The Role of Oral Health in the Acquisition and Severity of SARS-CoV-2: A Retrospective Chart Review

Abstract

Objective: Studies have shown that gingival crevices may be a significant route for SARS-CoV-2 entry. However, the role of oral health in the acquisition and severity of COVID-19 is not known.

Design: A retrospective analysis was performed using electronic health record data from a large urban academic medical center between 12/1/2019 and 8/24/2020. A total of 387 COVID-19 positive cases were identified and matched 1:1 by age, sex, and race to 387 controls without COVID-19 diagnoses. Demographics, number of missing teeth and alveolar crestal height were determined from radiographs and medical/dental charts. In a subgroup of 107 cases and controls, we also examined the rate of change in alveolar crestal height. A conditional logistic regression model was utilized to assess association between alveolar crestal height and missing teeth with COVID-19 status and with hospitalization status among COVID-19 cases.

Results: Increased alveolar bone loss, OR = 4.302 (2.510 - 7.376), fewer missing teeth, OR = 0.897 (0.835-0.965) and lack of smoking history distinguished COVID-19 cases from controls. After adjusting for time between examinations, cases with COVID-19 had greater alveolar bone loss compared to controls (0.641 ± 0.613 mm vs 0.260 ± 0.631 mm, p < 0.01.) Among cases with COVID-19, increased number of missing teeth OR = 2.1871 (1.146- 4.174) was significantly associated with hospitalization.

Conclusions: Alveolar bone loss and missing teeth are positively associated with the acquisition and severity of COVID-19 disease, respectively.

Keywords: AC, alveolar crest; ACE2, angiotensin-converting enzyme 2; ACH, alveolar crestal height; Bone loss; CEJ, cemento-enamel junction; COVID-19; COVID-19, coronavirus disease 2019; Coronavirus; Periodontal disease(s)/periodontitis; Periodontal tissues/periodontium; SARS-CoV-2, severe acute respiratory syndrome virus 2; TMPRSS2, transmembrane serine protease 2.

Fig. 1

Alveolar Crestal Height Measurements. A. Alveolar crestal height (ACH) measurements were obtained from bitewing radiographs. B. Investigators visually located the cemento-enamel junction (CEJ) and alveolar crest (AC) on the mesial and distal of teeth present on bitewings, demonstrated by the dot markings on tooth #29. C. Measurements were obtained using the image analysis tools within Medcore Imaging MiPACS Dental Enterprise Viewer software. ACH was measured as the distance between the CEJ and the AC on the distal (a) and mesial (b) of each tooth captured on bitewing. An average of all measurements was taken to determine the patient’s average alveolar crestal height.