The relentlessly advancing COVID-19 pandemic has revolutionised the way we will ever consider hygiene and sanitation.
It has opened doors to newer concepts of looking at community and individual health. The resulting situation has triggered a wave of medical research projects, associating the dreaded -SARSCov-2 virus with various other diseases that might complicate the patients’ situation.
One such breakthrough research has been recently done on the relationship between our oral hygiene and severity of COVID-19 by a team of researchers in London, claiming that the bacteria within the mouth may have a role to play in the increased complications and fatality of the patients.
Role of bacteria in this viral disease
Whilst it is known that COVID-19 is a viral disease, it has been speculated that in the severe forms of infection bacteria play a role in increasing the chance of complications, such as acute respiratory distress syndrome (ARDS), sepsis, pneumonia, septic shock and in worse cases, death. This has been attributed to the phenomenon of bacterial super-infection.
It has been noted that about 20% of the patients’ progress to a severe form of the disease that is associated with higher levels of bacteria and a remarkably higher neutrophil count than normal. This is atypical for a viral infection, but very common in its bacterial counterpart. Therefore, suggesting that bacterial superinfection is common in severe cases of COVID-19.
Successful treatment of several critically ill COVID-19 patients in ICU with a dual regime of an antiviral and an antibiotic has further strengthened this theory.
Healthy oral cavity- the barrier against multiple diseases
It has been established that hygiene of our mouth plays a pivotal role in determining the progression of life-threatening conditions such as diabetes, so much that the environment of our mouth directly affects the complications of the disease. It has also been proved to play a part in the overall health during the pregnancy.
A review of medical literature published back in ’06 concluded that even our respiratory tract gets affected by its implication. The review suggested that evidence of association was found between pulmonary diseases such as pneumonia, COPD and oral health. It was discovered that improved oral hygiene can help reduce the occurrence and progression of respiratory diseases among high-risk elderly population.
The link between our mouth- health and COVID -19
Researcher Victoria Sampson and her team of experts in London have found that a potential connection exists between high bacterial load in the mouth and the complications associated with COVID-19 infection. Their study was published in the latest issue of the British Dental Journal.
They have identified several risk factors and co-morbid conditions that are associated with poor COVID-19 disease outcome. The main co-morbidities associated with increased risk of complications included diabetes, heart disease, high blood pressure, and obesity. Interestingly, these conditions are also associated with altered oral bio-films and periodontal disease, explained the researchers.
It is important to understand that various type of bacterial flora that are normal inhabitants of our oral cavity, when allowed to grow unchecked, especially during a lung infection, get aspirated in our respiratory passage through the oropharynx. This causes risk of super-infection in an already attacked pulmonary system, leading to increased chances of complications such as ARDS, pneumonia and sepsis.
Dr Sampson and the colleagues found that periodontitis or infection of the gums is one of the most prevalent causes of harmful bacteria in the mouth. Bacterial groups such as “Prevotella, Staphylococcus, and Fusobacterium,” that are commensals of mouth “have been found in the metagenome of patients severely infected with COVID-19”.
They concluded “Bacteria present in patients with severe COVID-19 are associated with the oral cavity, and improved oral hygiene may reduce the risk of complications”
Although only limited data is available on SARS-CoV 2 and many factors remain unclear due to the severe knowledge gap, we recommend that poor oral hygiene is a risk factor for COVID-19 complications notably, in patients susceptible to altered bio-films due to cardiovascular diseases, hypertension or diabetes.
Amid all the stress and precautions being taken to prevent getting infected it has become all the more necessary to incorporate good oral hygiene practices in our daily routine checklist. After all, spending five minutes in cleaning your mouth daily has never been more important, as they say:
“A healthy mouth is a gateway to a healthy body”.
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Dr. Vidushi Khanna
Student Coordinator, IACDG