A plague has descended upon our country. It is called a Pandemic. The culprit is the SARS-CoV-2 virus. The virus is scary. Initially, we were concerned with morbidity, death. Our attention went to people who had impaired lungs (smokers, asthma, emphysema). We looked at the elderly, diabetics, obesity, and people with hypertension. It was indeed an upper respiratory disease. Happily, we now have survivors. Some of these people, especially those who were sick for more than four weeks, are showing manifestations of oral disease. They complain of “teeth falling out, sensitive gums, teeth turning grey and teeth cracking”. Science is theorizing that there is a direct link between dental disease and the SARS-CoV-2 virus. In the tissues of the mouth, there is a receptor. This receptor is ACE2 (angiotensin-converting enzyme). Cells that have this receptor will allow the virus to permeate the cell membrane and thus infect the cell and eventually the person. We will discuss the oral pathology that is presenting itself in these “long haul survivors”.
Bleeding and inflammation in the gums may be from the virus. The virus causes an inflammatory response in our tissues by elevating chemicals in our body that are harmful to us. This phenomenon is seen in the tonsils, tongue, salivary glands as well as in the gums. These chemicals are cytokines and interleukins. Thus the periodontal disease is being researched as a potential “contributing Disease” toward Covid-19 severity.
Xerostomia (Dry Mouth)
People who can not breathe well from the virus and who are wearing a mask tend to breathe through their mouth. This dries out the mouth. Also, invasion of the virus into the salivary glands may inhibit their ability to produce saliva and thus contribute to the dry mouth condition. When our patients have dry mouths we see an increase in caries (cavities). Sometimes xerostomia leads to an imbalance of the microbes living in our mouths. This leads to an overgrowth of a fungal organism known as Candida Albicans which in turn leads to a thrush infection.
The virus attacks our oral tissues because of the abundance of ACE2 receptors in the tissues themselves. More specifically it attacks the endothelial cells which line the inside of our blood vessels in the mouth. When this occurs, blood cannot flow and cannot bring oxygen to our tissues. If our tissues are deprived of oxygen (i.e. tongue) they will turn necrotic(die). This process will manifest as painful ulcers in the mouth.
Cracked teeth are caused by trauma. Traditionally we see this from bruxism (the grinding of our teeth while we are sleeping). Stress plays a major role in causing people to grind and exhibit TMJD (Temporomandibular Joint Dysfunction). So the psychological disruption of our lives leads to stress (working from home, poor sleep habits, depression, anxiety, lack of exercise, eating junk food high in sugar). The virus has attacked us medically and also emotionally. The stresses from dealing with this pandemic have affected us psychologically and physically, i.e. cracked teeth.
Loss of Taste and Smell
You feel like you have a cold and all of a sudden you lose your sense of taste (ageusia) and smell (anosmia). These are some of the earliest signs that you indeed have Covid-19. The good news is that we see this condition in patients who are either asymptomatic or will have a mild disease experience. Science believes that the virus attacks our cranial nerves, specifically 1, 7, 9, and 10. Additionally, the tongue has an abundance of ACE2 receptors making it a prime target for the virus and the disruption of taste.
Poor Oral Hygiene
Patients struck with the COVID Virus become sick. They don’t have the strength to get out of bed, let alone brush and floss their teeth. They tend to lose their appetite and compensate with comfort junk food. They are so tired, beat up and depressed that they just don’t take care of themselves. They breathe through their mouths and grind their teeth. It is a mess.
We at 172 NYC Dental feel that using an electric brush with fluoride toothpaste, rinsing with a non-alcoholic fluoride rinse (i.e. Act) will be most helpful. Instituting a healthy diet, free from refined sugars will add to a speedy and complete recovery.
Although we are not allowed to see anyone who has COVID or is symptomatic in our office; we are available to talk and render advice to you on the phone. Once you are COVID negative for two weeks we welcome you back to our expert care and concern.