Cleaning Up your COVID Mouth

By: Dr. Amy Dukoff

Even with the vaccine and boosters, we are all vulnerable to COVID infections. When infected with the virus, what should we do differently to clean our teeth, tongue and gums? A great question! So, what is the answer? Cleaning your mouth during COVID is different than one’s normal routine. Just like, soap can affect how your skin reacts especially when it!s cut or bruised, so can oral care products affect your oral tissues especially when you are COVID + and are prone to Inflammatory lesions, blisters, and ulcers. As an essential worker during lock- down, creating an oral care protocol for COVID infections began out of necessity for my pa- tients, staff, practice, family and friends. I am thankful that by implementing oral care guidance during the COVID lockdown, my staff and myself remained COVID free. The knowledge gained clinical experiences combined with the scientific basis proves the importance of oral care during a COVID infection.COVID’s cytokine storm can cause havoc to oral mucous membranes and cause lesions. Oral care products may either calm down, have no effect, or aggravate oral tissues. I suggest se- lecting oral care products that do not aggravate or exacerbate the tissues in order to reduce the risk for provoking the COVID inherent properties of inflammation to encourage the forming of oral lesions.

What to use is based on what not to use. I recommend avoiding products containing ingredi- ents that are known to aggravate conditions and lesions of the mouth that are common in COVID infections, Common lesions may be oral ulcers, tissues inflammation, petechiae, red bumps, burning feelings, dry mouth, white lesions,… So, what to recommend to our patients, family and friends when they have COVID-19? I advocate avoiding ingredients that are prone to causing similar lesions, such products are:
SLS Free;
Alcohol Free;
Peroxide Free;
Acid Free;
Low abrasiveness of RDA.

SLS, a detergent, is short for sodium lauryl sulfate. I recommend to avoid using a toothpaste with SLS if you have mouth ulcers as per advised by NHS.1 Also, SLS is known to have a delay in wound healing. 2 Alcohol has a drying effect on the oral mucosal membranes.3 Similarly, per- oxides and peroxide releasing agents have a drying side effect symptom.4 It is important to avoid oral care products and toothpastes that have these ingredients. It is common knowledge that dry mouth is a symptom of COVID. Also, it is common knowledge that saliva protects the oral tissues. Thus, with lack of saliva, tissues may become more prone have the virus stick to it and find its receptor site. Also, avoiding acidic oral care products aids in creating an unfavor- able environment for the virus to bind to its receptor site since pH 5.5 appears to be a preferred
condition for having the virus bind to its receptor site on the mucosal tissues5. Lastly, brushing your tongue and teeth often during the day is essential so that having a low RA abrasive index number aids to keep the level of possible abrasion to the enamel or dentin low. There common ingredients in many oral care products should be avoided during a COVID infection.

Along with picking the right oral care product, it is equally important that daily habits are modified to include the following such as have:
A New Soft toothbrush;
The New soft toothbrush is discarded after infection;
Each day and after each use disinfecting the toothbrush;
Water pik and power toothbrushes avoided due to production of aerosols; Wash hands before touching your toothbrush;
Daily Tongue brushing;
Keep your toothbrush separate from the other members of the household.

We forget, but when you think about it, would you want to put COVID back into your mouth by brushing your teeth? We wash and disinfect surfaces that may have been exposed to COVID before touching them. So, would you use the toothbrush that was used in infected saliva and now has it in its brittles and put it back your mouth? I assume your answer would be to disin- fect it first. For tongue brushing, because the tongue has deep crevices and lots of taste buds and salivary glands, keeping it clean by removing dead tissues and microorganisms benefits the individual. Common knowledge is when you clean an infected area, that area heals faster. Makes sense to keep the tongue clean getting rid of unwanted tissue and debri.

Oral care is strongly associated with improved health during COVID. British researchers agree that oral hygiene and care are integral in affecting the disease progression6. Similar research funded by NIH has research has been linking the connections between oral infections and in- fections of the salivary gland .7 Additionally, the research further explores the connections be- tween the mouth and the virus’ transmission in the body correlating to disease progression. Presently, infection is associated with both vaccinated and non-vaccinated groups, so what are we missing? Oral care guidance and instructions are missing. Therefore, keeping your mouth clean like keeping your hands clean is essential during a COVID infection. A clean mouth is also a happy mouth and promotes good general health.

About the Author:
Dr. Amy Dukoff is an Endodontist in private practice in midtown Manhattan for over 30 years and supports medical/dental innovation through her family’s foundation, Dukoff-Toro Founda- tion. She is a graduate of Tufts School of Engineering and Tufts School of Dental Medicine. Dr. Dukoff is a researcher, innovator, lecturer, and holds domestic and foreign patents. 1/1/2023©

1 https://www.nhsinform.scot/illnesses-and-conditions/mouth/mouth-ulcer)
2 . Herlofson BB, Barkvoll P. Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study. Acta Odontol Scand. 1994 Oct;52(5):257-9. doi: 10.3109/00016359409029036. PMID: 7825393.
3https://www.mayoclinic.org/diseases-conditionas/dry-mouth/expert-answers/dry-mouth/ faq-20058424
4 Tombes MB, Gallucci B. The effects of hydrogen peroxide rinses on the normal oral mucosa. Nurs Res. 1993 Nov-Dec;42(6):332-7. PMID: 8247815.
5 Chu VC, McElroy LJ, Chu V, Bauman BE, Whittaker GR. The avian coronavirus infectious bronchitis virus undergoes direct low-pH-dependent fusion activation during entry into host cells. J Virol. 2006;80(7):3180-3188. doi:10.1128/JVI.80.7.3180-3188.2006
6 Senior, R., Link Between Oral Hygiene and COVID-19; July 8, 2002; https:// www.elitecme.- com/resource-center/covid-19/link-between-oral-hygiene-and-covid-19
7 Scientists find evidence that novel coronavirus infects the mouth cells.NIH News Release, March 25, 2021; https://www.nih.gov/news-events/news-releases/scientists-find-evidence- novel-coronavirus-infects-mouths-cells