According to a recent study published in the British Dental Journal, poor oral hygiene could increase the risk of infection in people, especially those with comorbidities. The study highlighted that bacterial load from the mouth could result in bacterial superinfection and cause complications for COVID-19 patients such as pneumonia, acute respiratory distress syndrome and sepsis.
Omnia Health Insights sat down with Dr. Ricardo AP Persaud, Consultant ENT, Head Neck and Rhinoplastic Surgeon, Head of ENT Department, Al Zahra Hospital, Sharjah, to understand the link between oral hygiene and COVID-19.
How does oral hygiene reduce the risk of viral infections?
Oral hygiene is not the total eradication of viruses, bacterial, and fungi from the oral cavity, as this is practically impossible. It is rather the maintenance of a balance between the non-pathogenic microorganisms in it. Maintaining this balance reduces the risk of viral and other types of infections. This is achieved by regular cleaning by antiseptic mouthwashes and eradicating pockets of high concentrations of microbes in the form of biofilms, whether that is in plaques or the unhealthy crypts and pockets in the tonsils.
Could poor oral hygiene increase the risk of contracting COVID-19?
To simply answer, yes. Viruses like COVID-19 may enter the body through the nose and mouth. They tend to become attached to the lining and subsequently invade the healthy cells through a process called internalization. This results in a sore throat. The nose, back of the nose and throat possess receptors for COVID-19 called ACE2 receptors which causes these areas to act as reservoirs for the virus. The virus then replicates in the nose and throat and is then shed.
Is povidone-iodine an effective virucide in vitro against SARS-CoV and MERS-CoV?
Povidone-iodine (P-I), discovered in the United States in 1955, is an antiseptic agent, which is known to possess virucidal activity (having the capacity or tendency to destroy or inactivate viruses). In various studies, it has shown to be effective against coronaviruses responsible for Sudden Acute Respiratory Syndrome (SARS) (4) and Middle East Respiratory Syndrome (MERS). Very recently, in vitro experiments have demonstrated that P-I is also virucidal against COVID-19.
The antiviral properties of P-I may be exploited in many ways in the fight against COVID-19. To give some perspective, P-I is an active ingredient in several over-the-counter mouthwashes. In general, it can be used as a disinfectant in the nose, pharynx and oral cavity to prevent and control COVID-19 infection as well as transmission. This is because those anatomical regions act as the initial sites of attachment and replication for COVID-19, in both symptomatic patients and asymptomatic carriers.
What is povidone-iodine’s role in reducing cross-infection risk among essential workers?
The application of virucidal P-I in the nose, pharynx and mouth may play a significant role in reducing COVID-19 transmission by decreasing viral replication and shedding take place in the upper respiratory tract (the principal reservoir for COVID-19), during the first phase of infection. Blanket usage of mouthwash/gargle (10mls of 0.5 per cent for at least 60 seconds) and nasal drops containing 0.5 per cent P-I is my own recommendation as an additional adjunct to personal protection equipment (PPE), hand washing, face mask and social distancing to prevent person-to-person transmission. Public Health Authorities and hospitals worldwide should now consider P-I in their preventative protocols or guidelines, as this may not only be the “silver bullet” in the current COVID-19 pandemic but also be applicable to future flu viral pandemics.
What are your tips to maintain an effective oral hygiene regimen?
Daily oral hygiene is the practice of keeping one’s mouth clean and disease-free. Regular brushing of the teeth and tongue are the simplest oral hygiene methods that should be followed at least twice a day. Rinsing and gargling with an antiseptic mouthwash is helpful as well. Sufficient hydration levels from water (not sugary or carbonated drinks) result in a healthy flow of saliva, which wash away many of the harmful organisms and pathogens. Regular check-ups and periodical professional cleanings with your dentist are also necessary and highly recommended.
Dr. Persaud is a British ENT surgeon, trained in the UK and has been an Otolaryngologist for the last 17 years. He chose to specialise in Otolaryngology because it is unique in many ways – it allows him to be a doctor and a surgeon at the same time, and he gets to treat a range of patients, from new-borns to the elderly.