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Collaboration Matters: Nursing and Oral Health

Afifa Lahbabi Eidher, RDH

April 2021

April is oral health month in B.C. and dental hygienists are exploring ways to help the public understand the importance of maintaining good oral hygiene and how it could even save their life! One of our goals is to engage more effectively with the nursing profession because no one knows patients better than nurses. Dental hygienists believe that if we do our job well, we may have a hand at preventing some members of the public from ending up in your emergency room. And really, isn't that the goal of all of us who work in healthcare? I am certain that with the help of nurses, we can make significant strides towards improving the health of all British Columbians.

Registered dental hygienists have always known that a direct link exists between your oral health and your overall health. We have worked hard over our career spans to educate the public and to encourage other healthcare professionals in relaying this important message to everyone. Contrary to what we have seen in the past, I am happy to report that the way the public now views their oral health has finally changed. Gone are the days when my patients would question the need for regular, preventive cleanings or dental visits, when some people believed it was better to ‘leave a little plaque’ or that fluoride was dangerous to your overall health. In 2021, we now have indisputable evidence that what is going on in your mouth is all too often a reliable indicator of what is happening with your overall health.

When COVID first happened, dental hygienists were ordered to stop working, and that interruption lasted almost three months. Although there were certainly personal hardships during this time, the reality is that we were alarmed by how this would affect the health of our patients – I was especially concerned about my immunocompromised patients and my community health colleagues were very worried about their clients living in long-term care. Mobile dental hygienists were unable to enter the sites that they regularly attend and felt anxious knowing that some of their regular patients had gone without any sort of oral health care for months. The result of this disruption of care resulted in dentists being called in, often only able to prescribe pain medication over the phone or transferring the patient to the ER so extractions could be done – not an ideal outcome for frail or elderly patients.

Sadly, many patients over this time of COVID have cancelled or delayed their scheduled visits with me because they do not want to risk getting Covid-19 by making their way to ‘another’ appointment. Many overdue patients are falling through the cracks, their gum disease is progressing along with build-up of hard and soft deposits that carry harmful bacteria, increasing their risks of health implications.

Good dental hygiene can help prevent halitosis, tooth decay, gingivitis, and periodontal disease. But there are other, even more important reasons to keep your mouth healthy. Research shows that gum disease may put you at risk of serious health problems such as heart attack, stroke, endocarditis, pneumonia, poorly controlled diabetes, preterm labor, and low birth weight in babies.

Unfortunately, the list of potential health risks goes on, in recent years gum disease has also been linked to a higher risk of hypertension, kidney disease and Alzheimer’s disease. Furthermore, some diseases such as diabetes and HIV/AIDS can compromise the body’s ability to heal or to fight off oral infections, as a result making them more severe and more difficult to control. As nurses who work with frail elderly are undoubtedly aware good oral hygiene has been shown to reduce the mortality from aspiration pneumoniai, and good oral health is linked with better outcomes in cardiac patients.ii

Other factors can also influence a person’s oral health. As a dental hygienist I regularly see patients with complicated medical histories who take medications such as painkillers, antidepressants, antihistamines, or diuretics for example, all of which can reduce salivary flow. This can have devastating effects for some. Saliva works by neutralizing the acids created by the bacteria in the mouth, if this process is hindered, patients will be more at risk of periodontal disease and/or rampant decay.

Periodontal disease (periodontitis) is a serious gum infection caused by bacteria which has been allowed to accumulate around the teeth and gums. Once harmful bacteria colonize the oral cavity, they will make their way through small blood vessels and capillaries in your gums – this heavy bacterial load will not only put you at risk for permanent bone loss and/or tooth loss, but will travel your blood stream, spread throughout your system, and trigger an inflammatory response that can put your health at risk. Professional intervention with a dental hygienist is essential for putting a stop to this damaging reaction.

It is important for everyone to have an effective oral hygiene routine that includes an individually tailored maintenance program at home and regular needs-based visits with your dental hygienist. Professional removal of hard and soft deposits is crucial for disrupting the biofilm responsible for the progression of gum disease. In most cases, gum disease and periodontal disease are painless, and as such are very deceiving, leading some individuals to think that foregoing routine dental hygiene visits is no big deal.

During oral health month, and every month throughout the year, I am reaching out to my nursing colleagues and asking you to partner with us in reminding patients that good, preventive oral hygiene could save their life.

No one understands the needs of patients more than nurses and dental hygienists. We need your eagle eye, and the trust patients place in you – and in return, we will work diligently at keeping patients well maintained, healthy and out of your emergency room.

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Afifa Lahbabi Eidher, RDH



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