Oral Health Through the Lens of Climate Change

By Genni Burkhart

Scientists recently reported that this summer was the hottest on record in the United States. Meanwhile, the European Union had its own record-breaking hot summer. Scientists now predict that next summer could be even warmer.

Wildfires have decreased air quality across the globe, with a record number of violent storms, flooding, and other catastrophic weather events. We all watched in horror as the historic town of Lahaina on the island of Maui was consumed by devastating wildfires, killing at least 97 people on Aug 8.

Massive wildfires like the one in Maui also pose a risk to the groundwater and drinking water people use to prepare food and brush their teeth.

Elsewhere, significant wildfires burned in Russia's boreal forests and raged across Canada, Greece, Spain, and Portugal. U.S. air quality alerts continue to be issued due to thick smoke from Canadian wildfires reaching from Maine to Florida.

Overall, total wildfire emissions (thus far) for 2023 are estimated to be approximately 410 megatonnes of carbon. The health impact of all this burning lead, arsenic, asbestos, and other dangerous chemicals creating toxic ash and dust will have a lasting effect on health for decades, perhaps centuries.

These rapid changes in temperature, precipitation, air quality, pollution, and humidity affect weather patterns, impacting the availability of resources such as clean water and food for millions of people.

We'll review the climate crisis's impact on oral health and what can be done to mitigate the effects on patients and dental practices.

Emerging Research

In the last decade, research has emerged on climate change's effect on human health, including oral health. Described as a "quintessential metaproblem and threat multiplier," the broad health implications of the climate crisis are becoming increasingly apparent.

Studies primarily address the direct and indirect impacts, such as direct exposure through shifting weather patterns and extreme weather events, and indirectly from changes to air quality, agriculture, the ecosystem, the economy, and human migration.

There are also health implications from rising pollen levels, decreasing nutritional value of food, and the increasing spread of vectorborne diseases. (1)

A study was published in the Jan-Mar 2023-Volume 10 issue of the International Journal of Preventive and Clinical Dental Research (IJPCDR) (2) on how a lack of clean drinking water and changes in temperature and humidity can lead to dental caries, tooth erosion, and sensitivity, and other issues due to increased bacterial growth in the mouth. Researchers also highlight the increased risk of oral cancer from ultraviolet (UV) radiation due to a thinning ozone layer.

Scientists are now pointing out that the full implications of this crisis are more significant and treacherous than first thought. They've also warned of a growing need to speed up climate and health research through the lens of climate change. (1)

Effects on Oral Health

• Poor air quality

Pollution, wildfire smoke, elevated pollen, increased pollution, and ground-level ozone have dramatically increased asthma rates, which are associated with dry mouth, dental caries, and gingival inflammation. (3)

• Heat stress

Excessive heat exposure can impact dental patients in several ways. For example, medications such as albuterol and epinephrine become less effective when exposed to heat. Furthermore, heat stress is shown to increase antibiotic resistance. (4)

• Food and water insecurity

Associated with a higher level of oral disease and decreased quality of life, 2.2 billion people lack safe drinking water, while 4.2 billion people lack adequate sanitation services. This also leads to increased gastrointestinal diseases, vomiting, and malnutrition. Malnutrition is associated with cancrum oris, gingivitis, and ulcerative periodontal lesions. (3)

• Extreme weather events

Aside from traumatic injury, extreme weather events pose a threat through water-borne illnesses from flooding. Dental clinics risk losing power, ability to access medical records, communication, and damage or complete loss of their physical location. (3)

• Vector-borne illnesses

Several vector-borne diseases present with oral manifestations, including the Zika virus, dengue fever, and Lyme disease. These illnesses can cause bleeding gingiva, hemorrhagic mucosal ulcers, lesions, oral pain, and temporomandibular joint disorders. (3)

• Social factors

Food and water insecurities, extreme weather events, and the economic impact of lost livelihoods will continue to force people to move from their homes and become climate refugees. These migrating populations lack access to medication and healthcare and are at increased risk for preventable oral disease. This will continue to stress infrastructure in urban areas and threaten the health of rural communities. (3)

What can be done?

Much of the current research emphasizes the importance of proactive preparation.

Improvements to power sources (such as the electrical grid and infrastructure) can significantly improve access to healthcare and lessen the recovery and response time after catastrophic weather events.

There's also the issue of improving the medical supply chain to avoid disruptions seen during the COVID-19 pandemic, which resulted in a scarcity of vital healthcare supplies and critical medications.

The 2020 Climate Crisis and Clinical Practice Symposium, the first symposium to bring together leading health institutions to address the impact of climate change on clinical practice held by the Harvard T.H. Chan School of Public Health, suggested that oral healthcare providers develop a strategy for practice resilience and consider the clinical manifestations of climate change in their own dental patients.

It was also emphasized that oral healthcare providers play a critical role in the "provider-patient-climate triad." (3)

Along with delivering patient care, dental clinics must now have the resilience to survive extreme weather conditions and events, as seen with the COVID-19 pandemic. Some suggestions include:

• Prepare for extended power outages, office closures, emergency access to patient records, impaired communications, and medical supply chain issues.
• Have a strategy to use teledentistry to treat patients during emergencies, disasters, and prolonged office closures.
• Have a business savings or investment account for emergency funds.
• Store medications on-site and back records for dispensing controlled substances.
• Avoid overprescribing antibiotics.
• Adding climate-risk screening questions in the standard medical history to include renal, respiratory, and cardiovascular issues.
• Awareness of oral health manifestations related to climate change risk factors.

In Conclusion

Climate change is a complex issue requiring international coordination to make meaningful changes for humanity. However, that doesn't mean we are powerless. As global citizens and clinicians involved in public health, dentists play an important role in mitigating the effects of climate change on their communities. Education and preparation are essential to sustain dental practices well into the future.

Dental professionals should strive to be current on the latest health and climate change research and incorporate strategies into their practice to reduce their carbon footprint and spread awareness to at-risk patients.

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Author: With over 13 years as a published journalist, editor, and writer, Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides in Northern Colorado, where she works as the Editor in Chief of the Incisor at DOCS Education.

References:

1. Renee N. Salas, M.D., M.P.H. The Climate Crisis and Clinical Practice. N Engl J Med 2020; 382:589-591. DOI: 10.1056/NEJMp2000331
2. Patil, Vinit Shashikant1,. Addressing the impact of the climate crisis on oral health. International Journal of Preventive and Clinical Dental Research 10(1): p 20-22, Jan–Mar 2023. | DOI: 10.4103/ijpcdr.ijpcdr_6_23
3. Hackley DM. Climate Change and Oral Health. Int Dent J. 2021 Jun;71(3):173-177. DOI: 10.1111/idj.12628. Epub 2021 Jan 27. PMID: 34024327; PMCID: PMC9275305.
4. MacFadden DR, McGough SF, Fisman D, Santillana M, Brownstein JS. Antibiotic resistance increases with local temperature. Nat Clim Chang 2018; 8:510-514