SARS-CoV-2 Infection and Oral Health: Therapeutic Opportunities and Challenges

Abstract

The novel corona virus, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), and the disease it causes, COVID-19 (Coronavirus Disease-2019) have had multi-faceted effects on a number of lives on a global scale both directly and indirectly. A growing body of evidence suggest that COVID-19 patients experience several oral health problems such as dry mouth, mucosal blistering, mouth rash, lip necrosis, and loss of taste and smell. Periodontal disease (PD), a severe inflammatory gum disease, may worsen the symptoms associated with COVID-19. Routine dental and periodontal treatment may help decrease the symptoms of COVID-19. PD is more prevalent among patients experiencing metabolic diseases such as obesity, diabetes mellitus and cardiovascular risk. Studies have shown that these patients are highly susceptible for SARS-CoV-2 infection. Pro-inflammatory cytokines and oxidative stress known to contribute to the development of PD and other metabolic diseases are highly elevated among COVID-19 patients. Periodontal health may help to determine the severity of COVID-19 infection. Accumulating evidence shows that African-Americans (AAs) and vulnerable populations are disproportionately susceptible to PD, metabolic diseases and COVID-19 compared to other ethnicities in the United States. Dentistry and dental healthcare professionals are particularly susceptible to this virus due to the transferability via the oral cavity and the use of aerosol creating instruments that are ubiquitous in this field. In this review, we attempt to provide a comprehensive and updated source of information about SARS-CoV-2/COVID-19 and the various effects it has had on the dental profession and patients visits to dental clinics. Finally, this review is a valuable resource for the management of oral hygiene and reduction of the severity of infection.

The treatment of Covid tongue in an isolation unit

“…Getting enough nutrition strengthened the immune system. 14 The patient was very cooperative in carrying out instructions from the operator. The patient also had a cheerful personality and did not give up easily, demonstrating a strong desire for recovery.…”

Should We Be Concerned about the Association of Diabetes Mellitus and Periodontal Disease in the Risk of Infection by SARS-CoV-2? A Systematic Review and Hypothesis

“…Five review articles [29][30][31][32][33], two hypothesis articles [34,35], one perspective article [36], one special issue [37], one commentary [38], one case-control study [39], and one case report [40] were included. Sampson et al mentioned that the four major comorbidities linked to an increased risk of COVID-19 complications and death are also linked to altered oral biofilms and periodontal disease; oral infections are normal in patients with a serious case of COVID-19, with bacterial superinfections responsible for more than half of all deaths [29].…”

“…Furthermore, PD can be a pre-existing condition that exacerbates COVID-19 outcomes. Inflammation in periodontal infections is often caused by a cytokine storm, which has been linked to adverse outcomes in COVID-19 infections such as acute respiratory disease and multiple organ failure [30]. Moreover, NRF2 (NF-E2-related factor 2) is a redox-sensitive, basic leucine zipper transcriptional factor that upregulates antioxidant gene expression by binding to the promoter region of the antioxidant response element (ARE), also regulating inflammation in the pathogenesis of various disease complications including periodontitis.…”

“…Moreover, NRF2 (NF-E2-related factor 2) is a redox-sensitive, basic leucine zipper transcriptional factor that upregulates antioxidant gene expression by binding to the promoter region of the antioxidant response element (ARE), also regulating inflammation in the pathogenesis of various disease complications including periodontitis. SARS-CoV-2 inhibits NRF2, indicating that the virus deprives the host cells of an essential cytoprotective pathway [30]. According to Takahashi et al, the presence of periodontopathic bacteria, even when lacking infectivity, are potent proinflammatory stimulants for the lower respiratory tract through aspiration.…”

A Perspective: Integrating Dental and Medical Research Improves Overall Health

“…The coronavirus pandemic is a case in point. A member of a family of viruses typically associated with respiratory symptoms, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is responsible for the coronavirus disease 2019 (COVID- 19), can result in fatigue, loss of smell and taste, gastrointestinal problems, cognitive deficits, depression, life-threatening pneumonia, neurological disorders and symptoms that can persist in some individuals long after initial infection (15)(16)(17)(18). Yet the mouth and oral health considerations continue to be treated as a class by themselves, separate from the rest of the body, ignored and omitted from research studies large and small.…”