Opinion
The Management of Periodontitis Patients Should not be Postponed During the COVID-19 Era
Yuh Baba1*, Keiso Takahashi2 and Yasumasa Kato3
1Department of General Clinical Medicine, Ohu University School of Dentistry, 31-1 Misumido Tomita-machi Koriyama City, Fukushima 963-8611, Japan
2Department of Conservative Dentistry, Ohu University School of Denttistry, 31-1 Misumido Tomita-machi Koriyama City, Fukushima 963-8611, Japan
3Department of Oral Function and Molecular Biology, Ohu University School of Dentistry, 31-1 Misumido Tomita-machi Koriyama City, Fukushima 963-8611, Japan
Yuh Baba, Department of General Clinical Medicine, Ohu University School of Dentistry, 31-1 Misumido Tomita-machi Koriyama City, Fukushima 963-8611, Japan.
Received Date: January 21, 2022; Published Date: February 04, 2022
Opinion
Recommendation for dental care during the COVID-19 pandemic was reported [1]. The authors present recommendations for (i) patient risk assessment, (ii) patient triage, and (iii) measures to prevent infection of health professionals and nosocomial transmission in dental clinics. With regard to patient triage, the authors classified dental treatments according to their emergency level. Their insistence consists of abscess drainage and tooth extraction due to acute pain as the “urgent level”, extraction of teeth due to chronic pain, pain from broken ortho-appliance, and so on the “as soon as possible level”, and finally, elective extraction and periodontal treatment as the “postpone level”. Among them, we have serious concerns about classifying elective periodontal treatment as the “postpone level”.
Patients with periodontal disease have an increasing risk in developing subsequent systemic diseases including diabetes, hypertension, cardiovascular disease (CVD), and cancer [2-5]. And, these all diseases are risk factors for severe conditions of COVID-19 such as acute respiratory distress syndrome (ARDS), thrombotic tendency, and myocardial injuries during COVID-19 infection [6- 9]. Taken together, we have concerns about that COVID-19 positive patients with periodontal disease undergo these severe conditions if periodontal treatment is postponed. Indeed, Larvin, et al. [10] reported that COVID-19 positive patients with periodontal disease have significant higher mortality compared to COVID-19 positive patients without periodontal disease [10]. Furthermore, Marouf, et al. [11] indicated that periodontitis was associated with COVID-19 complication including death, ICU admission and need for assisted ventilation, consequently concluding that chronic periodontitis aggravates mild cases of COVID-19 [11]. Increasing expression of angiotensin-converting enzyme 2 (ACE2) which is the host cellular receptor in respiratory epithelial cells and the aberrant secretion of proinflammatory cytokines such as interleukin (IL)-6 and IL-8 by periodontopathic bacteria, are considered as the mechanisms of severe COVID-19 by periodontitis [12]. Furthermore, Aquino- Martinez et al. stated that dissemination of periodontal bacteria into lung tissues may cause lipopolysaccharide-induced senescence, which facilitates SARS-CoV-2 cell attachment, entry, and replication [13].
Periodontal inflamed surface area (PISA) would be a useful marker to determine the patient triage and treatment regimen [14]. We think that periodontal treatment can be postponed for patients with low PISA values. On the other hand, when periodontal treatment is postponed for patients with intermediate or high PISA values who have also systemic diseases such as diabetes mellitus and CVD, we have the great concern that unchecked periodontitis can deteriorate the condition of COVID-19 if a person is infected with SARS-CoV-2.
Periodontitis is a chronic inflammatory disease initiated by infection with periodontopathic bacteria which cannot be treated successfully with acute management and requires long term intervention and maintenance. Furthermore, the treatment of periodontal disease during the COVID-19 pandemic may result in exposing dental practitioners and the general public to unnecessary viral transmission. However, we think that all doctors including dentist and physicians must resolve the concern that unchecked periodontitis can deteriorate the condition of COVID-19 if a person is infected with SARS-CoV-2 because the increase of the patients with severe COVID-19 can make the function of hospital admission insufficient.
Acknowledgement
None.
Conflict of interest
No conflict of interest.
References
- Gurzawska-Comis K, Becker K, Brunello G, Gurzawska A, Schwarz F (2020) Recommendations for dental care during COVID-19 pandemic. J Clin Med 9: 1833.
- Ide R, Hoshuyama T, Wilson D, Takahashi K, Higashi T (2011) Periodontal disease and incident diabetes: a seven-year study. J Dent Res 90: 41-46.
- Joshipura KJ, Wand HC, Merchant AT, Rimm EB (2004) Periodontal disease and biomarkers related to cardiovascular disease. J Dent Res 83: 151-155.
- Lee JH, Kweon HH, Choi JK, Kim YT, Choi S H (2017) Association between Periodontal disease and Prostate cancer: Results of a 12-year Longitudinal Cohort Study in South Korea. J Cancer. 8: 2959-2965.
- Rivas-Tumanyan S, Spiegelman D, Curhan GC, Forman JP, Joshipura KJ (2012) Periodontal disease and incidence of hypertension in the health professionals follow-up study. Am J Hypertens 25: 770-776.
- Fadini G P, Morieri ML, Longato E, Avogaro A (2020) Prevalence and impact of diabetes among people infected with SARS-CoV-2. J Endocrinol Invest 43: 867-869.
- Liang W, Guan W, Chen R, Wang W, Li J, et al. (2020) Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol 21: 335-337.
- Cook TM (2020) The importance of hypertension as a risk factor for severe illness and mortality in COVID-19. Anaesthesia 75: 976-977.
- Narita K, Hoshide S, Tsoi K, Siddique S, Shin J, et al. (2021) Disaster hypertension and cardiovascular events in disaster and COVID-19 pandemic. J Clin Hypertens (Greenwich) 23(3):575-583.
- Larvin H, Wilmott S, Wu J, Kang J (2020) The Impact of Periodontal Disease on Hospital Admission and Mortality during COVID-19 Pandemic. Front. Med (Lausanne) 7: 604980.
- Marouf N, Cai W, Said KN, Daas H, Diab H, et al. (2021) Association between periodontitis and severity of COVID-19 infection: A case-control study. J Clin Periodontol 48: 483-491.
- Takahashi Y, Watanabe N, Kamio N, Yokoe S, Suzuki R, et al. (2021) Expression of the SARS-CoV-2 Receptor ACE2 and Proinflammatory Cytokines Induced by the Periodontopathic Bacterium Fusobacterium nucleatum in Human Respiratory Epithelial Cells. Int J Mol Sci 22: 1352.
- Aquino-Martinez R, Hernández-Vigueras S (2021) Severe COVID-19 Lung Infection in Older People and Periodontitis. J Clin Med 10: 279.
- Nomura Y, Morozumi T, Numabe Y, Ogata Y, Nakayama Y, et al. (2021) Estimation of the Periodontal Inflamed Surface Area by Simple Oral Examination. J Clin Med 10: 723.
-
Yuh Baba, Keiso Takahashi, Yasumasa Kato. The Management of Periodontitis Patients Should not be Postponed During the COVID-19 Era. On J Dent & Oral Health. 5(3): 2022. OJDOH.MS.ID.000614. DOI: 10.33552/OJDOH.2022.05.000614.
-
Dental clinic, Extraction of teeth, Periodontal disease, Dental practitioners, Inflammatory disease, Periodontal treatment, Periodontopathic bacteria, Periodontitis, Periodontal patients.
-
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.