Oral health incidence of Covid masks
Incidence of oral health on systemic health in times of Covid-19.
It is becoming increasingly clear that oral health is fundamental to maintaining a state of general well-being. In this review, we will learn not only about the vital role played by the microbiota as a link between oral and systemic health but also about the oral health problems derived from the prolonged and, in some cases, inadequate use of the mask.
It is becoming increasingly clear that oral health is fundamental to maintaining a state of general well-being. In fact, the negative impact of poor oral health on different chronic pathologies, such as diabetes, and cardiovascular or pulmonary disorders, among others, has been described. In this sense, the microbiota plays a vital role as the link between oral and systemic health.
The oral microbiota comprises bacteria, viruses, fungi, archaea, and protozoa. As for the bacterial fraction of our oral microbiota, it is made up of more than 700 species. The great variety of niches provided by the oral cavity, formed by mucosal tissues and the surface of the teeth, gives rise to an enormous diversity and a spatial organization of microorganisms characteristic of this microbiome. In the oral cavity, facultatively anaerobic bacteria predominate, while in the subgingival area, as the oxygen concentration is reduced, strict anaerobic microorganisms are more abundant.
In addition, three-dimensional structures are formed on the oral surface in which different bacterial species are involved, although other microorganisms, such as Candida, may also participate. When these biofilms are eubiotic, i.e., in equilibrium, they favor homeostasis and the host's health. But suppose there is an imbalance between commensal and pathogenic species, that is, when there is a state of dysbiosis. In that case, there is an increase in proinflammatory signals that will favor different oral pathologies.
One of them has to do with gingival inflammation and gingivitis. When the overgrowth of certain microorganisms such as Treponema denticola, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, or Porphyromonas gingivalis, among others, escape the control of the immune system, chronic inflammation occurs, and periodontal tissue is destroyed, leading to periodontitis. This local inflammatory response, and even some pathogenic microorganisms, can reach distal organs, which explains the association between periodontitis and various pathologies.
Another pathology that has been related to oral dysbiosis is diabetes mellitus. Some studies suggest that periodontitis may play an essential role in the incidence of type 2 diabetes and the increased risk of gestational diabetes. The systemic inflammation caused by periodontitis contributes to insulin resistance and explains the poorer glycemic control of patients with this oral health problem.
In the case of Alzheimer's disease, a mechanism has been described that would link oral dysbiosis with neurodegeneration. Oral pathogens and the toxic substances they produce, such as lipopolysaccharides (LPS) from the membrane of gram-negative bacteria, would reach the systemic circulation and, under certain conditions, could cross the blood-brain barrier, producing neuroinflammation and the formation of β-amyloid protein deposits. This neuroinflammation contributes to cognitive impairment in patients suffering from this neurodegenerative pathology. LPS from oral bacteria have even been detected forming part of the myeloid plaques in the brains of these patients.
Oral microbiota and SARS-CoV-2: "mask mouth."
We are going through a tough time at the health level due to the SARS-Cov-2 pandemic, which has once again highlighted how essential it is to maintain a good state of health.
Having an altered oral microbiota, for example, due to periodontitis, increases the risk of pneumonia or other complications during hospitalization. In addition, the passage of periodontal pathogens from the mouth to the respiratory tract may be enhanced by cough reflex or increased inhalation under abnormal conditions, as well as by mechanical ventilation.
In addition, it has been shown that some of the bacteria above causing this oral pathology, such as F. nucleatum or P. gingivalis, cause an increase in proinflammatory cytokines at the level of the respiratory epithelium. And not only them. Other microorganisms that make up dental plaque, such as Chlamydia pneumonia, can cause respiratory infections.
