Salisbury Foundation Trust

Salisbury Hospital drives for excellence in mouth care for COVID-19 patients

Salisbury Hospital has initiated a hospital-wide quality improvement project to offer best-quality oral healthcare for all our patients, with specific guidance relevant to those with COVID-19.

Please see this link -

The specific guidance for COVID-19 patients is based on the research of Dr Graham Lloyd-Jones, consultant radiologist at Salisbury Hospital, who earlier this year published a scientific hypothesis in the Journal of Oral Medicine and Dental Research relating to the development of the lung disease in COVID-19.

Dr Lloyd-Jones explains: "The lung disease of COVID-19 is in the blood vessels, not in the airways. The virus enters the nose and replicates in the mouth. A single teaspoon of saliva contains 500 million copies of the virus. The virus could easily leak from your saliva into the blood vessels of the mouth, especially if you have gum disease or bleeding gums. The virus would then be passed directly to the lungs via the bloodstream exactly to the areas where it does the most damage. There are everyday oral hygiene steps which might reduce the virus in the mouth and saliva, and lower the risk of it spreading to the lungs."

Developed further with an international group of experts in oral healthcare, the theory has gained much attention in medical research circles and the media. The hypothesis would explain why those with gum disease get more severe COVID-19. It highlights the potential central importance of good oral hygiene during the illness.

Dr Lloyd-Jones continues: "It is striking that the risk factors for severe COVID-19 are the same as the risk factors for severe gum disease. These include patient age, sex, ethnicity, blood group, obesity, other diseases such as diabetes and heart disease, and for those who have difficulty looking after their mouths such as those with dementia, learning difficulties or physical disabilities. Until clinical trials are performed to confirm the benefit of oral hygiene measures, we are advising careful attention to simple mouth care steps for anyone with COVID-19, including regular toothbrushing and use of certain mouthwashes."

Research shows that some mouthwash products contain ingredient which completely eradicate SARS-CoV-2 in the test tube in 30 seconds. These ingredients include cetylpyridinium chloride (CPC) and ethyl lauroyl arginate (ELA/LAE). Specific mouthwashes tested by Cardiff University which contain these ingredients are now being provided for all Salisbury Hospital patients with COVID-19. The Cardiff research shows that products which contain chlorhexidine or ethanol alone do not eradicate the virus.

The Salisbury Hospital mouth care project has now gained the attention of central figures including Sara Hurley, Chief Dental Officer for England.

She says: "Good oral health is a key element of compassionate care. Every patient care pathway, in every hospital, should include routine daily mouth care. I welcome the Salisbury Hospital initiative, their recognition that mouth care matters and the wider dividends for health."

Links to further information

Salisbury Hospital COVID-19 mouth care guidance

Video animation of the proposed bloodstream infection route

Cardiff University Research
Brief Report: The Virucidal Efficacy of Oral Rinse Components Against SARS-CoV-2 In Vitro. Statkute et al. Biorxiv. 18th November 2020.

The scientific hypothesis
The COVID-19 pathway: A proposed oral-vascular-pulmonary route of SARS-CoV-2 infection and the importance of oral healthcare measures. G Lloyd-Jones et al. Journal of Oral Medicine and Dental Research. April 20, 2021.

The original theory
First published by Dr Graham Lloyd-Jones, February 20, 2020


18 October 2021

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