Association of periodontal therapy, with inflammatory biomarkers and complications in COVID-19 patients: a case control study

Abstract

Background In previous studies, COVID-19 complications were reported to be associated with periodontitis. Accordingly, this study was designed to test the hypothesis that a history of periodontal therapy could be associated with lower risk of COVID-19 complications. Methods A case–control study was performed using the medical health records of COVID-19 patients in the State of Qatar between March 2020 and February 2021 and dental records between January 2017 and December 2021. Cases were defined as COVID-19 patients who suffered complications (death, ICU admissions and/or mechanical ventilation); controls were COVID-19 patients who recovered without major complications. Associations between a history of periodontal therapy and COVID-19 complications were analysed using logistic regression models adjusted for demographic and medical factors. Blood parameters were compared using Kruskal–Wallis test. Results In total, 1,325 patients were included. Adjusted odds ratio (AOR) analysis revealed that non-treated periodontitis was associated with significant risk of need for mechanical ventilation (AOR = 3.91, 95% CI 1.21–12.57, p = 0.022) compared to periodontally healthy patients, while treated periodontitis was not (AOR = 1.28, 95% CI 0.25–6.58, p = 0.768). Blood analyses revealed that periodontitis patients with a history of periodontal therapy had significantly lower levels of D-dimer and Ferritin than non-treated periodontitis patients. Conclusion Among COVID-19 patients with periodontal bone loss, only those that have not received periodontal therapy had higher risk of need for assisted ventilation. COVID-19 patients with a history of periodontal therapy were associated with significantly lower D-dimer levels than those without recent records of periodontal therapy. Clinical relevance The fact that patients with treated periodontitis were less likely to suffer COVID-19 complications than non-treated ones further strengthen the hypothesis linking periodontitis to COVID-19 complications and suggests that managing periodontitis could help reduce the risk for COVID-19 complications, although future research is needed to verify this.

Association of periodontitis and COVID-19 – a narrative review

“…Another observational study demonstrated that periodontitis posed a similar risk for COVID-19 complications as well as diabetes and hypertension, as periodontitis patients were 3 times more likely to have COVID-19 complications compared to non-periodontitis patients (p = 0.025), while diabetes and hypertension patients were 3.5 times more likely to have COVID-19 complications [10].…”

Epidemiological pattern of COVID-19 and its association with periodontal health in an urban Indian cohort

“…This could be due to the differences in study design (case-control vs. prospective) and settings (hospital-based vs. community). On balance, the existing literature suggests that while severity of COVID-19 infection may be positively associated with oral health indicators including PD (14)(15)(16)(17)(18)(19), the occurrence of COVID-19 may be unrelated to oral health (13). One of the largest available studies, examined retrospective UK Biobank data on oral health status from 13,253 adults and also reported no association between poor oral health (loose teeth or painful, bleeding gums) and risk of COVID-19 infection.…”

“…Despite reporting statistically significant results, the wide confidence intervals indicate low precision due to small sample size. Other limitations of these studies include convenience sampling, relative paucity of prospective data, lack of data from clinical oral examinations, and limited information on recent access to oral care (Supplementary Table S2, [12][13][14][15][16][17][18][19][39][40][41][42][43]. Additionally, only one of the previous studies had a representative population-based sample (13) and sample for most studies comprised of COVID-19 positive cases to explore the association with severity rather than risk (14)(15)(16)(17)(18)(19).…”

“…An understudied dimension of COVID-19 risk is oral health. Studies have highlighted shared risk factors between oral and chronic diseases and COVID-19 infection and thus a possible influence of poor oral hygiene, gingival, and periodontal diseases on the risk of COVID-19 infection (12,13) and its severity (14)(15)(16)(17)(18)(19). Gingival disease (GD), characterized by poor oral hygiene and plaque biofilm harboring oral microbial pathogens deposited on dental and tissue surfaces of the oral cavity, clinically manifests as episodes of acute inflammatory changes and bleeding from gums that may be transient or persistent in nature (20).…”

“…Cross-sectional (12,14,(16)(17)(18)(19) and prospective (13,15) observational studies report, over three-fold increase in severity of COVID-19 infection (and death) among persons with poor oral health or PD. However, they are limited by either sample size, lack of community level prospective data, or clinically ascertained oral health status.…”