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Breath testing in Brazil
Breath testing in Brazil as part of the Breathe Well project

Oral health in Brazil needs better promotion and more accessible public dental services, in order to help tackle the impact of Chronic Obstructive Pulmonary Disease (COPD) – the country’s third leading cause of adult death, according to a new study.

Despite poor oral health being associated with worse clinical outcomes in COPD, many patients and primary health care professionals in Brazil do not know enough about the link between a lack of oral hygiene and the killer disease.

Interviewing COPD patients and health care 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 preventative oral health.

Working with Brazilian research partners, the team have published their findings in npj Primary Care Respiratory Medicine. They 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. This could be through developing educational programmes or integrating oral health protocols into the primary care pathway for COPD patients.

Amber Swann, Lead co-author and Intercalating medical student from the University of Birmingham

Co-lead Matthew Riley is also on the intercalating course, which allows medical students to carry out high-quality research before graduating. He added: “Dentists felt that the problem lay with patients avoiding preventative care, whilst patients highlighted significant barriers to accessing oral healthcare. Our research indicates that incorporating preventative oral health into COPD management and expanded public dental services would help this group of vulnerable patients.”

COPD is a long-term incapacitating respiratory condition – the fourth leading cause of death world-wide. 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, hospitalisation and death. Up to half of such COPD ‘flare-ups’ may result from bacterial infections and recent evidence suggests a significant decrease in flare following periodontal (gum) treatment.

While Brazil’s universal healthcare system was introduced 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 Brazil’s elderly population may have missed out – over 50% of Brazilian 65-74-year-olds are missing teeth, whilst the remainder have some degree of periodontal disease.

The research, carried out with São Paulo Faculty of Medicine of ABC, São Paulo Department of Community Health and the Brazilian Society of Family and Community Medicine, 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 established partnerships with teams in Brazil, China, Georgia and Republic of North Macedonia and the International Primary Care Respiratory Group (IPCRG). It will publish key research findings this year, based on projects in primary care settings evaluating accuracy of COPD screening strategies, promoting smoking cessation and improving disease management.

More about Medical and Dental Sciences at the University of Birmingham

Project leader, Dr Rachel Jordan, Reader in Epidemiology and Primary Care at the University of Birmingham, commented: “COPD is a global killer and we’re working with partners in Brazil to improve healthcare outcomes for people with COPD. 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. This allows us to build robust platforms for collaborative research with partner countries and other LMICs.”