Could Oral Ulcers Be Linked To Covid-19?

If you suffer from mouth ulcers (small, painful sores inside the mouth) you could possibly have or had COVID-19. Studies are still being conducted, but if you would like more information you should check out this article "Oral ulcers may be sign of the virus that causes COVID-19" by Melissa Busch, DrBicuspid.com assistant director.

May 28,2020 --Painful ulcers in the oral cavity may be linked to SARS-CoV-2 infection, which causes COVID-19, according to an article published on May 5 in Oral Diseases. This is thought to be the first reported case of oral lesions being a possible symptom of COVID-19, the authors noted.

A connection is possible considering lesions inside the mouth are often misdiagnosed due to the lack of an intraoral exam, as well as the severity of other pathological processes that might occur with SARS-CoV-2 infection, they wrote.

"It makes good sense that this virus provokes exanthematic lesions that may resemble other viral processes we are used to diagnosing in the dental clinic," wrote the group, led by Carmen Martín Carreras-Presas from the adult dentistry department, oral medicine, at the European University of Madrid.

Still learning

At press time, approximately 5.4 million confirmed cases of COVID-19, including about 343,00 deaths, have been reported globally to the World Health Organization. More than 1.6 million COVID-19 cases and nearly 100,000 deaths have occurred in the U.S.

As the novel coronavirus continues to spread, scientists and healthcare workers are also learning new details about the infection. Initially, the most common signs and symptoms of a SARS-CoV-2 infection were fever, sore throat, and headache. Over time, symptoms of diarrhea, loss of taste and smell, and skin conditions, including vasculitis and chicken pox-like lesions, were added. Therefore, it is plausible to think that lesions found in the oral cavity of one COVID-19-positive patient and two suspected positive patients are connected, the authors wrote.

All three patients developed the oral lesions during an isolation period between the last week of March and the first week of April. Due to the shutdown, the clinicians saw the patients via video consultations.

A 56-year-old healthy man

A man who had a fever and enlarged lymph nodes in his neck, felt weak, and lost some of his ability to smell and taste was suspected of being infected by SARS-CoV-2 and told to self-isolate. The man was asked to send photos of his mouth after he began experiencing pain in his palate and a sore throat. The lesions looked like herpetic recurrent stomatitis; however, it was the first time he had them. The lesions healed after the patient took the prescribed valaciclovir 500 mg every eight hours for 10 days and used topical antiseptics with chlorhexidine and hyaluronic acid. At the time of this writing, the man was waiting for serological testing to confirm whether he had COVID-19.

A 58-year-old man with underlying conditions

A man with diabetes and hypertension reported pain on his palate. He assumed it was a bacterial infection of a tooth. His wife had been diagnosed with COVID-19, and they were both isolated in their home. The doctors had him send a photo of his mouth, which showed multiple small ulcers on his palate with unilateral affection. He had no previous history of herpetic infection. The lesions healed within one week after using a topical antiseptic mouthwash.

A 65-year-old woman infected with SARS-CoV-2

A woman reported having a high fever, diarrhea, and pain on her tongue on March 12. She was obese and had hypertension, which were controlled with diuretics and an angiotensin-converting enzyme (ACE) inhibitor. A week later, she fainted at home and was taken to the hospital, where she was diagnosed with bilateral pneumonia due to SARS-CoV-2 infection. She was given antibiotics, corticosteroids, and the antiviral drugs lopinavir, ritonavir, and hydroxychloroquine. She was discharged from the hospital on March 30. On April 4, she developed a rash on various parts of her body. Though she experienced tongue pain from the beginning, she said she never had an intraoral examination.

She returned to the hospital and a dermatologist performed a biopsy and prescribed antifungal medications. A week later, she developed blisters in her internal lip mucosa and desquamative gingivitis. She was prescribed hyaluronic acid and chlorhexidine mouthwash. Her general practitioner prescribed prednisolone, 30 mg per day. Her lesions improved within three days, and she continued recovering in isolation at home. The biopsy revealed nonspecific morphological findings with some criteria suggestive of a nonspecific viral rash or eczema-like lesions with discrete blood extravasation.

More to know

Biopsies could not be performed on all of the patients, and further studies are needed to determine whether ulcers in the oral cavity are common in patients affected by SARS-CoV-2 infection or if the emotional distress of the situation triggers the lesions, the authors wrote.

These cases also shine a light on the importance of conducting intraoral exams.

"We encourage all medical doctors, dentists and dermatologists to perform intraoral examinations in patients suspected or affected by SARS-CoV-2, always when having the recommended protection measures available," they wrote.

7 Things You Didn't Know About Toothpaste!

As we all know there are so many different types of toothpaste out on the market! But did you know there are things you need to know about toothpaste!

• It’s all about the fluoride- when buying toothpaste look for the one with added fluoride.
• Look for the seal of approval- when looking for toothpaste look for the ADA seal before purchasing.
• Whitening toothpastes work—at least to a certain degree- All toothpaste contains mild abrasives to help remove surface stains on your teeth, but toothpaste does not have bleach, so you will not get the professional look.
• Less is more- Most people pile on the toothpaste, I know I do! But did you know actually less is better? All you need is a pea-size amount!
• How you brush is more important than what you brush with- when brushing your teeth you need to brush at a 45-degree angle, and brush in a circular motion!
• What’s inside your toothpaste might surprise you- some ingredients inside your toothpaste are seaweed and detergents. This is how they get your toothpaste to foam.
• Pastes or gels—they all do the trick- they both work equally!

Do you know the Cost vs Benefit of your dental coverage?

Do you know the Cost vs Benefit of your dental coverage? Would it surprise you to know that most people don't? It is sad reality that most people who are paying for some form of dental coverage cannot even tell you what it covers. So to them I ask this: What are you paying for? 

Now, if I made you go to your filing cabinet, grab your benefit guide or insurance declarations, then this blog has already served it's intended purpose. If not, read on while I fill you in on this little tidbit of information. If you don't know what the benefits you are receiving are, how do you know if you cost is worth it or not?

Let's break it down a little further. I will pick on dental insurance again because that's my favorite thing to do! Let's say you are paying $45.00 per month for your family, (that's $540 per year). What are getting for that? If you just said "dental insurance" then you owe me 20 push-ups. Look deeper, 30%-80% off of dental work. (you are getting there, keep going), 2 free cleanings per year (alright), 12-24 month waiting period on major procedures..(wait... what was that??) YES! My point exactly. You are going to be paying for this coverage for an entire year before your little Sammy or Sally can get their braces, or you can the get a bridge or implant that you might need. Even worse, once you are eligible to even have the procedure done, what percentage is really covered? 30%, 35%, 50% or 60%, because I can guarantee you it will not be the 80%. (that comes after you have maintained coverage for 3-4 years). Read a little more.. $1500.00 of dental work covered per person per year. So you are paying $540.00 per year to have $1500.00 worth of work done (which can go fast now days) and don't even get me into the deductible!

Anyway, my point is this. Make sure that you are not just being bedazzled by the "low monthly premium" phrase.  Please Please Please check your Cost vs Benefits and make sure you are getting coverage that is worthy of your money.

To compare various insurance or plans side by side, visit this comparison zone!

Homemade Denture Cleaner

Tired of constantly buying denture cleaner? I know I get tired of buying it for my retainers.

Now you will no longer have to buy denture cleaner after I give you a few simple homemade cleaner recipes I have found made from household products.

•  Bleach-based soak:
• Directions for Making: 
• 1 part bleach mixed with 10 parts of water.
• Best to make when ready to use.
• Directions for use:
• Soak for only 3-10 minutes. **Do not soak overnight**
• Rinse dentures off with cool water before placing them back into the mouth.
• Vinegar-based soak:
• Directions for making:
• Soaking duration mixtures:
• 10-minute soaking: Full strength vinegar.
•  30 minute soaking: 1 part vinegar to 1 part water.
• 8 hours soaking: 1 part vinegar to 9 part water.
• Directions for use:
• After soaking, brush the denture to help remove stubborn mineral deposits.
• Rinse the denture with cold water and place them back into the mouth.
• Sodium Bicarbonate soak:
• Directions for making:
• 1 Tsp of baking soda dissolved in 8 oz of water.
• Directions for use:
• Soak for 30 minutes.
• Rinse and place back into the mouth.

*Note: If you are not placing your dentures back into your mouth after you have soaked them, they should be immersed in clean water.

Remember to always discuss your plan with your dentist before trying something new!

The Process of Obtaining Quality Dental Care for the Developmentally Disabled

A subject worth reposting....

If there is a specialty that is sorely lacking in the dental field, it is this one. And even though there doesn't appear to be an actual specialty category for treatment of disabled persons, in my humble opinion there should be! Is it because of the limited instruction given in dental schools? The slow or limited funding by medicaid or the governmental agencies that provide dental coverage for the disabled? Is it because of the cost of establishing a practice that can accommodate special needs patients? All of the above.

It is estimated that up to 80% of people with intellectual and developmental disabilities have periodontal disease. There are many possible reasons for this staggering statistic. Many have cognitive impairment, meaning that they simply don't understand the need for maintaining proper oral hygiene. Many do not have the manual dexterity to do the task, and many take medications to control drooling and excess saliva which causes the mouth to be dry, hence the risk for dental caries is increased. Caregivers are often the ones who must see to the basic needs of these patients. It is unfortunate, but brushing and oral hygiene are often overlooked in many cases because the medical needs of the patient are more pressing. Finding quality dental care in a private practice setting for patients of this type is difficult, because treatment is different for each individual due to the level of severity of their disability. Consequently, private practitioners will, in many cases, refer the patient to a University or a teaching facility to have their dental treatment done. This is not such a bad thing(!), as many Universities and teaching hospitals have residency programs and specialized treatment options and are well equipped to handle it. Additionally, pedodontists are the one specialty group that have the advanced training to handle patients with disabilities...although most limit their practice to children.

We've discussed the difficulties encountered by the patient and caregiver, now we'll address the issues and difficulties that the private practitioner faces when treating a developmentally disabled individual.

The first issue is training, or the lack thereof. Dental schools provide very limited, basic training in this field. Unless a new practitioner completes his/her residency in a teaching facility and gains hands on experience working with the disabled, he/she may come away with limited knowledge of how to treat the patient. They may leave college and go straight into private practice, or complete their residency with a private practitioner.

The next issue would be the cost of set-up; that is, establishing a practice that is equipped to accept disabled patients, i.e., special equipment, wider doorways, wider hallways, knowledgeable staff.

Next, slow or limited payment by the governmental agencies and programs designed to give financial aid to the disabled patient. Granted, this is a common problem everywhere...it doesn't matter what the specialty or service! However, it is a deterrent for private practitioners.

Every patient is different. It isn't as simple as being wheelchair accessible. Added challenges for treating developmentally disabled persons may include: behavioral problems, uncontrolled body movements and mobility issues (are they able to get into a dentist chair?). Some patients are non-verbal and cannot tell you if they are in pain, uncomfortable, etc. Some suffer seizures. Some have difficulty swallowing. The dentist must be aware of and sensitive to all of those issues in order to successfully treat the patient.

All of that said, there are continuing education classes available to a practitioner and it is possible to complete a residency at a teaching facility that has a specific department or program geared toward the disabled. The unfortunate thing is that such a small percentage of practitioners will actually take advantage of the opportunity.

Thanks to Dr. C and Dawn_DA for the professional input for this blog!

Keep Smiling!

Diastema...What is it?

Do you know what Diastema is? I'm sure you do but maybe not the technical term. Diastema is commonly known as a gap-tooth.

Having a gap-tooth as a child is normal and as our permanent teeth start to grow usually the gap will close on its own but sometimes it does not and it can be a cause of multiple different reasons such as:

• Teeth Vs. Jaw size - If you have smaller teeth, you are more likely to have a gap-tooth. 
• Genetics - This can be passed down from generation to generation.
• Missing teeth - If you are missing an incisor, the front teeth will shift causing a gap-tooth.
• Gum Disease - Inflammation causes deterioration of the bone that holds your teeth in place. The damage done to the bone eventually causes loose teeth which leads to a gap-tooth. 
• Swallowing wrong - If you push your tongue into your front teeth when swallowing will eventually cause a gap-tooth.
• Habits - thumb sucking, lip sucking, or tongue thrusting can cause a gap-tooth.

Treating is not necessary but there are cosmetic procedures you can do to improve your smile, such as braces or veneers. If you are interested in fixing your mouth it's important to consult with your dentist to see which option will work best for you!

Cavity Prevention - Just Another Good Reason To Enjoy a Piece of Cheese!

Have you ever read the book "Who Moved My Cheese"? (If you haven't it is a great book, I definitely recommend.) Well, it has nothing to do with teeth, actually, but for those of you who want to protect from cavities, that phrase could become common in your household.

A study that was published in the June 2013 issue of Journal of General Dentistry reveals that cheese increases the dental plaque pH level of someones mouth above 5.5 which, in essence, reduced the chances of that person getting a cavity. This does not apply to all dairy products. Milk and sugar free yogurt were also used in the study. The results showed no change in the dental plaque pH level. Which doesn't hurt your mouth or put you at risk, but it doesn't help it either. 

So why the cheese? Let me explain! The study suggests that it has to do with the saliva. Saliva creates and maintains the acidity level in your mouth. The increased chewing motion of eating the cheese creates more saliva. Combine that with the vitamins, nutrients and other compounds in cheese that can stick to the tooth enamel and the result you get is better protection against cavities.

As always, the BEST way to protect from cavities and other dental related problems is to maintain good oral health practices and visit your dentist on a regular basis.

Enjoy your cheese!