Should Dentist be a Part of COVID Care Team?

Dear Editor,

The Coronavirus Disease-19 (COVID-19) pandemic sweeping across the globe can cause an altered immune reaction similar to the autoimmune damage, deleteriously affecting the cellular response of the host. At times, body’s first line of defence mechanism fails to defeat the virus as it does not respond effectively to inflammatory shield [1]. The morbidity rate is reportedly higher in the geriatric population and in patients with underlying comorbidities such as asthma, diabetes, cancer and cardiac diseases [2]. Interestingly, COVID -19 patients do not follow a categorical pattern of infection. Population specificity of Angiotensin Converting Enzyme 2 (ACE2), which is the receptor of Severe Acute Respiratory Syndrome-Corona Virus-2 (SARS-CoV-2) and mutation of viral surface proteins (spike-S-protein and nucleocapsid-N protein) could be responsible for atypical symptoms of the disease [3].

Though lungs are the primary site of COVID-19 infection with manifestations ranging from flu-like symptoms to sudden respiratory distress, mucotropic ability of SARS-CoV-2 could potentially lead to altered salivary gland function, reduced sensation of taste and changes in oral mucosa [1]. Studies have revealed expression of ACE2 receptors in tongue, buccal and gingival tissue and minor salivary gland ducts in oral cavity. Oral symptoms like amblygeustia and dry mouth in COVID-19 patients suggest dysfunction of these receptors [4]. SARS-CoV-2 could also provoke oral atypical herpetic look alike lesions like ulcers or blisters that may resemble other viral infections [5]. However, more robust scientific evidence is required to support this claim. It is still not clear, if oral manifestations are caused primarily due to COVID-19 or secondary to immunodeficiency condition, considering the possibility of opportunistic infections [6]. Moreover, the effect of intricate pharmacotherapy and emotional distress during intense hospitalisation for COVID-19 cannot be underestimated while assessing patient’s oral health [1].

India’s COVID-19 cases are escalating at an alarming rate. Currently, Indian Public health care system catering to the world’s second highest population is under-resourced and over-stretched. Adopting a multidisciplinary approach of including a dentist in person or via teledentistry in the COVID care team may have a positive impact on patient’s quality of life. Dentist can provide supplementary treatment by suggesting rehydration therapy, alleviating pain and discomfort in oral cavity and reinforcing oral hygiene measures. This will help to tackle nutritional deficiencies, thereby aiding faster recovery from COVID-19.

Thus, dentists can provide curative as well as preventive oral care for hospital/home quarantined COVID-19 patients.

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