COVID-19 and Periodontal Conditions — A Narrative Review of Implications for Oral Health Providers

Figures & data

Table 1. Studies on the potential link between periodontitis and COVID-19. DMFT = the sum of the number of decayed, missing, and filled teeth in the permanent dentition.

Author	Year	Country	Design	N	Variables	Outcomes
Costa et al.^Citation31	2022	Brazil	Prospective	128	Clinical periodontal measurements, Tooth loss, DMFT	Periodontitis associated with ICU admission, severity, and mortality risk after adjusting for age and comorbidities.
Gupta et al.^Citation32	2022	India	Cross-sectional	78	Clinical periodontal measurement	Periodontitis linked to increased risk of mortality.
Gupta et al.^Citation33	2021	India	Cross-sectional	82	Clinical periodontal measurement	Severe periodontitis (stage III-IV) increased risk for assisted ventilation, hospital admission, COVID-19 pneumonia and death.
Anand et al.^Citation15	2021	India	Case-control	79 cases 71 controls	Clinical periodontal measurement	There were significant associations between plaque scores, gingivitis, clinical attachment level, and severe periodontitis (stage III-IV) with COVID-19
Marouf et al.^Citation14	2021	Qatar	Case-control	40 cases 528 controls	Radiographic alveolar bone loss	Periodontitis increased COVID-19 complication, measured as risk of death, ICU admission, and need for ventilation.
Larvin et al.^Citation34	2020	UK	Retrospective	13253	Self-reported periodontitis indicators	Periodontitis linked to higher mortality amongst COVID-19 patients.
Larvin et al.^Citation35	2021	UK	Retrospective	58897	Self-reported periodontitis indicators	Higher hospital admission and mortality rate observed in obese COVID-19 patients with periodontitis compared to those without it.
Katz, Yue, Xue^Citation36	2022	USA	Retrospective	889	Periapical infection, caries, and periodontitis	Periodontitis increased the risk for COVID-19
Sirin et al.^Citation37	2021	Turkey	Retrospective	137	Radiographic alveolar bone loss, apical periodontitis, dental caries	Oral disease was linked with increased severity and worse COVID-19 prognosis.
Wang et al.^Citation38	2021	China	Mendelian randomization	Public databases	Five Single Nucleotide Polymorphisms	Genetically proxied periodontitis increased susceptibility to COVID-19 and hospitalization.

Figure 1. The potential link between periodontitis and COVID-19. Oral dysbiosis, activation of the immune system, and molecular changes promoted by periodontal bacteria cause local inflammation and tissue destruction. This facilitates the entrance of pathogens and toxins into the bloodstream, leading to systemic consequences that increase the risk of infection in other organs. In patients with COVID-19, periodontitis can increase the risk of complications and death.

Costa CA, Vilela ACS, Oliveira SA, et al. Poor oral health status and adverse COVID-19 outcomes: a preliminary study in hospitalized patients. J Periodontol. 2022;93(12):1889–1901. doi:10.1002/JPER.21-0624.

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Gupta S, Saarikko M, Pfützner A, Räisänen IT, Sorsa T. Compromised periodontal status could increase mortality for patients with COVID-19. Lancet Infect Dis. 2022;22(3):314. doi:10.1016/S1473-3099(22)00065-2.

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Gupta S, Mohindra R, Singla M, et al. The clinical association between periodontitis and COVID-19. Clin Oral Investig. 2022;26(2):1361–1374. doi:10.1007/s00784-021-04111-3.

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Anand PS, Jadhav P, Kamath KP, Kumar SR, Vijayalaxmi S, Anil S. A case-control study on the association between periodontitis and coronavirus disease (COVID-19). J Periodontol. 2021;93(4):584–590. doi:10.1002/JPER.21-0272.

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Marouf N, Cai W, Said KN, et al. Association between periodontitis and severity of COVID-19 infection: a case–control study. J Clin Periodontol. 2021;48(4):483–491. doi:10.1111/jcpe.13435.

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Larvin H, Wilmott S, Wu J, Kang J. The impact of periodontal disease on hospital admission and mortality during COVID-19 pandemic. Front Med. 2020;7. doi:10.3389/FMED.2020.604980.

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Larvin H, Wilmott S, Kang J, Aggarwal VR, Pavitt S, Wu J. Additive effect of periodontal disease and obesity on COVID-19 outcomes. J Dent Res. 2021;100(11):1228–1235. doi:10.1177/00220345211029638.

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Katz J, Yue S, Xue W. Dental diseases are associated with increased odds ratio for coronavirus disease 19. Oral Dis. 2022;28(Suppl 1):991–993. doi:10.1111/odi.13653.

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Sirin DA, Ozcelik F. The relationship between COVID-19 and the dental damage stage determined by radiological examination. Oral Radiol. 2021;37(4):600–609. doi:10.1007/s11282-020-00497-0.

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Wang Y, Deng H, Pan Y, et al. Periodontal disease increases the host susceptibility to COVID-19 and its severity: a Mendelian randomization study. J Transl Med. 2021;19(1):528. doi:10.1186/s12967-021-03198-2.

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