Oral health in Brazil needs better promotion and more accessible public dental services before it can help in the fight against chronic obstructive pulmonary disease (COPD), which is the country’s third leading cause of adult death, according to the University of Birmingham.
Despite poor oral health being associated with worse clinical outcomes in COPD, many patients and primary healthcare professionals in Brazil do not know enough about the link between a lack of oral hygiene and the killer disease, the researchers said.
Interviewing COPD patients and healthcare professionals in São Paulo, researchers from the University of Birmingham discovered that many of those with the disease viewed tooth loss and decay as normal and seldom practice preventive oral health.
Working with Brazilian partners, the researchers further noted that a lack of oral health advice relating to COPD, alongside poor oral hygiene practices and difficulties accessing free dental care, has worsened the problem.
“There is a clear desire for greater integration between medical and dental services to promote preventative oral health,” said lead co-author Amber Swann, an intercalating medical student at the University of Birmingham.
“This could be through developing educational programs or integrating oral health protocols into the primary care pathway for COPD patients,” Swann said.
“Dentists felt that the problem lay with patients avoiding preventative care, whilst patients highlighted significant barriers to accessing oral healthcare,” said co-lead Matthew Riley, who also is on the intercalating course, which enables students to carry out research before graduating.
“Our research indicates that incorporating preventative oral health into COPD management and expanded public dental services would help this group of vulnerable patients,” Riley said.
COPD is a long-term incapacitating respiratory condition and the fourth leading cause of death worldwide, the researchers said. Caused mainly by smoking and exposure to air pollution, it is more common in low- and middle-income countries (LMICs) with disadvantaged populations most affected.
Worsening of COPD symptoms is a common and costly complication, often associated with irreversible loss of lung function, hospitalization, and death. Up to half of such COPD “flareups” may result from bacterial infections, the researchers said, and recent evidence suggests a significant decrease in flareups following periodontal treatment.
When Brazil introduced its universal healthcare system in 1988, oral health was a low priority, and services were limited. The 2004 Oral Health National Policy aimed to expand access to public services, but more than 50% of 65- to 74-year-olds in Brazil are missing teeth, while the remainder have some degree of periodontal disease, the researchers said.
Caried out with the São Paulo Faculty of Medicine of ABC, the São Paulo Department of Community Health, and the Brazilian Society of Family and Community Medicine, the research is linked to the £2 million NIHR Global Health Research Group on Global COPD in Primary Care and its Breathe Well project.
Formed in June 2017, the group has partnered with teams in Brazil, China, Georgia, and the Republic of North Macedonia and the International Primary Care Respiratory Group. It will publish key research findings this year, based on projects in primary care settings evaluating the accuracy of COPD screening strategies, promoting smoking cessation and improving disease management.
“COPD is a global killer, and we’re working with partners in Brazil to improve healthcare outcomes for people with COPD,” said project leader Dr. Rachel Jordan, reader in epidemiology and primary care at the university.
“We are strengthening local research capacity in partner countries, co-creating local plans for finding the best ways to prevent, identify, and treat COPD in the community,” Jordan said. “This allows us to build robust platforms for collaborative research with partner countries and other LMICs.”
The study, “Knowledge, Attitudes and Practices of Patients and Healthcare Professionals Regarding Oral Health and COPD in Sao Paulo, Brazil: A Qualitative Study,” was published by npj Primary Care Respiratory Medicine.
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