Oral care during COVID-19

Experts from the School of Dental Medicine share tips on how to maintain healthy teeth and gums even when a trip to the dentist isn’t in the cards for the time being and what to expect as restrictions are lifted.

Parent brushes their toddler’s teeth seen in a bathroom mirror

Staying healthy during the pandemic doesn’t just mean avoiding infection with COVID-19. Keeping up with routine oral care is a crucial part of overall health. And while dentists and dental hygienists may remind us that a visit every six months is a part of that maintenance, such regular checkups might not be a reality for many around the country, at least for the short term.

In the Philadelphia area, dental care went from being off limits, to being emergency-only, and now, open to elective and nonemergency procedures but with stipulations that emphasize lower-risk procedures, such as those that do not produce aerosols.

Penn Today spoke with the School of Dental Medicine’s Deanne Wallaert, public health dental hygiene practitioner, about how to keep up or enhance dental home care, and to Mark Wolff, Morton Amsterdam Dean, about what to expect as nonemergency dental visits resume.

If routine dental care is off limits, are there any special precautions we should be taking to safeguard our dental health?

Wallaert: There really are no special precautions during this time. It’s a matter of continuing with what the dental professional team has recommended all along. If you up your oral hygiene game, that’s going to help you get through this.

Brushing: Never skip brushing before bed, and make sure you’re brushing twice a day for two minutes using fluoridated toothpaste. An electric toothbrush has the ability to remove much more plaque and bacteria much more than a manual toothbrush. Remember to change your manual toothbrush or replace your electric toothbrush head every three months, or after you’ve been ill. If you’re concerned about infection, you can disinfect your toothbrush daily by running it under really hot water for a few minutes. Or depending on the brand, you can even boil your manual toothbrush.

Also keep in mind that you might want to brush your tongue. A lot of bacteria plays hide and seek under the papillae on our tongues and can cause halitosis, or bad breath. I hear from patients that they gag when they brush their tongue, so you can also buy a tongue scraper. Or even a spoon will do the same thing. You just put it back and rake it toward the front of your mouth, or side to side, and that will be effective. 

Interdental cleaning: Flossing is really important. If people have trouble with string floss, those premade flossers work really well too. One time a day is recommended but flossing twice a day won’t hurt. 

Mouthwash: Another thing that will you keep you feeling fresh is using a mouth rinse. The swishing action reaches areas the brush and floss miss. Read the label of whatever product you choose to know how long to use it. If you experience dry mouth, we recommend using a mouth rinse with no alcohol. If you’re concerned about cavities a fluoride rinse is what’s recommended.

Nutrition: It’s really important to minimize the simple carbohydrates and sugar consumption in between meals. Simple carbs, like pastas or cereals, convert to sugar really quickly in the mouth; those are cavity-causing foods. We recommend eating more fresh and crunchy vegetables, maybe serving them with hummus or a ranch-style dip if you’re having trouble getting your kids to enjoy them. 

We also encourage people to drink more water.  If you don’t love the flavor of your tap water, you can use filters and to help remove any bad flavor without removing the fluoride. When you drink water with fluoride, it gets into our saliva, so it’s like an extra little bath of fluoride throughout the day.

Reducing the sugar-containing beverages between meals will help your teeth stay healthy. Just for example, a can of soft drink can contain 10 or more teaspoons of sugar. If you’re taking little sips of a sweetened coffee or tea beverage throughout the day, you’re bathing your mouth in sugar. I’m not saying don’t have these beverages. But consider drinking it through a straw and drinking it all at once rather than stretching the damage out over a longer time.

Do you have any special advice for babies, children, or the elderly who may have more complex dental needs?

Wallaert: For kids it never hurts to help them with brushing and flossing, making sure they’re brushing with a fluoridated toothpaste. For babies before they get their teeth, you can wipe their gums down with a washcloth morning and night. Once they have teeth, you just want to use a smear of toothpaste; the size of a grain of rice is what’s recommended on the brush. Brushing before night is very important. For babies that might be nursing or having formula overnight, we’ve seen some of them have decalcification in their teeth from that. Your saliva levels decrease at night so there’s less opportunity to wash away those sugars.

For older kids, 2 and above, they should be using a small pea-sized amount of toothpaste. We advise helping kids brush until they’re able to tie their own shoes, and even beyond that it’s good to go in and help them out. You can have them brush, encourage that independence, then go in afterward and make sure they hit all the tough spots.

Caregivers should also help kids clean in between their teeth. Once kids’ teeth are touching, they should be flossing or cleaning interdentally. And a rinse is recommended as long as they’re able to spit it out in the sink. 

For older adults, if they need a caregiver that person should assist with cleaning the oral cavity. Many people, young and old, take medications that cause dry mouth, and that puts them at an increased risk of getting cavities because of that lack of saliva. There are some over-the-counter rinses, toothpastes, and lozenges that are specifically designed to help dry mouth. We really encourage not using mint and candies to overcome dry mouth. That really concentrates the sugars in one spot. And once a cavity begins it will continue to grow, which can cause tooth pain and eventually even tooth loss.

Those who have removable dentures or partials, should remember to remove them at nighttime to let the tissues breathe. I will always say to patients, It’s like you wouldn’t sleep in your shoes and socks. They should clean their appliance daily in a denture cleaner, and never use toothpaste because it can cause scratches on the appliance.

What should we be paying attention to catch problems early, and what qualifies as a dental emergency?

Wallaert: It’s kind of the same as always: Pay attention to pain and swelling, pain when drinking and eating, or pain that keeps you awake at night. Call your dental professional and they’ll be able to help assess the concern you have and they may have you come into the office if it’s more serious. You don’t necessarily notice your teeth until they start causing you pain, so I encourage anyone who is experiencing pain to contact their dental professional.

What is Penn Dental Medicine doing to prepare for opening up to performing more services? And how might those appointments look different going forward?

Wolff: We are taking all the usual precautions—personal protective equipment, disinfecting, and cleaning—and moving them up a notch. We have increased disinfection of tables, chairs, door handles, and other surfaces. We have decreased the number of people entering the building and the number of appointments to allow for social distancing. Everyone will be wearing masks, and we will all be practicing social distancing.

Before anyone comes into the office, we are going to start you off with a phone call, or telehealth encounter, where you’ll be asked about your health and possible exposure to the coronavirus. We’re going to be prioritizing treating people who really need to be seen urgently: those who have serious issues, maybe pain, tooth decay, or gum disease. Those who just want to come in for their regular six-month cleaning but otherwise have a pretty healthy mouth: We may ask you to hold off on coming in for the time being, as we will be seeing fewer patients every day.

We will be able to protect our patients from the virus while at Penn Dental Medicine, and we will ask our patients to be safe during their trip to and from the dentist. While getting to and from our dental care center, patients should always wear a mask, use hand sanitizer frequently, not touch their face without disinfecting their hands, and practice social separation as much as possible. Because we’re striving to keep the number of people in the office to a minimum, we’ll ask you to wait in your car until it’s time to come back to the chair.

We will take your temperature on entering the building and ask if you have had any of the following in the prior 14 days: fever greater than 100.3 degrees Fahrenheit, cough, sore throat, shortness of breath, flu-like symptoms, muscle ache, chills, tiredness, diarrhea, recent and abrupt loss or reduction of the sense of smell or taste, or close personal contact without PPE with a suspected or laboratory-confirmed COVID-19 patient. If you have any of the above, we will ask you to consult with your primary health care provider. 

After the appointment, we’re also going to be following up with you 48 hours later to make sure you’re still feeling well. Dental care is crucial, and we want to make sure we’re able to provide it in as safe an environment as possible.

Deanne Wallaert is a public health dental hygiene practitioner at the University of Pennsylvania School of Dental Medicine.

Mark Wolff is the Morton Amsterdam Dean and professor in the Division of Restorative Dentistry at the University of Pennsylvania School of Dental Medicine.