Q&A with Dr. Jeff: Exploring the Connection Between COVID-19 and Oral Health
COVID-19 has been part of every Iowan’s life for nearly 2 years. Researchers are continuously learning about the disease, including how oral health affects the severity of the virus.
Dr. Jeffrey Chaffin, Chief Dental Officer for Delta Dental of Iowa, shares an update on the links between COVID-19 and oral health, and the key considerations to help protect your total health.
Q: Can you share a brief overview of the research linking COVID-19 severity and oral health status?
Dr. Chaffin: There is a lot of emerging research on COVID-19 as a whole. It seems like researchers learn more each week during this pandemic, and the new learnings are more evidence-based.
Some of the recent studies on oral health and COVID-19 focus on gum disease. We often use gum disease as a more global term, with gingivitis being early gum disease with inflamed gums but no loss of tooth. Gingivitis can progress to periodontitis, the most serious form of gum disease. Periodontitis is when we see destruction of the supporting bone and even tooth loss from inflammation and bacteria.
A recent study reported that COVID-19 patients with gum disease were 3.5 times more likely to be admitted to the intensive care unit, 4.5 times more likely to need a ventilator and nearly 9 times more likely to die compared to those without gum disease.1 It’s important to know that gum disease doesn’t cause COVID-19, but severe gum disease can be a sign of overall poor health — and that overall poor health is often a factor in how severe a person's COVID-19 case will be.
Q: Based on what we know about these study findings so far, what is the main takeaway patients should understand?
Dr. Chaffin: The latest research emphasizes the importance of good overall and oral health, and that good oral health is a part of overall health. A person’s body must be healthy in order to combat diseases and viruses. COVID-19 is serious, but it’s only one of the viruses we encounter throughout our lives. Taking your overall health seriously will help you lead a happier and healthier life.
Q: Some patients have put their twice-yearly dental visits on hold due to concern for COVID-19. What would you say to patients who might be worried about their risk for contracting COVID-19 in the dental environment?
Dr. Chaffin: I totally understand why patients may have delayed routine dental care early in the pandemic. Many dental offices were closed for a few months. Those closures shouldn’t scare patients, as a major reason for the closure was the shortage of personal protective equipment (PPE). Closing dental offices and delaying routine medical appointments saved the protective equipment for the most serious health conditions and the surge of COVID-19 patients.
Dentistry has always been a leader in infection control and has modified its procedures for COVID-19. To date, there is no known transmission of COVID-19 in a dental care setting.
Many patients have restarted their dental preventive visits over the last year. Given that overall and oral health are so important, I think that almost everyone should keep up with their routine dental preventive care. There may be a small segment of the population that is at extreme risk of getting COVID-19 and other viruses based on their health conditions. In those limited situations, those patients should seek advice from their medical and dental providers before restarting routine preventive dental care.
Q: Looking at how COVID-19 severity and oral health are connected, what does this say about the importance of oral health to the total health picture?
Dr. Chaffin: I believe that this is another scenario that shows the connection between oral and overall health. Good oral health is a major predictor in one’s quality of life, but it is much more than just quality of life. The mouth is a part of the body — just because the providers who treat diseases of the mouth may be different from providers who treat diseases in other parts of the body doesn’t minimize the importance of oral health to overall health.
Q: Do you have any other words of advice for patients about their oral health and COVID-19?
Dr. Chaffin: The first thing is to take COVID-19 seriously. Preventive measures are available for everyone to be safe. Often, those preventive measures are not only for our own personal health, but also for the health of our families and those in our community. Patients should schedule their routine preventive dental care because minor dental conditions can become worse and more expensive to treat over time.
Everyone should assess their own risk but most people find that visiting the dentist is safe and important part of maintaining good health.
1Association between periodontitis and severity of COVID‐19 infection: A case–control study” by Wenji Cai, Belinda Nicolau and al. was published in the Journal of Clinical Periodontology, 2021
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Pain Relief Options After Dental Surgery
If you have dental surgery planned, one of your big questions may be about easing your pain when you get home from your procedure. Are opioid pain relievers your only option? Will medications like ibuprofen and acetaminophen be enough to manage your pain?
If your dentist suggests oral surgery, now is a good time to think through the options you have for pain relief. You should feel encouraged to share your concerns, preferences, questions and past pain management experiences with your oral surgeon.
Here, we’ll share information about changing perspectives on pain relief after oral surgery in hopes that it will help shed light on recommendations your doctor may provide for you.
Are Opioids the Best Option for Intense Pain?
Immediately after dental surgery, you may not feel any pain because the numbing agent used during your surgery may not have worn off yet. But once you’re home, you’ll begin to feel post-operative pain. Depending on the type of oral surgery, this may be significant pain.
Opioids, also known as narcotics, are strong pain relievers. Decades ago, prescribing an opioid, such as Vicodin, was a standard practice among oral surgeons to manage their patients’ pain after dental surgery.
Today, we know a lot more about opioids. Many patients are aware that opioids bear a significant risk of dependance, addiction and abuse. Despite this awareness, patients undergoing oral surgery may request an opioid because they feel opioids are the only type of pain reliever able to reduce intense pain after surgery.
Fortunately, medical researchers have also learned more about the effectiveness of alternative pain management options. In fact, they have discovered other options that actually manage post-surgery pain better and more safely than opioids: ibuprofen and acetaminophen.
Ibuprofen and Acetaminophen: Can They Manage Post-Surgery Pain?
If your oral surgeon recommends a combination of ibuprofen and acetaminophen after surgery, you may wonder whether it will be enough to ease mouth pain after surgery. But studies show acetaminophen and ibuprofen, when combined, are more effective and safer than opioids at relieving dental pain.
Oral surgeons have to balance a patient’s need for pain relief with the possible adverse side effects of certain medications. Findings showing the safety and effectiveness of ibuprofen and acetaminophen are good news for patients.
It is important to recognize that, like all medications, ibuprofen and acetaminophen bear side effects too. Some patients cannot take these pain relievers and may need opioid pain relievers to manage their post-surgery pain. As a patient, it’s important you understand the options available to you and weigh the benefits and drawbacks with your oral surgeon to ensure your recovery experience is comfortable and safe.
Questions to Ask Your Dentist Before You Go Home
Below are examples of questions that can help you achieve pain relief safely. After surgery, you may not feel like interviewing your surgeon (and you may be so groggy you won’t be able to anyway). But it’s important you’re crystal clear on your post-surgery instructions. You can ask questions before your procedure or you can have the person who is taking you home after the procedure ask them on your behalf. Note: The questions below are specific to medication safety, but please ensure you understand all the at-home recovery instructions.
- How long do I take this medication?
- How much of this medication do I take each day?
- Do I need to take this drug with food or at a specific time each day?
- Are there activities I should avoid or dietary adjustments I need to make while taking this medicine?
- What should I do if this medication isn’t managing my pain?
- What side effects warrant a call to your office or emergency care?
- Does this drug have any interactions with the medications I’m already taking? (Important note: Make sure your surgeon knows about any medications or allergies you have.)