Dental Health and the Heart

Posted by Pi Dental Center on Feb 16, 2021 12:00:00 PM

Heart with tooth graphic for blog - dental health and the heartFebruary is heart month. So this month we review current literature and research about the link between dental health and the heart and discuss tips.

Heart Disease

Heart disease refers to conditions that involve the heart, its vessels, muscles, valves, or internal electric pathways responsible for muscular contraction. Common heart disease conditions include coronary artery disease, heart failure, cardiomyopathy, heart valve disease, and arrhythmias.

Heart disease claims around 610,000 lives each year, heart disease is the number one killer of both men and women in the United States. There is a link between this deadly disease and the health of your gums.

According to a study by the Karolinska University Hospital, Sweden, gum disease increases the risk of a first heart attack by 28%.

Gum Disease

Periodontal diseases (gum diseases), including periodontitis, affect the surrounding tissues which support the teeth. Periodontitis, (inflammation around the teeth), is a serious gum infection that progressively damages the soft tissue and alveolar bone that supports the tooth. Microorganisms, such as bacteria, stick to the tooth surface and multiply causing an overactive immune system to react with inflammation.

Untreated periodontitis eventually results in tooth loss, increasing the risk of stroke, heart attack and other health problems. Bacterial plaque is a sticky, colorless membrane that develops over the surface of teeth. It is the most common cause of periodontal disease.

Signs of gum disease include red, swollen gums that are sore to the touch. Gums may bleed during brushing, flossing and eating. Pus is present around gums and teeth. Gums appear to pull away from the teeth. Teeth are loose or mobile.

Studies show gum disease is linked to heart disease.

By promoting systemic inflammation, periodontal disease may lead to cardiovascular disease. Treatment of periodontal disease has been reported to improve cardiovascular function in patients without overt coronary disease.

One study supported earlier findings that chronic periodontitis was associated with an incidence of coronary artery disease among men under the age of 60. Research also found a trend toward reduced periodontal risk in patients using statins. This supports findings that statin use was associated with fewer periodontal pockets.

Doctors at the University of Alabama studied the relationship between periodontal disease and stroke. Given that atherosclerosis is a systemic disease and periodontal disease may promote atherosclerosis, periodontal disease may also be associated with an increased risk of stroke. They hypothesized that tooth loss would also be associated with higher levels of inflammation and stroke. The study reinforced the association between periodontal disease, as measured by tooth loss and inflammation, and supports an association between periodontal disease and stroke.

Oral inflammation and the heart

Inflammation is part of an immune response to fight off pathogens and clear infections, protecting the body. Chronic inflammation damages the heart, even when no infection is present. This inflammation can cause structural changes to the heart, causing the muscle to become enlarged or develop fibrous tissue, impeding the heart’s ability to pump blood efficiently and leading to further deterioration.

Gum Disease and Plaque

The most common strain of bacteria in dental plaque can cause blood clots that induce heart attacks when they escape into the bloodstream. Heart disease is approximately twice as high in people with periodontal disease. Chronic inflammation of the gums due to plaque could also be involved in the inflammation of the lining of the blood vessels that is known to lead to the build-up of plaque in the arteries.

“Smoking has strong relationships to both tooth loss and heart disease,” said Dr. Catherine Okoro, an epidemiologist at the CDC. “Nonetheless, when we stratified by age group and smoking status, a significant association remained between tooth loss and heart disease among respondents aged 40 to 59 years who had never smoked.” The researchers reported the results are consistent with previous studies that link periodontal disease and tooth loss to an increased risk of atherosclerosis and heart attack.

Gum disease appears to worsen blood pressure and can interfere with medications designed to treat hypertension, high blood pressure.

Poor dental health also poses a risk to people with heart valve problems, stated Dr. Ann Bolger, a cardiologist and professor of medicine emeritus at the University of California, San Francisco. “I spend an inordinate amount of time talking to heart valve patients about their teeth because we know certain heart valve infections can be associated with poor oral health.” This latest research “is a good reminder that the mouth is an important part of a person's entire health and simple, daily behaviors that improve health are incredibly important.”

Heart disease symptoms:

  • Coronary artery disease symptoms may be different for men and women. For instance, men are more likely to have chest pain. Women are more likely to have other signs and symptoms along with chest discomfort, such as shortness of breath, nausea and extreme fatigue.
  • Signs and symptoms can include:

    • Chest pain, chest tightness, chest pressure and chest discomfort (angina)
    • Shortness of breath
    • Pain, numbness, weakness or coldness in your legs or arms if the blood vessels in those parts of your body are narrowed
    • Pain in the neck, jaw, throat, upper abdomen or back
  • Always call 911 or emergency medical help if you think you might be having a heart attack.

What if you already have heart disease?

If you already have heart disease, be sure to follow a meticulous oral hygiene regimen. Good oral hygiene can help prevent heart infections.

Follow these easy steps to keep your heart and mouth healthy.

  • Practice good oral hygiene by brushing twice a day and flossing once a day. In addition, make sure that you see your dentist regularly.
  • Make sure you tell your dentist about your heart condition.
  • Follow any instructions given to you by your dentist and physician. This is especially important because you may need a prescription for an antibiotic before your dental appointments.
  • Prevention is the best medicine
  • Avoid cigarettes and smokeless tobacco. These habits can destroy your gums and increase your chance of heart disease.

Good oral hygiene and regular dental examinations are your best protection against the development of gum disease. If you would like to schedule an appointment for an examination including oral hygiene at Pi Dental Center, give us a call at (215) 646-6334 or click the link below to fill out an online form.

Ask A Dental Question Or Schedule An Appointment

Sources:

  • Uncovering a Link Between Inflammation and Heart Disease: Immune cells can exacerbate heart failure. A new study reveals a potential way to stop them, Laura Castañón Tufts Now, February 1, 2021.
  • Higashi Y, Goto C et al. Department of Cardiovascular Physiology and Medicine, Hiroshima University, Graduate School of Biomedical Sciences, Hiroshima, Japan. 2009 Oct;206(2):604-10.
  • Significant association between score of periodontal disease and coronary artery disease. Oe Y.et al. Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Honjo, Kumamoto, Japan.2009 Mar;24(2):103-7.
  • Tooth loss, systemic inflammation, and prevalent stroke among participants in the reasons for geographic and racial difference in stroke study. You Z et al. Department of Biostatistics, University of Alabama at Birmingham. 2009 Apr;203(2):615-9. Epub 2008 Aug 8.
  • Catherine Okoro, Ph.D., epidemiologist in the Division of Adult Community Health at the Centers for Disease Control and Prevention.
  • CDC, NCHS. Underlying Cause of Death 1999-2013 on CDC WONDER Online Database, released 2015.
  • Gum Disease Linked to Heart Disease, Tim Friend, USA Today.
  • Rydén L, Buhlin K, Ekstrand E, et al. Periodontitis increases the risk of a first myocardial infarction: A report from the PAROKRANK study. 2016.
  • Jeffcoat et al. Impact of periodontal therapy on general health: evidence from insurance data for five systemic conditions. American Journal of Preventive Medicine. 2014;47(2):166-74.
  • Gum Disease and Heart Disease. American Academy of Periodontology. Dec. 2016. http://www.perio.org/consumer/heart_disease

Tags: dental and medical health, dental health, dental medical health connection, dental hygiene

A New Smile and Kissable Mouth This Valentine’s Day

Posted by Chris Raines on Feb 10, 2021 12:00:00 PM

Kissing couple in profile for Valentine's Day blog.

Roses are red,
Violets are blue,
Be true to your teeth,
Or they’ll be false to you!

 

Valentine’s Day is a time when people think about romantic evenings with that special someone. Whether it’s a candle-lit dinner or romantic stroll, an unsightly mouth can be a downer. Here are some tips for your smile and mouth.

Your smile is one of your best assets in communicating. A gorgeous new smile can increase your confidence and transform your life.

Sparkling white teeth project confidence and charm. Lifestyle and the aging process can stain and darken your teeth. Habits such as drinking coffee, tea, cola and red wine can discolor teeth. Our in-office tooth whitening systems are effective, fast, convenient and long lasting. Pi Dental Center’s professional tooth whitening products are proven safe and effective. Consider tooth whitening to brighten your smile and give you a more youthful appearance.

Fresh breath and a healthy mouth are essential to ensure an enjoyable date night. A rigorous at-home oral hygiene regimen by brushing twice a day, flossing and regular dental visits with exam and dental cleaning can help you maintain your dental health and keep your breath fresh. For more information about fresh breath, read blog.

Stop smoking. This can be the best Valentine gift that you give to yourself and to a loved one. The benefits are numerous. Quitting is not easy but you will feel better and be healthier. You will have more energy and improve your lung function. For tips to quit smoking, click here

Replace your toothbrush every three months. Worn bristles are abrasive to the teeth and damaging to gums. In addition, remember to change your toothbrush after you have been sick.

Make a date with your dentist to repair or replace damaged and missing teeth. If you would like to learn how to get a new smile with a kissable mouth, give Pi Dental Center a call.

Pi Dental Center opened its doors 34 years ago on Pennsylvania Avenue in Fort Washington. Our board certified prosthodontists have placed over 23,000 implants.

Teeth in a Day® is a safe and proven technique for dental implant placement. With the Teeth in a Day® protocol, damaged teeth can be extracted, dental implants inserted and non-removable teeth delivered in one office visit. Drs. Thomas Balshi and Glenn Wolfinger created the Teeth in a Day® protocol over 25 years ago and own the trademark for this groundbreaking procedure.

The All-On-4® Treatment Concept is a cost-saving dental implant treatment option. Learn more about All-On-4.

Get a new smile and kissable mouth this Valentine’s Day. Call us at (215) 646-6334 to schedule your complimentary evaluation.

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Tags: dental implant treatment, healthy teeth, dental care, replacement of missing teeth

A Master Ceramist Is A Valuable Asset

Posted by Chris Raines on Dec 15, 2020 12:00:00 PM

In this photo, Master Ceramist, Dental Lab Technician, Nancy puts the final touches on a Zirconia crown while Andrea assists. Matching the front teeth is a very complex and delicate procedure. Nancy uses stains and glazes to duplicate and blend any characterizations and color variations. After the crown is artistically perfected, it is fired in a porcelain kiln.A porcelain crown is a piece of artwork and patients who have crowns on their front teeth are displaying artwork for everyone to see.

At Pi Dental Center, our resident artist is Nancy Gausz. She is a Master Ceramist and Dental Lab Technician. Having an in-house ceramist allows us to achieve superior esthetic results. An in-house lab technician is a luxury that few other dental offices have.

Nancy Gausz joined Pi Dental Center in 2016. Nancy has worked in the Dental Technology field for over 30 years. It is a field that is ever-evolving with technology and products that change and improve. For example, during the last decade, we have seen remarkable advances in CAD / CAM digital dentistry. She works closely with the doctors and clinical staff to deliver the exceptional results in ceramic restorations.

Nancy works directly with our dental patients in the office providing chairside custom shading. This customized approach is both convenient for our patients and adds an enhanced dimension to the level of treatment. It also improves the patient’s final result!

A dental restoration must look natural and attractive. The shape and shade of the teeth must suit the individual. A front crown must match the adjoining teeth. Unique markings on the new crown must match adjacent teeth. Nancy uses stains and glazes to duplicate and blend characterizations and color variations.

In addition to Zirconia and eMax crowns, Nancy does custom layering on Zirconia cores, fuses porcelain to metal for upper and lower arch crowns, and glazes eMax porcelain veneers. She builds crowns onto dental implant restorations.

A Master Ceramist is the artist that finishes your dental restoration, whether it’s a crown, veneer or fixed implant restoration. At Pi Dental Center, Nancy ensures that our patients’ dental restorations look both fabulous as well as natural. A Master Ceramist is a valuable asset at Pi Dental Center.

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Photo Caption: Master Ceramist, Dental Lab Technician, Nancy puts the final touches on a Zirconia crown while Andrea assists. Matching the front teeth is a very complex and delicate procedure. Nancy uses stains and glazes to duplicate and blend any characterizations and color variations. After the crown is artistically perfected, it is fired in a porcelain oven (kiln). 

Tags: prosthodontic dental restoration, dental crowns, dental lab technology

Holistic Dentistry and Pi Dental Center

Posted by Chris Raines on Oct 28, 2020 12:00:00 PM

Image taken at Cape May Point State Park of lighthouse.

People often ask us if we are a holistic dental practice. In many ways, Pi Dental Center has a lot in common with a holistic office. In other ways, we do not. Read on to learn about the philosophy of a holistic office and what aspects are applicable to our center.

What do holistic dentists believe?

A holistic dentist sees the mouth as an integrated part of the body and considers oral health problems as they relate to total body health.

The doctors and staff at Pi Dental Center agree that dental health affects the entire body. One example of the relationship between oral health and overall health is the connection between periodontal disease, heart disease and diabetes. Research has proven that there is a strong link between them. We also believe that a person’s habits and behavior can affect their dental health.

Holistic dentists choose minimally invasive options. At Pi Dental Center, long-term predictable dental health is our goal for our patients. When a patient is evaluated, all reasonable options are explored and when it is feasible, Pi Dental Center will consider a minimally invasive option.

Holistic practices build a partnership with their patients. Our goal is to empower each of our patients to achieve optimal dental health. We do this through wide-ranging treatment options, advanced prosthodontic care and a comprehensive program of oral hygiene maintenance and education.

What types of treatment do holistic dentists provide?

Traditional dentists treat problems that affect the teeth, gums, oral structures and the jaw. Holistic dentists focus on the entire person. Not all holistic dentists’ approach to dentistry is the same and they don’t all offer the same procedures, but here are some of the most common offerings.

Holistic dentists offer only composite fillings rather than mercury fillings. Pi Dental Center also offers composite fillings and has never used mercury fillings.

While many holistic dentists remove mercury fillings and replace them with composite fillings, Pi Dental Center removes mercury fillings that show decay or breakdown.

Like holistic practices, Pi Dental Center utilizes advanced 3D low dose digital x-rays.

The titanium dental implant systems that Pi Dental Center uses are backed by substantial research and can be used in all indications of tooth replacement. Ceramic implants have little long-term follow-up and are only indicated for single tooth replacement.

When compared to traditional impressions, digital scanning technology is more efficient, precise and comfortable for the patient. At Pi Dental Center, TRIOS scanning technology is used for crowns, bridges and single tooth dental implants.

What types of treatment don’t holistic dentists offer?

Holistic dentists do not perform root canals. At Pi Dental Center, patients are referred to an endodontist (root canal specialist) when necessary.

Holistic dentists don’t advocate the use of fluoride. Pi Dental Center focuses on scientifically proven treatment, procedures, techniques and products. While we do provide fluoride products and treatments, patients can choose not to use them.

Pi Dental Center works closely with dental offices that provide additional holistic dental procedures, and referrals to those offices can be made for those who are interested. The health of the mouth impacts the entire body. At Pi Dental Center, our mission is to work with our patients to help them achieve and maintain healthy mouths. Give us a call if you would like to schedule an appointment or have questions.

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Photo Credit: Andrea Clendaniel shot this photo of the lighthouse at Cape May Point State Park.

Tags: dental fillings, oral health and quality of life, good doctor/patient relationship, prosthodontic dental restoration, dental care

Pi Dental Center's New eBook

Posted by Pi Dental Center on Oct 6, 2020 12:00:00 PM

Learn the Basics: Dental Implant Treatment at Pi Dental CenterDental implants are the first choice in dental care for the replacement of missing teeth. Pi Dental Center has produced a handy guide to dental implant treatment in a convenient eBook.


In this eBook you will learn about life-changing dental implant treatment at Pi Dental Center with our new eBook. This detailed volume describes what to expect at every stage of treatment.


Here is a list of some of the subjects covered in the eBook:

• What are dental implants?
• Your first and second visits to Pi
• Will the procedure hurt?
• How long will it take?
• The healing phase of treatment
• Your final smile
• Ten reasons to choose implants
• What is a prosthodontist?
• Dentures accelerate aging. Dental implants preserve youth.
• Dental implants versus crowns or bridges
• Everyday rewards with dental implants
• Avoiding chips and breaks
• Dental implant technology
• Teeth in a Day®
• “No Bone Solutions.”
• Zygomatic implants
• The All-On-4® Treatment Concept
• The AvaDent® digital implant supported prosthesis
• General anesthesia
• How do I maintain my dental implants?
• Fees and insurance

Click the link below to request your copy.

Learn About Dental Implant Treatment At Pi Dental Center

 

If you have any questions, please feel free to call (215) 646-6334

Tags: dental implants, No Bone Solution, Teeth In A Day, All-On-4 dental implant treatment

Dentistry: An Essential Service During COVID-19 Pandemic

Posted by Pi Dental Center on Sep 14, 2020 10:27:49 AM

Graphic "Dentistry is an essential service during pandemic"A healthy mouth is crucial to the health of the entire body. Dentistry is an Essential Service that must be available to the public at all times, especially during this pandemic. Dentistry and dentists are undervalued by the medical community and the population at large. This attitude was reflected in a recent recommendation by the World Health Organization (WHO). The American Dental Association, the American College of Prosthodontists and other major dental organizations have released statements stating that they strongly disagree with WHO. While the dental community has always practiced stringent infection control and sterilization measures, they have greatly increased these measures to ensure patient safety.

An “Essential Business” provides products or services that customers require at all times, even during pandemics, natural disasters or community unrest. These businesses are permitted to remain open, whereas those that provide products or services that are for “comfort or entertainment” rather than “necessity” may be recommended to close.

The World Health Organization (WHO) released a recommendation in August that patients should delay “routine” oral health care until there is a reduction in COVID-19 transmission rates. The last thing that people need is another reason not to go to the dentist. Well, that is exactly what the World Health Organization has done.

The fact that the health of the mouth impacts the entire body has been well documented. Research shows that there is an association between periodontal disease, tooth loss, cancer, stroke, cardiovascular disease and preterm birth. Periodontal disease can worsen lung disease and complicate diabetes. There is a link between osteoporosis and periodontal disease. Tooth loss is associated with poor nutrition and oral cancer. Read More.

The idea that you don’t need to go to the dentist unless you have a problem with a tooth is a fallacy. Tooth decay can occur in areas that are not visible. A dental examination is necessary to ensure that your teeth are healthy. Read More

Dentists identify dental conditions that contribute to serious health issues and medical health problems during oral examination. Signs of anorexia, bulimia and drug use are evident from the gum tissues and teeth. A dentist’s cone beam CT scanner can identify a range of issues from chronic sinusitis to intracranial calcifications, multiple myeloma, soft tissue masses, osteoarthritis of the temporomandibular joint, degenerative cervical spine, and narrowing of the airway. Oral cancer screenings are conducted at every oral hygiene visit. Early detection improves treatment outcomes. Dentists save lives!

Read More.

Dentists all over the country have increased their sterilization protocols. At Pi Dental Center, we have examined and updated our office practices, making improvements above and beyond those suggested by the Centers for Disease Control, the Occupational Safety and Health Administration, the Pennsylvania Department of Health and the American Dental Association. We have improved air quality, required mask wearing, provided Level-3 N-95 face masks, used face shields, conducted frequent disinfection procedures, introduced screenings and temperature checks and enforced social distancing. Read More.

Centers for Disease Control and Prevention:

The U.S. Centers for Disease Control and Prevention (CDC) have updated and reaffirmed their guidance for dental settings, which still allows for the delivery of care to patients when proper precautions and safety measures are followed.

American Dental Association:

The Dental Team is Essential. The American Dental Association (ADA) affirms that the oral health workforce is essential during public health emergencies. Government agencies such as the Department of Homeland Security and Federal Emergency Management Agency have already acknowledged dentistry as an essential service. Dental health is a fundamental component of a person’s overall health and dentistry is a vital health care service. Oral disease can affect systemic health. Dentistry is an essential service whether it's the current pandemic, a future epidemic or a natural disaster in a particular area. People need to be able to access the full range of dental services.

American College of Prosthodontists:

The American College of Prosthodontists (ACP) joins the American Dental Association (ADA) in respectfully yet strongly disagreeing with this WHO recommendation. We assert that dental care is an essential part of an individual’s overall health. As an organization we will continue to work with the ADA on advocacy efforts to designate dentistry as an essential service. The ACP encourages members to follow CDC, ADA, and state and local health official guidance regarding patient care.

American Academy of Periodontology:

“It is well-established science that periodontal disease and systemic disease are interconnected. As a result, establishing and maintaining healthy teeth and gums is fundamental to overall health,” said Dr. Bryan Frantz, American Academy of Periodontology (AAP) president. The AAP added there is limited evidence that dental offices pose an increased risk of spreading disease, including COVID-19.

Academy of General Dentists

The Academy of General Dentists (AGD) calls dental care an essential component of the overall healthcare model and notes that dental offices are practicing enhanced safety measures to address their patient needs during this time.

“Good oral health contributes to good overall health, and any recommendations against the continuum or oral care negatively impact dental patients,” said AGD president Connie L. White, DDS. “Delaying a dental visit may create further health issues and long-term problems.”

Oral cancer is a serious health problem and the oral hygiene/exam visit is crucial for identifying oral cancer. A delayed oral hygiene visit can mean the difference between a manageable lesion to something much more serious.

Oral health problems can actually make recovery from COVID-19 more difficult. Studies have linked gum disease to COVID-19 deaths. One study by U.S. dental surgeon Dr. Shervin Molayem and South African scientist Carla Pontes suggests COVID patients with gum disease are more susceptible to a respiratory crisis known as a cytokine storm, essentially an overreaction of the body’s immune system.

“Gum disease has been linked to other breathing ailments, including pneumonia and chronic obstructive pulmonary disease, so we weren’t surprised to find a link to respiratory problems with COVID-19,” Molayem said in a press release. “What shocked us was the discovery of the protein’s devastating, life-threatening impact to patients once they’re hospitalized. One tiny, inflammatory protein robbed them of their ability to breathe!”

At Pi Dental Center, we have seen evidence that gingivitis can quickly turn into periodontitis. Just since the quarantine began, we have seen tooth loss in an adolescent orthodontic patient. Patients who have missed their regularly scheduled hygiene appointments have presented with advanced caries.

Many of Pi Dental Center’s patients are in the process of completing comprehensive treatment plans. Any delay in care can lead to a setback or worsening of the patient’s dental condition.

The dental Hippocratic Oath reminds dentists that prevention is preferable to cure of disease. Shutting dentistry down during the pandemic has forced dentists to break their Hippocratic Oaths.

Dentists are essential health care workers who should be afforded early access to a safe and effective SARS-CoV-2 vaccine when one becomes available, stated ADA Executive Director Kathleen T. O’Loughlin. “There is little doubt that there will be a high demand for a safe and effective SARS-CoV-2 vaccine once one becomes available — and doses of the vaccine will likely have to be rationed until production can meet the demand,” Dr. O’Loughlin stated.

“The vital role that dentists play in maintaining overall health and screening for systemic disease is critical to the health of the public,” Dr. O’Loughlin said.

“Dental care is absolutely ESSENTIAL and very much necessary to maintain a healthy balance for all populations, but especially for the mature adult population who may have already lost several teeth due to bone loss and periodontal disease. These populations are the most in need of close attention to minimize inflammatory disease which can affect the cardiovascular system,” stated Thomas Balshi, DDS, FACP, PhD.

Pi Dental Center continues to utilize the highest level of PPE available with stringent sterilization protocols and has complied with all regulations from the Centers for Disease Control and Prevention and state of Pennsylvania. As dentists, Drs. Wolfinger and Slauch have taken an oath to prevent disease whenever possible. They have a special obligation to their patients. They strive to realize this oath during this pandemic. Pi Dental Center provides a safe environment for patients and staff.

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Sources:

https://decisionsindentistry.com/2020/08/ada-responds-to-who-dentistry-is-essential-healthcare-2/?inf_contact_key=9cd2de8a9995dbf19bf07a4dd5f527df16358d5485884e2f31e6019a0d26c8b0


https://decisionsindentistry.com/2020/08/paper-explores-connection-between-oral-hygiene-severity-covid/


https://www.ada.org/en/publications/ada-news/2020-archive/july/ada-board-of-trustees-dentistry-is-essential-health-care?utm_source=Labs.Dental+Inc.&utm_campaign=3d69664a4b-200807+Products+DaVinci_COPY_01&utm_medium=email&utm_term=0_d94c263c04-3d69664a4b-388261518


https://www.ada.org/en/publications/ada-news/2020-archive/september/ada-urges-dentists-be-offered-early-access-for-sars-cov-2-vaccine#:~:text=Washington%20%E2%80%94%20Dentists%20are%20essential%20health,and%20Medicine%20panel%20Sept.%202.


https://www.dentistrytoday.com/news/industrynews/item/6778-covid-19-patients-with-periodontitis-face-greater-risk-of-dying


https://www.dentistrytoday.com/news/industrynews/item/6797-organized-dentistry-disagrees-with-who-covid-19-recommendations?hq_e=el&hq_m=2091329&hq_l=5&hq_v=93f24336ae

 

Tags: dental health, oral health