Specialist Dental Group has launched an on-going series of blog posts by our individual dental specialists. All views provided are the dentist’s own opinions and are posted on this blog as part of our on-going efforts to educate the public about dental issues and other matters of interest.
For the past three months, many of us have likely gotten our body temperature checked at a frequency higher than the past ten years combined. I cannot blame anyone for the thought of Covid-19 when the thermometer flashes a figure of 37.5°C or more. Fever, however, is neither descriptive of nor associated with a particular illness or disease. Rather, fever is a reaction of our body to a plethora of conditions (e.g. infections, inflammations, metabolic disorders, cancer) harmful to us.
Recently, a colleague at the Specialist Dental Group reminded me of another important cause of persistent fever in Singapore – dengue. She casually asked me to blog about the effect of dengue on oral health after coming across an article on tooth brushing (or the lack of) and dengue. I could have easily completed the blog in a few words since the oral manifestations of dengue are not as extensively studied as other systemic diseases, such as diabetes. Think diabetes, we think of gum disease, tooth loss, dry mouth, burning mouth sensation, oral fungal infection. The list goes on. Think dengue, hmm… gum bleeding? Gum itch is not a symptom, even if dengue is spread by Aedes mosquitoes!
The characteristic signs and symptoms of a dengue infection include a sudden onset of high fever, headache, vomiting, muscle and joint pain, and skin rash. Oral manifestations are usually seen in more severe stages of dengue infection (i.e. dengue hemorrhagic fever) where the platelet count is affected. Gum bleeding is the most common oral presentation and can happen when the platelet count is low. Viral vesicles on lips and within oral cavity as well as metallic taste in the mouth are other less common oral presentations.
Good oral care is essential during the infectious period. Several clinical reports observed that patients with dengue fever who experienced acute gum bleeding also had poor oral hygiene. This is not surprising as dental plaque and tartar are known to cause gum inflammation and bleeding. So, should we stop tooth brushing or not? Or in Covid-19 lingo, “Is tooth brushing essential or not?” For a start, I would recommend gentle brushing twice a day with a soft bristle toothbrush. This is recommended for both adult and children patients with dengue fever. A soft oral foam swab soaked in water or mouthrinse can be used as an alternative. This is particularly useful for patients who are hospitalised and require oral hygiene maintenance by a caregiver. If there is spontaneous or profuse gum bleeding, this may indicate an abnormally low platelet count (a condition known as thrombocytopenia). Here, a prompt visit to your medical physician for consultation is imperative.
With regard to dental procedures, I would advise patients with dengue fever to defer all elective procedures until they recover from the infection. Should a dental procedure be necessary, a thorough history taking and discussion with our medical colleagues can help determine the severity of the dengue infection. Extra precaution will be taken to minimise any risk of bleeding and secondary infection during and after the dental procedures. Use of aspirin and non-steroidal anti-inflammatory drugs (e.g. ibuprofen) should be avoided as these drugs tend to increase bleeding risk.
As of 15 June 2020, the number of dengue cases for this year stands at 11,166, with 211 active dengue clusters reported. There is a high chance that some patients with dengue fever might have encountered abnormal gum bleeding. It is my hope that this blog shares with our readers some insight on the relationship between oral health and dengue. If in doubt, please visit your medical doctor and dentist for a proper consultation.
Dr Tan Kian Meng is a Dental Specialist in Prosthodontics (Teeth Replacement & Cosmetic Dentistry) with Specialist Dental Group®. He received his specialty training in Prosthodontics from University of Maryland, USA. He is also an Adjunct Lecturer with the National University of Singapore, a Visiting Consultant at Singapore’s Khoo Teck Puat Hospital and serving as the Vice President of Prosthodontic Society Singapore. Dr Tan has a special interest in prosthetic and implant restorative dentistry.
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