admitted to intensive care, are muscle atrophy and weakness after prolonged connection to respirators. Another impact of hospitalization is delirium or acute confusional syndrome, which can lead to long-term cognitive impairment, such as memory problems.
The presumed increase in anxiety, depression, and post-traumatic stress disorder cases will be no less significant. Previous studies show that one-third of people hospitalized with SARS had developed moderate or severe symptoms of depression within a year of overcoming the illness.
In dentistry, it is emphasized that there is a positive association between periodontitis and nosocomial pneumonia in patients admitted to intensive care. This could further complicate the prognosis of patients with coronavirus referred to these units.
