Oral health can be an additional, modifiable risk factor for high risk COVID-19 patients

 The correlation between poor oral health and COVID-19 severity, as well as the correlation between oral health and delayed recovery, demonstrates a potential need to consider oral health an additional risk factor for cardiac patients who may contract COVID-19. The new sub-study, examining Egyptian cardiac patients, will be presented at ACC Middle East 2021, a hybrid meeting held in partnership by the American College of Cardiology, Egyptian Society of Cardiology and the ACC Egypt Chapter on Oct. 14-15, 2021.

The oral cavity is a potential reservoir for respiratory pathogens. Previous trials have linked poor oral hygiene with increased inflammation and cardiovascular disease. According to the researchers, COVID-19 severity has also been linked to an inflammatory response.

The researchers hypothesized that increased COVID-19 severity may be linked to poor oral health status, especially in patients with cardiovascular diseases. According to the study authors, the study assessed oral health status, severity of COVID-19 symptoms, C-reactive protein (CRP) levels and duration of recovery.

“Oral tissues could act as a reservoir for SARS-CoV-2, developing a high viral load in the oral cavity. Therefore, we recommended maintenance of oral health and improving oral hygiene measures, especially during COVID-19 infection,” said Ahmed Mustafa Basuoni, MD, cardiology consultant at Cairo University and lead author of the study. “Simple measures like practicing proper oral hygiene, raising awareness of oral health importance either in relation to COVID-19 infection or systemic diseases by using media and community medicine, regular dental visits, especially in patients with CVD, and using [antimicrobial] mouthwashes [could help in] preventing or decreasing the severity of COVID-19 disease.” 

The study included 86 Egyptian heart disease patients with a confirmed COVID-19 PCR test. Using a questionnaire, researchers from Cairo University assessed oral health and COVID-19 severity. An oral health score was used to determine the effect of oral health on COVID-19. Data on CRP levels and COVID-19 PCR tests were collected via the questionnaire and confirmed via medical records. CRP levels are used to determine when there is inflammation in the body.

According to the researchers, the correlation between oral health and COVID-19 severity showed a significant inverse relationship, as did the correlation between oral health with recovery period and CRP values. Poor oral health was correlated to increased values of CRP and delayed recovery, especially in patients with cardiac diseases.

“Oral health should be a part of routine history taking and examination in cardiac patients,” Basuoni said. “Lifestyle measures should be instructed to all cardiac patients regarding good oral hygiene with regular dental visits. We need to give more space in research for these risk factors which can be easily modified.”