Oral Diseases and COVID-19
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Oral Hygiene Status and COVID-19 Severity

Published on May 07, 2021 and last reviewed on Dec 02, 2022   -  5 min read


A recent study has linked poor oral hygiene to the severity of COVID-19 disease. Please read this article to know more.

Oral Hygiene Status and COVID-19 Severity


We all know that the spread of coronavirus infection is mainly through the mouth and nose. A loss of smell and taste sensation, along with various other symptoms, are seen in COVID-19. The reason behind them is SARS-CoV-2, the coronavirus that causes COVID-19 disease.

Virus from the oral cavity enters the bloodstream through saliva, and it can commonly happen in patients suffering from gum or gingival diseases and periodontal diseases. Evidence shows that the blood vessels of the lungs are affected initially rather than airways in patients who are having more virus load in saliva associated with gingivitis, periodontitis and are having an increased risk of death. So let us gain some knowledge about plaque, gum, or periodontal infection and how to prevent it, which are responsible for the increased severity of corona infection.

Why Is There a Loss of Smell and Taste in COVID-19 Infection?

The virus binds to a protein called ACE2 that is found on the surface of potential host cells. The virus binds to ACE2 receptors, which are present abundantly in the nose and mouth. There is also a possibility that the virus could directly invade nerve cells of sensory organs. There are new researches that state that the coronavirus could enter and invade the lungs. Virus from the oral cavity enters the bloodstream through saliva, and it can commonly happen in patients suffering from the gum or gingival diseases and periodontal diseases.

How Is Gum Disease Correlated to COVID-19 Infection?

As mentioned before, it has recently been determined that the lungs' blood vessels are affected initially rather than airways in patients who have more virus load in saliva associated with gingivitis, periodontitis and are having an increased risk of death. A recent study shows that when there is a good breeding ground for a virus to grow in the oral cavity along with a compromised immune defense system, it is easier for the virus to enter into the bloodstream. So through blood vessels of gums, it can directly enter in heart veins and pulmonary arteries. So it means that plaque accumulation and periodontal inflammation increase the chances of more severe corona infection. So now we should look into the prevention aspect of it.

In this pandemic, what we can do at home is to maintain good oral hygiene to prevent any gum or periodontal infection from occurring. There will not be any breeding ground for bad microorganisms in our oral cavity. Let us gain some knowledge about plaque, gum, or periodontal infection that are responsible for the increased severity of COVID infection.

What Is Plaque?

Plaque is a natural biofilm that accumulates on the tooth surface. It is caused due to colonization of bacteria on the smooth surface of the tooth. When dental plaque remains for a longer duration of time on the tooth surface, then it may lead to caries, gingivitis, and periodontitis. When plaque remains for a long period of time on the tooth surface, then it hardens to form calculus. Calculus can only be removed by a professional cleaning procedure that is scaling and polishing. Plaque and calculus, in turn, causes irritation to gums around the neck of the tooth, causing inflammation of gums that eventually leads to puffiness of gums and bleeding gums.

What Is Periodontitis?

Periodontitis is a disease affecting the area around the tooth, and it includes bone as well as gum. The cause of the disease is poor oral hygiene associated with plaque harboring bacteria reacts with the immune system of the body that gives the reaction and so causes inflammation. Its treatment is good oral hygiene, but in advanced cases, it may require periodontal surgery. When talking about the relation of systemic diseases and periodontitis, then periodontitis is the sixth complication of diabetes. Also, there are researches where it is found that there is a link between heart disease and gum diseases. So it is advisable to follow few simple steps for maintenance of oral hygiene to reduce plaque accumulation and to prevent gingival or periodontal infection.

What Do We Have To Follow To Prevent Oral Diseases?

Following are few things to be performed by each and every individual without much expense-

1. Brush twice daily with fluoride-containing toothpaste. One should brush daily for two minutes, either with an electric or manual toothbrush that has soft bristles. Rinse the brush well after use and store it in an upright position after use. Brush should be changed after every 3 to 4 months, or earlier if bristles of brush got frayed. Brush carefully or with more attention in the area having crowding of teeth, uneven surfaces, bridges, crowns, and dentures, etc.

2. Use of antimicrobial mouthwash after brushing can effectively reduce bad microbes from the oral cavity and reduce the inflammatory reaction of gums if it is there. Even mouth rinse with lukewarm water with salt in it can help to reduce inflammation if it is there. There are many benefits of saltwater, such as it acts as a natural disinfectant that ensures healing. Apart from this, saltwater helps in soothing inflamed gingiva, reduces pain, reduces bacterial load, and helps to get rid of malodor.

Saltwater rinse:

  1. Take half to 3/4th teaspoon of salt, add in a glass of lukewarm water and mix well.
  2. Rinse or swish with a prepared solution for up to 30 seconds and then spit out.
  3. Repeat this procedure about two to three times per day.
  4. Do not rinse for a long period of time, as the acidic solution can damage the enamel of teeth.

3. Floss daily to remove plaque from in between the teeth. If you have spacing in between the teeth, then you can use an interdental brush.

4. Rinse your mouth or brush your teeth after having sweet sticky food so as to minimize chances of caries.

What Can We Do At Home if We Have Bleeding Gums?

If you are having a problem with bleeding gums, then at the present situation of the pandemic, you can do the following along with the above oral hygiene measures.

  • Increase intake of food supplements rich in vitamin C (oranges, carrots, sweet potatoes, etc.).
  • Increase intake of food supplements rich in vitamin K, as it helps in blood clotting. (Spinach, collard greens, mustard greens).
  • Apply cold compress on site of bleeding gum. Apply ice or cold cloth on-site several times. 20 minutes on then 20 minutes off. Cold compress reduces swelling of that site and restricts the bleeding of that area.
  • Green tea- Green tea contains the natural antioxidant Catechin that reduces the inflammatory response. So daily intake of green tea to some extent can reverse periodontitis and stops bleeding gums.
  • Reduce intake of sugary food and carbohydrates as they cause tooth decay and gum infection on staying for more time on tooth surface because of increased microorganism colonization on gums.
  • Reduce stress level- there are studies that show a correlation between stress and periodontal diseases as stress decreases the immune response of the body that causes weakening of body response or defense mechanism of the body to infection and inflammation.

Always bleeding gums does not mean inflammation and infection. There are many other causes for bleeding gums, such as brushing too vigorously, trauma or injury to gums, pregnancy because of hormonal changes, nutritional deficiency, etc.

Definitely, one needs to visit a dental clinic for clinical examination and treatment planning accordingly. One may need a deep cleaning to remove plaque and calculus from sites that are usually not approached with regular brushing procedures. After a professional cleaning procedure, there will be a promotion of gingival healing. Your dentist also may ask for some laboratory tests to check for vitamin deficiency that may be a cause of bleeding gum.


In the current scenario of the pandemic, the experts state that this discovery of a correlation between oral hygiene and severity of COVID-19 disease could make proper oral healthcare practice a potentially lifesaving action, so they recommend that people should take simple but effective daily steps to maintain oral hygiene so as to reduce the factors contributing to gum disease like gingivitis and periodontitis.

Frequently Asked Questions


Is COVID-19 Severity Correlated With Periodontitis?

Patients with moderate-to-severe periodontitis had a considerably higher incidence of COVID-19 problems than those with less severe or no periodontitis. Noncommunicable diseases (NCDs), particularly cardiovascular diseases, diabetes, kidney disease, pneumonia, hypertension, and chronic inflammatory diseases known to influence COVID-19 severity, are common risk factors for periodontitis.


During COVID-19, How do you Maintain Oral Hygiene?

The COVID-19 virus might be in the mouth, particularly on the tongue, a significant repository for viral infections. Therefore, to lower the viral load, maintaining oral hygiene is recommended. The practical tips for maintaining appropriate hygiene are:
- Brushing two times a day with fluoride toothpaste.
- Interproximal or interdental cleaning with floss or interdental brushes
- Sugar consumption should be avoided because it lowers the pH of the oral cavity.
- Stay hydrated to maintain the neutral pH of the mouth.


Can COVID Lead To Tooth Issues?

COVID-19 does not directly influence dental problems, but wearing a mask for a longer period has significant side effects on oral health. Dry mouth, bad breath, tooth decay, and gum disease. A dry mouth increases the chances of developing tooth decay and other oral infections. In addition, wearing the mask for a longer period increases plaque build-up, leading to bleeding of the gums or gingivitis. Other oral manifestations are aphthous stomatitis, candidiasis, necrotizing periodontal disease, and angular cheilitis.


What Are the Factors That Influence COVID-19 Severity?

The coronavirus majorly affects the lungs and the severity of COVID-19 increases with the following factors.
- Chronic obstructive pulmonary disease (COPD). 
- Lung cancer.
- Kidney disease.
- Heart disease.
- Liver disease.
- Stroke.
- Dementia.
- Diabetic.
- Blood disorders like thalassemia.
- Autoimmune diseases.


Who Is Most at Risk From COVID-19?

COVID-19 is a pandemic condition that significantly affects the world population, but a higher risk of COVID-19 is seen in middle and older individuals, pregnant women, obese patients, and patients undergoing chemotherapy or radiotherapy (cancer treatment), among other conditions such as:
- Chronic kidney disease, where patients undergo significant dialysis.
- Organ or bone marrow transplant.
- HIV or AIDS.
- Sickle cell disease.
- Down syndrome.


How Do You Clean Toothbrushes?

The toothbrush contains a bunch of oral germs and is cleaned by rinsing it in antibiotic mouthwash for 30 seconds. The 3 percent hydrogen peroxide solution is most effective in cleaning the toothbrush. The other natural methods of cleaning are done with the help of baking soda and white vinegar, which kill the microorganisms.


Why Do Dentists Have a High Risk of COVID?

Dental personnel teams are at significant risk of contracting the virus from other patients or staff due to the special nature of dental procedures and the provider's proximity to the patient's mouth and throat. In addition, when performing some dental operations, there is a chance that aerosols will be produced, which raises the risk of transmission to dental professionals or potential patients by direct inhalation or contact with contaminated surfaces.


How Long Does It Take for Positive COVID Testing After Exposure?

Generally, the immune system takes one to three weeks to develop an antibody to the virus. Hence, after exposure to the coronavirus, wait at least five full days before undergoing COVID-19 testing to avoid inaccurate results (false positives or adverse effects).


How Long Do You Stay Infectious After Being Exposed to COVID?

The incubation period, also known as the duration between exposure and the development of symptoms, is estimated to last two to 14 days. Therefore, the persons are usually most contagious in the early stages of illness. Most Omicron transmission occurs one to two days before symptom onset and two to three days after that. Mild to medium COVID-19 are infectious for up to 10 days from the beginning of symptoms. Severe cases remain contagious for up to 20 days.


What Impact Has COVID Had on the Dentistry Sector?

Because of the increased risk of transmission in dental offices, COVID-19 had a significant impact on the dental industry. Recommend patient pre-screening before visiting the clinic, allowing only one patient at a time in the waiting room, measuring staff and patient body temperatures, washing hands and sanitizing them, allowing patients access to sanitizers, disinfecting surfaces, providing personal protection equipment for the medical staff, providing disposable shoe covers for patients, using UV lamps and other air purifiers, and using high-tech air purifiers and high-speed.


Is Periodontitis the Attributing Factor for COVID-19?

Periodontitis is associated with diabetes, obesity, aging, and hypertension. Therefore, these related factors are considered risk factors for COVID-19.


Why Does COVID Make You Tasteless?

COVID-19 blocks the olfactory nerve, which transmits smell and taste impulses to the brain. However, coronavirus doesn't directly harm sensory neurons in the nose. Once the infection is gone, the olfactory nerve resumes its normal function.

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Last reviewed at:
02 Dec 2022  -  5 min read


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