Periodontitis and COVID-19

We are now more than 1 year into the COVID-19 pandemic, and each day we understand more about its virulence, transmission, and effects. In fact, it’s impressive to realize what we’ve learned since March 2020. We’ve identified the individuals who seem to be most susceptible to severe reactions from SARS-CoV-2, including those with cancer, chronic kidney disease, chronic obstructive pulmonary disease, Down syndrome, cardiovascular disease, obesity, sickle cell disease, and type 2 diabetes mellitus, as well as those who are pregnant, immunocompromised due to organ transplant, and smokers.¹ While we all need to take precautions to avoid contracting and spreading COVID-19, these populations need to be particularly careful. And they are why those of us who are less susceptible to morbidity and mortality need to do all we can to keep them and us safe.

IF THE ORAL CAVITY IS HARBORING HARMFUL BACTERIA THAT COULD COMPROMISE HEALTH, THEN IT’S RESONABLE TO ASSUME THAT PERIODONTITIS COULD IMPACT COVID-19 SUSCEPTIBILITY AND SEVERITY.

One condition that has received little attention regarding its increased risk for severe COVID-19 illness is periodontitis. As oral health professionals, we instinctively know that a link between poor oral hygiene and COVID-19 severity likely exists. COVID-19 is an upper respiratory infection and the respiratory tract is connected to the oral cavity. If the oral cavity is harboring harmful bacteria that could compromise health, then it’s reasonable to assume that periodontitis could impact COVID-19 susceptibility and severity. It’s been demonstrated that treatment of periodontitis might help mitigate respiratory and lung diseases.² To that end, a recent study in the Journal of Clinical Periodontology has examined the association between periodontitis and COVID-19.³ The case-control study of more than 500 patients with COVID-19 showed that those who had periodontitis were 3.5 times more likely to be admitted to intensive care, 4.5 times more likely to need a ventilator, and nearly 9 times more likely to die compared to those without periodontitis. As President-Elect of the European Federation of Periodontology, Lior Shapira, DMD, PhD, commented, “The results of the study suggest that the inflammation in the oral cavity may open the door to the coronavirus becoming more violent. Oral care should be part of the health recommendations to reduce the risk for severe COVID-19 outcomes.”

And while it’s important to note that periodontitis has not been shown to cause severe reactions from COVID-19, the authors stated, “If a causal link is established between periodontitis and increased rates of adverse outcomes in COVID-19 patients, then establishing and maintaining periodontal health may become an important part of the care of these patients.”

We do all we can to improve our patients’ oral and overall health. Perhaps helping to prevent the devastating effects of COVID-19 is yet another aspect of health promotion that’s in our purview. Time will certainly tell.

REFERENCES

1. United States Centers for Disease Control and Prevention. COVID-19. Available at: cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Accessed February 11, 2021.
2. Bansal M, Khatri M, Taneja V. Potential role of periodontal infection in respiratory diseases-a review. J Med Life. 2013;6:244248.
3. Marouf N, Cai W, Said K, et al. Association between periodontitis and severity of COVID-19 infection: a case-control study. J Clin Periodontol. 2021 Feb 1. Epub ahead of print.

From Dimensions of Dental Hygiene. March 2021;19(3):6.