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Let’s Salute Our Children, Pre-Teens And Teens

Let’s Salute Our Children, Pre-Teens And Teens

 

 

 

 

 

 

 

 

Dr Maya Amlani was born and raised in London, England where she also went to university to study Dentistry. She moved to Kenya in 2019 with the aim of contributing to the public health sector here. She provides dental treatment and promotes dental education and tips to patients at her private practice and on social media. She also spends time volunteering by performing dental treatment for remote communities which are otherwise unable to access such treatment. With the ongoing pandemic having challenged health systems and professions, Dr Amlani discusses the effects of Covid-19 on dentistry and explores the role of oral hygiene and health in the prevention and transmission of viruses.

BY MILLY MAINA

Where did you study and what qualifications do you hold? I studied at King’s College London and graduated with a Bachelor of Dental Surgery (BDS). I have also achieved additional qualifications in paediatric dentistry from the Eastman Dental Hospital, University College London Hospital.

What motivated you into dentistry? And to get further qualifications in paediatric dentistry? My older brother who is a doctor introduced me to the idea of studying dentistry. It appealed to me because it is the most hands-on specialty in the medical field. I also liked the idea that you have the potential opportunity to see your patients for years and years and build a long-term relationship with them.

I was inspired to get extra training in paediatric dentistry because I found children really tricky to treat when I first graduated. They bring a whole host of challenges which are very different compared to adult patients. I wanted to develop my skills in working with children to ensure I could treat them confidently and effectively throughout my career. I think now I prefer treating them to adults!

Let us talk about dentistry and the pandemic. The US CDC has recommended that dental facilities postpone elective procedures, surgeries and non-urgent dental visits and priorities urgent and emergency visits and procedures for now. What is your take on this? I think that it is a responsible decision because firstly, I believe that it is our communal responsibility to stay at home as much as possible to limit the transmission of infection. The majority of dentistry is elective and can be delayed until there is less risk.

Secondly, the work of a dentist is extremely high-risk in terms of infection transmission. We are working very close to the mouth and in close proximity to our patients. We also carry out procedures which are “aerosol generating” and can irritate the back of the throat and cause virus particles to spread. So, to protect dentists, dental-nurses and patients from potentially transmitting and further spreading Covid-19, it is wise to temporarily suspend non-urgent dental care.

Lastly, elective dental care should be suspended because of the global shortage of personal protective equipment (PPE)- the masks, gloves, gowns and facial

shields- that our front-line workers desperately need. If we keep using them in dental practice, we are restricting the supply available for our doctors, nurses and other front-line workers.

What dental procedures would be classified as emergencies for them to be prioritised during a global pandemic?Normally, a dental emergency would include things such as intense dental pain, dental trauma, facial swellings or a lost bridge or filling. But this has changed during the pandemic. In a number of countries, the dental authorities have issued a set of guidelines for dental professionals to follow, which contains advice regarding what should be considered a dental emergency during this time.

The Kenya Dental Association has included the following in their classification of dental emergencies: uncontrolled bleeding from the mouth or orofacial region; cellulitis and soft tissue infections that may compromise the airway; trauma involving the facial bones that may compromise the airway; and cancer patients in need of urgent care. These are the emergencies that would be ideally managed in a hospital setting. If you are experiencing excruciating dental pain, have sustained any dental trauma or have suffered from any other form of dental emergency, you must seek dental advice, be it in person or over the phone. Certain treatments such as a tooth being completely knocked out (avulsed) are time dependent so quick management is essential even if it is carried out by you at home with the dentist on the phone. Where necessary, you will be advised to visit a dental practice or hospital.

Is the risk of exposure to a virus, not just the one that causes Covid-19, increased in your line of work? Yes, dentists and dental nurses are definitely at higher risk of being exposed to many infectious diseases including viruses. That is why PPE is very important.

Can dental and oral hygiene contribute to the prevention of contracting viruses and other diseases? Specifically related to Covid-19, some interesting research is currently being carried out in the United Kingdom on the potential link between poor oral hygiene and the increased susceptibility to Covid-19 complications. The bacteria present in patients with severe Covid-19 are associated with the oral cavity and improved dental hygiene may reduce the risk of complications.   

Other research has shown that toothpastes contain the same detergents as antibacterial hand gels and as the virus spreads via saliva and cough droplets, using toothpaste could kill the germs before they are spread further. The British Dental Association has suggested that it may be beneficial for people to brush their teeth before going outdoors and for front-line workers before putting on their PPE.

In general, good dental and oral hygiene is vital to prevent gum disease and dental decay, both of which are highly prevalent bacterial diseases. In denture wearers, it is crucial in avoiding opportunistic fungal infections. Poor oral hygiene is associated with rarer diseases such as necrotizing gingivitis and the exacerbation of existing viral infections.

Health experts predict that we will not go back to life as we know it anytime soon until a vaccine for Covid-19 is developed; that wearing masks and social distancing might have to be part of our daily life going forward. What predictions can you make on the changes the practice of dentistry is likely to witness as a result of this pandemic? I think dentistry is a profession that will be heavily impacted in the aftermath of Covid-19 and a public health response will be needed to help manage this situation.  As I touched on earlier, dentistry is a high-risk profession for the transmission of infectious disease and this pandemic has demonstrated that our existing PPE protocols may not offer adequate protection in the future.

The infection control protocols may change with regards to disinfection and sterilisation of the surgery in-between patients. The use of ventilation in medical settings has been heavily discussed during this pandemic and that too is something that may transfer across to regular practice once this pandemic is resolved.   

Another dental complication of the pandemic will be managing the backlog of dental patients who have been unable to access dental care during this time, especially in countries where dental services are already heavily burdened. This build up will inevitably have a detrimental impact on oral health and patient care. People may find that they struggle to access dental care even when dental practices reopen.

Another exacerbating factor will be the addition of more lengthy infection control procedures, meaning that the turnaround between patients is longer, ultimately resulting in less patients being seen per day.

The increased levels of infection control, in addition to the possible PPE requirement changes and the slower patient turnaround, will result in increased costs for the dental practice. How these extra costs will be managed is yet to be seen.

Another implication for the poorest population is that they may not be able to afford dental cleaning aids due the impact of the pandemic on their earning potential. Simple implementations such as rinsing with water after eating sugar and avoiding sugar just before sleeping may be helpful.

What does personal oral hygiene and dental care for a dentist look like?I use an electric toothbrush because I find it easier. I brush twice a day with a fluoridated toothpaste for at least two minutes. After brushing I spit out the excess toothpaste without rinsing with water. I also make sure that I brush my teeth every night after dinner and that I only have water after brushing. I use mouthwash once a day at a different time to brushing, normally after lunch. I try to floss four to five times a week.

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