Dr Seif El Din Hegab

It found that patients with inadequate oral hygiene routines produced positive test results – despite their clinical recovery. Clinical recovery was determined as returning to normal body temperature and termination of supportive oxygen inhalation. As a result, researchers at a hospital in Tokyo, Japan, suggest oral hygiene could affect the accuracy of coronavirus testing. Regular toothbrushing Among the eight patients assessed, the average viral shedding period – the time from the onset of symptoms until the virus was undetectable – was found to be 15.1 days. Reported symptoms included a fever, cough and diarrhoea. However, for patients one and two, the viral shedding period continued for 53 and 44 days. For the patients three to eight, two negative tests were confirmed within 18 days of clinical recovery. The team found that patients three to eight had adequately maintained their hygiene routines, which included regular toothbrushing. In contrast, patients one and two – who had mental or psychiatric disorders – did not voluntarily brush their teeth in hospital. But once asked to practise regular gargling and toothbrushing, both patients produced a negative test result within four to nine days. Hygiene improves accuracy The researchers concluded: ‘In this study, six of the eight patients with mild to moderate COVID‐19 had a viral shedding period of 30 days or less. ‘But two patients had significantly longer shedding periods. In such prolonged viral shedding cases, noninfectious viral nucleic acid may accumulate in an uncleaned oral cavity and may continue to be detected by PCR. ‘We propose tooth brushing and gargling to remove accumulated noninfectious viral nucleic acid, leading to consistently negative PCR test results. Thus avoiding unnecessarily long hospital stays.’ By concluding that appropriate oral hygiene care may decrease the viral shedding period, the team suggested it could help to prevent unnecessarily long hospital stays.

Causes Canker sores have no known causes. Researchers have identified numerous factors associated with canker sores, including: genetics infections physical or emotional stress food intolerance or allergies injury or damage to the tissues of the mouth hormonal changes, such as those experienced during menstrual cycles, pregnancy, and menopause nutritional deficiencies, such as low iron, vitamin B12, and folic acid blood disorders, such as Sutton Disease II or Behcet’s disease Risk factors A research article in BMC Oral Health indicates the following factors may increase the chances of developing a canker sore on the lip: injury or tissue damage due to dental work, sports accident, or accidentally biting the lip using oral hygiene products that contain sodium lauryl sulfate poor oral hygiene that leads to bacterial overgrowth in the mouth eating spicy or acidic foods eating foods that trigger allergic reactions, such as eggs, nuts, dairy, or chocolate changes in hormone levels experience intense or chronic emotional stress having a weakened or overactive immune system In one 2014 study, researchers investigated canker sore occurrence in 3,244 people from India. They found that canker sores primarily affected females and adults in their 30s and 40s. Symptoms A canker sore is a round, white, or yellow sore that forms on the soft tissue inside the mouth. A person can develop a single canker sore or clusters of canker sores at a time. Canker sores are usually recurrent, non-contagious, and heal within 4–14 days without treatment. According to one article, there are three types of canker sore. These include minor, major, and herpetiform. A minor canker sore is smaller than 5 millimeters (mm) in diameter and moderately painful. Major canker sores are larger than 5 mm. People usually only develop one or two major canker sores at one time. These canker sores can lead to significant pain and discomfort, especially while eating, drinking, or speaking. A major canker sore can take several weeks or months to heal. Herpetiform canker sores occur when a cluster of pinpoint ulcers fuse, forming one large, irregularly shaped lesion. This is the rarest form, accounting for 5–10% of all canker sore diagnoses. Diagnosis A doctor can diagnose a canker sore based on a physical exam. They may also ask about a person’s current symptoms and whether they have a history of mouth sores, nutritional deficiencies, or other canker-sore risk factors. A doctor may order laboratory tests, such as blood work or a swab culture of the lesion. They use these tests to rule out other potential diagnoses, such as cold sores and bacterial infections. Treatment Most canker sores heal on their own without medical treatment. However, certain over-the-counter (OTC) and prescription treatments can help prevent infection and promote healing. Treatment options for a canker sore on the lip include: OTC gel, paste, or patch An over-the-counter (OTC) gel or paste, such as Orajel, soothes canker sore pain and shields it from external irritants, such as food and bacteria. Inner mouth patches cover open sores inside the mouth. These patches protect against irritants and promote faster healing. OTC anti-inflammatory drugs Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pain and reduce inflammation. Medicated mouthwash Mouthwash containing hydrogen peroxide, chlorhexidine, or zinc sulfate prevents the growth of harmful microorganisms, such as bacteria. Antiseptic mouthwashes may also promote faster healing and prevent canker sores in the future. Some prescription mouthwashes contain a local anesthetic or a corticosteroid to relieve pain and reduce inflammation. Systemic treatments A doctor may recommend one of the following medications if a person experiences severe canker sores that do not respond to more conservative treatments: sucralfate (Carafate), which people typically use to treat intestinal ulcers colchicine (Mitigare) is a potent anti-inflammatory that people use to treat gout prescription oral corticosteroid, such as prednisone Home remedies People may manage and help treat canker sores at home with these steps: drinking warm chamomile tea with honey chewing or suck on ice chips to numb a canker sore maintaining good oral hygiene using a soft toothbrush limiting or avoiding spicy or acidic foods limiting or avoiding food sensitivities, such as eggs, nuts, coffee, or chocolate eating foods rich in folic acid and iron, such as legumes and leafy greens taking a vitamin B12, iron, or folic acid supplement Click here to learn more about ways to treat canker sores.

The FDI World Dental Federation states: ‘A good oral hygiene routine, regular dental check-ups and a healthy lifestyle are crucial for protecting oral health and maintaining general health’. Oral diseases, if left untreated, not only impact the mouth, but can also impact every aspect of life. ‘The COVID-19 pandemic has severely affected oral health around the globe. In addition to fuelling unhealthy eating and drinking habits (Abbas, 2020), the pandemic has severely disrupted dentistry services and access to care.’ Keeping patients protected, not only from the virus but from dental disease where possible, is key to maintaining a high standard of quality care. Supporting patients in maintaining good oral hygiene at home is therefore more important than ever. Dental teams can reach out to proactively advise, educate, and motivate patients to improve their daily oral hygiene routines. The pandemic has been a catalyst for many people to become more aware of their own physical health along with the importance of self care. Oral hygiene is also important to general health and wellbeing. So this situation is an opportunity to proactively advise patients on how they can better maintain or improve their oral health at home. An effective oral hygiene routine should be evidence based and ideally tailored to patients’ specific needs. Dentists can deliver this advice to the patient whilst chair side or remotely through digital media. What is important is the patient is both aware and understands how they can help themselves to maintain their own oral health at home. Although largely preventable, dental caries and periodontal disease continue to be the two largest threats to oral health. Research has indicated possible associations between chronic oral infections and diabetes, heart and lung disease, stroke, and low birth weight or premature births (Benjamin, 2010). In other words, whilst oral health refers to the health of our mouth it ultimately supports and reflects the health of the entire body. So, what is the best advice we can pass on to patients at this time to support them? Optimising toothbrushing advice We know that optimising daily toothbrushing can help to prevent dental caries and periodontal disease. But we should not assume that patients always know how best to achieve this. Another important factor to consider is the benefit of the entire dental team delivering consistent and evidence-based messages. This consistency in messaging can help support behaviour change in patients to help improve oral hygiene outcomes. Manual toothbrushes are accessible for most patients, easy to use and can be effective at plaque control. The way we use the toothbrush is as important as the toothbrush itself. Make patients aware that the effectiveness of their toothbrush reduces. So they should replace it every three months, or before, if the bristles become worn and splayed. Another reason to change their toothbrush is if they have had a cold or a virus. Once an infection has passed, together with the typical symptoms such as a cough, sneezing, or fever, they should replace their toothbrush. In terms of toothbrushing technique, no particular technique is better than another. The patient’s existing method of brushing may need modifying to maximise plaque removal, emphasising the need to systematically clean all tooth surfaces. To control caries, it is the fluoride in toothpaste that is the important element of toothbrushing in preventing, controlling, and arresting caries. Higher concentration of fluoride in toothpaste leads to better caries control. To help control gum disease, the physical removal of plaque is an important element of toothbrushing. It reduces the inflammatory response of the gingiva and its sequelae. Unfortunately, many patients are unable to achieve optimum plaque control from brushing alone. This means using an appropriate toothpaste technology containing an antibacterial agent. Managing the oral biofilm In seeking a truly innovative approach to support everyday prevention, Colgate has leveraged the recent change in focus of the dental profession from treatment of disease to proactive prevention. Harnessing the trend to more health-conscious and educated patients. Building upon a new understanding of oral biology and oral health. As a result, Colgate has developed the next generation of Colgate Total toothpaste. It embraces a contemporary approach to everyday prevention by delivering superior biofilm control (Manus et al, 2018; Colgate data on file),* for whole mouth health.** As we consider biofilms, it is important to highlight their relative distribution in the oral cavity. Hard tissue surfaces make up for only 20% of oral surfaces. The remaining 80% are soft tissue surfaces – mainly on tongue, cheeks and gums. Colgate Total, with 1,450 ppm sodium fluoride and dual-zinc and arginine, enables superior biofilm (Manus et al, 2018; Colgate data on file)* control. It delivers comprehensive benefits for the whole mouth.** There is also evidence to support optimising toothbrushing by brushing for two minutes and discouraging patients from rinsing immediately after toothbrushing (Chestnutt et al, 1998). The ‘spit don’t rinse’ message prevents washing away the fluoride protection in the toothpaste. If a fluoride mouthwash is indicated, this should be used at a different time to toothbrushing (Marinho et al, 2003). Colgate Fluorigard 0.05% daily rinse is medicinally licensed and clinically proven to prevent caries. Finally, with all oral hygiene advice, it is also important to remember to reinforce diet messages to support oral health. Remind patients to reduce the frequency and amount of sugary food and drinks and, when consumed, limit to mealtimes (Moynihan and Kelly, 2013). Keep in touch – keep oral hygiene top of mind These oral care messages may seem rather simple; however, their impact will be far reaching in supporting patients whilst they are outside your direct care. Many patients are now especially open to these types of messages at a time when there has also been an increased use of digital media replacing face to face contact. A number of digital tools have been developed during this time to allow dental teams to engage remotely to raise the importance of oral hygiene and educate and motivate their patients to keep oral health top of mind. Visit www.Colgatecommunication.co.uk/educational-resources today to see the range of educational resources available to share with your patients. For additional information please visit www.Colgateprofessional.co.uk or www.colgatetalks.com. References Abbas AM (2020) Dietary habits in adults during quarantine in the context of COVID-19 pandemic. Obes Med 19 Benjamin RM (2010) Oral Health: The Silent Epidemic Public Health Rep 125(2): 158-9 Chestnutt IG, Schäfer F, Jacobson AP and Stephen KW (1998) The influence of toothbrushing frequency and post-brushing rinsing on caries experience in a caries clinical trial. Community Dent Oral Epidemiol 26(6): 406-11 Manus LM, Daep CA, Begum-Gafur R, Makwana E, Won B, Yang Y, Huang XY, Maloney V, Trivedi HM, Wu D and Masters JG (2018) Enhanced In Vitro Zinc Bioavailability through Rational Design of a Dual Zinc plus Arginine Dentifrice. J Clin Dent 29 (Spec Iss A): A10-19 Marinho VCC, Chong L, Worthington HV and Walsh T (2003) Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2003 3: CD002284 Moynihan PJ and Kelly SAM (2013) Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines. J Dent Res 93(1): 8-18