Dr. Justin Pfaffinger: Maintaining oral health care in times of crisis | TheUnion.com
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Dr. Justin Pfaffinger: Maintaining oral health care in times of crisis

Dr. Justin Pfaffinger
Special to The Union

Healthcare professionals have been thrust into a world of patient care unlike any they have ever experienced. Along with the rest of society, their main attention is on COVID-19 and limiting its spread. An inspirationally concerted effort is being seen, with healthcare networks around the world extremely focused and resolute, having a clear purpose and desired end. All-hands-on-deck is the mode of operation these days, with all eyes centered on stopping this novel coronavirus.

In physiology, we see this type of extremely focused and energized behavior in the fight-or-flight response of our body’s sympathetic nervous system. When a threat is perceived, the body is thrust into an adrenaline-rich state where all senses are directed toward one objective: survival. The response is instinctive, necessary and altogether amazing. It’s also designed to be short-lived, with significant negative consequences if activated for too long. Other parts and systems of the body are strained, even neglected, during this sympathetic reaction, but the end-goal is obviously for the body’s good. The healthcare system is in a fight-or-flight mode, and the question these days is, “how long will it last?”

While we are focused and of one mind, pulling all resources to work efficiently and effectively against COVID-19, the healthcare system is inadvertently suffering in its ability to provide non-essential, non-urgent health care. Comprehensive health care, attending to the general health and well being of an individual, has taken a back seat to COVID-19, with preventative health care nearly thrown out the window. Go to http://www.cdc.gov, and for healthcare professionals you’ll find the following directive from the Centers for Disease Control (CDC):

Delay all elective ambulatory provider visits

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Reschedule elective and non-urgent admissions

Delay inpatient and outpatient elective surgical and procedural cases

Postpone routine dental and eyecare visits

This tactic on part of the CDC, directing healthcare professionals in all disciplines to treat only those conditions that are considered to be urgent or essential, is absolutely necessary to flatten the curve and reduce the rate of transmission of this novel coronavirus. However, the struggle for many healthcare professionals, like myself, is that routine and preventative health care can prove to be just as essential to provide as urgent health care. Big problems often start off as little problems, and some of those little problems can often be avoided. So, with this shift in health management, where into the hands of patients is being placed a greater responsibility of self-care, how do we ensure that little problems are kept at bay or prevented from developing at all? I would argue simply that now is the time to be following those preventative recommendations our doctors have been advising all along in their attempt to prevent disease. After all, “an ounce of prevention is worth a pound of cure.”

As a dentist, my prevention-centered advice can be boiled down to this: brush twice a day, floss, and eat a balanced diet, low in sugar. We’ve heard it all before, but are we doing it? If ever there were a time to improve our flossing game, now is it! By in large, most cavities and gum problems are the result of poor hygiene, particularly poor flossing. And a healthy diet is just as critical to maintaining good oral health. Avoid snacking throughout the day, because the more frequently you expose your teeth to food and drink, the more likely you are to develop tooth decay.

If you’re trying to decide if you should break your quarantine and go in to see your dentist, call your dentist first and discuss your situation, he or she can guide you through that decision. Unfortunately, “urgent” dental conditions don’t always present with urgent-like symptoms, so even if you are pain-free, it doesn’t mean that you shouldn’t still consult with your dentist. Pain and swelling are often the telltale signs of a significant problem, however, dental abscesses can present without any perceived symptom at all. An asymptomatic dental abscess is most concerning for me when I consider the potential consequences of it being left untreated. Infection of the surrounding bone, sinuses, and oral soft tissues are most commonly seen. But complications with artificial heart valves and prosthetic joints are a potential, as are septicemia, where the entire bloodstream becomes infected, and an infection of the brain, both of which can be life threatening.

We need to listen to our bodies closely as there are certain precursors or “red-flag” warnings that our bodies often give us that indicate a more urgent condition is lurking. Below are listed several red-flag warning signs that you should not ignore. If you’ve experienced any of these symptoms, even for just a brief period of time, but now it seems to have subsided, a professional dental evaluation may still be warranted:

Intense tooth or jaw pain that does not resolve within a few seconds of its development

Spontaneous development of tooth or jaw pain, where a specific action of yours (such as eating or drinking) did not or does not elicit the pain.

Tooth or jaw pain that interrupts or inhibits your sleep

A sinus ache, particularly if you have a history of more complicated dental treatment or if you have a history of clenching and grinding your teeth

Difficulty applying pressure without pain to a tooth or group of teeth, or applying pressure to the gums or jaw.

Though this list may not be exhaustive, it is often the first line of questions your dentist may ask you. It’s important to know also that “pain” in these red-flag warnings is meant to include any mild, low-grade, or barely perceivable ache or awareness. Pain is relative, and only you can listen to your body. If ever in doubt, call your doctor. As healthcare professionals, although we are currently limited in our scope of treatment, we are still here to look after the health and well-being of our patients to the best of our abilities.

Dr. Justin Pfaffinger, DDS, is a dentist in Grass Valley.


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