Oral and systemic health follows a bi-directional relationship. The effect of Covid-19 since it’s beginning has had
a profound impact on oral health, some caused as a direct result of its viral implications and others caused by the
societal response to the infection and poor oral hygiene. With the lockdown causing closure of dental practices as
a government issued order, this was made worse in some cases, as existing oral disease progressed and got
complicated, and thus required greater dental intervention to the extent of surgical remedies being needed to
combat it. This not only affected oral health, but also had a direct influence on systemic conditions, the most
important of which was Covid-19 itself. Studies showed a direct correlation between oral hygiene and the severity
of Covid infection and how the treatment of oral health conditions could lead to better underlying disease control.
Poor oral health begins from a lack of proper care, leading to gum disease in its initial stages, called gingivitis. As
gingivitis gets worse and there’s a lack of care and attention given to it, it worsens into periodontitis and involves
the deeper structures of the mouth weakening its foundations. Periodontal disease is characterized as a chronic
inflammatory oral health condition and the bacterial challenge it brings activates our host immune system inducing
a series of events which eventually causes tissue loss. The systemic repercussions of dental disease are vast and
many systemic conditions including arteriosclerosis, diabetes, pulmonary disease are affected by it, sometimes
directly and at other time’s as superadded complications.
Bacteria play a role in the advancement of oral disease and while a colony of bacteria exists in the oral cavity at
all times, a progression from predominantly good to bad bacteria leads to adverse conditions in the oral cavity,
resulting in anaerobic bacteria thriving. The mechanism by which bacterial infections can develop as a result of
poor oral hygiene and how they progress into respiratory infections is such that when there is bacterial overgrowth
in the mouth and oral diseases develop,there is constant migration and elimination of these pathogens in the mouth
to the lungs, and as the patient inhales those oral pathogens they are aspirated into the lungs, forming colonies
there. Pathogens associated with oral periodontal disease modify the mucosal lining of the oral cavity and the
respiratory tract, making it sticky and causing more adhesion. The lungs are in turn affected due to cytokines being
released and hence these bacteria colonise on these surfaces, initiating pneumonia. Covid-19 comes with its
complications and there is a higher number of Porphyromonas Gimgivalis, and P. Intermedia in cases of diabetes,
hypertension and heart disease all of which serve as dangerous predecessors of and may lead to more severe
consequences for patients affected by the Covid-19. Studies show P. Intermedia to induce severe bactermic
pneumonia and also cause more adhesion to cells of the lower respiratory tract. Periodontal disease causes direct
systemic implications, with heightened levels of Interleukin 2, 6 and 10 which are also the same cytokines that
are shown to be increased in Corona affected patients.
Covid-19 and superadded infections
Evidence of a strong relation between viral infections that are later prone to develop into superadded bacterial
infections has always existed. This could be interpreted especially during the Influenza virus in 1918 where
although the primary cause of illness was a virus, the cause of death of most patients infected was bacterial super
infections. During this pandemic of covid-19, most of the deaths reported were of patients who developed bacterial
superinfections as a result of a virus. In healthy conditions, the body fights these respiratory pathogens which are
transported to the lungs but in the case of infections such as Covid-19, which when occur during an existing oral
condition like periodontitis especially , this rise in bacterial superinfections and the lowered immune system
struggles to fight off illness as a result. Patients with periodontal disease are three times at a higher risk of diabetes,
25% higher risk of cariovascular disease and 20% increased risk of hypertension.
Poor oral hygiene has evidently been linked with inflammatory responses by the body which can be compared to
the hyper-inflammatory responses as a result of Covid infection. As we know, periodontitis causes inflammation
of the gums which may spread to other parts of the body if left uncontrolled. The inflammatory response is similar
in Covid patients who later require intubation and in the worst of conditions can even lead to death. Some studies
have shown that the severity of Covid disease is markedly enhanced in patients with poor oral health. Another
study proved that Covid-19 patients that have gum disease were 8.8 times more likely to die compared to those
without gingival diseases. With new research rapidly developing as the life of the virus progresses we will learn
more about how the effects of proper oral health help neutralise severity of this debilitating virus.
Our duty as dental practitioners is to continually monitor and assess what can be done to combat this global
situation. In this effort, the first and foremost approach should be to improve oral health conditions in a way that
the accumulation of plaque biofilm is dismantled to prevent the oral bacteria from thriving in poor oral conditions.
Patient education is therefore crucial in the prevention of dental diseases progressing, which includes explaining
the implications of their oral health and its implication to systemic health. There is a dire need to communicate
the effectiveness of practicing better oral hygiene to prevent severe systemic illness.
How oral conditions can be improved
• Proper brushing techniques practiced
• Change of tooth brush immediately after recovery from Covid-19 infection
• High fluoride toothpastes
• Fluoride varnishes and dentifrices
• Interdental cleaning, including interdental tooth brushes and dental floss
• In-clinic dental cleaning done — scaling and root planing
• Periodontal screening and assessment done
• Management of risk factors, e.g smoking, diet, diabetes
All of this will lead to a health oral microbiota which will reduce the risk of acquiring a viral or bacterial infection. The dental community has a strong ability to alter the course of this pandemic and reduce its life or the life threatening complications it currently bears. These simple practices have shown to reduce mortality and comorbidities in patients affected by the Corona virus. Our aim as of now is still to focused on saving lives and having better outcomes for patients as contribution to the healthcare community.