Corona Daily 333: Tooth fractures

An interactive chart ranks professions according to the coronavirus risk they face. Measured against two parameters, “exposure to diseases” and “physical proximity to others”, dentists are identified as carrying the highest risk.

In March, most dentists around the world shut their clinics. In April, YouTube posted some horrible clips about how to extract teeth by the DIY method.

Last month, WHO once again recommended delaying all “routine” dental care. American dental association vehemently disagreed with the advice.  It argued oral conditions are related to overall health. Routine visits can find diabetes, cancer or liver illnesses. Gum disease is linked to increased risk of stroke, respiratory disease, heart disease, diabetes, ulcers and arthritis. At the global level, an estimated 3.5 billion are affected by oral disease. Untreated dental caries in permanent teeth is the most common health condition in human beings.

And most of those 3.5 billion humans have not visited the dentist for the past six months. Increased intake of sweets and fizzy drinks have made our mouths dirtier.

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Dental associations argue many dentists have been wearing Personal Protective Equipment, masks, gloves, goggles since 1980s, after the HIV/AIDS epidemic. Now additional precautions are practiced. Fewer patients are given appointments, aerosols in the room are given time to settle before taking another patient, patients are spaced in the waiting rooms. Some dentists use rubber dams to cover the patient’s mouth, only exposing teeth that require work. Clinic ventilation is improved; expensive PPEs are bought for assistants. A 45 page document that recommends a re-opening plan for dentists worldwide is worth reading for any dentist, as well as for patients who need reassurance.

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In yesterday’s NYT, Dr Tammy Chen raises a new issue from her practice. She talks about an epidemic of tooth fractures. In the past six weeks, she has seen more tooth fractures than in the last six years. She gives two main reasons.

One is the stress. The pandemic related anxiety or coronaphobia leads to clenching and grinding, damaging the teeth.

Secondly, work from home has resulted in people working on sofas, beds, kitchen counters. The employee is sometimes C-shaped, bending to look at the smartphone. Dr Chen explains that the nerves in the neck and shoulder muscles lead into the TMJ (temporomandibular joint), which connects the jawbone to the skull. Bad posture during the day translates into a teeth-grinding problem at night.

Most people aren’t getting restorative sleep. Restlessness and insomnia are on the rise. Instead of resting and recharging, the body stays in a battle-ready state, and that tension is expressed through the teeth. Most of Dr Chen’s patients are unaware of their teeth grinding. (Heavy snorers also deny they snore).

Are your teeth currently touching, Dr Chen asks us. They shouldn’t, throughout the day, except when eating and chewing. To protect, a device called night guard or retainer can be held between the teeth. Better to crack a night guard than a tooth, says Dr Chen.

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Based on my reading, a summary:

·     Unless you are among the most vulnerable Covid-19 group, please visit your dentist, including for a preventive routine check.

·       Call to check precautions taken by the clinic and expected from the patients.

·       The pandemic may last for a long time. Not visiting a dentist for more than a year can create health problems worse than Covid-19.

·       Check your posture when working. Get a proper ergonomic chair and a table. When seated, your shoulders should be over your hips, and your ears should be over your shoulders. Computer screens should be at eye level.  

Ravi