Aspiration of periodontopathic bacteria due to poor oral hygiene potentially contributes to the aggravation of COVID-19

Takahashi, Yuwa; Watanabe, Norihisa; Kamio, Noriaki; Kobayashi, Ryosuke; Iinuma, Toshimitsu; Imai, Kenichi

doi:10.2334/josnusd.20-0388

Cited by 112 publications

(164 citation statements)

References 40 publications

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“…Several hypothetical mechanisms may explain the strong associations observed between periodontitis and COVID‐19 severity. Takahashi et al suggested that aspiration of periodontopathic bacteria might aggravate COVID‐19 by inducing the expression of angiotensin‐converting enzyme 2, a receptor for SARS‐CoV‐2, and inflammatory cytokines in the lower respiratory tract (Takahashi et al, 2020). Also, it was suggested that periodontopathic bacteria might enhance SARS‐CoV‐2 virulence by cleaving its S glycoproteins (Madapusi Balaji et al, 2020; Takahashi et al, 2020) and that the oral cavity, and specially periodontal pockets could act as a viral reservoir (Badran et al, 2020; Bao et al, 2020; Botros et al, 2020; Herrera et al, 2020; Kheur et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Association between periodontitis and severity of COVID‐19 infection: A case–control study

Marouf

Cai

Said

et al. 2021

J Clinic Periodontology

296

330

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Aim COVID‐19 is associated with an exacerbated inflammatory response that can result in fatal outcomes. Systemic inflammation is also a main characteristic of periodontitis. Therefore, we investigated the association of periodontitis with COVID‐19 complications. Materials and Methods A case–control study was performed using the national electronic health records of the State of Qatar between February and July 2020. Cases were defined as patients who suffered COVID‐19 complications (death, ICU admissions or assisted ventilation), and controls were COVID‐19 patients discharged without major complications. Periodontal conditions were assessed using dental radiographs from the same database. Associations between periodontitis and COVID 19 complications were analysed using logistic regression models adjusted for demographic, medical and behaviour factors. Results In total, 568 patients were included. After adjusting for potential confounders, periodontitis was associated with COVID‐19 complication including death (OR = 8.81, 95% CI 1.00–77.7), ICU admission (OR = 3.54, 95% CI 1.39–9.05) and need for assisted ventilation (OR = 4.57, 95% CI 1.19–17.4). Similarly, blood levels of white blood cells, D‐dimer and C Reactive Protein were significantly higher in COVID‐19 patients with periodontitis. Conclusion Periodontitis was associated with higher risk of ICU admission, need for assisted ventilation and death of COVID‐19 patients, and with increased blood levels of biomarkers linked to worse disease outcomes.

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Section: Discussionmentioning

confidence: 99%

Association between periodontitis and severity of COVID‐19 infection: A case–control study

Marouf

Cai

Said

et al. 2021

J Clinic Periodontology

296

330

View full text Add to dashboard Cite

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“…Considering that poor oral hygiene and the aspiration of periodontal bacteria could aggravate COVID-19 lung infection [ 95 ], appropriated oral care is a crucial factor to prevent the exacerbation of lung inflammation. Takahashi et al recently suggested that the aspiration of pathogenic periodontal bacteria exacerbates lung inflammation through the production of cytokines, in particular the elevated production of IL-6.…”

Section: Pre-existing Periodontal Bacterial Infection and Respiratmentioning

confidence: 99%

“…Takahashi et al recently suggested that the aspiration of pathogenic periodontal bacteria exacerbates lung inflammation through the production of cytokines, in particular the elevated production of IL-6. Furthermore, proteases derived from periodontal bacteria could promote SARS-CoV-2 infection [ 95 ]. On the other hand, these authors proposed that periodontal bacteria promote viral infection by increasing ACE2 expression due to bacterial products, such as endotoxins.…”

Section: Pre-existing Periodontal Bacterial Infection and Respiratmentioning

confidence: 99%

Severe COVID-19 Lung Infection in Older People and Periodontitis

Aquino-Martínez

Hernández-Vigueras

2021

JCM

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Periodontal bacteria dissemination into the lower respiratory tract may create favorable conditions for severe COVID-19 lung infection. Once lung tissues are colonized, cells that survive persistent bacterial infection can undergo permanent damage and accelerated cellular senescence. Consequently, several morphological and functional features of senescent lung cells facilitate SARS-CoV-2 replication. The higher risk for severe SARS-CoV-2 infection, the virus that causes COVID-19, and death in older patients has generated the question whether basic aging mechanisms could be implicated in such susceptibility. Mounting evidence indicates that cellular senescence, a manifestation of aging at the cellular level, contributes to the development of age-related lung pathologies and facilitates respiratory infections. Apparently, a relationship between life-threatening COVID-19 lung infection and pre-existing periodontal disease seems improbable. However, periodontal pathogens can be inoculated during endotracheal intubation and/or aspirated into the lower respiratory tract. This review focuses on how the dissemination of periodontal bacteria into the lungs could aggravate age-related senescent cell accumulation and facilitate more efficient SARS-CoV-2 cell attachment and replication. We also consider how periodontal bacteria-induced premature senescence could influence the course of COVID-19 lung infection. Finally, we highlight the role of saliva as a reservoir for both pathogenic bacteria and SARS-CoV-2. Therefore, the identification of active severe periodontitis can be an opportune and valid clinical parameter for risk stratification of old patients with COVID-19.

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“…47 Though these proteases were expressed in the oral cavity, periodontopathogens can also produce such proteases that may help activate the S-protein and further increase SARS-CoV-2 infectivity. 48 Periodontal pockets provide favorable environments for replication of pathogenic viruses like human herpes simplex virus and human papillomavirus. 49 The virus may enter the systemic circulation from periodontal pockets via GCF and then mix with saliva, or may enter the systemic circulation via periodontal capillaries.…”

Section: Nexus Between Covid-19 and Periodontal Diseasementioning

confidence: 99%

Nexus between COVID-19 and periodontal disease

Sukumar

Tadepalli

2021

J Int Med Res

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Over the past several decades, studies have demonstrated the existence of bi-directional relationships between periodontal disease and systemic conditions. Periodontitis is a polymicrobial and multifactorial disease involving both host and environmental factors. Tissue destruction is primarily associated with hyperresponsiveness of the host resulting in release of inflammatory mediators. Pro-inflammatory cytokines play a major role in bacterial stimulation and tissue destruction. In addition, these cytokines are thought to underlie the associations between periodontitis and systemic conditions. Current research suggests that increased release of cytokines from host cells, referred to as the cytokine storm, is associated with disease progression in patients with coronavirus disease 2019 (COVID-19). An intersection between periodontitis and pulmonary disease is biologically plausible. Hence, we reviewed the evidence linking COVID-19, cytokines, and periodontal disease. Plaque control is essential to prevent exchange of bacteria between the mouth and the lungs, reducing the risk of lung disease. Understanding these associations may help identify individuals at high risk and deliver appropriate care at early stages.

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Aspiration of periodontopathic bacteria due to poor oral hygiene potentially contributes to the aggravation of COVID-19

Cited by 112 publications

References 40 publications

Association between periodontitis and severity of COVID‐19 infection: A case–control study

Association between periodontitis and severity of COVID‐19 infection: A case–control study

Severe COVID-19 Lung Infection in Older People and Periodontitis

Nexus between COVID-19 and periodontal disease

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