Oral Hygiene Status and COVID-19 Severity

Introduction:

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.

Conclusion:

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.