Hygiene Tribune Middle East & Africa No.2, 2021
Dental disaster: Dentists evaluate consequences of the COVID-19 pandemic / Plaque control measures and thrust for preventive dentistry—dentists’ attitude / World Oral Health Day
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DTMEA_No.2. Vol.11_HT.indd
NL
Y
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DE
www.dental-tribune.me
Published in Dubai
March-April 2021 | No. 2, Vol. 11
Dental disaster: Dentists evaluate
consequences of the COVID-19 pandemic
By FDI World Dental Federation
GENEVA, Switzerland: In light of
World Oral Health Day (WOHD),
which is being celebrated on 20
March, FDI World Dental Federation
has released a statement that sums
up how oral health behaviours have
deteriorated during this time. One
year into the pandemic, FDI councillors and members say that they are
seeing first-hand the catastrophic aftermath of the virus on the health of
people’s teeth and gingivae in dental
practices around the globe.
During the first wave of the COVID-19 outbreak, dental practices
around the world were forced to
close. For two to three months, all
dental appointments had to be
postponed or cancelled, except for
urgent emergency treatments. The
World Health Organization reported
that oral health services were among
the most affected essential health
services because of the COVID-19
pandemic, 77% of countries reporting partial or complete disruption.
Between the first and second waves,
dental practices in many countries
were able to reopen. Dentists have
always abided by the most stringent
infection prevention and control
protocols and have revised hygiene
measures mandated by govern-
©Darko Stojanovic/Pixabay
“Let’s call it what it is: a dental disaster,” said FDI President Dr Gerhard
Konrad Seeberger. “Restrictions have
certainly played a part in oral health
hesitancy, but they don’t tell the
whole story.”
One year after the first lockdowns came into effect, dentists around the world are facing the consequences of the COVID-19 pandemic on people’s oral health and have found a
higher incidence of dental caries and more advanced periodontal disease
ments during the COVID-19 pandemic. In addition, a recent survey
indicates that oral health professionals have significantly lower SARSCoV-2 infection rates than other
healthcare workers in most parts of
the world. Despite this, many people
have still avoided routine check-ups
and only visit the dentist once they
are in extreme pain. Many have developed advanced dental caries and
related complications, including
infections, which makes treatment
more complex.
Today, dentists are confronting the
fallout from a year of disrupted
dental care. Dr Paulo Melo, an FDI
councillor who teaches and practises
dentistry in Oporto in Portugal, has
seen a dozen high-risk patients who
were afraid of being infected with
SARS-CoV-2 and postponed their
appointments. High-risk patients
AD
are encouraged to have a dental
check-up every three to six months.
Instead, many patients have waited
nine months to a year or longer between appointments. Many have
reported severe toothaches and
complications, leading to extraction
for some and endodontic treatment
for others.
“During the pandemic, high-risk patients have tended to develop more
than one problem, often exhibiting three or four at the same time
because too much time has gone
by without a check-up,” said Melo.
“Problems typically include carious
lesions and periodontal disease.”
“Dental caries that could have been
treated with a simple restoration has
now gone to the stage of apical periodontitis and abscesses, which call for
more sophisticated treatment,” said
Dr MK Vanishree, a lecturer in public
health dentistry, based in Bangalore
in India. “Patients should set aside
their fear and not postpone essential,
routine dental treatment.”
“One of the dramatic consequences
of the pandemic is that oral health issues that were not considered urgent
during the outbreak of the pandemic did in fact became urgent after
having to wait two months to seek
treatment,” said Dr Maria Fernanda
Atuesta Mondragon, president of
the Federación Odontologica Colombiana (Colombian dental federation)
and an FDI councillor. “We’ve seen
some patients undergoing orthodontic treatment who have lost the
gaps that were created for their teeth
to align, while others have developed
significant periodontal issues.”
“Teenagers usually suffer from
dental caries, and I’ve observed an
increasing level of tooth decay in
this age group,” said Dr Nahawand
Abdulrahman Thabet, who practises
in Cairo in Egypt and is an FDI councillor. “A 15-year-old patient of mine
admitted he had been snacking
more while stuck at home since the
closure of his school. I imagine thousands of kids his age are in a similar
situation.”
The pandemic’s repeated lockdowns,
restrictions on people’s movements
and work-at-home edicts have all
contributed to shifting daily habits
and behaviours, ultimately impacting on people’s oral health.
Modelling good oral care habits like
day and night brushing is imperative, according to a global research
study conducted by Unilever, which
found that children mirror their parents’ behaviours to the detriment of
their own health. Children are seven
times more likely to skip brushing if
their parents do not brush day and
night. Surveyed dentists agreed that
the change in children’s oral care
habits stemmed from the change in
parents’ routines. Despite the ongoing challenges with the pandemic,
it is crucial for parents to prioritise
their oral care routines as well as
those of their children.
Seeberger emphasised that “people
must not be afraid to visit the dentist. Safeguarding oral health is of
paramount importance to ensure
general health, well-being and a good
quality of life”.
[2] =>
DTMEA_No.2. Vol.11_HT.indd
E2
HYGIENE TRIBUNE
Dental Tribune Middle East & Africa Edition | 2/2021
Plaque control measures and thrust for
preventive dentistry—dentists’ attitude
By Dr Hadal C. Kishore, India
Many studies state that low dentistto-patient ratios and lack of awareness among patients are some of
the plausible causes of the high incidence of periodontitis in the Indian
population. However, hardly any
studies exist that inform us about
dentists’ awareness and their views
on plaque control measures available and the professional recommendations that they endorse to
their patients in the ever-changing
world of plaque control. We thought
that it would thus be of relevance to
seek valuable insight on this issue
through an online questionnairebased survey. The questionnaire was
devised in a multiple-choice format,
and the link to the survey was shared
with Indian dentists through various
social media channels.
It all starts interdentally
More than 300 respondents completed the survey, among whom
there was a balanced mix of 52%
males and 48% females. The age of
the respondents ranged from 23 to
65 years, and the majority were in
the age group of 29 to 50 years. Regarding professional experience, the
respondents included dentists who
were just starting out their careers
and seasoned practitioners with over
25 to 30 years of experience. The
study sample ranged from general
dentists to post-graduate students.
The majority of the survey respondents (54%) had a master’s degree in
dentistry.
It is almost universally accepted that
periodontitis is initiated mostly in
the interdental areas, and these regions are the most vulnerable to the
accumulation of plaque. Hence, the
survey questions were designed in
such a manner that sufficient weight
was accorded to matters pertaining
to interdental areas and the plaque
control measures employed to keep
these areas healthy.
An overwhelming 96% of the dentists stated that they prescribed interdental cleaning aids on a routine
basis to most patients, which we believe is a very healthy indication. As
to which is the most recommended
interdental cleaning aid, most of the
respondents fell into two categories:
55% of them preferred interdental
brushes and 40% dental floss. Only
2.65% recommended oral irrigators.
We deduced that India being a costsensitive market, the higher expense
© Joseph Shohmelian/Pixabay
Periodontitis is pandemic in nature
and distributed all over the world.
The disease’s prevalence and burden
on oral health in India is no different, and periodontitis shows no discrimination between race, sex, caste
or creed. Many studies quote an
incidence rate of greater than 30%
among the global adult population.
The numbers are staggering: more
than 300 million people in India
have periodontitis. If we consider
gingivitis, the numbers are even
more mind-boggling. Periodontitis
remains the single largest reason
for loss of teeth currently. Although
many risk factors and predisposing
factors are attributed to the aetiology of periodontitis, dental plaque
is the predominant reason and the
most easily modifiable risk factor to
prevent periodontal disease.
for the patient of procuring an irrigator deterred most of the dentists
from recommending irrigators.
Practice what you preach
The survey probed this matter further, asking whether the dentists
themselves used an interdental
cleaning aid on a regular basis;
nearly half of them confessed that
they did not use such aids, while another 35% of the dentists responded
that they used them occasionally.
These figures point to an apparent
contradiction: it would appear that
dentists are not practising what they
are preaching. This left us wondering
whether all the professional advice
that dentists provide is limited to
patients alone and whether dentists
lack conviction in prescribing interdental cleaning aids.
There were various reasons given by
the respondents for not using interdental cleaning aids themselves. The
most predominant being that they
could manage to clean their interdental areas with regular brushing
alone, followed by the reason that
they had tight contacts between
their teeth and thus the use of interdental aids was not warranted. Other
main reasons given were that they
were lazy to use the aids and that it
was time-consuming to clean interdental areas.
The questionnaire investigated this
compliance issue in patients too
with a question on the main challenges associated with the use of interdental cleaning aids in patients.
Most of the dentists (54%) opined
that a lack of awareness was the major issue, followed by a lack of motivation in patients and the technique
sensitivity in using the aids. Some respondents said that patients found
it too time-consuming, and ten per
cent said that cost factor was an issue
for patients.
Mouthrinses are employed routinely as a chemical plaque control
measure as adjunct to mechanical
plaque control. Mouthrinses are a
popular choice among both dentists and patients, as these are easily
available, cost-effective, and not very
technique-sensitive or time-consuming to use. The survey questionnaire elicited the dentists’ opinions
regarding the efficacy of anti-plaque
mouth- rinses in disrupting plaque
in the interdental areas. Forty per
cent of respondents believed that
such mouthrinses could effectively
disrupt plaque even in interdental areas, and an equal number of respondents felt this not to be true, while 20%
were uncertain in this regard.
importance in light of hardly any of
the dentists recommending these to
their patients on a routine basis. This
supports our earlier affordability
reasoning; patients who can afford
high-value treatments such as implants can also afford irrigators.
Another interesting insight that we
obtained through the questionnaire
survey was that 60% of the dentists
had never used a single-tufted brush,
yet 57% opined that single-tufted
brushes can benefit all patients.
Some of the dentists felt that their
use is limited, being beneficial only
in orthodontic patients, in cases of
crowding or in implant patients. This
highlights lacunae in our education
system: the majority of the dentists,
some of them having more than
25 years’ experience, had not used
something as basic as a single-tufted
brush even once.
We wanted to test the awareness of
dentists on the functioning of sonic
toothbrushes. In response to the
question on this, nearly 40% said
that they knew how a sonic toothbrush functions, whereas the other
60% of respondents either did not
know or had only a vague idea.
Dental implants have been the fastest-growing treatment modality for
quite some time now. We wanted
to ascertain what measures are
employed by dentists to maintain
implants and keep them plaquefree. Of concern was that 20% of
the dentists did not prescribe any
special form of care. Oral irrigators
were the most prescribed tool, more
than 30%of the respondents recommending these. Implant floss/tape,
interdental brushes and single-tufted brushes were prescribed by fewer
than 20 per cent of the dentists. Only
two respondents said that they recommended the Hydrosonic sonic
brush (CURAPROX). The choice of
oral irrigators as the most preferred
for maintaining implants assumes
Toothbrushes are the most humble of tools, but are the workhorses
when it comes to plaque control.
When asked about their choice of
bristle hardness of toothbrushes,
62%of the respondents recommended soft bristles and 12.5% ultra soft.
Nearly 25% of the dentists preferred
medium-hardness bristles.
cation in India. They have to be exposed to the plaque control tools
available in the market, and their
pros and cons have to be debated
upon. In pursuit of incorporating advanced treatment modalities in their
practices, it appears that dentists
are neglecting something as basic
as plaque control, which forms the
cornerstone of the preservation of
natural teeth.
Editorial note:
This article was originally published in
prevention-international magazine
for oral health, Issue 2/2020.
About the author
Better prevention through
hands-on instruction
We believe that, with rising awareness on oral health among the patients, preventive programmes will
receive thrust henceforth. Thus, we
explored the dentists’ views in this
regard. An overwhelming 97% of
the respondents agreed that a great
deal more emphasis has to be given
to plaque control measures in their
practices, and 91% of the dentists
agreed that adopting preventive
dental care routines in their clinics
could benefit their practices. The majority of the respondents (76%) regularly set aside clinic time to educate
their patients regarding prevention;
however, most dedicated only two to
five minutes to educating patients,
which we feel is grossly inadequate.
In conclusion, we would like to make
the following observations. A great
deal more emphasis has to be given
to training dental students on the
practical aspects of plaque control
measures during their dental edu-
Dr Hadal Chandrasekhara Kishore
He has over a decade’s experience as
a consultant periodontist and is from
Bangalore in India. He holds a BDS and
MDS in Periodontics from Krishnadevaraya College of Dental Sciences and
Hospital in Bangalore. Dr Hadal places
great emphasis on patient education
alongside treatment, in order to create
a motivated and educated patient, as he
believes this is beneficial to the patient,
the dentist and society at large. He is a
postgraduate guide and associate professor at Krishnadevaraya College of Dental Sciences and Hospital and is a much
sought-after speaker in dental circles. He
has over 15 international and national
publications to his name. The first iTOP
lecturer from India, Dr Hadal completed
the iTOP Teacher seminar in Prague in the
Czech Republic and is head of education
at Curaden India.
[3] =>
DTMEA_No.2. Vol.11_HT.indd
E3
HYGIENE TRIBUNE
Dental Tribune Middle East & Africa Edition | 2/2021
World Oral Health Day
Dentsply Sirona proves its commitment to healthy smiles with more
than 1 million participants in its Clinical Education courses
By Dentsply Sirona
On March 20, an important topic is
in the spotlight worldwide: World
Oral Health Day, which this year is
themed “Be proud of your mouth.”
The day aims to raise awareness of
oral health as a key factor in living
a longer, healthier life. Dentsply Sirona, as the world’s largest manufacturer of professional dental products
and technologies, wants to demonstrate on this day that it is focusing
its energies on innovative product
solutions and clinical education
for dental professionals. The goal
of these efforts is to empower dental professionals to give patients a
healthy smile.
7,300, 80, and 1 million – these figures represent Dentsply Sirona’s
comprehensive commitment to
clinical education for dental professionals. Last year, almost 7,300
courses (mainly online) were held
in 80 countries with a total of more
than one million participants. Using
than 180 courses as dentists are using this format more and more. “
Dentsply Sirona is committed to
empowering dental professionals
through innovation and education.
These continuing education courses
support dentists and team members
in their daily work to provide the
best possible care to their patients,”
said Dr. Terri Dolan, Vice President
Chief Clinical Officer at Dentsply
Sirona. “In addition to appreciating
timely information about infection
prevention and the safe delivery
of dental care, feedback indicates a
strong commitment to enhancing
their knowledge and skills using cutting-edge technology as they care for
their patients.”
More information about webinars
and on-demand courses is available
on Dentsply Sirona Website: https://
www.dentsplysirona.com/education
Aligner treatment with a completely digital workflow
Around the globe dentists and team
A beautiful smile as a sign of oral health for a longer and healthier life.
With SureSmile Aligner treatment, various tooth misalignments can be treated easily and safely.
DAC Universal – for safe, effective and environmentally friendly reprocessing of instruments.
educational technology, Dentsply Sirona more than doubled the number
of dental professionals participating
in clinical education as compared to
those in 2019. In addition, the on-demand CE library has grown to more
Leader that works with Dentsply Sirona. “SureSmile is a very attractive
concept for me because the digital
workflow with my CBCT and Primescan for digital impression is really
simple. Since it is constantly being
advanced by Dentsply Sirona, it is
only natural for me to continue my
education even in spite of the conditions of the COVID-19 pandemic so
that I can keep offering my patients a
high-quality dental treatment.”
A lab study from the independent
accredited test lab “HygCen Germany”***, by Dr. med. Univ. Sebastian Werner and commissioned by
Dentsply Sirona, recently confirmed
on June 30, 2020 the full virucidal
activity of the DAC Universal family,
including activity against all enveloped and non-enveloped viruses. Enveloped viruses include SARS-CoV-2,
hepatitis B and hepatitis C virus, HI
virus and influenza.
ing patients feel confident, comfortable and safe at all times on their way
to a healthy smile. “Dentsply Sirona
continues to lead the dental industry through its commitment to innovation, clinical education, and as
a reliable partner to dentists, dental
hygienists and dental team members, as well as dental technicians,”
Dr. Terri Dolan summed up.
A success for infection control
and prevention
Dr. med. univ. Sebastian Werner,
Medical Specialist for Hygiene and
Environmental Medicine, states: “As
far as I know, there is currently no
other technical reprocessing unit of
this size and speed on the market in
the field of dentistry that could represent the bactericidal, levurocidal
and virucidal activity in the same
way as a DAC Universal.”
*DAC Universal D
**DAC Universal S
***A summary of the study can be
made available by Dentsply Sirona
upon request.
Dr. Terri Dolan, VP Chief Clinical Officer at Dentsply Sirona: “Our strong commitment to clinical
education is to help dentists provide their patients with a safe journey to a healthy smile.”
members participated in clinical
education on endodontics, implant
and restorative dentistry and digital
technologies. We have also seen an
increased interest in clinical education in orthodontic treatment for
patients who want to have their
teeth corrected with clear aligners.
SureSmile brings precision, ease of
use, control and flexibility to the
clinician and delivers comfort and
predictable outcomes to their patients. With over 20 years of dedicated research in Orthodontics,
the clinical expertise and technical
skills of SureSmile technicians in
the SureSmile Digital Lab as well
as in-practice support, Dentsply Sirona can support clinicians through
all phases of aligner treatments.
SureSmile is integrated into the
workflows of other Dentsply Sirona
digital products, intraoral scanners
and imaging devices. The company’s
digital products complement each
other and work together seamlessly.
“I specialize in aesthetic dentistry in
my digitally equipped practice,” said
Dr. Shivi Gupta, a dentist from San
Diego, California, and a Key Opinion
DAC Universal for reprocessing instruments has been providing the
necessary hygienic safety for over 20
years. The automatic reprocessing
takes approximately 15 minutes* /
21 minutes** and meets all legal requirements. It cleans, thermally disinfects* / sterilizes* and can optionally lubricate the instruments. All
steps are standardized and initiated
at the push of a button. Only demineralized water and compressed air
are used for cleaning – this is effective and helps to preserve the service
life of the instruments.
Dental professionals attach great
importance to workflows that meet
the highest hygiene requirements.
Enhanced diagnostics, digital workflows as well as safe reprocessing
procedures are important for mak-
Due to different approval and registration times, not all technologies and
products are immediately available
in all countries.
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