BY NORMAN J CLEMENT RPh., DDS.
COVID-19 has been proven to be an oral pharyngeal disease before it becomes a pulmonary and systemic disease.(id.) Once this Virus gets past your hands and into your mouth and nose, your dentist, the dental office, Dental schools must be brought on board and utilized for testing and identification of preventive, intervention procedures.(1)
In China’s State Key Laboratory of Oral Disease, National Center for Clinical Research in Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu China, a study done by J. Xu’, Y.Li’, F.Gan’, Y.Du’, and Y.Yao’ called “Salivary Glands: Potential Reservoirs for COVID-19 Asymptomatic Infection,” these authors had drawn attention to dental risk in asymptomatic patients. Stating the following:
“Previously, researchers have shown the role of oral mucosa in COVID-19 infection (Xu, Zhong, et al. 2020). We would like to draw attention to salivary glands in the epidemic process of asymptomatic infections.”
“ACE2 is an important receptor for COVID-19 (Xu, Chen, et al. 2020). In a previous study about severe acute respiratory syndrome–coronavirus (SARS-CoV), salivary gland epithelial cells with high expression of ACE2 were infected (Liu et al. 2011). We analyzed the expression of ACE2 in human organs in the GTEx portal (https://www.gtexportal.org/home/gene/ ACE2#geneExpression).
“The expression of ACE2 in minor salivary glands was higher than that in lungs (lung medium PTM [transcripts per kilobase of exonmodel per Million mapped reads] = 1.010, minor salivary gland medium PTM = 2.013), which suggests salivary glands could be potential target for COVID-19. In addition, SARS-CoV RNA can be detected in saliva before lung lesions appear (Wang et al. 2004). This may explain the presence of asymptomatic infections. For SARS-CoV, the salivary gland could be a major source of the virus in saliva (Liu et al. 2011). The positive rate of COVID-19 in patients’ saliva can reach 91.7%, and saliva samples can also cultivate the live virus (To et al. 2020). This suggests that COVID-19 transmitted by asymptomatic infection may originate from infected saliva.”
“Therefore, the cause of asymptomatic infection might be from salivary glands. We should not ignore the potential infectivity of saliva alone.”
YALE UNIVERSITY SARS-CoV-2 SALIVA DETECTION TESTING
The Yale University study April 22, 2020, more than demonstrated that “saliva is a viable and preferable alternative to nasopharyngeal swabs for SARS-CoV-2 detection. The Yale University study found that the sensitivity of SARS-CoV-2 detection from saliva is comparable, if not superior, to nasopharyngeal swabs in early hospitalization and is more consistent during extended hospitalization and recovery.”
Moreover, the detection of SARS-CoV-2 from the saliva of two asymptomatic healthcare workers despite negative matched nasopharyngeal swabs suggests that saliva may also be a viable alternative for identifying mild or subclinical infections. With further validation, widespread implementation of saliva
THE JOURNAL OF THE AMERICAN DENTAL ASSOCIATION
The Journal of the American Dental Association, Vol 135, issue April 4, 2004, Pages 429-437, Aerosols and Splatter in Dentistry: A Brief Review of the Literature and Infection Control Implications, by Stephen K. Harreld, DDS., John Molinari, Ph.D.;(2)
” The saliva and nasopharyngeal secretions also may contain other pathogenic organisms. These may include common cold and influenza viruses, herpes viruses, pathogenic streptococci and staphylococci, and the SARS virus. The use of universal precautions with all patients initially was based on the assumption that all patients may have an infectious bloodborne infection, such as with hepatitis B virus, the hepatitis C virus, and HIV. It also should be assumed that all patients may have an infectious disease that has the potential to be spread by dental aerosols; thus, universal precautions to limit aerosols also should be in place.”
A SPECIFIC DENTAL HEALTH SPECIALTY KNOWN AS COVIDONTICS IN OUR HEALTHCARE ARMED FORCES
We are at War, and Oral Health will likely be the key to controlling the Novel Corona Virus COVID-19. Thus what will be needed a group called Covidontist consisting of General Dentist, Specialist (oral surgeons, periodontist, endodondist, orthdontists, oral pathology, dental hygienist, etc.) lead in the United States by the Oral health Assistant Surgeon General coordinating his/her efforts around the World with health ministries around the World, specifically to identify and treat COVID-19 pandemic or any disease which results in a pandemic that can be prevented and treated in the Oral Cavity; we can no longer be ordered out of the valued regiments of our healthcare armed forces to sit home (on the sidelines).
The Field of Dentistry, including its specialties, can ill-afford to sit at home and must change their roles as providers of dental oral health to “a covered person” during this Sars-2 pandemic. We cannot permit those most knowledgeable in Oral Health and Oral Pathology to be sidelined. The failure to implement Oral Health protocols has resulted in unnecessary deaths and destruction of the world/s economy. We are at war. Dentistry has a role in our Healthcare Armed Forces and will primarily be:
a) Oral and nasal testing to identify the presence or non-presence of COVID-19 Virus
b) Intervention and Prevention
c) Adopting an Oral-Healthcare Guideline.(1)
WHAT CDC, WORLD HEALTH AND FDI WORLD DENTAL FEDERATION GOT WRONG “BETTER HEALTH THROUGH THROUGH BETTER HEALTH PARTNERSHIPS“
Contributing to this misguided short sidedness of CDC, World Health Organization, FDI World Dental Federation, and their failure to mobilize those who are knowledgable of oral diseases such as dental practitioners in the testing, detection, and prevention of COVID-19 during this pandemic. What they failed to understand in better health comes directly from “Better Health Partnerships.” Thus, this simple oversight on their part has resulted in prolonging this War and causing unnecessary deaths world wide and disastrous outcomes.
JUST THE USE OF A PERIODONTIST AND DENTAL HYGIENIST
One area these groups got wrong was the critical role Periodontist and Dental Hygienists should be playing in working together with the physician and medical personnel in maintaining Oral Health before a patient has been placed on a respirator.
Instead, in most of the United States of America and likely around the World, those who are most learned and knowledgeable of oral diseases and know the ORAL CAVITY were ordered to the sidelines and sent home to apply for SBA PPP, and watch the SARS-2, VIRUS express itself around the World.
THE DENTAL SCHOOLS WERE FORCED TO CLOSE INSTEAD BEING OF USED FOR TREATMENT
Even more tragically, Dental Training Institutions such as The University of Michigan School of Dentistry, University of Oregon School of Dentistry, University of Florida College of Dentistry, The Ohio State College of Dentistry, Meharry Medical College Dental School, Howard University School of Dentistry are closed and shut down. These earlier warnings fell upon death ears and of bureaucrats and politicians whose ego jump far ahead of the issues at hand-further, many within the dental profession who choose to remain silent in fear of ridicule and retribution.
As we have now seen, the failure to utilize Oral Health Care practitioners and not recognize them as a part of the healthcare armed forces has become our greatest tragedy. Hundreds of thousands of lives have been unnecessarily lost during this pandemic because of the dismissing of the importance of Oral Health as an essential component of overall well being. Thus it is the fear of this author the pandemic crisis will only become worst:
- Implement “Better Health Through Better Health Partnerships.”
- The Formation of a Healthcare Armed Forces
THE UNITED STATES SURGEON GENERAL JEROME ADAMS MD
The United States Surgeon General Dr. Jerome Adams has rightly stated his concept: “Better Health Through Better Health Partnerships.” Each one will teach one, Dr. Adams concept using the Pharmacist/Dental partnership will lead to better health outcomes and success in places such as New York City, Cape Town, Lisbon, Johannesburg, Tokyo, Detroit, Tampa and Weewawhitchka. (3)
Yet, success can only be possible with more testing, testing, testing. Sanjay Gupta MD. has estimated in the United States we must test 2.5 million persons per day Nation-Wide. The success of the Covidontic Program rests upon one most important inclusion, testing, testing, testing.
YOU ARE WITHIN THE NORMS
- The Journal of the American Dental Association, Vol 135, issue April 4 2004, Pages 429-437, Aerosols and Splatter in Dentistry: A Brief Review of the Literature and Infection Control Implications, by Stephen K. Harreld, DDS., John Molinari, Ph.D
- Release Philip Adams from Prison.