Abstract
This overview was conducted to highlight the importance of adequate oral hygiene for patients severely affected by coronavirus disease 2019 (COVID-19) due to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). These are patients who were admitted to the intensive care unit (ICU) to receive oxygen through mechanical ventilation due to severe pneumonia as a complication of COVID-19. Various dental plaque removal methods for ventilated patients were discussed with regard to their efficacy. The use of chemical agents was also considered to determine which one might be proposed as the best choice. Also, oral care programs or systems that can be implemented by ICU nurses or staff in the case of these ventilated patients were suggested based on evidence from the literature. These interventions aim to reduce microbial load in dental plaque/biofilm in the oropharynx as well as the aspiration of the contaminated saliva in order to prevent the transmission of the dental plaque bacteria to the lungs or other distant organs, and reduce the mortality rate.
Highlights
This overview was conducted to highlight the importance of adequate oral hygiene for patients severely affected by coronavirus disease 2019 (COVID-19) due to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
– Out of 86 ventilated intensive care unit (ICU) patients, 31 cases of pneumonia were diagnosed (36% of patients). – Oropharyngeal colonization, detected either on admission or from subsequent samples, was a predominant factor for nosocomial pneumonia in comparison with gastric colonization. – Oropharyngeal colonization with Acinetobacter baumannii yielded an estimated 7.45-fold increased risk of pneumonia in comparison with patients not yet or not identically colonized (p = 0.0004). – DNA genomic analysis demonstrated that an identical strain was isolated from oropharyngeal, gastric or bronchial samples in all but 3 cases of pneumonia due to Staphylococcus aureus. – The findings provide better knowledge of the pathophysiology of nosocomial pneumonia in mechanically ventilated patients
As bacterial infections have been associated with the atypical pneumonia seen in cases of COVID-19, the control of the oral environment and its microbiome seems like a logical step to be taken for these patients
Summary
The development of non-oral diseases may be promoted directly or indirectly by periodontal pathogens. Gram-negative anaerobic bacteria, which can be found in abundance in the oral cavity, release endotoxins that may directly contribute to the development of systemic diseases. This association was described by Socransky et al as early as in 1998.1 These oral pathogenic bacteria may reach other organs, such as the lungs, by direct inoculation or travel to distant organs via the bloodstream or the lymphatic system. The first confirmed death associated with COVID-19 was in Wuhan on January 9, 20203 and the first death outside of mainland China was reported in February in the Philippines.[4]. By March 2020, when the disease was declared a pandemic, many more countries had reported deaths caused by COVID-19.5 As of September 30, 2020, according to WHO, the death toll due to COVID-19 had reached 1,004,421.6
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