How Oral COVID-19 Infections Impact Dental Safety

During the COVID-19 epidemic, we’ve heard a lot about how the virus invades the upper airways, nasal cavity, lungs, and even blood.  A new study looks at how the virus infects the mouth, and it has implications for how we close out the current pandemic and prepare for new ones in our dental practices.

Researchers discovered that the virus can replicate in the glands and mucosal tissue of the oral cavity. This means that it’s present in saliva, including the saliva of asymptomatic individuals.  The scientists found that concentration of the virus in saliva relates to the severity of oral symptoms like ulcers or loss of taste. Infections that begin in the mouth can also go systemic and progress to more serious forms of the disease. COVID-19 in the oral cavity has to be taken seriously.

The findings shed light on some of the mysterious traits of COVID-19.  For instance, if asymptomatic spread can occur through contact with saliva, it could explain the presence of super spreaders and super spreader events.  A recently infected individual who spits more when they talk would spread more virus into the air. Similarly, events like basketball games, where many people are yelling in an enclosed space for a long period of time, would result in more spread from saliva.  Meanwhile, shopping at a big box store does not release as much saliva into the air, even when people are not masking or distancing.

The research also has implications for less-researched viruses, like the ones that cause normal colds and flus.  Perhaps we’ve also underestimated the role of survival in the spread of other respiratory viruses.

Mitigating COVID-19 In Your Practice

With the new information on saliva and asymptomatic spread, there are several take-aways for your dental practice:

• Saliva-based rapid tests could be a minimally invasive, reliable way to screen patients before procedures and to monitor infection rates among team members.
• Other screening methods like temperature checks or symptom lists may not be effective since asymptomatic spread is possible through saliva.
• Even as we reopen, the enhanced air filtration, pre-procedure rinses, and vacuum systems added by many practices should remain in place.  Even if vaccinations greatly reduce the prevalence of COVID-19 in our communities, these precautions may protect our teams and patients against other respiratory infections.
• Even if your team can’t wait to ditch the masks once vaccinated, consider at least keeping the face shields. These might provide some extra protection against patients who spit when they talk.
• Continue to encourage you team to get vaccinated to keep themselves and their patients safe. If you’re having trouble persuading some team members, consider paid time off for post-vaccine reactions. A little extra attention now will keep everyone safer if COVID-19 flares up again this winter.
• Educate your team about what the mouth ulcers associated with COVID look like, so they can take precautions if they treat a patient who has them.
• Keep in mind that, given your existing precautions, the greatest point of spread is likely to be the breakroom during mealtimes.  Shared eating is essential for team bonding, so consider adding a HEPA unit to the breakroom even after everyone has been vaccinated.

The good news about the new findings is that, as dental practices, we’ve already optimized our spaces to protect ourselves and our patient from saliva-borne illness. If we continue to use best practices, we’ll be able to serve our patients well now and in any future pandemics.