COVID19 and Oral Health: Is there a link ?
The COVID-19 pandemic
On the 30th of January 2020 the World Health Organization (WHO) declared COVID-19 a global emergency and, on the 11th of March 2020, declared it a pandemic when this highly contagious virus infected populations across the globe. Till date around 30.5M cases have been reported worldwide. In India, total cases have crossed 5.3M. There has been considerable development in various aspects of management of the pandemic in terms of testing and treatment. Health workers have come across several observations and scientific evidence is building up with each passing day. With this dynamics, it has been noted by several researchers that there exists a link between oral health and COVID19.
Should oral health care be delayed due to COVID19 ?
Although there exists a general conviction that most of the dental procedures involve generation of aerosols, which might pose risk of transmission of SARS- Cov-2 virus at dental clinics, there is limited scientific evidence for the same. Dental professionals have been adhering to universal precautions in practice since ages. This practice has certainly made the dental professionals quickly accommodate to the extra precautionary personal protections needed for COVID19 per se. Recently, WHO recommended delaying oral health care citing the risk of transmission. However due to limited evidence, American Association of Periodontology has expressed its disagreement with WHO.
Good oral health may prevent severe COVID-19 progression
Authors of a study published in the British Dental Journal have reported that poor oral hygiene can be considered as a risk factor for COVID-19 complications, especially in patients with diabetes, hypertension or cardiovascular disease. Those comorbidities are associated with altered oral biofilms and periodontal disease. Periodontopathic bacteria are implicated in systemic inflammation, bacteraemia, and pneumonia. It has been noted that Over 80% of patients in ICU exhibited high bacterial load. Hence, bacterial superinfections are common in patients suffering from a severe case of COVID-19. With these reports, it is suggested that good oral health may prevent severe COVID19 progression.
Poor oral hygiene could affect accuracy of COVID19 (SARS-CoV-2)tests
Researchers from Tokyo, Japan have found that poor oral hygiene could lead to prolonged viral shedding in patients with COVID-19. They concluded that in prolonged viral shedding cases, non-infectious viral nucleic acid may accumulate in an uncleaned oral cavity and may continue to be detected by PCR. Hence, they proposed that tooth brushing and gargling to remove accumulated non-infectious viral nucleic acid, leading to consistently negative PCR test results and thus avoiding unnecessarily long hospital stays.
Link between Gum Disease and COVID-19 Deaths
The researchers have reported that Bacteria from inflamed gums can be aspirated and adhere to the lung epithelium, promoting infection. It was also showed that, an inflammatory mediator namely interluekin-6 (IL-6) which is associated with periodontal diseases is also seen in COVID-19 patients and COVID patients with high levels of IL-6 have a 22 times greater chance of being placed on a ventilator and an increased chance of death.
Final Note
COVID19 pandemic, a disastrous health care issue mankind faced, has affected millions worldwide and taken several lives so far. With several evidences and evolving researches, now it has been shown that oral health is linked to COVID19 in different ways. It is established fact that oral health is window of general health. However, it is proved again in relation to COVID19 as well.
