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Is dentistry relevant to Covid -19 risk?

Where lays the biggest risk, in seeing your dentist or in NOT seeing your dentist?

It has been suggested that seeing your dentist is a risk in the present COVID-19 alert, that there is an increased infection rate through dental procedures. Research is suggesting the coronavirus may be able to spread in aerosol, fine water droplets that are suspended in the air, such as that produced by the dentist’s drill or hygienist’s scaler.

The question is what is the risk? One has to assess the level of risk in everything we do and way up the danger against the benefits, that’s life! We risk assess crossing the road or driving a car, taking a flight or eating sweet foods. We are aware of the dangers and we know why we like to do it, so we make an educated decision on whether or not to go ahead. Often the benefits outweigh the risk and the risk is really very small. The mental and physical boost from a holiday abroad is not overshadowed by the minimal risk of flying, we benefit from the holiday. The airlines are very diligent in reducing our exposure to risk, we trust them to be safe and take us off to the joy of our vacation.

The dental world has been faced with this before, AIDS, CJD, Hepatitis, severe conditions that can theoretically be passed on in a clinical setting, but the evidence on recorded cases of cross contamination are next to none. We have always assessed the risk and put precautions in place to protect our Public, our patients, we are good at it. So now is no different. At Whelby we have instigated a raft of safety procedures to reduce risk (click here to learn more). New patient journeys through the practice, ventilation, air filtration and high-volume suction and protective barriers reduce your exposure to these virus holding aerosols to a minimum.

Dental aerosol is clean water mixed with saliva, at average saliva flow 0.4ml/min and drill water flow at 120ml/min, the average saliva concentration is around 0.6% in dental aerosol. Bear in mind that 90% of this is removed by the high volume suction, dental barriers reduce this further: then once out of the mouth, external high volume suction and increased ventilation systems scavenge the air, before the aerosol is given fallow time to settle between patients and the room is fogged and all surfaces are decontaminated…..the risk is reduced to minimal levels

Consider the fact that such aerosols are also produced by a cough or sneeze, even loud talking. The concentration of COVID-19 in such an aerosol producing event is high, it is released straight from the throat, where the virus likes to colonise and reproduce. It is 100% mucous secretions. In COVID-19 breath 38% of the droplets contain virus RNA, this really does constitute a potential risk. Be careful outside the clinical environment!

So, here’s the kicker: the risk of cross infection can be kept very low, but people are still infected (not in the dental surgery from current evidence). Once infected the disease effects individuals differently according to their predisposition. We are all aware of age and race playing a part, but there are other risk factors to becoming severely sick.

New research is suggesting the mechanisms for severe reactions and mortality with coronavirus are similar and linked to dental health and “gum disease”. Researchers into SARS-CoV-2, the coronavirus, have found the importance of cytokine storms in the severe tissue destruction caused. This is marked by a rise in interleukin-6 (IL-6). The same rise in IL-6 is brought about by “gum disease”. Raised IL-6 is a predisposition to severe lung and respiratory problems in COVID-19

Therefore, we can reduce to a minimum the chance of contracting COVID -19 in the dental chair and 80% of people will only experience mild flu-like symptoms with no long-term damage, but the 20% will be at a higher risk of severe illness if they are predisposed. The reduction of IL-6 can reduce your risk, and this has direct links to periodontal (gum) disease.

To summarise, you may think avoiding the dentist will keep you safe during this epidemic, but in reality, leaving dental disease unchecked and untreated will have the potential to increase your risk to severe complication and hospitalisation from coronavirus infection.

A well-controlled visit to the dentist (read more on the precautions we take) should be given strong consideration in reducing your risk to the disease.

Please take care out there, if anyone has any concerns please feel free to call for a dental health check to put your mind at rest.

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