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Fedoricw, Massoumi, & Kolbig

How COVID-19 Complications Can Start in the Mouth

How COVID-19 Complications Can Start in the Mouth

Throughout the duration of the COVID-19 pandemic, researchers and medical professionals have been trying to learn as much about the virus as possible. Towards the beginning of the pandemic, it was believed that the virus was inhaled through the upper respiratory system where it would then reach and infect the lungs. While this is still the most generally accepted theory, another hypothesis for how the virus reaches the lungs has been proposed. 

This hypothesis was recently published in the Journal of Oral Medicine and Dental Research and is titled, The COVID-19 Pathway: A Proposed Oral-Vascular-Pulmonary Route of SARS-CoV-2 Infection and the Importance of Oral Healthcare Measures. Basically, the new hypothesis states that the SARS-CoV-2 virus can enter the bloodstream through the mouth and then travel down into the lungs. The new hypothesis also notes that there is a relationship between people with periodontitis and more severe COVID-19 infections. 

It is a dental fact that individuals with periodontitis have higher amounts of gingival crevicular fluid (GCF). GCF is produced by the body as an anti-inflammatory in response to periodontal disease. People with healthy gums have very little GCF, while those with periodontitis have significantly more GCF. The article notes that the SARS-CoV-2 virus has been found in both saliva and GCF. In fact, it is indicated that 64% of patients who tested positive for COVID-19 had the virus present in GCF samples. 

It is another dental fact that individuals with periodontitis have periodontal pockets, which are small gaps between the teeth and soft tissues. These pockets form when the gums begin to pull away from the teeth due to severe inflammation. Periodontal pockets become a collection site for excess plaque and bacteria. Since the SARS-CoV-2 virus is in GCF, it also accumulates within these periodontal pockets. Unfortunately, these pockets provide an ideal environment for the virus to survive and replicate. 

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Another commonly accepted dental fact is the notion that excess bacteria in the periodontal pockets can eventually overwhelm the mouth’s immune defenses. When this happens, the bacteria are able to enter the bloodstream where they can travel to other parts of the body. This is why periodontitis can be associated with endocarditis, pregnancy complications, and respiratory infections. This new hypothesis notes that the SARS-CoV-2 virus can also enter the bloodstream in the same way. From the mouth, the body’s circulation patterns will transport the virus down through the veins in the neck and chest, into the heart, and then into the pulmonary arteries where it can infect the lungs. 

Once infected, it has been noted that people with periodontitis are more likely to have complications. In fact, another study found that periodontitis was associated with death, the admission to urgent care, and the need for ventilation. The article hypothesizes that this is due to the constant delivery of the virus from the mouth, especially when oral care is not being practiced. The article then concludes by promoting good oral hygiene as a possible way to minimize complications associated with the virus. Specifically, careful management of periodontitis is recommended through regular brushing, flossing, and teeth cleanings. 

Dr. Roman Fedorciw has been in private practice in Cromwell since 1991. He is a member of the Academy of General Dentistry, American Academy of Cosmetic Dentistry and the American Dental Association. He is also a member of the Connecticut Dental Association and Middlesex County Dental Association. Dr. Fedorciw has been acknowledged by his peers as one of the “Top Dentists” in Hartford County by Hartford Magazine and in the state of Connecticut by Connecticut Magazine.