Evaluation of the influence of oral health on COVID-19 severity among cardiac patients (primary outcome)
Oral health status
COVID-19 severity
p-value
Severe
Mild
Poor (N, %)
21 (75%)
7 (25%)
< 0.001*
Good (N, %)
9 (15.5%)
49 (84.5%)
Group contrasts were evaluated utilizing the Chi-squared test for incidence comparisons. * A significance level of p < 0.05 was utilized as the criterion for statistical significance
AB: Conceptualization, Methodology, Formal analysis, Investigation, Visualization, Writing—original draft. AHMK: Conceptualization, Methodology, Formal analysis, Supervision, Validation, Writing—review & editing. Both authors read and approved the final manuscript.
Conflicts of interest
Both authors confirm that they have no competing interest to disclose.
Ethical approval
This questionnaire and methodology were approved by the Ethics Committee of Faculty of Dentistry, Cairo University, Cairo, Egypt, approval number: 21/6/20.
Consent to participate
Informed consent to participate in the study was obtained from all participants.
Consent to publication
Not applicable.
Availability of data and materials
The data is available from the corresponding author upon reasonable request.
Funding
This research did not receive financial support from any funding agencies.
Muralidar S, Ambi SV, Sekaran S, Krishnan UM. The emergence of COVID-19 as a global pandemic: Understanding the epidemiology, immune response and potential therapeutic targets of SARS-CoV-2.Biochimie. 2020;179:85–100. [DOI] [PubMed] [PMC]
Wang Y, Wang Y, Chen Y, Qin Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures.J Med Virol. 2020;92:568–76. [DOI] [PubMed] [PMC]
Aas JA, Paster BJ, Stokes LN, Olsen I, Dewhirst FE. Defining the normal bacterial flora of the oral cavity.J Clin Microbiol. 2005;43:5721–32. [DOI] [PubMed] [PMC]
Fajnzylber J, Regan J, Coxen K, Corry H, Wong C, Rosenthal A, et al. SARS-CoV-2 viral load is associated with increased disease severity and mortality.Nat Commun. 2020;11:5493. [DOI] [PubMed] [PMC]
Luo X, Zhou W, Yan X, Guo T, Wang B, Xia H, et al. Prognostic Value of C-Reactive Protein in Patients With Coronavirus 2019.Clin Infect Dis. 2020;71:2174–9. [DOI] [PubMed] [PMC]
Kotronia E, Brown H, Papacosta AO, Lennon LT, Weyant RJ, Whincup PH, et al. Oral health and all-cause, cardiovascular disease, and respiratory mortality in older people in the UK and USA.Sci Rep. 2021;11:16452. [DOI] [PubMed] [PMC]
Scannapieco FA. Role of oral bacteria in respiratory infection.J Periodontol. 1999;70:793–802. [DOI] [PubMed]
Liu PP, Blet A, Smyth D, Li H. The Science Underlying COVID-19: Implications for the Cardiovascular System.Circulation. 2020;142:68–78. [DOI] [PubMed]
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.Lancet. 2020;395:1054–62. [DOI] [PubMed] [PMC]
Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, et al. COVID-19 and Cardiovascular Disease.Circulation. 2020;141:1648–55. [DOI] [PubMed]
Inciardi RM, Adamo M, Lupi L, Cani DS, Di Pasquale M, Tomasoni D, et al. Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy.Eur Heart J. 2020;41:1821–9. [DOI] [PubMed] [PMC]
Lockhart PB, Bolger AF, Papapanou PN, Osinbowale O, Trevisan M, Levison ME, et al.; American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, Council on Epidemiology and Prevention, Council on Peripheral Vascular Disease, and Council on Clinical Cardiology. Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association? a scientific statement from the American Heart Association.Circulation. 2012;125:2520–44. [DOI] [PubMed]
Lee SK, Hwang SY. Oral health in adults with coronary artery disease and its risk factors: a comparative study using the Korea National Health and Nutrition Examination Survey data.BMC Cardiovasc Disord. 2021;21:71. [DOI] [PubMed] [PMC]
Levin L, Shpigel I, Peretz B. The use of a self-report questionnaire for dental health status assessment: a preliminary study.Br Dent J. 2013;214:E15. [DOI] [PubMed]
Ruíz-López del Prado G, Blaya-Nováková V, Saz-Parkinson Z, Álvarez-Montero Ó, Ayala A, Muñoz-Moreno M, et al. Design and validation of an oral health questionnaire for preoperative anaesthetic evaluation.Braz J Anesthesiol. 2017;67:6–14. [DOI]
Kamel AHM, Basuoni A, Salem ZA, AbuBakr N. The impact of oral health status on COVID-19 severity, recovery period and C-reactive protein values.Br Dent J. 2021;[Epub ahead of print]. [DOI] [PubMed] [PMC]
Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai N, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis.Lancet Infect Dis. 2020;20:669–77. [DOI] [PubMed] [PMC]
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China.JAMA. 2020;323:1061–9. [DOI] [PubMed] [PMC]
Wynants L, Van Calster B, Collins GS, Riley RD, Heinze G, Schuit E, et al. Prediction models for diagnosis and prognosis of covid-19: systematic review and critical appraisal.BMJ. 2020;369:m1328. [DOI] [PubMed] [PMC]
Greenhalgh T, Koh GCH, Car J. Covid-19: a remote assessment in primary care.BMJ. 2020;368:m1182. [DOI] [PubMed]
Chorin E, Padegimas A, Havakuk O, Birati EY, Shacham Y, Milman A, et al. Assessment of Respiratory Distress by the Roth Score.Clin Cardiol. 2016;39:636–9. [DOI] [PubMed] [PMC]
Zhang H, Zhang Y, Wu J, Li Y, Zhou X, Li X, et al. Risks and features of secondary infections in severe and critical ill COVID-19 patients.Emerg Microbes Infect. 2020;9:1958–1964. [DOI] [PubMed] [PMC]
Khan AA, Khan Z. COVID-2019-associated overexpressed Prevotella proteins mediated host-pathogen interactions and their role in coronavirus outbreak.Bioinformatics. 2020;36:4065–9. [DOI] [PubMed] [PMC]
Cox MJ, Loman N, Bogaert D, O’Grady J. Co-infections: potentially lethal and unexplored in COVID-19.Lancet Microbe. 2020;1:e11. [DOI] [PubMed] [PMC]
Pujadas E, Chaudhry F, McBride R, Richter F, Zhao S, Wajnberg A, et al. SARS-CoV-2 viral load predicts COVID-19 mortality.Lancet Respir Med. 2020;8:e70. [DOI] [PubMed] [PMC]
Wölfel R, Corman VM, Guggemos W, Seilmaier M, Zange S, Müller MA, et al. Virological assessment of hospitalized patients with COVID-2019.Nature. 2020;581:465–9. [DOI] [PubMed]
Meister TL, Brüggemann Y, Todt D, Conzelmann C, Müller JA, Groß R, et al. Virucidal Efficacy of Different Oral Rinses Against Severe Acute Respiratory Syndrome Coronavirus 2.J Infect Dis. 2020;222:1289–92. [DOI] [PubMed] [PMC]
Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa.Int J Oral Sci. 2020;12:8. [DOI] [PubMed] [PMC]
Alhaffar S, Yalamanchi S, Shukla A. Association of self-reported periodontal disease and inequities with long haul COVID-19.PLoS One. 2024;19:e0311644. [DOI] [PubMed] [PMC]
Page RC. The pathobiology of periodontal diseases may affect systemic diseases: inversion of a paradigm.Ann Periodontol. 1998;3:108–20. [DOI] [PubMed]
Vettore MV. Periodontal disease and cardiovascular disease.Evid Based Dent. 2004;5:69. [DOI] [PubMed]
Chistiakov DA, Orekhov AN, Bobryshev YV. Links between atherosclerotic and periodontal disease.Exp Mol Pathol. 2016;100:220–35. [DOI] [PubMed]
Sanz M, Del Castillo AM, Jepsen S, Gonzalez-Juanatey JR, D’Aiuto F, Bouchard P, et al. Periodontitis and cardiovascular diseases: Consensus report.J Clin Periodontol. 2020;47:268–88. [DOI] [PubMed] [PMC]
Herrera D, Serrano J, Roldán S, Alonso B, Sanz M. Oral and systemic health: is there a “new” link with COVID-19?Clin Oral Investig. 2023;27:3–13. [DOI] [PubMed] [PMC]
Sahu BR, Kampa RK, Padhi A, Panda AK. C-reactive protein: A promising biomarker for poor prognosis in COVID-19 infection.Clin Chim Acta. 2020;509:91–4. [DOI] [PubMed] [PMC]
Wang G, Wu C, Zhang Q, Wu F, Yu B, Lv J, et al. C-Reactive Protein Level May Predict the Risk of COVID-19 Aggravation.Open Forum Infect Dis. 2020;7:ofaa153. [DOI] [PubMed] [PMC]
Machado V, Botelho J, Escalda C, Hussain SB, Luthra S, Mascarenhas P, et al. Serum C-Reactive Protein and Periodontitis: A Systematic Review and Meta-Analysis.Front Immunol. 2021;12:706432. [DOI] [PubMed] [PMC]
