Dental care in Brazil must be more accessible to patients with chronic obstructive pulmonary disease (COPD) and integrated into their primary care to better combat the impact of the disease in the country, suggests a study.
“Our research indicates that integrating preventive oral health into the management of COPD and expanding public dental services would help this vulnerable group of patients,” said Matthew Riley, one of the lead co-authors of the study, in a press release from the University of Birmingham.
The study, “Knowledge, attitudes and practices of patients and healthcare professionals regarding oral health and COPD in São Paulo, Brazil: a qualitative study, ”Was published in the journal npj Primary care Respiratory medicine, and was a collaborative effort between researchers from the UK and Brazil.
Poor oral health has been associated with poorer clinical outcomes in COPD. For example, up to half of the episodes in which COPD symptoms get worse – called flare-ups – can be from infections caused by bacteria that enter the lungs through the mouth.
However, “to date, the evidence exploring the attitudes of health professionals (HCPs) towards the provision of oral care to patients with COPD or the oral health views and practices of COPD patients are rare, ”the researchers wrote.
To better understand public awareness of the link between poor oral health and COPD, researchers interviewed nine COPD patients and 25 healthcare professionals from São Paulo, Brazil.
The patients interviewed were on average 68 years old and two-thirds were men. Although more than half (55.6%) did not have natural teeth, tooth loss and the development of dental caries in young adults were considered the norm.
“[Tooth loss] is a family affair because all of my friends and sisters have all had tooth extraction, it’s a common thing, ”said one of the patients.
Patients reported brushing their teeth daily, but neglected to adopt other preventive oral health practices.
“Occasionally [the dentist] wants to do treatment on a specific tooth, but it doesn’t hurt or hurt, so I don’t understand why I would do it, ”said one of the respondents.
The 25 healthcare professionals were brought together in three focus groups to participate in a discussion on oral health and COPD. Most of them (96%) were women and almost half (48%) said they had no regular contact with COPD patients. Those who have had contact have reported poor oral health in their patients.
In general, both patients and healthcare professionals were unaware that poor oral health could be a risk factor for COPD or that it could worsen the symptoms of the disease.
“Despite a high prevalence of oral health problems in patients with COPD, patients and healthcare professionals have insufficient knowledge of the relationship between oral health and COPD,” the researchers wrote.
Patients remembered the lack of education of health professionals about oral hygiene, and most relied on family members for information on oral health.
“There weren’t any teachers, doctors or dentists, or anyone who could explain how to brush your teeth. So we did like the elderly, ”said one of the patients.
In turn, medical professionals felt that the problem was that patients avoided dental appointments and did not practice healthy oral hygiene. However, patients highlighted significant barriers to accessing dental care.
These findings are a call to action for future healthcare practices, the researchers said. Key recommendations from the focus groups included better education for patients and healthcare professionals, increased access to dental care, and the incorporation of oral care protocols into primary care for COPD.
“There is a clear desire for greater integration between medical and dental services to promote preventive oral health,” said Amber Swann, co-lead author of the study. “This could be done by developing educational programs or integrating oral health protocols into the primary care pathway for patients with COPD. “
In addition, the researchers wrote, Brazil must continue to expand and promote public dental services to ensure equity in access to oral health care.