Periodontal Gum Disease Increased Death Rate from Pneumonia Almost 3.5 times
Periodontal disease may be a co-morbidity with Coronavirus deaths from pneumonia
Periodontal disease may also be a co-morbidity with Coronavirus deaths from pneumonia and patients should be made aware of this possible risk.
A seven-year study to evaluate the association between periodontal disease and pneumonia mortality in dialysis patients. Iwasaki et al, Journal of Clinical Periodontology, October 2017
Materials and Methods
This prospective cohort study included 211 patients (mean age, 64.4 years) undergoing dialysis at a single medical center. The patients underwent a baseline clinical dental examination in 2008 and were then followed up until July 2015. Periodontal gum disease was defined as the presence of clinical attachment loss of ≥4 mm in ≥30% of the probed sites. The primary endpoint, that is death from pneumonia, was determined by reviewing death certificates and was analyzed using the competing‐risks regression model.
At baseline, 92 patients (43.6%) had periodontal disease. The median follow‐ up period was 84 months (interquartile range, 36–86 months). Of the 68 deaths that occurred, 21 were from pneumonia. The multivariable competing ‐ risks regression model showed that periodontal disease was significantly associated with death from pneumonia (adjusted sub hazard ratio, 3.49; 95% confidence interval, 1.14–10.64), after adjusting for other baseline health characteristics.
The results of this study suggest that periodontal disease increased the death rate from pneumonia almost 3.5 times and is independently associated with pneumonia mortality in dialysis patients with kidney failure. Periodontal disease may also be a co-morbidity with Coronavirus deaths from pneumonia and patients should be made aware of this possible risk.
Dental Preparedness Check List
Coronavirus Disease 2019 (COVID-19) is a respiratory disease caused by the SARS-CoV-2 virus. It has spread from China to many other countries around the world, including the United States. Dental-Prepareness-Check-List.pdf
For most dental practice, protecting dental workers will depend on emphasizing basic infection prevention measures. As appropriate, all dental staff should implement good hygiene and infection control practices, including:
Promote frequent and thorough hand washing, including by providing workers, customers, and worksite visitors with a place to wash their hands. If soap and running water are not immediately available, provide alcohol-based hand rubs containing at least 60% alcohol.
Encourage dental workers to stay home if they are sick.
- Encourage respiratory etiquette, including covering coughs and sneezes.
OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION COMMON PRACTICE
Provide paients with tissues and trash receptacles.
Dental staff should explore whether they can establish policies and practices, such as flexible worksites (e.g., teledentistry) and flexible work hours (e.g., staggered shifts), to increase the physical distance among dental staff and between dental staff and patients and others if state and local health authorities recommend the use of social distancing strategies.
Discourage dental staff workers from using other workers’ phones, desks, offices, or other work tools and equipment, when possible.
Maintain regular housekeeping practices, including routine cleaning and disinfecting of surfaces, equipment, and other elements of the work environment. When choosing cleaning chemicals, employers should consult information on Environmental Protection Agency (EPA)-approved disinfectant labels with claims against emerging viral pathogens. Products with EPA-approved emerging viral pathogens claims are expected to be effective against SARS-CoV-2 based on data for harder to kill viruses. Follow the manufacturer’s instructions for use of all cleaning and disinfection products (e.g., concentration, application method and contact time, PPE).
Control guidence for Dental Settings During Coronavirus COVID-19 Response
According to the CDC there are suggested dental settings to consider as follow
- Dental settings have unique characteristics that warrant additional infection control considerations.
- Postpone elective procedures, surgeries, and non-urgent dental visits.
- Proactively communicate to both staff and patients the need for them to stay at home if sick.
- Know steps to take if a patient with COVID-19 symptoms enters your facility
Cleaning Products That Destroy Coronavirus
Soap and Water
Just the friction from scrubbing with soap (any kind of soap) and water can break the coronavirus’s protective envelope. “Scrub like you’ve got sticky stuff on the surface and you really need to get it off,” says Richard Sachleben, an organic chemist and a member of the American Chemical Society. Discard the towel or leave it in a bowl of soapy water for a while to destroy any virus particles that may have survived.
Using antibacterial soap won’t give you added protection against the coronavirus because it kills bacteria, not viruses. You can still use it as long as you scrub.
The Centers for Disease Control and Prevention recommends a diluted bleach solution (⅓ cup bleach per 1 gallon of water or 4 teaspoons bleach per 1 quart of water) for virus disinfection. Wear gloves while using bleach, and never mix it with ammonia—or anything, in fact—except water. (The only exception is when doing laundry with detergent.) Once mixed, don’t keep the solution for longer than a day because the bleach will lose potency and can degrade certain plastic containers.
“Always clean the surface with water and detergent first, since many materials can react with bleach and deactivate it,” Sachleben says. “Dry the surface, then apply the bleach solution and let it sit for at least 10 minutes before wiping it off.”
Bleach can corrode metal over time, so Sachleben recommends that people not get into the habit of cleaning their faucets and stainless steel products with it. Because bleach is harsh for many countertops as well, you should rinse surfaces with water after disinfecting to prevent discoloration or damage to the surface.
If you can’t find liquid bleach, you can use bleach tablets instead. You may have seen Evolve bleach tablets, which dissolve in water, at Walmart or on Amazon. Just follow the dilution instructions on the packaging (1 tablet is equal to ½ cup liquid bleach). A label on the bottle states the product is not a disinfectant, but chemically, it’s the same as liquid bleach. A company spokesperson at Custom Bottling & Packaging, which acquired Evolve three years ago, says the company hasn’t had the time or resources to put their product through the Environmental Protection Agency’s registration process that would allow them to make disinfecting and sanitizing claims. As of this update, Evolve is not experiencing any shortages and is supplying hospitals, research centers, and correctional facilities.
Alcohol solutions with at least 70 percent of alcohol are effective against the coronavirus on hard surfaces. First, clean the surface with water and detergent. Apply the alcohol solution (do not dilute it) and let it sit on the surface for at least 30 seconds to disinfect. Alcohol is generally safe for all surfaces but can discolor some plastics, Sachleben says.
According to the Centers for disease control and prevention (CDC), household (3 percent) hydrogen peroxide is effective in deactivating rhinovirus, the virus that causes the common cold, within 6 to 8 minutes of exposure. Rhinovirus is more difficult to destroy than coronaviruses, so hydrogen peroxide should be able to break down the coronavirus in less time. Pour it undiluted into a spray bottle and spray it on the surface to be cleaned, but let it sit on the surface for at least 1 minute.
Hydrogen peroxide is not corrosive, so it’s okay to use it on metal surfaces. But similar to bleach, it can discolor fabrics if you accidentally get it on your clothes. “It’s great for getting into hard-to-reach crevices,” Sachleben says. “You can pour it on the area, and you don’t have to wipe it off because it essentially decomposes into oxygen and water.”