COVID-19 has the potential to cause severe acute respiratory tract infection among infected humans and is commonly transmitted from person to person via surface droplets, hands, nasal droplets, and saliva. The average incubation period ranges from 4 to 14 days. The infected person usually presents with upper respiratory tract infection (RTI) and complaints of high-grade fever, a dry cough, and Dyspnoea. Quarantine (self-isolation) is recommended and under observation until further investigation by the real-time polymerase chain reaction (RT-PCR) can take place. Unfortunately, there is no antiviral vaccine available on the market. But the first clinical trial was initiated by the National Health Institute (NHI), the USA on 14thMarch 2020.
How is Covid-19 causing a constant state of stress?
On exploringthe Psychological, social, and Neuroscientific effects of COVID-19 has set out immediate priorities clear and longer-term strategies for each of these aspects.
Various surveys, done by Ipsos MORI, revealed widespread concerns about the effect of social isolation or social distancing on wellbeing; increased anxiety, depression, stress, and other negative feelings in pandemic response, including financial difficulties. The prospect of becoming physically unwell with COVID-19 ranked lower than these issues related to the social and psychological response to the pandemic. Also, frequently expressed concerns about the exacerbation of pre-existing mental health issues, greater difficulty in accessing mental health support and the effect of COVID-19 on the mental health of family members, especially children, and older people has been reported. A major adverse consequence of the COVID-19 pandemic is likely to be increased social isolation and loneliness(as reflected in surveys) which are strongly associated with withanxiety, depression, self-harm, and suicide attempts.
Increasing unemployment, financial insecurity, and poverty as socio-economic policies used to manage the pandemic will inevitably have serious effects on mental health
Changes in body due to chronic stress
Multiple studies have proven fear and stress significantly lowers our immunity. In the recent adverse of coronavirus outbreak, it’s now our immunity that is fighting back.
White blood cells are the main type of immune cells.
There is a reduction in the immune system’s ability to fight off antigens when we are stressed. That is why we are more susceptible to infections. Which our body releases under stress can suppress the effectiveness of the immune system (e.g. lowers the number of lymphocytes).
The Indirect effect on the immune system as a person may use unhealthy behavioral coping strategies to reduce their stress, such as drinking and smoking.
Stress is linked to headaches; infectious illness (e.g. ‘flu); cardiovascular disease; ‘diabetes, asthma, and gastric ulcers.
Phobic fear continuously significantly decreases your natural killer cells (are our bodies fighter cells, which recognizes and kills foreign bodies like virus infection)
General Physiological alterations in stress
| Influenced factors | Alterations |
| cortisol | increases & decreases |
| Catecholamine level | Increases |
| testosterone | Decreases |
| Natural killer cells | Decreases |
| lymphocytopenia | Increases |
| Affected factors | Alterations |
| Collagen factors | Decreases |
| Hyaluronic acid product | Decreases |
| Wound healing | Decreases |
| Fibroblast proliferation | Decreases |
| Gingival microcirculation | Decreases |
| Endothelial cell injury | Increases |
Also, Coronavirus disease 2019 is associated with a variable inflammatory reaction that can induce vascular inflammation. Erythematous rash has been described and could also be explained by an inflammatory reaction that can be found in the oral cavity.
ORAL MANIFESTATIONS OF CHRONIC STRESS
Extreme stress may affect your mood and cause you to skip brushing, flossing, rinsing, and taking care of your general health.
If you don’t take good care of your mouth and teeth, you raise your chances of getting cavities or gum or more severe oral problems.
Evidence supports that oral mucosa is an initial site of entry for SARS-CoV-2 and that oral symptoms, including loss of taste and smell and dry mouth, might be early symptoms of COVID-19, although the mechanism and prognosis of oral symptoms of COVID-19 are not clear.
Fig: Conceptual framework of causal and moderating pathways linking the stress process to oral health practices and outcomes. Boxes indicate factors involved in the stress process (i.e., sources, mediators, and manifestations). Straight lines indicate the main causal relationships of interest. Circle with dashed line indicates a moderating effect of oral health practices
A psychosomatic disorder is the one that involves both the body and mind as they are one and influence each other. There is an interaction of diseases between body- mind and mind-body.TheMouth is directly or symbolically related to major human instincts and passion. In medicine oral diseases with psychosomatic etiology have long been known. Mental or emotional factors may act as risk factors that could influence the initiation and progression of oro-mucosal diseases.
- Cognitive symptoms– constant worrying, memory problems, inability to concentrate, poor judgment, seeing only negative.
- Emotional symptoms– short temper, inability to relax, moodiness, irritability, sense of loneliness and isolation, depression
- Physical symptoms– diarrhea and constipation, pain, nausea, rapid heartbeat, frequent cold, and body aches.
- Behavioral symptoms– eating more or less, sleeping too much or too little, isolating oneself.
Common oral health conditions due to stress
- Burning mouth syndrome (BMS)
Burning sensation of lips, tongue, oral cavity, sleep disturbances due to pain is known as BMS. Most common in the age group 50 to 60 years. The exact cause of burning mouth is still unknown, however, suggested possible causative factors include hormonal disturbances associated with menopause; psychogenic factors such as stress, anxiety, and depression; life events; personality disorders; cancer phobia; and nerve abnormalities
Treatment: Suck on small ice chips, Drink or sip cold liquids, Avoid acidic foods, like citrus fruits. Limit your consumption of hot beverages and spicy foods. Monitor your symptoms after smoking or consuming alcohol. Practice relaxation techniques to reduce stress, like yoga, exercise, and meditation. Consult your nearest dentist if the problem persists.
2.Xerostomia
Saliva is an essential fluid that lubricates and protects the oral cavity and also helps to taste, swallow, and speak. A reduced salivary flow imposes several risks to the oral cavity, such as increased susceptibility to caries, tooth demineralization, fungal infections, and mucosal lesions. Therefore, a decreased salivary flow may contribute to a reduced quality of life and Dry mouth syndrome, also known as xerostomia.Chronic stress seems to be associated with several aspects of dry mouth, including the perception of dry mouth, suffering from dry mouth. These effects were independent of the use of psychotropic medication.
Symptoms: A sticky, dry feeling in the mouth is observed. Signs like frequent thirst, split skin at the corners of the mouth, cracked lips, dry feeling in the throat, a burning sensation in the mouth and on the tongue or sores can be seen. A dry, red, raw tongue can also be observed.
Treatment: Help Yourself improve saliva flow
- Suck on sugar-free candy or chew sugar-free gum, avoid acidic ones like a lemon that can soften teeth.
- Drink plenty of water frequently to maintain moisture.
- Improve the habit of breathing through nose more and avoid mouth breathing.
3. Gingivitis
Periodontal diseases occur only in the presence of poor brushing habits which results in dental plaque, and with chronic stress, it may bring gingivitis.
Symptoms
- Swollen or puffy gums.
- Dusky red or dark red gums.
- Bleeding Gums.
- Bad breath.
- Observed receding gums.
- Tender or painful gums.
Treatment: use a soft bristle toothbrush, floss at least once a day, use mouth wash(alcohol -free) regularly, Do warm water gargles. Consult your nearest Dentist if the problem persists.
4.BRUXISM
Bruxism is the excessive grinding of teeth consciously or unconsciously. During sleep, grinding mostly occurs and most people are unaware that they grind their teeth. However, a dull, constant headache or sore jaw when you wake up is a telling symptom of bruxism. At times people learn that they grind their teeth by a loved one who hears the grinding at night.
Treatment: Consult a dentist who can fit you with a mouth guard which protects your teeth from grinding during sleep. Attending stress counseling, starting an exercise program, seeing a physical therapist, or obtaining a prescription for muscle relaxants are among some of the options that may be offered.
Other tips to help you stop teeth grinding include
- Reduce consumption on foods and drinks that contain caffeine, such as colas, chocolate, and coffee.
- Grinding tends to intensify after alcohol consumption. Minimize intake of alcohol
- Chewing gum must be avoided as it allows your jaw muscles to get more used to clenching and makes you more to grind your teeth.
- If you notice that you clench or grind during the day, try to position the tip of your tongue between your teeth. This practice trains your jaw muscles to relax.
- You can also relax your jaw muscles at night by holding a warm washcloth against your cheek in front of your earlobe.
5. Recurrent Aphthous Stomatitis
RAS affects approximately 20% of the general population. The meaning of the Greek word aphtha is ulceration. One or two days before the onset of ulceration, the prodromal phase of paresthesia followed by pain is present. Precipitating factors in cases of aphthous ulcers are acute psychological problems. Predisposing factors are Iron, vitamin B12, and folic acid deficiency. Other factors that have readily been implicated in promotion or exacerbation of RAS include positive family history, local trauma, smoking cessation, and psychological stress. Psychological stresses induce immunoregulatory activities by increasing the number of leukocytes at the sites of inflammation. The age group of 31 to 60 years are more affected by Recurrentaphthous ulcers and were more frequent in females as compared to males.
6. Oral Lichen Planus
The etiology of LP comprises a cell-mediated immunological response or disturbance, which leads to the degeneration of the basal epidermal cells. It consists of slightly elevated thin whitish lines in the form of a ring or ring-like lesion. The most frequent conditions which may lead to lichen planus are depression, anxiety, and stress. Oral symptoms may persist for many years with periods of exacerbation and quiescence. Increased erythema or ulceration with severe pain and sensitivity is common in periods of exacerbation. During periods of quiescence, there is a decrease in symptoms. Periods of psychological stress and anxiety exacerbates the occurrence of lichen planus.
7. MYPDS (Myofascial pain and dysfunction syndrome)
The psychological makeup of the patient as a predisposing factor in the MYPDS was first stated by Shwartz. He stated that stress was a significant cause for clenching and grinding habits which results in spasm of muscles of mastication. According to Travell and Simons, myofascial pain results from trigger points, which are discrete focal hyperirritable spots located in the taut bands of skeletal muscles. It was found that chronic musculoskeletal pain disorders like MYPDS affect approximately 10% of the population of the United States of America in a study done by Alvarez and Rockwell.
Strategies for the general public to minimize the effect of outbreak-related stress: (1) check the accuracy of the information, (2) enhancing social support, (3) reducing the stigma associated with the disease, (4) maintaining as normal a life as feasible while adhering to safety measures, (5) use of available psychosocial counseling.
Such methods, would empower society to handle the COVID-19 outbreak adaptively and providing accurate information to the general public to minimize responses such as “panic” and paranoia regarding the disease and its transmission.
