Our 30th President, Calvin Coolidge, was a man of few words and an extremely pragmatic, practical, skeptical New Englander.
On a brief vacation, President Coolidge and an old friend were riding horses in Vermont.
His friend said to Coolidge as they rode through the rugged Vermont farmland, "See how closely they have shorn those sheep."
"On this side," said the President.
We only really know what we can verify by direct observation. And sometimes, the culture overlooks an important observation for a very long time, as we shall explore here.
Our situation is sobering: I wish all of our practice family well as we enter into a dangerous surge in Covid-19 cases across the nation. Noting this alarming increase in cases, I wonder how many people have been harmed by other diseases because they did not seek medical care. Broad reporting indicates these numbers are turning out to be nearly as large as the Covid-19 statistics. Thus, we are all strongly advised even at this time to continue our normal health care, including any specialists we normally see and, of course, that includes dentistry.
Most Covid-19 deaths involve the virus itself and also a bacterial superinfection; the host gets weakened, and then other bad actors move in to take advantage. In some cases, perhaps in many cases, the bacteria that cause these dangerous superinfections in the lungs are traceable to periodontitis—gum disease. The germs that cause periodontitis thrive in a small band of gum tissue around our teeth and are particularly vicious. Many are extremely effective at evading the human immune system. Further, current science informs us that when present, these bacteria invade the bloodstream, and also travel directly to the lungs, day after day, hour after hour.
This scenario makes sense if we think about it carefully. One of the most powerful defenses we have against infections of all kinds is shedding. The outer layer of our skin completely renews itself from the base up every 28 days or so. Our intestinal lining regenerates even faster, with a turnover time of an astonishing 4–5 days. Our corneas, nasal passages, hair and so on—every external part of us is, in a manner of speaking, continuously falling off and being renewed from within. It’s rather wasteful, but apparently also necessary, as it makes it very difficult for bacteria and even viruses to invade. They can’t gain any footing.
Teeth are different.
Teeth are the one and only place in the body where a hard tissue comes through to the surface. (Fingernails are a specialized skin structure.) Teeth don’t shed, teeth don’t have turnover, teeth don’t renew. They only time they fall off is during Flyers games.
Unfortunately for us, in their own strange haven’t-got-a-brain way, bacteria “know” this about our teeth and are constantly, relentlessly attacking us at this unique interface, this special place where our teeth come through to the surface, this vitally important 3-millimeter-wide band of protective gum tissue in our mouths. This is why periodic examinations and continuing care in which we remove the plaque and tartar from the teeth remain so important, even—perhaps particularly—during this pandemic. In fact, a June 26 British Dental Journal paper by Sampson and Kamona suggests a link between oral hygiene and the severity of Covid-19 outcomes. Current evidence shows that periodontal disease has a terrible effect on cardiovascular health, as well. There’s hope, of course—periodontal disease can be treated, and even more importantly, prevented!
In these strange and anxious times, we are all balancing one risk against another. As you know, in our practice we have put in place airflow and surface disinfection and patient-flow protocols such that our dental office is one of the safest indoor spaces in Philadelphia. We live and work by mindful mask wearing, handwashing and by the nature of a dental practice with five treatment rooms, social distancing. We vigorously encourage you all to maintain your periodontal health by keeping your continuing care visits with us.
We all need to keep our guard up, and conscientious dental care is significantly contributive to overall health.
If Calvin Coolidge, that eminently practical man of few words, were to come back today as a periodontist—which would be an absolutely wild thing, in my view—I know exactly what he would say, to the dental profession, to the medical profession, and to all the patients he would treat:
“Focus on the part that doesn’t shed.”
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