Bahrain. An archipelago. A small Middle Eastern Arab country. A Kingdom. Known for its date palms, pearl fisheries and traditional markets. With independence declared from the UK in in 1971, it’s a veritable jewel, set in the waters of the Persian Gulf. An island, but not as you know it. Almost the midpoint between Qatar and the east coast of South Arabia, a 27km causeway, consisting of five bridges, has connected it to the Saudi city of Al Khobar for the last 35 years.
The tiny Amwaj islands. An area of only 4.3km square, again man made. Reclaimed from the relatively shallow seas to the northeast of Muharraq Island and a stunning holiday and hotel destination.
The King Fahd Causeway consists of seven embankments, converted into sizeable artificial islands, the largest of which is Middle Island. It has customs and immigration facilities, a mosque, gardens and fast food restaurants. Another island further along the causeway is simply known as Mother of Sleepiness.
Ironic, with the temporary closure of the entire causeway from March 2020 to July of the same year, as a result of the COVID-19 pandemic. In order to stem the spread of virus, all passenger traffic has been suspended, with commercial transport authorised to cross the border only after passing stringent health and cargo tests. Two months later it was announced by the Saudi Arabia embassy that citizens could return to the Kingdom via the King Fahd Causeway without prior permission.
Such are the changes the world now lives with.
Bahrain has had a universal care system since 1960. This government provided health care is free to Bahrainis, and heavily subsidised for non-citizens. Healthcare accounts for 4.5% expenditure of the nation’s GDP with physicians and nurses forming a majority of the country’s workforce.
2020 had a strangely apocalyptic air to these islands.
All businesses of the heavily tourist island were closed. Another huge challenge was the 2000 Bahrainis returning from Iran, just 160km away but could have indeed been likened to an attempt at arrival from another planet. Migrant worker camps were a potential disaster should a COVID-19 outbreak occur. Bahrain treats its non-citizen workforce well with legal protections and a very livable minimum wage. Many from the Asian subcontinent and the Philippines relocate because in 3 years enough money can be earned to build a house, or start a business. Living conditions however are comparable to an old style youth hostel with a lot of sand.
How have dentists responded to necessity of covid safety measures, and the ongoing oral heath of their clients? Surgeries and clinics have suffered unexpected and lengthy closures. And along with dealing with the fallout of the pandemic, dentists, globally, have been attributed to the ever-rising global problem of antibiotic resistance. COVID-19 with its greater concerns, meant dental emergencies are being addressed via a triage system. Dentists were advised on avoiding invasive and aerosol generating procedures. Many dentists had little choice but to prescribe medications, unable to provide usual, or necessary intervention.
Many clinics found that a community emergency is sometimes an opportunity and posted detailed dental care information ontheir websites.
Dental emergencies were addressed using a triage system and dentists were advised on avoiding invasive and aerosol generating procedures. It meant that many dentists opted to prescribe medications without undertaking the necessary dental intervention.
An average of two medications were prescribed for each patient, including systemic and local analgesics and anti-microbials. 33.4% of patients were prescribed only medication, without any dental intervention. Approximately 35% of the data showed inappropriate diagnosis and undetermined rationale.
100% of the patients with acute or chronic periapical abscess, and 41% with gingivitis or periodontitis were prescribed medications without any dental intervention. Chlorhexidine mouth rinse, twice or thrice daily seemed to be on the regular list for any diagnoses, prescribed between 7 and 14 days.
Unfortunately the suspension of dental practices causes more harm in terms of overuse and unindicated prescriptions. Guideline-based effective infection control practices are a better solution to COVID-19 transmission than the suspension of dental care.
It could be some time before the dental world reaches a level of normality, being early days still, of learning about this virus’ association with the world.
There is increasing evidence to support the detection of coronavirus in saliva.
Whether it has the ability to break down the walls of the virus within the mouth remain questionable.
Dentists still use dental veneers that are mostly porcelain and the denial of dental access carries huge impact. Patients are may suffer in pain for a longer. With the near impossibility and to reach a dental surgery, the management of dental pain is pivotal.
With the ongoing restricted dental guidelines in full swing, the scope of practice is limited and absolute inability to carry out routine dentistry people are pretty resourceful and resilient when they have to be.
Personalised oral hygiene advice is given freely on Bahraini and Amwaj Island dental sites, encouraging an opportunity for patients to personally improve their brushing methods and regime to sustain both their oral, and therefore overall health.
The top teeth brushing advice suggest:
- Brushing twice daily for at least two minutes using firm pressure and a fluoridated toothpaste
- Spitting out rather than rinsing after brushing
- Adopting a good brushing technique as opposed to scrubbing teeth and gums
- Cleaning between teeth with a dental pik to dislodge food, debris and bacteria
- Avoiding brushing straight after eating; ideally waiting 45 minutes to allow saliva components to break down residual food in your mouth
- Not neglecting the brushing the tongue. It is strong, active muscle that can release potent smells if not cleaned effectively. Brush using a toothbrush or a tongue scraper
- Regularly check that your mouth looks and feels normal. Take notice of random bleeds and differences in tissue texture.