05 Jun 20

The biggest tragedy of the COVID-19 outbreak has been the number of elderly patients in care homes who have succumbed to the disease. But it appears that something as simple as brushing their teeth could dramatically improve their chances of survival.

Two top dentists, Martin Addy, Emeritus Professor in dentistry at the University of Bristol, and his son, Liam Addy, a consultant in restorative dentistry at the Dental School and Hospital of Cardiff University, are campaigning to improve the oral care of elderly people, particularly in care homes, and involve dental teams in getting that message out.

‘The detergents in toothpaste are the same as those found in many hand washes and are effective against coronavirus, so we believe that "washing your hands and brushing your teeth" will be complementary in helping to prevent both the spread of and infection by coronavirus,’ said Professor Addy. 

‘People living in residential or nursing homes are particularly in need of oral hygiene and care,’ he said. ‘Most are elderly and a proportion have a cognitive and or physical impairment.’ The current lockdown means that it is even more difficult for elderly people to access any kind of dental care or treatment, and they cannot receive the usual visits from relatives who could help.

‘There are concerns about the provision of routine and emergency dental treatment, and oral and denture hygiene for residents in nursing homes and self-isolating elderly and infirm at home,’ he went on.

‘Many of these residents rely on carers for all their hygiene regimens, but oral care may be lacking', said Professor Addy. His comments are supported by a study of the oral health of residents in 22 nursing homes in the South West, where high levels of plaque, gingivitis, and root caries were found. Most dentures were rated as unhygienic and denture stomatitis was present in one-third of denture wearers. Almost two-thirds had not seen a dentist in five years. Many of these issues are down to lack of time and knowledge among care workers and, currently, worries about lack of PPE.

It’s not all bad news though, he said. A randomised controlled trial assessing professionally delivered oral care education to caregivers in the same nursing homes resulted in significant reductions in plaque, gingivitis, denture plaque and denture stomatitis.

One young London dentist has reached the same conclusions through her research and is carrying out her own COVID-19 campaign to deliver supplies of toothpastes, toothbrushes, and mouthwash to care homes and homeless shelters. Dr Victoria Sampson is appealing to the dental industry and any practices with spare samples to donate them to her so that she can take them where they can be used.

‘I worry for my older patients,’ said Victoria. ‘We have a lot of shielded and vulnerable people who we won’t see for several months, and therefore prevention is very important for these patients.’ She is visiting care homes, not only delivering products but also educating staff about the importance of oral care via Facetime, reducing the risk not only of COVID-19 but other nosocomial infections.

Professor and Dr Addy have created an information sheet for dental teams to use and customise under the banner: ‘Wash your hands and brush your teeth.’ In addition to handwashing, their key recommendations for older patients and those caring for them include:

  • Brush teeth twice daily for two minutes using fluoride toothpaste
  • Spit but don’t rinse, so that the toothpaste continues to work for longer in the mouth
  • For carers: brush teeth before putting on PPE
  • Brush before going out or using public transport
  • Carry a small tube of toothpaste with you when out and apply with a (clean!) finger
  • Dentures can become infected with coronavirus so should not be worn during sleep. They should be cleaned daily with a product that will kill coronavirus, either toothpaste on a brush or soaking them overnight in diluted handwash or washing up liquid, rinsing them before reinserting.

Why not read Don’t just wash your hands – brush your teeth! Part 1 in this series. 

For further information, look at Bathroom Basics and COVID-19; which provides practical advice on what we can do in our homes to limit the risks of cross-contamination or infection – starting in our own bathrooms.