Correlation of COVID-19 with Severity of Periodontitis-A Clinical and Biochemical Study

Abstract

Background: Various conceptual hypotheses have been put forth to link association of COVID-19 with various chronic diseases such as periodontitis. Empirical evidence is still lacking to correlate the severity of COVID-19 with periodontal diseases. Objectives: This study was undertaken with an objective to correlate COVID severity in systemically healthy patients suffering from periodontal diseases. Materials and Methods: 44 systemically healthy patients of both genders with minimum of 20 teeth in their oral cavity in age range of 20 to 50 years suffering from periodontitis were recruited and categorised into four stages as per American Academy of Periodontology (AAP) 2017 classification for periodontitis. Serum C-reactive protein (CRP) levels and periodontal disease parameters of all the patients were measured. Because of COVID-19 and the nationwide lockdown, the dental practice was highly affected. With the help of self-designed online questionnaire information regarding COVID-19 infection and associated symptoms were recorded. Cases were categorized into five groups based on the World Health Organization clinical progression scale of COVID severity. Results: All the patients suffering from COVID disease in moderate and severe forms had increased probing pocket depth, clinical attachment level, and raised serum C-reactive protein levels as compared to patients who were uninfected or suffering from mild COVID disease and the results were statistically significant. Conclusion: Prioritisation and Implementation of periodontal treatment as a preventive measure for COVID-19 should be done. A positive correlation is observed between the severity of periodontitis and COVID-19.

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 ].…”

“…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 ].…”

“…There was no a significant association between loose teeth with COVID-19 parameters: risk of COVID-19 (OR = 1.15, 95% CI = 0.84–1.59); hospital admission (OR = 1.55, 95% CI = 0.87–2.77); or mortality (OR = 1.85; 95% CI = 0.92–2.72) Gupta et al 2021 [ 23 ] There is a significant association between PD and COVID-19 - outcomes. Higher severity of PD was associated with 7.45 odds of requiring assisted ventilation, 36.52 odds of hospital admission, 14.58 odds of death, and 4.42 odds of COVID-19 -related pneumonia Holt et al 2021 [ 40 ] The results showed a significant increase in the risk of COVID-19 in PD subjects (OR: 1.20). However, after controlling all potential confounding factors, no significant association was observed between the two conditions.…”