Abstract
Recent studies have demonstrated a relationship between the severe clinical course of COVID-19 and other chronic diseases such as: cardiovascular disease, hypertension, diabetes mellitus, obesity and chronic renal disease. It may be possible to extend this association to a common and chronic oral disease in adults: periodontitis. Alternatively, the latter could be simply related to the systemic chronic diseases cited above, as already observed in the non-COVID-19 literature. In order to provide an overview and their opinion, the authors in this perspective article will report and discuss the most recent references of interest relating to COVID-19 and periodontitis pathophysiology. Within such a narrative review, the authors will hypothesize that the association between chronic periodontitis and COVID-19 could exist via two pathways: a direct link, through the ACEII and CD147 receptors used by the virus to infect the cells, which would occur in greater numbers in cases of periodontitis (thereby favoring a SARS-CoV-2 infection); and/or an indirect pathway involving the overexpression of inflammatory molecules, especially IL-6 and IL-17. An expression of the latter has been found to play a role in periodontitis, in addition to severe cases of COVID-19, although it is still unclear if it plays a direct role in the worsening of the clinical course.
Highlights
Coronavirus disease 2019 (COVID-19), due to SARS-CoV2, is the most pressing and emergent health problem worldwide
With reference to the hypothesis in this article concerning the association between periodontal pathophysiology and COVID-19, let us begin with the argumentation of the studies showing that SARS-CoV-2 enters the Campisi et al Head & Face Medicine (2021) 17:16 human body via the oral mucosa [1, 14] through the Angiotensin Converting Enzyme II (ACE2) receptor [15,16,17], which is highly expressed in the oral mucosa [16, 18] and in the salivary glands [5]
ACE2, TMPRSS2 and furin, which are expressed in the aforementioned oral epithelial cells and the proteases produced by periodontopathic bacteria, could cleave the protein S of the virus, thereby favoring infection
Summary
Coronavirus disease 2019 (COVID-19), due to SARS-CoV2, is the most pressing and emergent health problem worldwide. By causing ulceration of the gingival epithelium, periodontitis could reduce the protective function of the oral epithelial cells, thereby exposing the patients to an elevated risk of invasion by SARS-CoV-2 [1].
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