Just when we thought that the havoc created by the novel coronavirus was on the verge of extinction, a new variant emerges which spreads the wave of fear and tension worldwide. So far numerous variants of the novel coronavirus are reported like alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), Epsilon (B.1.427 and B.1.429), Mu (B.1.621 and B.1.621.1), Zeta (P.2) and delta (B.1.617.2).

These variants are classified by World Health Organisation as Variant of Interest (VOI), Variant being Monitored (VBM), Variant of High Consequence (VOHC), and Variant of Concern (VOC). On March 11, 2020, since the pandemic started the South Asian countries have witnessed two major waves of Covid-19. And these two waves of the covid-19 disease have accentuated the importance of oral health. Simple oral hygiene measures have proved to be extremely beneficial to patients.

Whilst we were coping to get out of the second wave, a new Variant of Concern (VOC), called ‘omicron’ (B1.1.529) has popped up in African countries. The variant has already spread its wings in countries like South Africa, Britain, Canada, France, Italy, Belgium, Switzerland, Germany, Netherland, Denmark, Hongkong, and Japan too! Even though the Variant has still not found a foothold on Indian soil if at all it happens a bigger and even more dangerous ‘third wave of corona’ is expected by the public health specialists. 

Omicron versus delta variant

The omicron variant is the newest variant of the novel coronavirus and has dominated the headlines across the globe. The delta variant is more contagious than the previous covid-19 variants and the new omicron variant has undergone even more mutations and is more likely to infect the patients who have had a history of Covid-19. The data available on the omicron variant is still very basic and not clear. However, an important fact to note is the pathogenicity, virulence, and transmissibility of the new variant. The rate of infection in an individual also depends on the age and immunocompromised versus the immunocompetent state of the person.

Re-investigating the Covid-19-mouth connection!

The ‘cytokine storm’, an immune reaction that releases excessive inflammatory molecules is the hallmark of Covid-19 infection. Periodontitis also being a host immune-inflammatory disease was reported to be a major risk factor in contracting Covid-19 infection. According to recent research patients with Periodontitis who suffered from Covid-19 were 3.5 times likely to be admitted directly to the intensive care unit, 4.5 times more likely to be put on a ventilator and had 8.8 times chances of death than patients who did not have periodontitis. Since the world was completely new to this disease the research and studies conducted were short-termed and on small scale.

 The above-mentioned statistical data is merely a correlation and not a definite causative factor but still highlights the importance of oral health and its correlation to a relatively new disease. Owing to the continuous research during the pandemic and with sufficient data available the dental front line health workers can gear up for the third wave! Most of the dental professionals around the world were connected with the patients by continuously updating them with the oral health solutions during the last two waves. It’s time now to improve, update and implement this knowledge even more stringently for the third wave.

What are the lessons that we learnt during the first two waves regarding oral health?

‘Oral health is of paramount importance in overall health’ is officially reported by the first and only General Surgeon in 2000! Due to the worldwide lockdown during the last two waves, the significance of dental health was realized since access to dental care was restricted. The two most important co-morbidities associated with Covid-19 are cardiovascular diseases and diabetes. Both of which also present with poor oral hygiene status. Chronic periodontal problems are like a classic sign of diabetes. 

Another vital finding which the researchers have noted is the strong association between dental erosion, dental caries, periodontal problems and extreme mood swings, stress, anxiety, isolation, loneliness. All of these factors heightened during the lockdown which also had an impact on oral health. During the first two waves since the world was not prepared for a pandemic of that magnitude, the health care services offered also had few limitations. But now with enough data and research, both the dental health professionals as well as the patients can prepare themselves to combat against the expected third wave.

Senior people with co-morbidities should definitely consult their Dentists for routine consultations and oral prophylaxis treatment. Dentists should encourage working individuals who can expect a ‘work from home’ job yet again to not post-pone any of the elective dental treatments. 

Time to brush-up simple oral care regime to battle against the third wave of corona!

The last two years have shown that a simple and basic oral care routine can be immensely useful to keep viral infections like Covid-19 at bay. The studies published in the reputed Journal of Oral Medicine and Dental Research stated that few of the mouthwashes like Povidone Iodine can be very effective against the Sars-cov-2 virus. Periodontal problems can be easily avoided by preventing plaque build-up on tooth surfaces. Plaque build-up can be prevented by mindful brushing and interdental cleaning or flossing. This simple oral care model can help a patient from life-threatening complications of Covid-19. 

Dental practice closure during the third wave?

Well, even though the answer is a big ‘No’ it will be an individual call rather than the official orders. The two waves have changed the entire face of dental practice being conducted. The work experience amidst these two waves can definitely bolster the confidence of dental professionals to even better prepare themselves during the expected third wave. Also, an important point to note is that according to CDC, there is no specific data available to indicate the transmission of Sars-cov-2 virus in the dental practice. Therefore, dental professionals can focus and carry on with preventive and restorative dental procedures even during the third wave.

‘CAB’ and ‘JAB’ are the only measures to halt the spread of expected third wave!

‘CAB’ or the covid appropriate behavior like wearing a mask, maintaining social distancing, and isolation in case of infection is the most vital measures and need to be reinforced yet again. Simple hand hygiene measures like using a hand sanitizer should be strictly followed yet again. In addition to these measures, the availability of vaccines has proved to be a great boon now! Thus, Dentists should encourage their patients to get vaccinated as early as possible. Along with these fundamental measures basic oral care routine should be followed to help the spread of the deadly Sars-cov-2 virus.

Highlights

• The emergence of a new variant called ‘omicron’ has proved that the battle with Covid-19 is yet not over.
• The covid appropriate behaviour like wearing a mask, social distancing and hand hygiene and dental hygiene has become even more mandatory.
• The significance of oral health cannot be overlooked and simple oral hygiene protocols need to be followed to curb the spread of the third wave.
• According to CDC, no data has been found to indicate the transmission of Sars-cov-2 virus in dental practice.
• Vaccination is of paramount importance to prevent the spread of expected third wave.