Thread by @DrGrahamLJ

Summary thread of the oral-vascular-pulmonary model of #COVID-19 lung disease, why this is important and what to do about it.

Also potentially relevant in #LongCOVID

@SpringerNature review -

1/21 bit.ly/3ME7LtC

2/21
Initial viral infection of epithelial lining of the upper respiratory tract mucosa (nose and mouth) ...

3/21
Viral replication (copying) and reservoir formation in the mouth (saliva, gingival crevicular fluid, dental plaque, periodontal tissues, minor salivary glands) ...

4/21
Transfer of viral particles/elements into the gingival venous drainage facilitated by micro-ulceration of the sulcular/pocket-lining epithelium due to gingivitis or periodontitis ...

5/21
Intravascular passage of viral particles (or procoagulant viral elements) from the venous drainage of the mouth to the neck and chest veins (jugulars and superior vena cava) …

6/21
… the right side of the heart …

7/21
… into the pulmonary circulation via the pulmonary artery, dominantly in the highly vascularized gravity-dependent lung peripheries ...

8/21
Direct interaction of viral particles/elements with endothelial cells of the pulmonary microvasculature, with intravascular pro-coagulant and pro-inflammatory viral interactions ...

9/21
... leading to vasoconstriction, endothelial dysfunction and intravascular thrombosis/immunothrombosis
(Immunothrombosis = blood vessel inflammation with clotting within small blood vessels) ...

10/21
Damage to the normal capillary network in the lungs (normal blood flow and normal gas exchange) ...

11/21
... with vascular congestion and impaired lung perfusion leading to lung damage, dominantly in the lung peripheries, with upstream pulmonary arteriovenous (AV) shunting and dilated proximal blood vessels ...

12/21
This model of disease development explains the vascular characteristics and vascular distribution of disease visible radiologically...
Green arrows = dilated/damaged blood vessels
Yellow arrows = lung tissue damage
(for this fig. please see original hypothesis - link below)

13/21
... and it explains the dominant histological/autopsy findings of pulmonary vascular congestion with clotting in the lungs at microscopic level.

doi.org/10.1016/S1473-…

14/21
Read our full @SpringerNature review - here

👇👇👇👇👇👇👇


(Published November 3rd 2023) bit.ly/3ME7LtC

15/21
Original scientific hypothesis published April 2021 is accessible here


With thanks to my co-authors @l_chapple @dentalsurgeon__ and Carla Pontes (@ dr.carlapontes on Instagram) radiologymasterclass.co.uk/documents/the_…

16/21
Why is this so important?

It means that it makes sense to care for your mouth if you have #COVID

Here is the mouth care guidance we offer our #COVID-19 patients @SalisburyNHS UK. It includes provision of an antiviral mouthwash against #SARS2

salisbury.nhs.uk/coronavirus/co…

17/21
Based on evidence that specific mouthwash ingredients eradicate #SARS2 in vitro and make it undetectable in the mouth for a prolonged period

See this systematic review of CPC mouthwash I wrote with Italian colleagues @DrFDamico/@MMarmiere
et al

onlinelibrary.wiley.com/doi/full/10.11…

18/21
And evidence that use of mouthwash in the setting of acute COVID-19 reduces intensive care admission and mortality!

See this research paper published in @Nature
nature.com/articles/s4159…

19/21
For a deeper dive please take a look at this presentation relating to the vascular nature of acute COVID-19 lung disease. (From November 2020)

20/21
And this presentation which expands on the connections between oral health, COVID-19 and other diseases. (From March 2022)

21/21
Here's my brief summary of how to care for the mouth

1 - Stop smoking/vaping
2 - Stop eating free sugar in all its forms (sugary/fruit drinks, cake, sweets)
3 - Learn how to brush your teeth properly
4 - Visit the dentist/hygienist preventatively (before things go wrong)