Dr Balika Reddy, BDS, Dentist at Harley Street Specialist Hospital, explains why it’s important to promote oral health and provide optimal dental care in Europe today
Oral health is more important than one might realise. The health of one’s mouth, teeth and gums can affect your general health. It has often been said that the mouth is a gateway to one’s overall health. A huge part of our remit is to educate the general public on taking care of their teeth, including oral hygiene and dietary advice. There is a lot of evidence to say a healthy mouth is essential for a healthy body.
Deterioration of oral health could mean that your general health is at risk. For example, untreated tooth decay or long-term periodontitis are linked to higher rates of heart disease and chest infections. Poor dental health results in weakened immune systems which, in turn, makes one prone to developing illnesses, infections and diseases.
With good dental hygiene, you can greatly reduce getting cavities, gingivitis, periodontitis and other dental problems. This, in turn, can reduce your risk of secondary problems caused by poor oral health. Some health problems that can be linked to poor oral health are diabetes, heart disease, osteoporosis, respiratory disease and cancer. Modern clinical practice emphasises preventative dentistry, in practice, this means dietary advice, fluoride application, fissure sealing and motivating patients to improve oral hygiene.
Issues facing dentists today
Dentistry has been one of the most challenging services to deliver during the pandemic, primarily due to aerosol-generating procedures such as carrying out fillings, crown preparations, surgical extractions use of ultrasonic scalers and the requirement for dentists to be in full PPE while staying close to the patients required to provide care.
9 million children missed out on care during the first lockdown. The proportion of children seen by an NHS dentist in the last twelve months fell from 58.7% as of March 2020 to 23% on 31st March 2021 (BDA news 27/08/21). BDA news also said 49.6% of adults were seen by an NHS dentist in the 24 months up to April 2020, falling to 42.8% in the period up to April 2021.
The frustrating challenges that a dentist faces today are having capacity slashed by pandemic restrictions and needing help to get patients back through their doors. In NHS practices in England, the BDA news website said, ‘around half the practices in England are not currently meeting controversial targets imposed by the government, that require them to hit 60% of pre- COVID activity levels and as a result, will face financial penalties.
While more routine treatments have been resumed under a phased return of services, strict hygiene measures and standard operating procedures have increased downtime between patients. This time is used to allow the room to be ventilated and then be thoroughly sanitised before the next patient comes in. This limits the number of non-urgent patients that can be seen, creating a bottleneck. Screening of oral cancer and periodontal diseases are carried out during routine dental check-up appointments. Delay in oral cancer referrals can have irreversible consequences as we are all aware early diagnosis is the key.
It is of deep concern that patients with conditions such as periodontitis (gum disease) are having to wait several months to get optimal treatment. Dentists are doing their best to prioritise who they are seeing, which includes patients with gum disease and dental emergencies, however, this makes it very difficult to see anyone else, such as children and teenagers who are missing out on their routine appointments.
A small occlusal cavity (small hole in the tooth) may be completely painless and hence not picked up by the individual, however, could end up needing a major procedure such as a root canal filling or an extraction due to the formation of an abscess. This highlights how important routine dental check-ups are and the detrimental effects it can have on society if these are not treated on time.
Postponing periodic check-ups & non-urgent dentistry
New coronavirus regulations mean that dentists have had to significantly reduce the numbers they treat to clean the surgery between patients to minimise the risk of transmitting the virus between patients. In my personal opinion, if the patients and we are vaccinated and with enhanced PPE, dentists should be able to offer most services. Every effort has to be made to not postpone periodic check-ups and non-urgent dental care. This could mean additional expense for the practices, as they will have to invest in more expensive equipment to purify the air and ensure better ventilation systems, hire more staff to assist in sanitisation and maintain infection control. This, in turn, means costs will have to go up for businesses, and patients will inevitably shoulder some of the increased costs. This is a small change we will all have to embrace to get services back to how they were pre- COVID. Failing which, I fear conditions like oral cancer, gum disease will go unnoticed and these can have irreparable long-term consequences.
There has been no meaningful relaxation of standard operating procedures so far, and millions are missing out on dental care, hence patients will be paying the price in years to come. Unless the government provides support and a transparent direction or strategy, I cannot see the situation improving. It is time for the professional and relevant authorities to reflect on what has happened so far. What have we done to measure the harm of these restrictions and is there an exaggerated nature of the threat?
Restorative dentistry including dental biomaterials
Dental biomaterials have been receiving a lot of attention lately, which are very similar to those used in orthopaedics. Dental biomaterials include metals, glass, polymers and ceramics.
Dental biomaterials have been playing an important role in the reconstruction of damaged dental tissues, as well as promoting tissue regeneration. Biomaterials are used in dentistry, mainly in restorative procedures such as restoration of teeth, replacement of teeth with dental implants and surgical procedures. As we embrace minimally invasive techniques in dentistry, through adhesive materials and adhesion principles, biomaterials have enabled clinicians to induce repair and regeneration of dental tissues. However, a thorough understanding of the chemistry of the materials and how they relate to the histology of the tissues for predicting the best outcome cannot be ignored.
The main objective of any technique is to extend the life of the restored teeth with the least intervention. When a biomaterial comes into contact with living tissue, it can react with tissues eliciting a chemical reaction and the oral cavity can be an extremely challenging environment. These materials have several limitations and require clinical research in unbiased settings. Ongoing research in regenerative treatments in dentistry includes alveolar ridge augmentation, bone tissue engineering and periodontal ligament replacement, and a future aim concerning bioengineering the whole tooth. Research towards developing bioengineered teeth is well underway and identification of adult stem sources to make this a viable treatment is advancing.
Modern dentistry, however, relies heavily on materials that provide optimal function and aesthetics. The ability to perform in a harsh oral environment without undergoing changes in diameter and stability has been a major focus of materials used in dentistry. Despite advances in tissue engineering, there has been limited progress, there remain distinct and important challenges in the development of reproducible and clinical safe approaches for oral tissue repair and regeneration.
- ‘Dental Mitigation Strategies to Reduce Aerosolization of SARS-CoV- 2’(02/08/21), J.J. Vernon, E.V.I. Black, T. Dennis, D.A. Devine, L. Fletcher, D.J. Wood, B. R. Nattress.
- NHS Digital’s Report ‘Underlines The Collapse in NHS Access’ (08/2021), Chris Tapper.
- NHS Dental Statistics for England-2020-21 Annual Report (26/08/21) • BBC News ‘Covid: Tooth loss fears over dentist check-up delays’ , Rachel Flint (28/08/21).
- Biomaterials fro Direct and Indirect Restorations: Concepts and Applications’, Mutlu Ozcan, Lucas da FOnseca Roberti Garcia, Claudia Anglea Maziero Volpato.
‘Biomaterials in Relation to Dentistry’, Sanjukta Deb et al. Front Oral Biol. 2015.