Even as the amazingly fast development of new high-tech COVID-19 vaccines enthralls the world, a simple piece of fabric has become the surprise emblem of the fight against one of the worst health crises in the nation's history. The ordinary facemask has brought home a basic truth about public and personal health: simple and smart works.
The lost jobs and monumental personal costs of widespread lockdowns have made simple, inexpensive means of deterring the virus' spread serious, even urgent, business. The iconic "Swiss Cheese Respiratory Pandemic Defense" illustration above designed by Australian virologist Ian Mackay brings home the point that there are numerous simple, smart, low-tech interventions that, cumulatively, can be extremely effective at preventing the spread of the coronavirus.
Physical distancing, wearing masks, and avoiding crowds in indoor venues are among the small things that individuals can do that add up. Similarly, contact tracing by public health agencies can be extremely effective but requires little more than organization and the allocation of manpower. (However, it is impractical when the level of community spread is high, as is the case currently.)
Some interventions are obvious. Some are surprising.
Consider chewing gum, about as unlikely as anything we might use to bolster health in the crisis – unlikely, perhaps, but real.
It is partly a matter of natural chemistry, partly basic physiology. The act of chewing generates saliva, which has anti-viral properties and also removes disease-causing bacteria. During a pandemic, keeping other, unrelated diseases at bay is critical to overall resilience and to making ourselves and our families less vulnerable. That includes oral diseases which – as we discussed in a previous article – can contribute to, and often reflect, serious health problems elsewhere in the body. Missed routine dental care during the pandemic will undoubtedly lead to myriad extra-oral health conditions going undiagnosed or untreated, as symptoms of many chronic medical conditions are first discovered in routine visits to the dentist. Periodontitis, the bacteria-caused inflammation of the gums that can result in bleeding when the gum tissue is ruptured, is one of those conditions. It provides a gateway for the bacteria to contaminate the bloodstream, potentially leading to abscesses, heart valve infections, and in the worst case, sepsis — a life-threatening, generalized invasion of the body by pathogenic microorganisms and their toxins.
Periodontitis is a particular concern to pregnant women, as higher hormone levels make their gums more permeable, potentially allowing bacteria and inflammation-related chemicals in the mouth to migrate via the blood to the fetus. Studies have shown an association between periodontitis and premature births, preeclampsia, and gestational diabetes.
That brings us to the easiest imaginable intervention to prevent tooth decay and its ravages: chewing sugar-free gum. A 2019 meta-analysis by investigators at Guy's Dental Hospital in London of 17 dental and medical journal articles found that the chewing of sugar-free gum (SFG) could significantly reduce "dental caries," i.e. tooth decay. The analysis concluded, "SFGs were found to significantly reduce caries increment, giving a preventative fraction (PF) of 28%." The trials using only xylitol gum scored a slightly higher preventative fraction of 33%.
Chewing gum offers another obscure benefit. The lockdown-imposed isolation and anxiety over lost jobs cause depression – all factors that erode the body's natural immune system. An ingenious 2009 controlled clinical study found that "gum chewing had consistently positive effects on mood during an acute laboratory stressor." The subjects who chewed gum had "significantly better alertness," reduced "anxiety, stress, and salivary cortisol," and performed significantly better on multi-tasking tests known to reliably evoke stress. The investigators noted that the "mechanisms underlying these effects are unknown but may involve improved cerebral blood flow and/or effects secondary to performance improvement during gum chewing." Simply put, chewing gum seems to help us calm down and think more clearly under stress.
The high-tech miracles will continue to garner headlines, but to advance public health and control health care costs, simpler and relatively inexpensive innovations are also essential. Now that's something to chew on.
Henry I. Miller, a physician and molecular biologist, is a senior fellow at the Pacific Research Institute. He was the founding director of the FDA's Office of Biotechnology. Shiv Sharma is a practicing dentist in Palo Alto, California.