Top

Published in:

Open Access 01-12-2023 | COVID-19 | Research

Prevalence of oral complications in the course of severe SARS-CoV-2 infection under mechanical non-invasive ventilation

Authors: Elzbieta Paszynska, Maria Gawriolek, Amadeusz Hernik, Justyna Otulakowska-Skrzynska, Hanna Winiarska, Daria Springer, Magdalena Roszak, Zuzanna Slebioda, Anna Krahel, Szczepan Cofta

Published in: European Journal of Medical Research | Issue 1/2023

Abstract

Background

The management of oral health during severe symptoms of Covid-19 is still a challenge, especially in intensive care units under invasive/noninvasive ventilation in hospital. Understanding the cause-and-effect relationships may allow for individual adjustment of oral care recommendations during Covid-19 disease. The study’s objective was to assess Covid-19 patients’ oral health status under hospital treatment due to pulmonary adverse Covid-19 outcomes.

Material and methods

Covid-19 patients (mean age 74.4 ± 15.4; n = 120, male n = 50/female n = 70) were admitted to hospital in the acute phase of Covid-19 between January and March 2022 who required oxygen therapy due to pneumonia, rapid respiratory failure, low saturation. Blood and radiological tests were taken according to National Health Fund guidelines. The condition of teeth (Decayed, Missing, Filled teeth as DMFT index), dental hygiene (Plaque Control Record as PCR index), periodontal status (probing depth PD, clinical attachment CAL, bleeding on probing BOP) and oral mucosa (BRUSHED and Beck scores) were examined.

Results

Charateristics of the teeth (dental caries 35.2%, DMFT Median 22), plaque retention (83.4%), advanced periodontitis (48.3%), xerostomia (74.2%), oral mucosa inflammation (80.8%), angular cheilitis (53.3%), hemorrhagic (21.7%) showed a high incidence of harmful oral conditions. BRUSHED model and Beck score indicated moderate oral dysfunction and need for oral care every 8 h. Spearman’s analysis revealed a significant positive correlation between pneumonia and neutrophile, interleukin-6 IL-6, C-reactive protein CRP (p = 0.01, p < 0.001, p < 0.001), negative to lymphocyte count (p < 0.001). Multiple and logistic regressions selected the following risk predictors for pneumonia as IL-6, CRP, obesity and for severe COVID-19 symptoms D-dimer level and a lack of targeted vaccination (p < 0.001). Among oral predictors, the PCR index and Beck score were significant for both outcomes (respectively p < 0.001, p < 0.012). Patients who received oxygen therapy with face masks had more often angular heilitis and debris (p = 0.025, p = 0.035).

Conclusions

COVID-19 hospitalised patients with severe symptoms crossing with poor oral health-related conditions. This may exacerbate a response for COVID infection, and play a role in cytokine storm. For Covid-19 management, to inhibit extraoral/intraoral complications, it is recommended to adjust oral hygiene procedures, including antibacterial, protective, moisturising agents after individual oral health assessment.

Available only for authorised users

Farid H, Khan M, Jamal S, Ghafoor R. Oral manifestations of Covid-19-a literature review. Rev Med Virol. 2022;32(1): e2248.PubMed

Paradowska-Stolarz AM. Oral manifestations of COVID-19 infection: brief review. Dent Med Probl. 2021;58(1):123–6.PubMed

Ochani R, Asad A, Yasmin F, Shaikh S, Khalid H, Batra S, et al. COVID-19 pandemic: from origins to outcomes. A comprehensive review of viral pathogenesis, clinical manifestations, diagnostic evaluation, and management. Infez Med. 2021;29(1):20–36.PubMed

Younis NK, Zareef RO, Maktabi MAN, Mahfouz R. The era of the coronavirus disease 2019 pandemic: a review on dynamics, clinical symptoms and complications, diagnosis, and treatment. Genet Test Mol Biomarkers. 2021;25(2):85–101.PubMed

Folayan MO, Zuniga RAA, Ezechi OC, Brown B, Nguyen AL, Aly NM, et al. Associations between emotional distress, sleep changes, decreased tooth brushing frequency, self-reported oral ulcers and SARS-Cov-2 infection during the first wave of the covid-19 pandemic: a global survey. Int J Environ Res Public Health. 2022;19(18):11550.PubMedPubMedCentral

Costa CA, Vilela ACS, Oliveira SA, Gomes TD, Andrade AAC, Leles CR, Costa NL. Poor oral health status and adverse COVID-19 outcomes: a preliminary study in hospitalized patients. J Periodontol. 2022;93(12):1889–901.PubMed

Herrera D, Serrano J, Roldán S, Sanz M. Is the oral cavity relevant in SARS-CoV-2 pandemic? Clin Oral Investig. 2020;24:2925–30.PubMedPubMedCentral

Sahni V, Gupta S. COVID-19 & periodontitis: the cytokine connection. Med Hypotheses. 2020;144: 109908.PubMedPubMedCentral

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(1):8.PubMedPubMedCentral

10.

Natto ZS, Afeef M, Bakhrebah MA, Ashi H, Alzahrani KA, Alhetheel AF, et al. Can periodontal pockets and caries lesions act as reservoirs for coronavirus? Mol Oral Microbiol. 2022;37(2):77–80.PubMedPubMedCentral

11.

Hua F, Xie H, Worthington HV, Furness S, Zhang Q, Li C. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev. 2016;10(10):CD008367.PubMed

12.

Zhao T, Wu X, Zhang Q, Li C, Worthington HV, Hua F. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev. 2020;12(12):CD008367.PubMed

13.

Keykha A, Ramezani M, Amini S, Karimi MH. Oropharyngeal decontamination for prevention of VAP in patients admitted to intensive care units: a systematic review. J Caring Sci. 2021;11(3):178–87.PubMedPubMedCentral

14.

Sidor A, Rzymski P. Dietary choices and habits during COVID-19 lockdown: experience from Poland. Nutrients. 2020;12(6):1657.PubMedPubMedCentral

15.

Paszynska E, Cofta S, Hernik A, Otulakowska-Skrzynska J, Springer D, Roszak M, et al. Self-reported dietary choices and oral health care needs during COVID-19 quarantine: a cross-sectional study. Nutrients. 2022;14(2):313.PubMedPubMedCentral

16.

Abidia RF. Oral care in the intensive care unit: a review. J Contemp Dent Pract. 2007;8(1):76–82.PubMed

17.

Goodson JM. Disease reciprocity between gingivitis and obesity. J Periodontol. 2020;91:26–34.

18.

Tonetti MS, van Dyke TE, Working Group 1 of the Joint EFP/AAP. Workshop periodontitis and atherosclerotic cardiovascular disease: consensus report of the joint EFP/AAP workshop on periodontitis and systemic diseases. J Periodontol. 2013;84(Suppl. 4):S24–9.PubMed

19.

Linden GJ, Herzberg MC, Working Group 4 of Joint EFP/AAP Workshop. Periodontitis and systemic diseases: A record of discussions of working group 4 of the joint EFP/AAP workshop on periodontitis and systemic diseases. J Clin Periodontol. 2013;40(Suppl. 14):S20–3.PubMed

20.

Winning L, Lundy FT, Blackwood B, McAuley DF, El Karim I. Oral health care for the critically ill: a narrative review. Crit Care. 2021;25(1):353.PubMedPubMedCentral

21.

Tomofuji T, Ekuni D, Irie K, Azuma T, Tamaki N, Maruyama T. Relationships between periodontal inflammation, lipid peroxide and oxidative damage of multiple organs in rats. Biomed Res. 2011;32:343–9.PubMed

22.

Ling Z, Tao H. Dental caries and systemic diseases. In: Xuedong Z, editor. Dental caries. Berlin: Springer; 2016.

23.

General Office of Chinese National Health Commission. Diagnosis and treatment protocol for novel coronavirus pneumonia (trial version 7). Chin Med J (Engl). 2020;133:1087–95.

24.

Xia L, Chen J, Friedemann T, Yang Z, Ling Y, Liu X, et al. The Course of mild and moderate COVID-19 infections-the unexpected long-lasting challenge. Open Forum Infect Dis. 2020;7(9):286.

25.

Bischoff JI, van der Merwe EH, Retief DH, Barbakow FH, Cleaton-Jones PE. Relationship between fluoride concentration in enamel, DMFT index, and degree of fluorosis in a community residing in an area with a high level of fluoride. J Dent Res. 1976;55(1):37–42.PubMed

26.

Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J. 1975;25:229–35.PubMed

27.

Ainamo J, Bay I. Periodontal indexes for and in practice. Tandlaegebladet. 1976;80:149–52.PubMed

28.

O’Leary TJ, Drake RB, Naylor JE. The plaque control record. J Periodontol. 1972;43(1):38.PubMed

29.

Caton JG, Armitage G, Berglundh T, et al. A new classification scheme for periodontal and peri-implant diseases and conditions—introduction and key changes from the 1999 classification. J Clin Periodontol. 2018;45(Suppl 20):S1–8.PubMed

30.

Hayes J, Jones C. A collaborative approach to oral care during critical illness. Dent Health (London). 1995;34(3):6–10.

31.

Beck S. Impact of a systematic oral care protocol on stomatitis after chemotherapy. Cancer Nurs. 1979;2(3):185–99.PubMed

32.

Dziedzic A, Wojtyczka R. The impact of coronavirus infectious disease 19 (COVID-19) on oral health. Oral Dis. 2021;27(Suppl 3):703–6.PubMed

33.

AbuBakr N, Salem ZA, Kamel AHM. Oral manifestations in mild-to-moderate cases of COVID-19 viral infection in the adult population. Dent Med Probl. 2021;58(1):7–15.PubMed

34.

Costa SM, Martins CC, Pinto MQC, et al. Socioeconomic factors and caries in people between 19 and 60 years of age: an update of a systematic review and meta-analysis of observational studies. Int J Environ Res Public Health. 2018;15(8):1775.PubMedPubMedCentral

35.

Konopka T, Dembowska E, Pietruska M, et al. Periodontal status and selected parameters of oral condition of Poles aged 65 to 74 years. Przegl Epidemiol. 2015; 69(3):537–42, 643–7.

36.

Barczak K. The condition of teeth and periodontium in the erderly from social care centers and family-care run homes in the province of west Pomerania. Ann Acad Med Stetinensis. 2011;57(2):104–9.

37.

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. 2022;93(4):584–90.

38.

Gupta S, Mohindra R, Singla M, et al. The clinical association between periodontitis and COVID-19. Clin Oral Investig. 2022;26(2):1361–74.PubMed

39.

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;48:483–91.PubMedCentral

40.

Lloyd-Jones G, Molayem S, Pontes CC, Chapple I. The COVID-19 pathway: a proposed oral-vascular-pulmonary route of SARSCoV-2 infection and the importance of oral healthcare measures. J Oral Med Dent Res. 2021;2021(2):1–25.

41.

Wu D, Yang XO. TH17 responses in cytokine storm of COVID-19: an emerging target of JAK2 inhibitor Fedratinib. J MicrobiolImmunol Infect. 2020;53:368–70.

42.

Shamsoddin E. Is periodontitis associated with the severity of COVID-19? Evid Based Dent. 2021;22:66–8.PubMedPubMedCentral

43.

Skośkiewicz-Malinowska K, Noack B, Kaderali L, et al. Oral health and quality of life in old age: a cross-sectional pilot project in Germany and Poland. Adv Clin Exp Med. 2016;25(5):951–9.PubMed

44.

Gomaa N, Glogauer M, Tenenbaum H, Siddiqi A, Quiñonez C. Social-biological interactions in oral disease: a ‘Cells to Society’view. PLoS ONE. 2016;11(1): e0146218.PubMedPubMedCentral

45.

Mira A, Simon-Soro A, Curtis MA. Role of microbial communities in the pathogenesis of periodontal diseases and caries. J Clin Periodontol. 2017;44(S18):S23-38.PubMed

46.

Wdowiak-Szymanik A, Wdowiak A, Szymanik P, Grocholewicz K. Pandemic COVID-19 influence on adult’s oral hygiene, dietary habits and caries disease-literature review. Int J Environ Res Public Health. 2022;19(19):2744.

47.

Petersen PE, Kandelman D, Arpin S, et al. Global oral health of older people—call for public health action. Community Dent Health. 2010;27(4 Suppl 2):257–67.PubMed

48.

Pitts NB, Zero DT, Marsh PD, Ekstrand K, Weintraub JA, Ramos-Gomez F, et al. Dental caries. Nat Rev Dis Primers. 2017;3:17030.PubMed

49.

Tablan OC, Anderson LJ, Besser R. Guidelines for preventing health-care—associated pneumoniae, 2003 recommendations of the CDC and the Healthcare Infection Control Practices Advisory Committee. Respir Care. 2004;49:926–39.

50.

Sands KM, Twigg JA, Lewis MAO, Wise MP, Marchesi JR, Smith A, et al. Microbial profiling of dental plaque from mechanically ventilated patients. J Med Microbiol. 2016;65(2):147–59.PubMedPubMedCentral

51.

Sands KM, Wilson MJ, Lewis MAO, Wise MP, Palmer N, Hayes AJ, et al. Respiratory pathogen colonization of dental plaque, the lower airways, and endotracheal tube biofilms during mechanical ventilation. J Crit Care. 2017;37:30–7.PubMed

52.

Manger D, Walshaw M, Fitzgerald R, Doughty J, Wanyonyi KL, White S, et al. Evidence summary: the relationship between oral health and pulmonary disease. Br Dent J. 2017;222(7):527–33.PubMed

53.

McNeill HE. Biting back at poor oral hygiene. Intensive Crit Care Nurs. 2000;16:367–72.PubMed

54.

Lovato A, de Filippis C, Marioni G. Upper airway symptoms in coronavirus disease 2019 (COVID-19). Am J Otolaryngol. 2020;41(3): 102474.PubMed

55.

Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral. 2020;12(1):9.

56.

To KKW, Tsang OTY, Yip CCY, Chan KH, Wu TC, Chan JMC, et al. Consistent detection of 2019 novel coronavirus in saliva. Clin Infect. 2020;71:841–3.

57.

Liu L, Wei Q, Alvarez X, Wang H, Du Y, Zhu H, et al. Epithelial cells lining salivary gland ducts are early target cells of severe acute respiratory syndrome coronavirus infection in the upper respiratory tracts ofrhesus macaques. J Virol. 2011;85:4025–30.PubMedPubMedCentral

58.

Erbaş GS, Botsali A, Erden N, et al. COVID-19-related oral mucosa lesions among confirmed SARS-CoV-2 patients: a systematic review. Int J Dermatol. 2022;61(1):20–32.PubMed

59.

Schwab G, Palmieri M, Zerbinati RM, Sarmento DJS, Reis T, Ortega KL, et al. Lack of direct association between oral mucosal lesions and SARS-CoV- 2 in a cohort of patients hospitalised with COVID-19. J Oral Microbiol. 2022;14(1):2047491.PubMedPubMedCentral

60.

Hellstein JW, Marek CL. Candidiasis: red and white manifestations in the oral cavity. Head Neck Pathol. 2019;13(1):25–32.PubMedPubMedCentral

61.

Rostami M, Mansouritorghabeh H. D-dimer level in COVID-19 infection: a systematic review. Expert Rev Hematol. 2020;13(11):1265–75.PubMed

62.

Zhang L, Yan X, Fan Q, Liu H, Liu X, Liu Z, Zhang Z. D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19. J Thromb Haemost. 2020;18(6):1324–9.PubMedPubMedCentral

63.

He R, Lu Z, Zhang L, Fan T, Xiong R, Shen X, et al. The clinical course and its correlated immune status in COVID-19 pneumonia. J Clin Virol. 2020;127: 104361.PubMedPubMedCentral

64.

Hummel R, Akveld NAE, Bruers JJM, van der Sanden WJM, Su N, van der Heijden GJMG. Caries progression rates revisited: a systematic review. J Dent Res. 2019;98:746–54.PubMed

65.

Jin LJ, Armitage GC, Klinge B, et al. Global oral health inequalities: task group—periodontal disease. Adv Dent Res. 2011;23(2):221–6.PubMed

66.

Shi Z, Xie H, Wang P, Zhang Q, Wu Y, Chen E, et al. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev. 2013;13(8):CD008367.

67.

Wang X, Tang G, Liu Y, Zhang L, Chen B, Han Y, et al. The role of IL-6 in coronavirus, especially in COVID-19. Front Pharmacol. 2022;13:1033674.PubMedPubMedCentral

68.

McGonagle D, Sharif K, O’Regan A, Bridgewood C. The role of cytokines including interleukin-6 in COVID-19 induced pneumonia and macrophage activation syndrome-like disease. Autoimmun Rev. 2020;19(6): 102537.PubMedPubMedCentral

69.

Coomes EA, Haghbayan H. Interleukin-6 in Covid-19: a systematic review and meta-analysis. Rev Med Virol. 2020;30(6): e2141.PubMedPubMedCentral

70.

Milenkovic M, Hadzibegovic A, Kovac M, Jovanovic B, Stanisavljevic J, Djikic M, et al. D-dimer, CRP, PCT, and IL-6 levels at admission to ICU can predict in-hospital mortality in patients with COVID-19 pneumonia. Oxid Med Cell Longev. 2022;2022:8997709.PubMedPubMedCentral

71.

Laguna-Goya R, Utrero-Rico A, Talayero P, Lasa-Lazaro M, Ramirez-Fernandez A, Naranjo L, et al. IL-6–based mortality risk model for hospitalized patients with COVID-19. J Allergy Clin Immunol. 2020;146(4):799-807.e9.PubMedPubMedCentral

72.

Sun H, Guo P, Zhang L, Wang F. Serum interleukin-6 concentrations and the severity of COVID-19 pneumonia: a retrospective study at a single center in Bengbu City, Anhui Province, China, in January and February 2020. Med Sci Monit. 2020;26: e926941.PubMedPubMedCentral

73.

Gallo Marin B, Aghagoli G, Lavine K, Yang L, Siff EJ, Chiang SS, et al. Predictors of COVID-19 severity: a literature review. Rev Med Virol. 2021;31(1): e2146.

74.

Lavillegrand J-R, Garnier M, Spaeth A, Mario N, Hariri G, Pilon A, et al. Elevated plasma IL-6 and CRP levels are associated with adverse clinical outcomes and death in critically ill SARS-CoV-2 patients: inflammatory response of SARS-CoV-2 patients. Ann Intensive Care. 2021;11(1):9.PubMedPubMedCentral

75.

RECOVERY Collaborative Group. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet (London, England). 2021;397(10285):1637–45.

76.

Peng J, Fu M, Mei H, Zheng H, Liang G, She X, et al. Efficacy and secondary infection risk of tocilizumab, sarilumab and anakinra in COVID-19 patients: a systematic review and meta-analysis. Rev Med Virol. 2022;32(3): e2295.PubMed

77.

Irwin C, Myrillas T. The role of IL-6 in the pathogenesis of periodontal disease. Oral Dis. 1998;4(1):43–7.PubMed

78.

Kostura V, Bezvushko E, Musij-Sementsiv K. Violation of the regulation of cytokine in chronic catarrhal gingivitis in overweight children. J Med Sci. 2017;86(3):204–6.

79.

Dongari-Bagtzoglou AI, Ebersole JL. Increased presence of interleukin-6 (IL-6) and IL-8 secreting fibroblast subpopulations in adult periodontitis. J Periodontol. 1998;69(8):899–910.PubMed

80.

Zhang Y, Wang C, Jinbu Y, Itoh H, Kusama M. Increased IL-6 levels in peri-implant crevicular fluid correlate with peri-implantitis. Oral Med Pathol. 2005;10(3):95–9.

81.

Yamazaki K, Nakajima T, Gemmell E, Polak B, Seymour GJ, Hara K. IL-4- and IL-6-producing cells in human periodontal disease tissue. J Oral Pathol Med. 1994;23(8):347–53.PubMed

82.

Stadler AF, Angst PDM, Arce RM, Gomes SC, Oppermann RV, Susin C. Gingival crevicular fluid levels of cytokines/chemokines in chronic periodontitis: a meta-analysis. J Clin Periodontol. 2016;43(9):727–45.PubMed

83.

Nibali L, D’Aiuto F, Donos N, Griffiths GS, Parkar M, Tonetti MS, et al. Association between periodontitis and common variants in the promoter of the interleukin-6 gene. Cytokine. 2009;45(1):50–4.PubMed

84.

Reis C, da Costa AV, Guimarães JT, Tuna D, Braga AC, Pacheco JJ, et al. Clinical improvement following therapy for periodontitis: association with a decrease in IL-1 and IL-6. Exp Ther Med. 2014;8(1):323–7.PubMedPubMedCentral

85.

Tamimi F, Altigani S, Sanz M. Periodontitis and coronavirus disease 2019. Periodontol 2000. 2022;89(1):207–14.PubMedPubMedCentral

86.

Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507–13.PubMedPubMedCentral

87.

Wang WK, Chen SY, Liu IJ, Chen YC, Chen HL, Yang CF, et al. Detection of SARS-associated coronavirus in throat wash and saliva in early diagnosis. Emerg Infect Dis. 2004;10:1213–9.PubMedPubMedCentral

Title: Prevalence of oral complications in the course of severe SARS-CoV-2 infection under mechanical non-invasive ventilation
Authors: Elzbieta Paszynska
Maria Gawriolek
Amadeusz Hernik
Justyna Otulakowska-Skrzynska
Hanna Winiarska
Daria Springer
Magdalena Roszak
Zuzanna Slebioda
Anna Krahel
Szczepan Cofta
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: COVID-19
Pneumonia
SARS-CoV-2
Published in: European Journal of Medical Research / Issue 1/2023
Electronic ISSN: 2047-783X
DOI: https://doi.org/10.1186/s40001-023-01273-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prevalence of oral complications in the course of severe SARS-CoV-2 infection under mechanical non-invasive ventilation

Abstract

Background

Material and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Material and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2023

PCMT1 is a potential target related to tumor progression and immune infiltration in liver cancer

Prevalence of asymptomatic strongyloidiasis co-infection in COVID-19 patients residing in endemic areas

Predicting diagnostic biomarkers associated with immune infiltration in Crohn's disease based on machine learning and bioinformatics

Identification of risk factors for disseminated cryptococcosis in non-hiv patients: a retrospective analysis

Coagulation parameters for the differential diagnosis of pancreatic cancer in the early stage: a retrospective study

Neurological manifestations of SARS-CoV-2: complexity, mechanism and associated disorders