Study links periodontitis and COVID-19 complications

Franziska Beier, Dental Tribune International

Tue. 9. February 2021

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DOHA, Qatar: Since periodontitis and COVID-19 are both associated with systemic inflammation, researchers from Qatar University and Hamad Medical Corporation in Qatar have investigated the connection of periodontitis with severe outcomes of the respiratory syndrome. The study findings supported a link between the two diseases, as COVID-19 patients with periodontitis were more likely to experience complications or to die.

Numerous previous studies have highlighted that periodontitis may impact systemic health and that it is associated with non-communicable diseases such as diabetes and cardiovascular disease and even with premature mortality. A possible link with COVID-19 has been the subject of earlier studies, as reported by Dental Tribune International back in October.

This recent study involved 568 patients diagnosed with SARS-CoV-2 between February and July 2020. Of these patients, 258 presented with periodontitis and 40 had COVID-19-related complications. Among the patients with periodontitis, 33 (12.8%) experienced severe COVID-19 outcomes in contrast to seven of the 310 patients (2.3%) without periodontitis.

After adjusting for factors such as age, sex, body mass index, smoking status and other conditions, the research team found that COVID-19 patients with periodontitis were 3.67 times more likely to experience all of the COVID-19 complications considered in the study, 3.54 times more likely to be admitted to an intensive care unit, 4.57 times more likely to require a ventilator and 8.81 times more likely to die, compared with patients without periodontitis.

In addition, blood markers indicating inflammation in the body were significantly higher in COVID-19 patients who had periodontitis compared with those who did not. According to the researchers, the heightened inflammation scores may be an explanation for the raised complication rates.

Nevertheless, the researchers pointed out that the study has limitations and its results need to be taken with caution, as it did not address causality. They highlighted the need for future research, including interventional studies focused on the influence of periodontitis and periodontal treatments on SARS-CoV-2 infections.

In a press release by the European Federation of Periodontology (EFP), co-author Prof. Mariano Sanz from Complutense University of Madrid in Spain noted that patients with periodontitis may inhale oral bacteria and in this manner their lungs may become infected. This is particularly dangerous for patients using a ventilator. “This may contribute to the deterioration of patients with COVID-19 and raise the risk of death,” he said. “Hospital staff should identify COVID-19 patients with periodontitis and use oral antiseptics to reduce transmission of bacteria.”

“The results of the study suggest that the inflammation in the oral cavity may open the door to the coronavirus becoming more violent,” added Dr Lior Shapira, EFP president-elect and professor of periodontics at the Hebrew University—Hadassah School of Dental Medicine in Israel. “Oral care should be part of the health recommendations to reduce the risk for severe COVID-19 outcomes.”

The study, titled “Association between periodontitis and severity of COVID‐19 infection: A case‐control study”, was published online on 1 February 2021 in the Journal of Clinical Periodontology, ahead of inclusion in an issue.

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