Post-Apocalyptic Dental Care

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W&H's Kate Scheer ponders post-apocalyptic oral care

An enduringly popular science fiction scenario is the apocalypse, or more specifically the post-apocalypse. Stories of people eking out an existence following a global catastrophe – whether man-made, natural, supernatural, or extra-terrestrial in origin – have become highly prevalent in literature and on screens big and small.

While some of these stories make a pretence of gritty realism, almost none of them deal with certain repercussions that the sudden collapse of civilisation would have on human existence, including how people may or may not care for their teeth. Films of protagonist survivors in post-apocalyptic wastelands often flash conspicuously Hollywood smiles.

This may seem somewhat whimsical, but it is interesting to consider how people’s teeth would fare if the advantages of our highly connected civilisation were to be suddenly removed. This idea also has a degree of application in the real world, where warzones and disaster areas can become just as barren of dental necessities as any fictional wasteland.

Oral care

In the case of most conceivable disasters, supplies of existing oral hygiene products such as toothbrushes and toothpaste would probably last for quite some time. Toothbrushes lose their efficacy after 2-3 months, or sooner if the bristles become bent or frayed.

The more worn a toothbrush is, the worse it performs at plaque removal [1]. However, even if the modern manufacturing base was severely disrupted or destroyed, and existing supplies of toothbrushes used up, some means of toothbrushing would still be available.

The toothbrush was invented in China around a thousand years ago (though it didn’t reach Europe until the 17th century) and far back into antiquity, people used sticks to manually clean their teeth [2]. Greeks, Romans, Babylonians and other societies used chewed plant sticks – a practice that continues in certain rural areas of the globe today [3]. As such, under most imaginable circumstances, people should be able to find or produce a means of brushing their teeth.

Toothpowders and pastes are likewise feasible without modern technology, having been invented somewhere between 3000-5000 BC. Ancient formulations were made from things like crushed or powdered shells and herbs, which served as abrasives and breath fresheners. Much more recently, bicarbonate of soda was used [4].

Garlic and ginger have considerable antibacterial and antifungal properties. Other well-known plants with some useful antimicrobial qualities include onion, thyme, aloe vera and oak [5,6]. Capsaicin – the active ingredient in chilli peppers – is an anti-bacterial proven to inhibit biofilm formation by P. gingivalis, as well as inhibiting V. cholera, S. aureus and streptococci [7].

Mint leaves are easy to grow and can be chewed or infused in hot water as tea – not only do they have antimicrobial properties, but can also help freshen breath [8]. While not as effective as modern pharmaceuticals, knowledge of the existence of these properties in easily cultivated plants could benefit people bereft of the former, and potentially aid oral hygiene.

Using saline solution (salt water) as an oral rinse for gingivitis and other complaints is believed to have originated in ancient China – as early as 2700 BC – and continues to be recommended today. Recent research suggests there is validity to this, with the use of salt solution as a mouth rinse observed to promote wound healing [9].

Disinfection and sterilization

Alcoholic drinks have been employed for pain relief throughout history, and can be produced with very simple methods and equipment. Isopropyl alcohol (surgical spirit/rubbing alcohol) can be used as a topical antiseptic, and is also feasible to produce with limited means, provided sufficient sugar is available. It should be noted that while such alcohol is useful for disinfecting hard-surfaces, it is not sporicidal and, therefore, not a viable sterilizer.

Drinkable alcohol can have some value as a makeshift antiseptic but at alcohol concentrations below 50%, the effect is substantially less, meaning that only stronger beverages such as whisky and vodka would be viable [10]. The application of heat, whether through fire or boiling, is a low-tech means of sterilization.

While some degree of sterilization can be accomplished with surprisingly low-tech means, any sort of surgical intervention is highly dangerous to patients without modern sanitisation and disinfection protocols. Historically, surgery was a last resort – even during the Industrial Revolution, mortality rates could be around 50% for even comparatively routine dental operations.

The principal reason for this was a lack of awareness of (and inability to perform) effective sterilization and infection control. Teeth would often be extracted by barber-surgeons or blacksmiths, rather than by trained dental practitioners [11].

Modern disinfection and sterilization equipment and protocols make procedures incomparably safer than what is achievable without them (see below, Lisa type B)

It is fascinating to consider the standard of dental care that could be achieved with minimal resources. Thankfully, however, the latest technology and protocols enable dental practitioners to offer a degree of certainty and safety that would be unthinkable without modern amenities.

Author:

Kate Scheer is a Marketing Executive with W&H. The Lisa type B vacuum steriliser from W&H is a highly advanced yet easy to use machine that can ensure your instruments are thoroughly sterilized in just 30 minutes. With integrated traceability and risk-free cycle selection, Lisa handles your practice’s needs with efficiency and efficacy. For more information, go to www.wh.com/en_uk 

References:

1] Van Leeuwen M., Van der Weijden F., Slot D., Rosema M. Toothbrush wear in relation to toothbrushing effectiveness. International Journal of Dental Hygiene. 2018; 17(1). https://onlinelibrary.wiley.com/doi/full/10.1111/idh.12370 February 28, 2019.

2] Tangade P., Shah A., Ravishankar T., Tirth A., Pal S. Is plaque removal efficacy of toothbrush related to bristle flaring? A 3-month prospective parallel experimental study. Ethiopian Journal of Health Sciences. 2013; 23(3): 255-264. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3847535/ February 28, 2019.

3] Malik A., Shaukat M., Qureshi A., Abdur R. Comparative effectiveness of chewing stick and toothbrush: a randomized clinical trial. North American Journal of Medical Sciences. 2014; 6(7): 333-337. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4114011/ February 28, 2019.

4] Lippert F. An introduction to toothpaste – its purpose, history and ingredients. Monographs in oral science. 2013; 23: 1-14. Click HERE.  February 28, 2019.

5] Petropoulos S., Fernandes A., Barros L., Ciric A., Sokovic M., Ferreira I. Antimicrobial and antioxidant properties of various Greek garlic genotypes. Food Chemistry. 2018; 245: 7-12. https://www.sciencedirect.com/science/article/pii/S0308814617317168 February 28, 2019.

6] Qadir M., Shahzadi S., Bashir A., Munir A., Shahzad S. Evaluation of phenolic compounds and antioxidant and antimicrobial activities of some common herbs. International Journal of Analytical Chemistry. 2017; 2017: 3475738. https://www.hindawi.com/journals/ijac/2017/3475738/abs/ February 28, 2019.

7] Marini E., Magi G., Mingoia M., Pugnaloni A., Facinelli B. Antimicrobial and anti-virulence activity of capsaicin against erythromycin-resistant, cell-invasive group A streptococci. Frontiers in Microbiology. 2015; 6: 1281. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4643145/ February 28, 2019.

8] Qadir M., Shahzadi S., Bashir A., Munir A., Shahzad S. Evaluation of phenolic compounds and antioxidant and antimicrobial activities of some common herbs. International Journal of Analytical Chemistry. 2017; 2017: 3475738. https://www.hindawi.com/journals/ijac/2017/3475738/abs/ February 28, 2019.

9] Huynh N., Everts V., Leethanakul C., Pavasant P., Ampornaramveth R.. Rinising with saline promotes human gingival fibroblast wound healing in vitro. PLOS ONE. 2016; 11(7): e0159843. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0159843 February 28, 2019.

10] McDonnell G., Russell A. Antiseptics and disinfectants: activity, action and, resistance. Clinical Microbiology Reviews. 1999; 12(1): 147-179. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC88911/ February 28, 2019.

11] Melin M. The industrial revolution and the advent of modern surgery. Intersect. 2016; 9(2). http://ojs.stanford.edu/ojs/index.php/intersect/article/view/819/797 March 1, 2019.

Photos by Cata and Toni Oprea on Unsplash