How a year of Covid wrecked Britons’ teeth
Early last August I was doing my civic duty and eating out to help out when, upon biting down on what should have been an innocuous cod steak, I heard an unwelcome crunch.
It was my first meal out in what felt like a million years – a birthday lunch for a close friend – and I wasn’t about to let a mere dental emergency ruin our big day out.
I carefully deposited the splintered tooth into my napkin and styled it out, finishing the meal. We even split dessert.
I’ve always had a tendency to clench my jaw – I’ve been doing it since my 20s – but during the pandemic the gnashing has gone into overdrive which resulted in this enamel-splintering dental car crash.
I’m one of millions whose teeth have been hit, one way or another, by Covid. Britain’s dental health – already a cause for concern – has suffered badly in the pandemic, with experts warning of a timebomb after 20 million fewer dental procedures were carried out last year than in 2019 and millions missed check-ups. Fortunately, this time around dental surgeries have largely remained open during lockdown, but a huge backlog remains.
“I’m seeing patients who cracked a tooth and have been waiting the best part of a year to see us,” says NHS dentist Dr Paul Woodhouse, a spokesperson for the British Dental Association. “If you leave a tooth with a little crack in it a decent amount of time, it’s not a simple 20-minute repair, it becomes an extravagant repair. Some root canals and crowns that had been planned turned into extractions. We’ve seen deterioration in teeth and an epidemic of people grinding.”
Worryingly, many have turned to DIY dentistry kits in desperation, with Boots the chemist saying sales of the kits rose 87 per cent in the last three months of 2020, compared with the previous year, fuelled by those unable to get an appointment or too afraid of Covid to attend. The products that proved popular included a “long-lasting” temporary repair for caps and fillings and a first-aid kit.
“Some patients have done a great job with these temporary kits but I’ve also seen some spectacular screw-ups (with other methods),” says Dr Woodhouse. “I had a couple of patients take teeth out themselves and I’ve seen patients take a nail file to polish sharp edges, making restorable situations unrestorable. We’ve ended up extracting teeth at the front of the mouth that probably could have been saved.”
Lockdown eating habits are likely compounding the problem, he says.
“Grazing between meals is a nightmare for teeth,” says Woodhouse. “We’re doing a lot more snacking because we’re stuck in our houses a lot more and so you get a constant dose of sugar throughout the day. It’s a nightmare for teeth.”
I was lucky that my tooth broke in August after dentists had reopened, but magazine editor Mary, 52, wasn’t so fortunate. She saw her NHS dentist last March, and was told she would need to see a specialist to have teeth extracted and implants put in.
“I had teeth that had been treated over years that were just crumbling and breaking down,” she says. Her dentist wrote the referral letter but, three days later, the country went into lockdown, meaning Mary was left languishing in pain for nine months before she could be seen. She is now about to have five teeth taken out.
“It was massively painful because the teeth are splintered. It feels like I’m eating on nails and my gums are really sore,” she says. “I’m very aware that inflammation in the mouth and gums has an impact on the health of the body. And I was worrying: ‘Will it get worse?’”
Mary is right – the dentistry fall out is about far more than our smiles.
This month, a leading dental consultant reported a surge in mouth cancer cases being caught at a late stage, due to missed dental appointments.
Research has also found that Covid patients are three times more likely to suffer severe complications if they have gum disease as a result of raised levels of inflammation in the body. The study, published in the Journal of Clinical Periodontology, found patients with severe gum disease were 4.5 times more likely to require a ventilator, 3.5 times more likely to be admitted to intensive care and nine times more likely to die of the virus.
“At the beginning of the pandemic we heard a lot about cytokine storms [where the body starts to attack its own cells rather than fight off the virus] in Covid-19 and that it is often this severe inflammation that actually kills the patient,” says Dr Faleh Tamimi at McGill University Faculty of Dentistry, the senior author on the study. “Then I noticed that some of the markers were the same as for periodontitis. We’ve known for 20 years that gum infections increase inflammation and chronic disease and it’s my opinion that periodontal disease is increasing Covid inflammation.”
Further research is needed to establish a causal link, but the study adds to a growing body of evidence linking gum disease to diseases such as heart disease and even Alzheimer’s.
Dentists are urging everyone to book a dental check-up if they have missed one during lockdown and to continue to take good care of their teeth, which is vital for all round health.
“If you follow a good oral health programme that will vastly reduce the bacteria that thrive in the mouth, in their billions, every time you eat,” says LA-based dentist, Dr Rodney Raanan. “If these bacteria are left unchecked and penetrate into our bodies, this can mean problems for our immune defence, especially for those with underlying health conditions. If your immune response is busy fighting bacterial pathogens, you will have less capacity to battle other infections leaving you more susceptible to the virus.”
“People should be brushing teeth twice a day with fluoridated toothpaste, flossing or using interdental brushes to make sure we are reducing bacterial overload as much as possible,” says London Hygienist’s Anna Middleton. “A lot of people see bleeding and are put off and stop. But if gums are bleeding it means there is plaque and you should keep cleaning.”
Dr Woodhouse says he spends 10 minutes giving his teeth a good brush and floss at night followed by a quicker brush in the morning.
For anyone allergic to the hygienist’s prodding, Guided Biofilm Therapy (GBT), a Swiss innovation, reduces treatment time to a speedy seven minutes. “It uses dye to highlight the plaque. Then, rather than scrapping and digging around, you’re literally jet washing it off,” says Middleton. “It’s much more effective for anyone with dental work like crowns, as it can get get into all nooks and crannies.”
With mouth cancer referrals dropping by 33 per cent since the start of the pandemic according to data from the Oral Health Foundation, experts also advise to regularly self-check your mouth for anything unusual.
Mouth cancer can appear on the tongue, tonsils, gums and lips. It can also be found on the roof and floor of the mouth, as well as the head and neck.
Mouth ulcers lasting three weeks, red or white patches in the mouth, or unusual lumps and swellings, are the typically early warning signs. Persistent hoarseness can also be a symptom.
“If you notice anything out of the ordinary, contact your dental practice who will be able to see you as an emergency patient,” says Dr Nigel Carter OBE, chief executive of the Oral Health Foundation.
Fortunately, my own dental woes were easily remedied. My dentist filed off the sharp edge on what was in fact a broken crown, rather than replacing it, saving me a small fortune. And now I’m wearing my mouthguard again, which I’d let drift in the first lockdown. I still find it annoying, but nowhere near as annoying as a mouthful of broken molars.