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.
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