Poor oral hygiene in COVID-19 patients can increase their risk of lung infections and pneumonia, says UK study

So far, more than 10 million people have contracted the novel coronavirus across the globe. In the absence of certain treatment, people with COVID-19 infection are currently being treated for their symptoms such as fever, cough and breathlessness.

Doctors have confirmed that older people and people with comorbidities are more likely to get serious symptoms of the infection. However, a study published in the British Dental Journal on 26 June 2020 stated that poor oral hygiene could increase the risk of infection in people, especially those with comorbidities. Previous studies have shown that high bacterial and viral loads in the mouth complicate the pre-existing systemic diseases such as cardiovascular disease, cancer and autoimmune diseases, thus making them prone to experiencing severe symptoms of COVID-19 infection.

The study states that bacterial load from the mouth can result in bacterial superinfection and complications such as pneumonia, acute respiratory distress syndrome and sepsis in COVID-19 patients.

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Oral bacteria may lead to lung infection

It is seen that infection in the lower respiratory tract occurs either due to inhalation of microorganisms present in aerosolised infectious droplets or by aspirating microorganisms present in the infectious oral cavity such as P. gingivalis, F. nucleatum and P. intermedia.

Due to poor oral hygiene, there can be severe inflammation in the gums. This is followed by the destruction of the underlying bone which is medically called periodontitis.

There are certain enzymes such as aspartate and alanine aminotransferase (AST, ALT), lactate dehydrogenase (LDH), creatine kinase (CK), alkaline and acidic phosphatase (ALP, ACP) and gamma-glutamyl transferase (GGT) which are present in the saliva of a person suffering from periodontitis.

These enzymes change the mucosa of the mouth in such a way that it allows the lung-infection causing bacteria to stick and grow on the mucosa.

The scientists further added that the cytokines (a type of immune cell of the body) such as InterLeukin-1 and TNF present in a periodontally-diseased tissue can get dissolved in the saliva and can be aspirated by the lungs. These cytokines bring some variations in the cellular layer of the lungs which promotes the growth of infection-causing bacteria in the lungs.

Oral bacteria and pneumonia 

It has been reported that the bacteria present in the oral cavity can initiate and progress conditions such as pneumonia and sepsis.

On testing the effect of periodontal bacteria, F. nucleatum, P. gingivalis and P. intermedia, on pneumonia, it was found that P. intermedia is responsible for initiating severe pneumonia in people who were suffering from periodontitis. In a randomised control trial done in Japan, 417 patients in a nursing home were given oral care after every meal and were compared with the control group who did not receive oral care. The study later concluded that out of the control group, 19% of people contracted pneumonia whereas out of those who got oral care only 11% of people got pneumonia.

Conclusion

The study concluded that maintaining oral hygiene can reduce the risk of getting lung infection and other severe COVID-19 related complications such as pneumonia and sepsis. People must brush their teeth twice daily to keep their mouth free from disease-causing bacteria. People with periodontitis should get their dental cleaning done regularly from their dentist.

For more information, read our article on Oral hygiene tips.

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