7/15/2021 2:19:00 PM
Does climate change affect dentistry?
Background
The effects of climate change on human health, including oral health, are detectable, making this an acute and present situation. In 2015, global mean surface air temperature (SAT) reached 1°C above pre-industrial levels1 and is predicted to increase rapidly to 1.5°C by 2030.
Consideration of climate exposure pathways, health risks, and potential areas for oral health surveillance and research:
Heat stress:
Heat stress contributes to increasing antibiotic resistance. Less effective antibiotics, patients who are more susceptible to medical crises, and emergency medications are less efficacious under extreme heat present.
Several drugs found within standard emergency kits for dental offices are affected by heat. Specific drugs for handling asthma episodes (albuterol) or allergic reactions (epinephrine) become less productive when exposed to heat.
Poor air quality:
Increasing rates of asthma and chronic pulmonary disease drug often used to treat asthma is antihistamines that contain sucrose and bronchodilators (albuterol) that may cause dry mouth. Both sugar exposure and dry mouth are risk factors for dental caries. Asthma is associated with an increased risk of dental caries, gingival inflammation, and alterations in the salivary pH
rising temperatures cause depletion of the ozone layer, which functions to absorb the sun’s ultraviolet radiation that increases the risk of lip and skin cancers of the face, head, and neck.
Food/water insecurity:
Water scarcity and heat curtail the growth of animals and crops and also lower the nutritional value of food, thereby contributing to food insecurity
Malnutrition is likely to occur in communities that depend heavily on farming and fishing, which exist outside temperate weather zones. Malnutrition is associated with early signs of onset include gingivitis and ulcerative periodontal lesions. Malnutrition is also associated with enamel hypoplasia, dental caries, and delayed tooth eruption.
Vector-borne illnesses:
As mean SATs rise, vector-borne illnesses will increase several vector-borne diseases present with oral manifestations. Zika virus may cause intraoral ecchymosis, petechiae, aphthous ulcers, or other ulcerative oral mucosal lesions. Early lesions of dengue fever include bleeding gingiva or hemorrhagic mucosal ulcers. Lyme disease can present as headaches and non-specific orofacial pain resembling temporomandibular joint disorders. A thoughtful review of the patient's history and scrupulous clinical examination will enable early diagnosis, earlier treatment, and better systemic disease outcomes. Oral healthcare providers often see patients more frequently than do physicians.
Social factors:
Weather events, food/water insecurity, and the economic impact of lost livelihood will continue to force significant numbers of people to move from rural to urban areas. Migrating populations lack access to healthcare and are at risk for an array of preventable and treatable illnesses and diseases, including common oral diseases such as dental caries and periodontal disease. They are also at risk for an individual or collective violence that causes potentially increased traumatic oral injuries.
Mental health
Climate-related displacement and violence contribute to a substantial burden of mental health illness. Oral health outcomes of mental stress include orofacial pain, temporomandibular pain, aphthous ulcers, necrotizing ulcerative periodontal lesions, and ulcerations related to autoimmune diseases (pemphigus and pemphigoid).
There has been an increase in domestic violence and abuse, which is often associated with increased drug or alcohol use (oral health risk factors) and may show a concomitant rise in orofacial trauma.
Discussion
There are some suggestions
1-Including climate-risk screening questions in the standard medical history; understanding possible renal, respiratory, and cardiovascular implications
2- Being aware of oral manifestations related to risk factors from climate change exposure pathways.
Within dental education programs, it is possible to integrate a climate lens into the existing dental curriculum, particularly related to practice preparedness, waste management, and models of service delivery. Within institutions, multi-stakeholder sustainability committees must endeavor to reduce fossil fuels, maximize energy efficiency, and improve waste management. This paper seeks to invite oral health researchers to investigate climate effects on oral health and contribute to the body of scientific literature on climate change and health.
Oral health indicators have the potential to form early warning systems for systemic disease surveillance. By bringing dental discipline expertise to the table, oral health professionals will collaborate with medical, nursing, and public health colleagues to tackle these unprecedented challenges and reinforce oral health status as part of overall health.
Climate change affects health, including oral health. Provider awareness is essential for the recognition and management of climate impacts on individuals and communities. Practice preparedness is critical for securing health system resiliency and navigating adverse climate events to ensure positive health outcomes.
By: Niloufar Abedi
Reference:
Hockley D. Climate Change and Oral Health. International Dental Journal 2021:71(3);173-177.