Assessment of correlation of COVID-19 infection and periodontitis- A comparative study

Abstract

Background: Periodontal disease constitutes a group of diseases involving inflammatory aspects of the host caused by several microbial agents that affect periodontal tissues and could have systemic implications. Objective: The present study was conducted to assess the correlation of COVID-19 infection and severity of periodontitis in subjects who has mild form of the disease as compared to subjects having moderate form of the disease. Materials and Methods: The study included 116 subjects suffering from COVID-19 that were equally divided into two groups, each based on a convenient sampling methodology. Group I had a moderate form of COVID that required hospitalization and Group II had a mild form of COVID and were treated at home. The stage of periodontal disease was assessed in both groups. Also, laboratory parameters such as level of C-reactive protein (CRP), white blood cell (WBC), D-dimer, vitamin D, and lymphocytes were also assessed. Statistical analysis was done using Chi-square and multiple logistic regression analysis. Results: More than 75% of subjects in both groups were non-smokers. Subjects having more than one comorbid condition were more in number in Group I (51.7%) as compared to Group II (24%). Severe periodontitis (stages 2–4) was found in 81% of subjects in Group I and 46.2% of subjects in Group II [ Figure 1 ]. The odds of getting severe periodontal disease were 6.32 times more in subjects belonging to Group I as compared to Group II. Subjects having more than one comorbid condition were 4.43 times at risk of severe periodontitis as compared to subjects with no co-morbidity Conclusion: Severe form of periodontal disease was associated with moderate-to-severe COVID-19 infection and levels of lymphocytes, WBCs, and CRP were elevated in subjects belonging to Group I.

The impact of periodontal disease on the clinical outcomes of COVID-19: A systematic review and meta-analysis

“…A total of 22 studies, involving 92,535 patients were included in the present systematic review; [ 22 – 25 , 27 – 29 , 33 – 47 ] of these, 12 studies were included in the meta-analysis [ 23 , 25 , 27 , 28 , 33 , 35 , 36 , 40 , 41 , 43 , 44 , 46 , 47 ]. Twelve of these studies were case–control studies, [ 22 – 25 , 29 , 34 , 35 , 37 , 38 , 42 , 44 , 46 ] three cohort studies, [ 27 , 28 , 39 ] and seven cross-sectional studies [ 33 , 36 , 40 , 41 , 43 , 45 , 47 ]. Six studies were conducted in India [ 23 , 34 , 38 , 40 , 42 , 44 ] three in the UK [ 27 , 28 , 39 ], two in Brazil [ 35 , 36 ] two in Saudi Arabia [ 33 , 43 ], two in Qatar [ 22 , 25 ], two in Turkey [ 46 , 47 ] and one each in: the Netherlands, [ 29 ].…”

“…Twelve of these studies were case–control studies, [ 22 – 25 , 29 , 34 , 35 , 37 , 38 , 42 , 44 , 46 ] three cohort studies, [ 27 , 28 , 39 ] and seven cross-sectional studies [ 33 , 36 , 40 , 41 , 43 , 45 , 47 ]. Six studies were conducted in India [ 23 , 34 , 38 , 40 , 42 , 44 ] three in the UK [ 27 , 28 , 39 ], two in Brazil [ 35 , 36 ] two in Saudi Arabia [ 33 , 43 ], two in Qatar [ 22 , 25 ], two in Turkey [ 46 , 47 ] and one each in: the Netherlands, [ 29 ]. Spain, [ 45 ] Egypt, [ 41 ] Mexico, [ 37 ] and the USA [ 24 ].…”

“…One or more of the following periodontal parameters were considered: number of missing teeth, pocket depth, gum bleeding, alveolar bone loss, and loose teeth (Table 1 ). Similarly, ascertainment of the exposure methods varied greatly across the included studies: clinical examination in nine studies, [ 23 , 34 – 36 , 38 , 40 , 42 , 44 , 46 ] self-reported in five studies, [ 27 , 28 , 37 , 39 , 41 ] and dental radiographs in eight studies [ 22 , 24 , 25 , 29 , 33 , 43 , 45 , 47 ].…”

SARS‐CoV‐2, periodontal pathogens, and host factors: The trinity of oral post‐acute sequelae of COVID‐19

“…Contributors to dysbiosis include (1) increased burden of pathogenic/pathosymbiont microbes, (2) a recent introduction of a novel virulent microbe, (3) a change in nutrients, (4) an exposure that enhances the survival and replication of a novel pathogen at the expense of other pathogens, or (5) the induction of a genetic somatic or non‐somatic induction of metabolic, physiologic (biochemical), and or immunologic event in host oral cells (predominantly epithelial or immune cells). Dysbiosis selectively eliminates some microbes, presenting an opportunity for pathogens to replicate and predominate 12–15 . We suggest that sustained dysbiosis collapses oral microbiome‐oral epithelial interactions and offers an additional risk for novel viruses, such as SARS‐CoV‐2, to establish a replicative reservoir of virion while attenuating host microbial resistance and clearance mechanisms.…”

“…Dysbiosis selectively eliminates some microbes, presenting an opportunity for pathogens to replicate and predominate. [12][13][14][15] We suggest that sustained dysbiosis collapses oral microbiome-oral epithelial interactions and offers an additional risk for novel viruses, such as SARS-CoV-2, to establish a replicative reservoir of virion while attenuating host microbial resistance and clearance mechanisms.…”