Additive Effect of Periodontal Disease and Obesity on COVID-19 Outcomes

Larvin, Harriet; Wilmott, Sheryl; Kang, Jing; Aggarwal, Vishal R.; Pavitt, S; Wu, Jianhua

doi:10.1177/00220345211029638

Cited by 39 publications

(51 citation statements)

References 27 publications

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“…14 The data from the UK Biobank cohort have enabled study of oral health on several health outcomes including cancer, CVD, diabetes, depression, and COVID-19. 8,10,15,16 The burden of hypertension affects up to 50% of the UK Biobank cohort 17 ; therefore the UK Biobank provides a demonstratable setting for an epidemiological study comparing outcomes in hypertensive and non-hypertensive populations. The aim of this study was to examine the effect of hypertension and PD on risk of subsequent systemic diseases.…”

Section: Introductionmentioning

confidence: 99%

The additive effect of periodontitis with hypertension on risk of systemic disease and mortality

Larvin

Kang

Aggarwal

et al. 2022

Journal of Periodontology

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Background: Recent evidence suggests that periodontitis (PD) causes hypertension, which is a precursor to development of other systemic diseases. The aim of this study was to examine the effect of hypertension and PD on the risk of subsequent systemic disease. Methods:This longitudinal cohort study included 244,393 UK Biobank participants who were free of systemic disease other than hypertension at baseline. Self-reported responses of painful gums or loose teeth were surrogates for PD. Hypertensives were identified by clinical diagnosis, or elevated blood pressure (≥140/90 mmHg). Systemic diseases including cancer, cardiovascular disease (CVD), and diabetes were identified from linked diagnostic codes. Multivariable Cox proportional hazard models were used to quantify the risk of systemic diseases and all-cause mortality, stratified by hypertensive and PD status. Results:The average age of the study population was 55.4 years (standard deviation [SD:] 8.1 years), and 130,220 (53.3%) participants were female. At baseline, 131,566 (53.8%) participants were hypertensive and 4.5% reported PD. The incidence rates of all systemic diseases were higher in hypertensive than nonhypertensive participants of the same PD status. In hypertensives, an additive effect was observed for PD on the risks of CVD (adjusted hazard ratio [HR]: 1.35, 95% confidence interval [CI]: 1.21-1.53) and respiratory disease (HR: 1.11, 95% CI: 0.95-1.30) compared to hypertensive healthy controls. Conclusions:Hypertensives with PD have exacerbated risks of several systemic diseases. Future interventional studies should consider the effect of periodontal treatment on systemic outcomes in targeted hypertensive populations.

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Section: Introductionmentioning

confidence: 99%

The additive effect of periodontitis with hypertension on risk of systemic disease and mortality

Larvin

Kang

Aggarwal

et al. 2022

Journal of Periodontology

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“…These observations together with the results reported by Larvin et al. 32 that obese COVID patients who experienced gingival pain and bleeding gums or teeth with mobility had an increased risk of death (CI 95% 1.91‐5.06) grants further investigations on the potential of dental biofilm plaque sampling to be used as detection tool for SARS‐CoV‐2.…”

Section: Discussionmentioning

confidence: 55%

SARS‐CoV‐2 RNA in dental biofilms: Supragingival and subgingival findings from inpatients in a COVID‐19 intensive care unit

Gomes

Fonseca

Miller

et al. 2022

Journal of Periodontology

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Background Saliva, salivary glands, gingival crevicular fluid, and supragingival biofilms may harbor SARS‐CoV‐2 RNA. This observational study aimed to investigate the presence and load of SARS‐CoV‐2 RNA in supragingival, and subgingival biofilms obtained from intensive care unit (ICU) patients. Methods A convenience sample, composed of 52 COVID‐19+ participants (48.6 ± 14.8 years, 26.9% females), were evaluated for pre‐existing comorbidities, number of teeth, and periodontal data [visible plaque (VPI), bleeding on probing (BOP), periodontal probing depth (PPD), and attachment loss (AL)]. Supragingival and subgingival samples (SubDeep: four sites with the deepest PPD; SubRemain: remaining shallower sites) were analyzed by RT‐qPCR with corresponding cycle quantification (Cq). Statistical analyses considered the individual ( P = 5%). Results Twenty‐six participants tested positive for dental biofilms (Biofilm+) with 96.2% of them being positive for subgingival samples. Pre‐existing comorbidities, number of teeth examined, VPI, PPD, AL, and BOP were similar between Biofilm+ and Biofilm‐. SubDeep PPD (3.72 ± 0.86), AL (4.34 ± 1.33), and % of BOP (66.0 ± 31.1) values were significantly greater compared to SubRemain values (2.84 ± 0.48, 3.37 ± 0.34, and 20.4 ± 24.1, respectively). Biofilm+ Cqs showed no association with the periodontal condition. Cqs from Nasopharynx/Oropharynx (Naso/Oro; n = 36) were similar between Biofilm+ and Biofilm‐ participants. Length of time since ICU intake, last Naso/Oro RT‐qPCR readings, onset of COVID‐19 symptoms, and biofilm samplings were greater for Biofilm‐. Conclusions ICU patients harbored SARS‐CoV‐2 RNA in supragingival and subgingival biofilms, irrespective of the periodontal condition, and systemic viral load. The high number of positive patients highlights the need to better understand this habit to provide adequate oral care.

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“…Moreover, according to two articles, it seems that there is a lack of evidence supporting the claim that periodontitis is linked to a higher risk of COVID-19 infection [ 53 , 54 ]. i Interesting data were published in a longitudinal cohort study where periodontitis, obesity and COVID-19 were examined and obesity seems to have a more impact on hospitalization than periodontitis for COVID-19 patients [ 56 ].…”

Section: Resultsmentioning

confidence: 99%

“…The design of the clinical studies included might be a limitation due to the predominant presence of case-control and retrospective studies with a limited population. Anand et al was the case-control study with the largest sample size of 196 patients and Larvin et al with 13 000 patients included was the largest retrospective study [ 18 , 56 ]. The molecules underlined in this review for a possible link between the diseases were predominantly ACE-2, cathepsin, Galectin-3, IL-17, NETs, and MMP-8.…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on Periodontitis and Peri-Implantitis: A Narrative Review

Mancini¹,

Americo²,

Pizzolante³

et al. 2022

Front. Oral. Health

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COVID-19 is reported as one of the most widespread diseases in the world. An extraordinary number of articles and manuscripts have focused on the inflammatory cascade and sequelae, showing the important roles of cytokines and renin-angiotensin levels and possible links to other pathologies. Nowadays, interest regarding the possible correlation between COVID-19 and periodontal and Peri-implant diseases is increasing. This mini-review aims to collect data regarding the possible correlation between COVID-19 and periodontitis or Peri-implantitis through the analysis of articles published in the last 3 years. The following keywords were used: ([periodontitis OR periodontal disease] AND [COVID-19]); ([Peri-implantitis OR mucositis] AND [COVID-19 OR Sars-CoV-2]). The inclusion criteria were studies on COVID-19 or SARS-CoV-2 and periodontitis or Peri-implantitis, and studies on the molecular and cellular aspect of COVID-19 in periodontal or Peri-implant tissues. The search revealed 484 articles in total (PubMed 208 and Scopus 276). After a screening of titles and abstracts, 47 articles were included in the full-text analysis. Two articles comprised the Peri-implant group: a short communication and a review. Regarding the periodontal group, 45 articles were selected and analyzed according to the type of study, population, and aim. Of these, 10 articles were clinical studies, and the other 35 were hypotheses, reviews, letters to the editor, or commentaries. In conclusion, according to the data extracted, a mutual correlation between COVID-19 and periodontitis can be stated; however, data linked to Peri-implantitis are still missing, and future clinical studies are still needed.

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Additive Effect of Periodontal Disease and Obesity on COVID-19 Outcomes

Cited by 39 publications

References 27 publications

The additive effect of periodontitis with hypertension on risk of systemic disease and mortality

The additive effect of periodontitis with hypertension on risk of systemic disease and mortality

SARS‐CoV‐2 RNA in dental biofilms: Supragingival and subgingival findings from inpatients in a COVID‐19 intensive care unit

Impact of COVID-19 on Periodontitis and Peri-Implantitis: A Narrative Review

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