This is the view of two highly respected dentists whose very similar views we have published recently on the BioMin blog pages, and who have collaborated to write a new paper for us stressing the importance of oral hygiene in preventing bacterial superinfections in sick patients.
They quote research showing that 80% of patients in ICU with severe complications of COVID-19 also suffered bacterial superinfections, potentially preventable with improved oral hygiene. Professor Martin Addy, Emeritus Professor of Dentistry at the University of Bristol, and London dental practitioner Dr Victoria Sampson are both strongly of the view that any interference with normal oral function and hygiene results in increases in bacterial plaque and salivary bacterial counts. Notably stopping or reducing oral hygiene practices does both (full article).
‘Studies in the elderly in residential homes, where toothbrushing and denture cleaning was not provided by carers, showed very high levels of plaque, gingivitis, root caries, and denture stomatitis,’ they argue, adding: ‘It has been concluded that one in 10 pneumonia-related deaths in care homes could have been prevented by improving oral hygiene.’ Patients hospitalised with COVID-19 are likely to have an oxygen mask over their mouth and nose, or even be intubated, which is expected to have adverse effects on their oral flora and predispose them to superinfection, which has been seen to cause a significant proportion of the deaths in the current pandemic.
‘The slogan, “Wash your hands and brush your teeth” should probably be extended to say “wash your hands, brush your teeth and wear a mask”, argue Prof Addy and Dr Sampson. They state that antimicrobial compounds in toothpaste, notably detergents, and a range of antiseptics in mouth rinses, reduce salivary bacterial load considerably – chlorhexidine in mouth rinses for up to 12 hours and toothpaste detergents (SLS) for three to five hours.
‘Many agents in toothpastes and mouth rinses should kill coronavirus,’ they said. Prof Addy and Dr Sampson call upon the dental team to play a frontline role in advising twice-daily, two-minute toothbrushing with toothpaste (such as BioMin® F), as well as the use of mouth rinses where necessary and giving denture hygiene advice.
If self-isolating at home, oral care is down to the individual, but in severe disease oral care needs to be delivered by nurses, particularly for those on ventilators. Unfortunately, the authors feel there to be a lack of knowledge about the importance of oral hygiene to both prevent infection in the first place and superinfection by oral micro-organisms. ‘The majority of the population, and healthcare workers outside the dental team, only follow two of the components of the slogan, ie “wash your hands and wear a mask,”’ they say.
They conclude that the dental team is ideally placed to provide oral care advice directly or indirectly to large numbers of people, particularly those at high risk of COVID-19 infection.
‘Poor oral hygiene has shown a direct link with systemic disease and bacterial infections long before COVID-19,’ they said. ‘If oral bacteria are allowed to increase, they could possibly introduce bacterial superinfections through aspiration or inhalation of salivary bacteria, creating further complications.’
Dr Sampson has written an article in the BDJ, and has been putting her words into action during the pandemic, by appealing for oral hygiene products, and delivering them, plus oral care advice, into care homes and homeless shelters.