Clinical and Pathogenetic Aspects of Oral Cavity Disorders in Patients with Post-COVID Syndrome
DOI:
https://doi.org/10.11603/2311-9624.2024.3.14976Keywords:
COVID-19, post-COVID-19 syndrome, inflammatory periodontal diseases, inflammatory diseases, immune responses, cytokine stormAbstract
Summary. The pathogenesis of inflammatory periodontal diseases is based on an immunologically mediated inflammatory response in periodontal tissues under the influence of specific microflora. The new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) significantly affects the condition of oral cavity organs, particularly the microbiome.
The aim of the study – to investigate the relationship between periodontitis and post-COVID syndrome through their cytokine connection, in order to form a basis for recommendations in the COVID era for patients with periodontitis who have an increased risk of adverse consequences.
Materials and Methods. A dental examination was conducted on 63 patients aged 25–45 years with a history of COVID-19, of which 47 patients were found to have periodontal tissue lesions (main group). Assessment of periodontal tissue condition was performed clinically, using the combined periodontal index (PI), and radiographic examination. The content of pro-inflammatory (IL-1β, IL-6, TNF-α) and anti-inflammatory cytokines (IL-4, IL-10) in oral fluid was determined by enzyme-linked immunosorbent assay.
Results and Discussion. Determination of periodontal status in patients of the main group showed that mild gingivitis was diagnosed in (19.15±2.12) % of cases, moderate gingivitis in (25.53±3.15) %, severe gingivitis in (31.91±6.26) %, and periodontitis in (23.41±4.26) % of cases. In patients aged 25-35 years, the frequency of detection of initial forms of inflammatory-destructive processes was (23.08±4.12) %, generalized periodontitis of II degree – in (12.50±2.11) %. In patients aged 36–45 years, generalized periodontitis of I degree was diagnosed in (11.53±1.21) %, II degree – in (41.17±11.23) %, III degree – in (2.13±0.12) %. The periodontal index in patients with generalized periodontitis of I degree aged 25–35 years was 0.45±0.05, in 36–45-year-olds – (0.78±0.07) points. The radiographic index of gingival recession in 25–35-year-olds was 1.89±0.21, in the 36–45 age group it was 1.5 times higher. Determination of IL-1β, IL-6, TNF-α content in the oral fluid of patients showed an increase in their levels by 2.46, 1.83, and 1.45 times respectively, which correlated with the severity of the disease. The content of anti-inflammatory cytokines IL-4 and IL-10 in oral fluid exceeded the values of the same indicator in the control group by 4.37 and 2.21 times respectively, which may indicate a "cytokine storm".
Conclusions. One of the pathogenetic mechanisms that occurs in periodontal tissue diseases in the post-COVID period is an increase in the formation of pro- and anti-inflammatory cytokines, which ensures their consistently high level. The common pathogenesis mechanism for periodontal condition and post-COVID syndrome - the "cytokine storm" – is important for finding modern, timely, and correct diagnostic methods, a rational approach to treatment, consistent with evidence-based medicine standards.
References
Repec’ka, O.M., Rozhko, M.M. Skrypnyk, N.V., & Il’nyc’ka, O.M. (2020). Poshyrenist’ ta intensyvnist’ zahvorjuvan’ tkanyn parodonta v osib molodogo viku na tli pervynnogo gipotyreozu [Prevalence and intensity of periodontal tissue diseases in young people with primary hypothyroidism]. Suchasna stomatologija – Modern dentistry, 1, 46-48.
DOI: 10.33295/1992-576X-2020-1-46 [in Ukrainian].
Melnyk, A.L., Dovha, I.M., Khrystian, H.Ye., Radchenko, O.O., Povolokina, I.V., & Kazmirchuk V.V. (2015). Intehralna kharakterystyka infektsiino-zapalnykh zakhvoriuvan porozhnyny rota [The integrated characteristic of infectious-inflammatory diseases of the oral cavity]. Klinichna ta eksperymentalna patolohiia - Clinical and experimental pathology, 1, 215-220.
DOI: 10.24061/1727-4338.XIV.1.51.2015.48 [in Ukrainian].
Mazur, I., Levchenko, A.-O., Slobodyanyk, M., & Mazur, P. (2022). Suchasni pidkhody do likuvannia zakhvoriuvan parodontu z vykorystanniam mistsevoho preparatu z protyzapalnymy ta antybakterialnymy vlastyvostiamy [Modern approaches to the treatment of periodontal diseases using a topical drug with anti-inflammatory and antibacterial properties]. Oral and General Health, 3(3), 47-51.
DOI:10.22141/ogh.3.3.2022.124 [in Ukrainian].
Nemesh, O.M, Honta, Z.M., Slaba, O.M., & Shylivskyi, I.V. (2021). Pathogenetic mechanisms of comorbidity of systemic diseases and periodontal pathology. Wiad Lek., 74(5), 1262-1267. PMID: 34090302.
Fesenko, V.I., & Shvec’, S.V. (2016). Dejaki klinichni ta laboratorni pokaznyky perebigu generalizovanogo parodontytu u hvoryh hronichnym virusnym gepatytom B. [Some clinical and laboratory indicators of the course of generalized periodontal disease in patients with chronic viral hepatitis B] Materials of the XII international research and practice conference. Sheffild., 18-22 [in Ukrainian].
Kotel’ban, A.V., Godovanec’, O.I. Koval’, G.D., & Kamyshnyj, O.M. (2017). Osoblyvosti ekspresii’ mRNK YL-1β, YL-17A ta YL-10 epiteliju rotovoi’ porozhnyny ditej, hvoryh na cukrovyj diabet [Expression of mRNA IL-1β, IL-17А and IL-10 of oral epithelium in diabetic children] Mizhnarodnyj endokrynologichnyj zhurnal – International endocrinological Journal, 1(13), 56-60.
DOI: 10.22141/2224-0721.13.1.2017.96758 [in Ukrainian].
Ghosh, A., Joseph, B., & Anil, S. (2022). Does periodontitis influence the risk of COVID-19? A scoping review. Clin Exp Dent Res, 8(5), 1011-1020.
DOI: 10.1002/cre2.584.
Ren, L.L., Wang, Y.M, Wu, Z.Q., Xiang, Z.C., Guo, L., Xu, T., & Jiang, Y.Z. (2020). Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study. Chin Med J (Engl), 133(9), 1015-1024.
DOI: 10.1097/CM9.0000000000000722.
Zhu, N., Zhang, D., Wang, W., Li, X., Yang, B., Song, J., & Zhao, X. (2020). China Novel Coronavirus Investigating and Research Team. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med., 382(8), 727-733. DOI: 10.1056/NEJMoa2001017.
Pfützner, A., Lazzara, M., & Jantz, J. (2020). Why Do People With Diabetes Have a High Risk for Severe COVID-19 Disease? - A Dental Hypothesis and Possible Prevention Strategy. J Diabetes Sci Technol., 14(4), 769-771. DOI: 10.1177/1932296820930287.
COVID-19 (coronavirus): Long-term effects. Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-long-term-effects/art-20490351.
Hutchings, S.D., Watchorn, J., Trovato, F., Napoli, S., Mujib, S.F., Hopkins, P., & McPhail, M. (2021). Microcirculatory, Endothelial, and Inflammatory Responses in Critically Ill Patients With COVID-19 Are Distinct From Those Seen in Septic Shock: A Case Control Study. Shock., 55(6), 752-758. DOI: 10.1097/SHK.0000000000001672.
Tay, M.Z., Poh, C.M., Rénia, L., MacAry, P.A., & Ng, L.F.P. (2020). The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol., 20(6), 363-374. DOI: 10.1038/s41577-020-0311-8.
Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., & Zhang, L. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet., 395(10223), 497-506.
DOI: 10.1016/S0140-6736(20)30183-5.
Okabayashi, T., Kariwa, H., Yokota, S., Iki, S., Indoh, T., Yokosawa, N., Takashima, I., Tsutsumi, H., & Fujii, N. (2006). Cytokine regulation in SARS coronavirus infection compared to other respiratory virus infections. J Med Virol., 78(4), 417-24. DOI: 10.1002/jmv.20556.
Qin, C., Zhou, L., Hu, Z., Zhang, S., Yang, S., Tao, Y., Xie, C., Ma, K., Shang, K., Wang, W., & Tian, D.S. (2020). Dysregulation of Immune Response in Patients With Coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis., 71(15), 762-768. DOI: 10.1093/cid/ciaa248.
Sahni, V., & Gupta, S. (2020). COVID-19 & Periodontitis: The cytokine connection. Med Hypotheses., 144, 109908. DOI: 10.1016/j.mehy.2020.109908.
Mohan, A., Iyer, V.A., Kumar, D., Batra, L., & Dahiya, P. (2023). Navigating the Post-COVID-19 Immunological Era: Understanding Long COVID-19 and Immune Response // Life (Basel), 13(11), 2121.
DOI: 10.3390/life13112121.
England, J.T., Abdulla, A., Biggs, C.M., Lee, A.Y.Y., Hay, K.A.R., Hoiland, L., Wellington, C.L.M., Sekhon, Jamal, S., Shojania, K., & Chen, L.Y.C. (2021). Weathering the COVID-19 storm: Lessons from hematologic cytokine syndromes. Blood Rev., 45, 100707.
DOI: 10.1016/j.blre.2020.100707.
Iannaccone, G., Scacciavillani, R., Del Buono, M.G., Camilli, M., Ronco, C., Lavie C.J., Abbate A., Crea F., Massetti M., & Aspromonte N. (2020). Weathering the Cytokine Storm in COVID-19: Therapeutic Implications. Cardiorenal Med., 10(5), 277-287.
DOI: 10.1159/000509483.
Wu, J.T., Leung, K., & Leung, G.M. Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study. Lancet. 2020;395(10225):689-697. DOI: 10.1016/S0140-6736(20)30260-9.
An, J., Liao, X., Xiao, T., Qian, S., Yuan, J., Ye, H., & Qi, F. (2020). Clinical characteristics of recovered COVID-19 patients with re-detectable positive RNA test. Ann Transl Med., 8(17), 1084. DOI: 10.21037/atm-20-5602.
Li, Q., Shuai, L., Tan, L., Song, L., Ou, C., Song, X., He, J., Gao, M., Hu, X., Liu Y., Chen H., Zou Z., Yu C., Qin B., & Xu W. (2021). Clinical characteristics and prediction analysis of the recovered COVID-19 patients with re-detectable positive RNA test. Am J Transl Res., 13(12), 14157-14167. PMID: 35035761; PMCID: PMC8748099.
Garg, J., Agarwal, J., Das, A., & Sen, M. (2021). Recurrent COVID-19 infection in a health care worker: a case report. J Med Case Rep., 15(1), 363.
DOI: 10.1186/s13256-021-02881-8.
Tang, X., Musa, S.S., Zhao, S., & He, D. (2021). Reinfection or Reactivation of Severe Acute Respiratory Syndrome Coronavirus 2: A Systematic Review. Front Public Health., 9, 663045. DOI: 10.3389/fpubh.2021.663045.
Cheng, W.C., Hughes, F.J., & Taams, L.S. (2014). The presence, function and regulation of IL-17 and Th17 cells in periodontitis. J Clin Periodontol., 41(6), 541-9. DOI: 10.1111/jcpe.12238.
Graves, D. (2008). Cytokines that promote periodontal tissue destruction. J Periodontol., 79(8 Suppl), 1585-91. DOI: 10.1902/jop.2008.080183.
Gheorghita, R., Soldanescu, I., Lobiuc, A., Caliman Sturdza, O.A., Filip, R., Constantinescu-Bercu, A., Dimian, M., Mangul, S., & Covasa, M. (2024). The knowns and unknowns of long COVID-19: from mechanisms to therapeutical approaches. Front Immunol., 15, 1344086.
DOI: 10.3389/fimmu.2024.1344086.
Sherif, Z.A., Gomez, C.R., Connors, T.J., Henrich, T.J., & Reeves, W.B. (2023). RECOVER Mechanistic Pathway Task Force. Pathogenic mechanisms of post-acute sequelae of SARS-CoV-2 infection (PASC). Elife., 12:e86002. DOI: 10.7554/eLife.86002.
Choutka, J., Jansari, V., Hornig, M., & Iwasaki, A. (2022). Unexplained post-acute infection syndromes. Nat Med., 28(5), 911-923. DOI: 10.1038/s41591-022-01810-6.
Doykov, I., Hällqvist, J., Gilmour, K.C., Grandjean, L., Mills, K., & Heywood, W.E. (2020). 'The long tail of Covid-19' - The detection of a prolonged inflammatory response after a SARS-CoV-2 infection in asymptomatic and mildly affected patients. F1000Res., 9, 1349.
DOI: 10.12688/f1000research.27287.2.
Fernández-de-Las-Peñas, C., Palacios-Ceña, D., Gómez-Mayordomo, V., Cuadrado, M.L., & Florencio, L.L. (2021). Defining Post-COVID Symptoms (Post-Acute COVID, Long COVID, Persistent Post-COVID): An Integrative Classification. Int J Environ Res Public Health., 18(5), 2621.
DOI: 10.3390/ijerph18052621.
Savielieva, N.M., & Diasamidze, M.Ye. (2023). Korelyatsiyni zviazky mizh kariiesom zubiv i klinichnymy pokaznykamy rotovoi porozhnyny v osib, yaki perekhvorily na COVID-19, iz urakhuvannyam psykhoemotsiynoho stanu [Correlations between dental caries and clinical indicators of oral fluid among patients with covid-19, taking into account the psycho-emotional state]. Ukrayinskyy stomatolohichnyy almanakh – Ukrainian Dental Almanac, 2, 10-14.
DOI:10.31718/2409-0255.2.2023.02 [in Ukrainian].
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 CLINICAL DENTISTRY
This work is licensed under a Creative Commons Attribution 4.0 International License.
