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Periodontitis, associated with an increased risk of complications from Covid-19

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MADRID, Feb. 3 (EUROPA PRESS) –

Patients with periodontitis are almost 9 times more likely to die, 4 times more likely to need assisted ventilation, and about 3.5 times more likely to enter an ICU if they are infected with Covid-19, according to a study conducted jointly by the University. Complutense de Madrid, McGill University in Montreal (Canada) and the University of Qatar.

Likewise, this study shows that people with periodontitis show a significantly higher blood level of markers related to a worse Covid-19 result, such as D-dimer, white blood cell count and C-reactive protein.

This, according to those responsible for the study, means that patients with periodontitis have a greater probability of developing an aberrant immune and inflammatory response, the so-called “cytokine storm” responsible for the rapid deterioration of many patients with COVID-19.

This research, published in the ‘Journal of Clinical Periodontology’, has been carried out between March and July 2020 with data from the national electronic medical records in the state of Qatar, including 568 patients with Covid-19. The team from this country has been led by Professor Faleh Tamimi and has had the collaboration of experts from the Oral Health Institute of the Hamad Medical Corporation in Doha.

“The result of this research has shown that periodontitis is significantly associated with the severity of the Covid-19 affectation and with the development of its complications,” reiterates one of the study coordinators and co-director of the Etiology and Therapeutics Research Group of Periodontal Diseases (ETEP) of the Complutense University of Madrid, Professor Mariano Sanz.

“Therefore, patients with periodontal pathology should consult with their dentist to obtain the appropriate diagnosis and treatment, and thus reduce the risk of complications if they become infected with the SARS-CoV-2 virus,” he advises. Thus, he adds that “periodontal diseases, and mainly periodontitis, have been shown to act as a complementary factor in increasing the infectivity and severity of the Covid-19 disease, which highlights once again the need to implement preventive and therapeutic measures to reduce the overall burden of periodontitis “.

RELATIONSHIP WITH PNEUMONIA AND ASSISTED VENTILATION

In addition to the relevance of these results, the scientific coordinator of the Foundation of the Spanish Periodontology Society (SEPA) recalled that “periodontitis has been closely related to pneumonia in patients hospitalized or in need of assisted ventilation”.

This association may be mainly due to the aspiration of bacterial pathogens that reside in the oral cavity (mainly within the periodontal pockets) in patients with periodontitis; once these pathogens are aspirated, and given the lack of adequate host defenses, the colonization of these pathogens in the lungs is promoted, which rapidly deteriorates the patient’s health status.

Given that the presence of bilateral pneumonia and the need for assisted ventilation are key indicators of the deterioration of the Covid-19 disease and an increased risk of death, Dr. Carasol points out that it is “essential to pay close attention to oral hygiene and the administration of antiseptics oral in hospital settings to reduce this possible oropharyngeal colonization “.

In addition, he has also urged to reinforce the diagnosis and treatment of people with periodontitis at the level of the general population, “in order to reduce possible additional risks if they require hospital admission due to coronavirus infection,” he said.

All these evidences, in the words of the president of SEPA, Antonio Bujaldón, “are especially important if one takes into account the high number of people who currently have periodontitis in Spain, in many cases undiagnosed”. In fact, the latest Oral Health Survey in Spain (from 2020) indicates that between 25-34 percent of adults have periodontal pockets, being severe in 8 percent of young adults and 12 percent of older adults.

ORAL HEALTH AND TRANSMISSION OF SARS-COV-2

Thus, this study joins the growing number of trials that try to shed light on the role of the oral cavity in the transmission and pathogenicity of SARS-CoV-2.

Currently, it is known that the infectivity of SARS-CoV-2 depends on its ability to penetrate cells, using the angiotensin-transforming enzyme-2 (ACE-2) as the main receptor and the gateway for this virus into the cell.

Thus, since epithelial cells in different mucosa of the oral cavity show a high expression of ACE-2, and since the oral cavity is one of the first interfaces between the exterior and the body, it is considered that there is a high potential for that this route of colonization and viral infection is decisive for the appearance of Covid-19.

According to David Herrera, also a researcher at the Complutense University, “this fact has clear implications in the implementation of measures to prevent viral colonization in the oral cavity, not only in terms of physical barriers, such as masks and screens, but also in terms of the identification of effective oral antiseptics that may influence the transmission and pathogenicity of this virus “.

Thus, the researchers have recalled that recent ‘in vitro’ and ‘in vivo’ investigations have shown that mouthwashes based on cetylpyridinium chloride and / or povidone-iodine have virucidal activity and could help prevent the infectivity of COVID-19 , although “clinical trials are necessary to verify this hypothesis”, warns Professor Herrera.

Finally, experts have called for the inclusion of dental health in the National Health System (SNS) and have highlighted the influence of oral care on general health. “In our profession there is a clear and restorative health component, to the extent that the consequences of dental diseases are alleviated; but precisely the treatment of periodontitis has especially relevant health consequences, such as reducing the vital risk of patients due to diseases cardiovascular diseases, diabetes and Covid-19, among others, “said Sanz. “It is a risk that should not be trivial by the health authorities,” he added.

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