As an expert in periodontology, I have always believed in the importance of periodontal health. I have also always believed in the importance of periodontal health to the human body’s overall health.
The confirmation of the link between periodontal health and the risk of cardiovascular disease or diabetes confirmed my interest in a crucial area of dentistry. Systemic inflammation, translocation of pathogens in the blood, and induced autoimmune damage are directly linked to this disease, the 6th most prevalent in the world (Kassebaum et al., 2014; Petersen PE & H, 2012).
The first study on the effects of periodontitis in patients with Covid-19 has just been published and shows that gingival inflammation worsens infection outcomes. In the following lines, I will just comment on the content of this study from the Journal of Clinical Periodontology: “Association between periodontitis and severity of COVID-19 infection: a case-control study.”
The severity of COVID-19 and periodontitis
I start by quoting the clinical relevance directly from the article “This study helps understand better the risk factors influencing the outcome of COVID-19 infections, and by revealing that periodontitis could be a risk factor, this study highlights the importance of periodontal health in the prevention and perhaps even management of COVID-19 complications.” And the scope of the study’s content is already evident.
It should not be underestimated that risk factors for periodontitis are common to many chronic inflammatory diseases that adversely affect the symptoms of covid-19. The study stems from an association between the inflammatory response typical of COVID-19 and typical periodontitis’s systemic inflammation. The severity of COVID-19 symptoms often seems to be related to an unresolved hyperinflammatory condition and comorbidity. Based on this data, the links between periodontal disease and complications of the novel coronavirus were investigated.
Prof Maurizio Tonetti, editor of the journal – whose article with Prof Mariano Sanz on the new classification of periodontal disease is also here on our blog – comments: “Chronic systemic inflammation induced by periodontitis could be one of the mechanisms behind the increased risk of COVID-19 complications because it could make patients more susceptible to the inflammatory storm triggered by the infection.”
Periodontitis worsen covid-19
The study (a case-control study) was conducted on a sample of 568 COVID-19 positive patients.
Thus, in those with very inflamed gums who contract the SARS-CoV-2 infection, the likelihood of dying increases 8.8-fold (OR=8.81,95% CI 1.00‐77.7), the possibility of needing assisted ventilation increases 4.6-fold (OR=4.57, 95% CI 1.19‐17.4), and the risk of admission to intensive care increases 3.5-fold (OR=3.54, 95% CI 1.39‐9.05). The danger rises as the severity of periodontitis increases and does not depend on other concomitant risk factors. This risk increases as the severity of periodontitis increases and does not depend on other concomitant risk factors. The high bacterial load in the mouth of patients with periodontitis and the general chronic inflammation associated with gum disease may be responsible.
Patients with periodontitis do not have a higher risk of infection. They may have more severe consequences once infected with covid-19, due to the high bacterial load in the mouth and the chronic systemic inflammation. The bacterial load may favour pulmonary over-infection, and the systemic inflammation may predispose the susceptibility to the inflammatory storm triggered by SARS-CoV-2.
Oral hygiene and early detection of periodontal disease are becoming increasingly important. And this will always remain true; however, many further studies are awaited to further this scientific discovery.
The study was developed by Nadya Marouf, BDS, MSc 1, Wenji Cai BDS, MSc 2, Khalid N. Said, BDS1, Hanin Daas, MSc 3, Hanan Diab, BDS, MSc1, Venkateswara Rao Chinta4, Ali Ait Hssain, MD4, Belinda Nicolau, DDS, PhD2, Mariano Sanz, MD, PhD 5, Faleh Tamimi, BDS, PhD 3
Read full text or download it as a PDF here: https://onlinelibrary.wiley.com/doi/epdf/10.1111/jcpe.13435