How COVID-19 Complications Can Start in the Mouth

By now, almost everyone is sick and tired of hearing about COVID-19. Although researchers, medical professionals, and the general public have learned more about the virus, there is still much to learn and various research studies are still being conducted. Recently, in fact, another study was published that discusses the possibility of COVID-19 complications starting in the mouth, instead of in the upper respiratory system. While this idea is still in the hypothetical stage, it can change the way we prevent and treat the virus. 

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. The basic argument of this hypothesis is that the SARS-CoV-2 virus enters the bloodstream through the mouth and then circulates through the bloodstream into the lungs. It also notes the relationship between periodontitis and COVID complications, and advocates for better oral healthcare in the management of COVID cases. 

Without getting too technical, the article notes that saliva and gingival crevicular fluid contain elements that allow the virus to infect them. Gingival crevicular fluid, in particular, is found in greater amounts in people with periodontitis since it is an anti-inflammatory fluid produced by the body in response to periodontal infections. This suggests that individuals with higher levels of GCF can also have a higher viral load. 

Not only do people with periodontitis have higher levels of GCF, but they also have periodontal pockets. These pockets form when the gums start to pull away from the teeth. They provide a space between the teeth and gums where plaque, bacteria, and the SARS-CoV-2 virus can collect. Periodontal pockets can also provide an ideal environment for viral replication, according to the article. 

The article also discusses the phenomenon of oral bacteria passing into the bloodstream, which is a phenomenon that dentists have been aware of for some time. Basically what happens is excess amounts of bacteria can overwhelm the mouth’s immune defenses in order to enter the bloodstream. When oral bacteria circulate through the body, they can cause a range of health issues such as pregnancy complications, respiratory infections, and endocarditis to name a few. The article notes that the SARS-CoV-2 virus can also enter the bloodstream in this way, eventually circulating into the lungs where it causes infection. 

Once the virus has infected the lungs, the article posits that there is a higher risk of complications due to the fact that a consistent viral load is being delivered to the lungs. While it has been shown that people with periodontitis have a higher rate of death, admittance to intensive care, and the need for ventilation, this constant delivery of the virus to the lungs could provide an explanation. Although this idea is still being researched, the article concludes by promoting good oral hygiene practices as a possible way to prevent and/or minimize the severity of COVID-19 infections. This is especially important for individuals who have already been diagnosed with gum disease or who think that they may have gum disease.