Oral hygiene and severity of COVID-19 – the connection
British researchers have found a link between poor oral
hygiene and severity of COVID-19 disease caused by severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) infection. The study from researchers collaborated to find
the connection between the severity of the infection and poor oral hygiene.
Their study titled, “Could there be a link between oral hygiene and the
severity of SARS-CoV-2 infections?” was published in the latest issue of the
journal.
The
COVID-19 pandemic
Since December last year, there have
been steadily increasing numbers of SARS-CoV-2 or novel coronavirus infection
that causes COVID-19 diesase. The World Health Organization (WHO) declared
COVID-19 a global emergency on the 30th of January 2020 and, on the
11th of March 2020, declared it a pandemic when this highly
contagious virus infected populations across the world. As of today, globally,
10,434,385 people have been infected and there have been 509,779 deaths
attributed to the virus around the world due to this infection.
What
was this study about?
Researchers to date have identified
several risk factors that are associated with severe COVID-19 course of disease
and outcome. While many patients infected with the virus recover without
complications, some may need hospitalization, oxygen supplementation, and even
ventilation. Some of the risk factors associated with poor outcome of the
disease include high blood pressure, diabetes obesity, and heart disease. The
team of researchers explains that 52 percent of the deaths due to COVID-19 also
occur in healthy individuals, and the cause behind this is unclear. They wrote
that the main complications of COVID-19 include “blood clots, pneumonia,
sepsis, septic shock, and ARDS (Acute respiratory distress syndrome).” These
complications are seen mainly among those with comorbidities and bacterial
overload, they wrote.
Bacteria
and COVID-19 outcome
The team speculates that there may
be a connection between SARS- CoV-2 infection and “bacterial load.” They tried
to explore if high levels of bacteria or bacterial superinfections and
complications of bacterial infections such as pneumonia, sepsis, and
respiratory distress syndrome could be associated with poor outcome from
COVID-19.
Oral
hygiene and COVID-19
This study explored the
complications of COVID-19 seen among those with poor oral health and
periodontal disease. The oral microbiome or the microbial flora of the mouth
was explored and its connection with the COVID-19 outcome was analyzed. The
authors wrote, “We explore the connection between high bacterial load in the
mouth and post-viral complications, and how improving oral health may reduce
the risk of complications from COVID-19.”
The authors of the study wrote that
during lung infection, there is a risk of aspirating the oral secretions into
the lungs, which could cause infection. Some of the bacteria present in the
mouth that could cause such infections include “Porphyromonas gingivalis,
Fusobacterium nucleatum, Prevotella intermedia,” they wrote. They explained
that periodontitis or infection of the gums is one of the most prevalent causes
of harmful bacteria in the mouth. These bacteria lead to the formation of
cytokines such as Interleukin 1 (IL1) and Tumor necrosis factor (TNF), which
can be detected in the saliva and can reach the lungs leading to infection
within them. Thus, the researchers wrote, “inadequate oral hygiene can increase
the risk of inter-bacterial exchanges between the lungs and the mouth,
increasing the risk of respiratory infections and potentially post-viral
bacterial complications.”
Results
of the study
The team wrote, “Good oral hygiene
has been recognized as a means to prevent airway infections in patients,
especially in those over the age of 70”. Those with periodontal disease are at
a 25 percent raised risk of heart disease, thrice the risk of getting diabetes,
and 20 percent raised risk of getting high blood pressure, the researchers
wrote. These are all risk factors of severe COVID-19 they wrote.
Conclusions
and implications
This study concludes that 20 percent
of the patients with COVID-19 progress to severe illness with high levels of
“inflammatory markers (IL-2, IL-6, IL-10), bacteria, and
neutrophil-to-lymphocyte count”. They noted that the oral microbial environment
and COVID-19 could be linked. The four essential risk factors for severe
COVID-19, diabetes, high blood pressure, heart disease, and obesity, are also
associated with poor oral hygiene, they wrote. They recommend “oral hygiene be
maintained, if not improved, during a SARS-CoV-2 infection in order to reduce
the bacterial load in the mouth and the potential risk of bacterial
superinfection.” These precautions are particularly important for those with
diabetes, heart disease hypertension, they wrote.