Routine Oral and Dental Care

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COVID-19 is a respiratory illness that can spread from person-to-person. The virus that causes COVID-19 is a novel coronavirus first identified in 2019. Everyone exposed to the virus is at risk, but older adults and those with chronic diseases (cardiovascular disease, diabetes, asthma, cancer, and other underlying medical conditions) are at higher risk for severe illness.

Although COVID-19 is predominantly a respiratory disease, many people have reported symptoms that go beyond the respiratory system, including those affecting the mouth.

The delay of preventive oral health care, wearing masks to reduce the spread, and the stress caused by COVID-19 has resulted in a higher incidence of adverse oral conditions for some.

Mask mouth describes the variety of oral side effects from wearing a mask for an extended time. Mask mouth might include dry mouth, bad breath, tooth decay, and even gum disease. Dental professionals attribute these side effects to a few factors:

Studies shows how wearing a mask can impact breathing, causing more rapid, shallow breaths using the mouth, chest, and neck instead of the diaphragm. Breathing out of your mouth decreases the amount of saliva, which plays an important role in oral health - washing away food debris and defending teeth from cavities.

Wearing a mask also causes you to drink less water than usual. Dehydration can lead to dry mouth, increasing the risk of tooth decay and bad breath.

When wearing a mask, more carbon dioxide is trapped in your mouth than usual, but it does not result in a toxicological effect on your body. However, it can increase your oral microbiome's acidity, which might put you at risk for infections or inflammatory conditions like gum disease.

The severity of mask mouth symptoms varies for each person, but the condition most commonly presents itself as:

Xerostomia, or dry mouth, occurs when you don't have enough saliva to keep your mouth moist. Not only does dry mouth make it difficult to eat, swallow, and speak, but it also increases your chance of developing tooth decay and other oral infections.

What you eat, your oral hygiene habits, and dry mouth can cause halitosis, more commonly known as bad breath. Prolonged mask-wearing can intensify dry mouth, but it also traps the stench caused by poor oral hygiene or eating smelly foods like garlic and onions.

If you notice your gums are swollen or bleeding, it could be a sign of gingivitis. Wearing a mask may impact the type and number of bacteria in your mouth, which can cause plaque build-up and advance that to your gum tissues.

Even if you experience some of these symptoms, wearing your mask slows the spread of the virus and helps protect the vulnerable in your community. Instead, implement some of these preventative measures:

Brush your teeth for two minutes twice a day and clean between your teeth with floss or other interdental devices once a day. Make sure to use the proper brushing technique to clean your mouth's nooks and crannies.

Keep a mouthwash on hand to freshen your breath and fight bacteria between cleanings. Ask your dental professional to recommend a mouthwash that does not exacerbate dry mouth. Chewing sugar-free gum can also help remove food debris and fix bad breath.

Because mask mouth increases your chances of infection, watch out for sensitive teeth and gums. If you notice any discoloration, pain, bleeding, or tenderness, see your dentist as soon as you safely can for treatment.

Drink water throughout the day to help prevent dry mouth. It might also help to limit alcohol and coffee consumption, which can cause dehydration.

Regularly replace or clean your mask to prevent bacterial growth. The Centers for Disease Control and Prevention (CDC) recommends washing your mask daily or throwing your mask out after each wear.

If you notice any oral complications from extended mask use, contact your dentist immediately. Similarly, if your mask causes skin issues, talk to your dermatologist.

The COVID-19 pandemic has caused a significant adverse effect on the emotional well-being of many. Loss of income, loss of loved ones, fear of coronavirus, and illness can all contribute to a condition called bruxism or teeth grinding and clenching. This condition can cause:

• Cracked teeth
• Loose teeth
  
• Temporal mandibular joint pain
  
• Headaches
  
• Wear on teeth
  
• Increased sensitivity to hot and cold
  

Consulting your dentists and having a mouth guard made could be the best solution. They may also recommend warm compresses and pain relievers. If you are unable to see a dentist right away, there are over-the-counter mouth guards that can be worn to relieve the symptoms.

Oral health should be a priority. There is a lot you can do through simple day-to-day habits.

• Brush twice daily for two minutes with a fluoridated toothpaste
• Properly floss and brush/clean your tongue once daily
  
• Never share a toothbrush
  
• Change your toothbrush every three months or sooner if you are sick
  
• Drink plenty of fluoridated water
  
• Limit starchy or sugary foods and drinks
  
• Resist unhealthy habits to manage stress (smoking, consuming alcohol, biting fingernails)
  

If your gums bleed while brushing or flossing, continue to brush and floss gently and thoroughly. Often when gum health improves, bleeding decreases.

For periodontal disease make sure to continue to brush your teeth with fluoridated toothpaste twice a day. The toothbrush should be angled where the teeth and gums meet. Flossing at least one time per day should also be part of your daily routine. You can add a mouth rinse to decrease the number of bacteria in your mouth.

For untreated dental cavities brushing your teeth with fluoridated toothpaste, flossing, and drinking water is helpful. To this routine, adding the use of sugarfree or xylitol-containing gum, eliminating sugar and carbohydrate snacks can help stop cavities from developing further.

For temporary crowns, temporary fillings, and in process root canal treatments, clean the area carefully and avoid chewing gum, chewy/sticky foods, and chewing on hard items, such as popcorn or ice chips. It is important to keep your tooth sealed.

If you experience any problems, contact your dentist.

Bleeding, acute pain or infection, and dental trauma are examples. Denture and some orthodontic issues impacting function may also be considered.

• Bleeding that doesn’t stop
• Painful swelling in or around your mouth
  
• Pain in a tooth, teeth, or jawbone
  
• Gum infection with pain or swelling
  
• After surgery treatment (dressing change, stitch/suture removal)
  
• Broken or knocked-out tooth
  
• Denture adjustment for people receiving radiation or other treatment for cancer
  
• Snipping or adjusting wire of braces that hurts your cheek or gums
  
• Biopsy of abnormal tissue
  

The CDC states that there is an increased need for access to oral health prevention, since many deferred dental visits during the COVID-19 pandemic. Now that dental offices have reopened, it is important to get professionally assessed for any oral diseases, stress-related habits that you may have (such as clenching or grinding), or untreated dental/oral diseases.

Dental offices have a high adherence to infection control procedures using personal protective equipment (PPE) (gloves, masks, etc.) and cleaning surfaces with high-level disinfectant. This combination has resulted in a history of safety. Additional PPE and disinfection are required for safe care during this time of COVID-19, including use of a N95 mask and other air processing measures.

• Understand your dentist may need extra measures and more time to complete your appointment.
• More PPE and cleaning may be required, which can result in the need for more time between patients.
  
• Inform the dental staff if you are currently sick and or recently exposed to someone who tested positive for COVID-19.
  
• If you have any COVID-19 symptoms, do not go to the dentist. Contact your physician who may suggest you be tested and isolate for a period of time.
  

If you do not have a regular source of dental care, make a contact through one of the sources below. In addition, the IDPH Oral Health Section has listed and mapped a dental resource map.

The below other sources are that may be helpful in your search for oral health services.

• “Find a Dentist” for Illinois State Dental Society (ISDS) member dentist directory: https://www.isds.org/for-the-public/find-a-dentist
• “Find a Dental Clinic” resource on the ISDS website: https://www.isds.org/for-the-public/find-a-dental-clinic. This is a listing of clinics for people with limited financial ability.
  
• Illinois’ federally qualified health centers: https://findahealthcenter.hrsa.gov. These centers are for people who are low income, uninsured, or are undocumented residents.
  
• Several local health department webpages will list if they have an oral health program..
  
• Illinois has three dental schools. Information about accessing urgent dental care is available by calling or visiting their website.