Periodontitis Linked to Severe COVID-19 Outcomes

Introduction:

COVID-19 pandemic has a far-fledged impact on people who have other diseases, including the oral cavity. As per the research of Mcgill University, Canada (published in the journal of clinical periodontology 2021), people with periodontitis, i.e., gum inflammation and infection, are 8.8 times more likely to die of COVID-19 disease. Additionally, these COVID-19 individuals with periodontitis are 3.5 times more likely to be hospitalized and 4.5 times more likely to require ventilator support.

How Is Periodontitis Linked to Systemic Complications?

Periodontitis is the clinical term for serious infection which occurs in between the teeth and gums due to:

• Bacterial accumulation.

• Heavy calculus.

• Plaque deposits.

Without dental treatment, periodontitis as an independent disease is a proven risk factor for systemic non-communicable diseases like:

• Heart disease.

• Diabetes.

• Respiratory disorders.

• Pregnancy complications like pre-eclampsia (high blood pressure in pregnancy often by fluid retention).

• Low fetal birth weight.

Researchers and periodontologists are of the opinion that if left untreated, inflammation due to periodontal disease can spread throughout the body. The main reason for COVID-19 patients proving to have fatal outcomes is due to the fact that increased blood levels of biomarkers which indicate systemic inflammation are more in people suffering from pre-existing gum diseases. Periodontal disease is also a slowly progressive condition that causes pain only after it sets in fully. Hence periodontitis can exacerbate the inflammatory response in patients battling the SARS-COV2 virus.

How Can Oral Hygiene Reduce COVID-19 Severity?

According to the research published in the journal of oral medicine and research, there are emerging evidence models which state that the ingredients prescribed by dentists to follow daily can significantly reduce the viral load concentrate in the saliva, and they are commonly found in:

• Routine mouthwashes.

• Simple oral hygiene techniques.

• Interdental brushing.

• Careful tooth brushing with a soft brush.

• Tooth flossing.

• Warm salt water rinsing.

The researchers of this study propose the link between dental plaque and periodontal disease inflammation to an intensification of the SARS-COV2 virus in the body. Periodontitis, as per the research, is thus an "invisible pandemic," and awareness needs to be created about this during this global pandemic.

What Precautions Are Important While Consulting Your Dentist?

Telemedicine is always beneficial in:

• Scheduling.

• Solving.

• Prescribing the appropriate measures.

• Solving remedies to the patient's needs or problems.

A telephonic triage or an online consultation with your dental surgeon to get rid of your doubts about your oral health status will definitely be useful. It will be further preventive against complications caused by dental disease in this pandemic crisis. Dental procedures in the dentist's clinic are no exception to the risk of spreading infection because it involves the use of aerosols through:

• Dental handpieces.

• Scalers.

• Syringes.

But as the newer protocols for sterilization and disinfection of dental clinics are now stricter and are followed by dental professionals. It is indeed safe to visit your dental clinic with the necessary precautions like a double mask or N-95 mask and disinfection before and after the dental visit. Especially in emergencies like:

• Gum bleeding.

• Severe toothache.

• Swelling or abscess.

• Cracked restorations or teeth.

• In case of trauma and accidents.

What Is the Mechanism of Transmission of the Disease From the Oral Cavity?

Evidence models of the journal of oral medicine and dental research propose the mechanism of direct entry of the SARS-COV2 pathogen into the lung pathway through the oral cavity. Initial observations of the CT scan of the lungs prompted the research teams to investigate the potential entry of the COVID-19 virus into the bloodstream via the gums and salivary load. Individuals who suffer from gum disease, i.e., periodontitis, have a viral load concentrated more than the average individual unaffected by gum disease and hence is a possibility established wherein the viral concentrate in the mouth would be transmitted to the lungs via the medium of saliva into the patient's bloodstream. The collaboration of medical and dental researchers on the study hence propose why this evidence model is more suggestive of the fact why people with gum disease and inflammation are more prone to coronavirus while the others not having periodontal issues are not prone to the pathogen. Apart from the periodontitis link that is being researched upon, the presence of ACE2 (Angiotensin-converting enzyme) receptors on the tongue make the oral cavity a vulnerable barrier that can be easily breached by the SARS-COV2 pathogen. Studies claim the pathogen binds to these ACE2 receptors more, causing inflammatory lesions of the tongue or COVID-19 tongue (imitating the viral manifestations seen on the tongue like any other oral infections).

Does Oral Hygiene Act as an Immune Defense?

More studies are underway to establish the link between periodontitis and COVID-19 severity. But the evidence that the novel coronavirus follows a pathway from the oral cavity is now verified by many research specialists (i.e., from the microbes of the saliva and the blood vessels in the gums to the neck and chest veins before entering the heart, eventually passing into the pulmonary arteries and vessels of the lungs). This theory also shows us that our mouth is rather like a breeding ground for a virus to thrive. Once this oral defense is breached, it makes the virus easier to replicate and follow the pathway into the lungs. The research models hence propose that simple oral hygiene measures we follow on a day to day basis like tooth brushing and mouthwash can be accompanied by what dentists usually suggest to keep the mouth free from plaque by mechanical and chemical methods of plaque control that are enlisted below:

Mechanical Plaque Control Measures:

• Manual or Electric toothbrushing.

• Flossing and Interdental brushing.

• Tongue cleaners.

• Oral irrigation devices (pulsating oral irrigators like Waterpik or magnetized irrigators like hydro floss).

Chemical Plaque Control Measures:

• Fluoride releasing toothpaste and dentifrices.

• Mouthwashes are commonly used on a daily basis.

• Mouthwashes containing potassium nitrate (for preventing dentinal hypersensitivity).

• Chlorhexidine and other phenols or essential oils (for preventing gingival inflammation and halitosis or bad breath).

All these are to be suggested by the dentist based on the patient's dental symptoms.

Conclusion:

Proper oral hygiene alongside timely consultation and treatment by your dental surgeon can be helpful in mitigating the development of lung disease that is directly affected by the SARS-COV2 pathogen. Mechanical and chemical plaque control also ensures that the risk of deterioration of the patient to severe COVID-19 is reduced.