Dental care in Brazil needs to be more accessible to patients with chronic obstructive pulmonary disease (COPD) and integrated into their primary care to better tackle the impact of the disease in the country, a study suggests.
“Our research indicates that incorporating preventative oral health into COPD management and expanded public dental services would help this group of vulnerable patients,” Matthew Riley, one of the study’s lead co-authors, said in a University of Birmingham press release.
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 in the U.K. and Brazil.
Poor oral health has been linked to worse clinical outcomes in COPD. For example, up to half of episodes in which COPD symptoms worsen — called flares — may result from infections caused by bacteria that enter the lungs through the mouth.
However, “to date, evidence exploring the attitudes of healthcare professionals (HCPs) towards delivering oral healthcare to COPD patients or the oral health views and practices of COPD patients is sparse,” the researchers wrote.
To gain insight into public awareness about the link between a lack of oral health and COPD, researchers interviewed nine COPD patients and 25 healthcare professionals from São Paulo, Brazil.
Interviewed patients were a mean average age of 68 years, and two-thirds were men. Although more than half (55.6%) lacked natural teeth, losing teeth and developing tooth decay as young adults was viewed as a norm.
“[Tooth loss] is a family thing because all of my friends and sisters have all had some of their teeth removed, it’s a common thing,” one of the patients said.
Patients stated they brushed their teeth daily, but neglected adopting other preventive oral health practices.
“Sometimes [the dentist] wants to do treatment in a specific tooth, but it is not aching and does not hurt, so I don’t understand why I would do it,” said one of the respondents.
The 25 healthcare professionals were assembled into three focus groups to participate in a discussion about oral health and COPD. Most of them (96%) were women, and nearly half (48%) reported having no regular contact with COPD patients. Those who did have contact reported often poor oral health in their patients.
In general, both patients and medical professionals were unaware that poor oral health could be a risk factor for COPD, or that it could worsen disease symptoms.
“Despite a high prevalence of oral health problems among patients with COPD, patients and HCPs have inadequate knowledge about the relationship between oral health and COPD,” the researchers wrote.
Patients recalled no education from medical professionals about oral hygiene, and most relied on family members for information about oral health.
“There were no teachers, doctors or dentists, or anybody that could explain how to brush our teeth. So we just did as the elderly did,” said one of the patients.
In turn, healthcare professionals felt that the problem lay with patients avoiding dental appointments and not practicing 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 both patients and medical professionals, increased access to dental care, and incorporation of oral healthcare protocols into primary care for COPD.
“There is a clear desire for greater integration between medical and dental services to promote preventative oral health,” said Amber Swann, the study’s lead co-author. “This could be through developing educational programs or integrating oral health protocols into the primary care pathway for COPD patients.”
“Additionally,” the researchers wrote, “Brazil must continue to expand and promote public dental services to ensure equity in accessing oral healthcare.”