Irene Hartmann
05/05/2021 12:10
Clarín.com
Society
Updated 05/05/2021 12:10
The upholsterer, an older man, told while extending the subway that he had had coronavirus in January.
He had had a bad time and had sequels: “The teeth ... you don't know.
They move me.
And the gums, all inflamed ”.
Pulling that cord, a novelty appeared: international research teams are watching with concern the link between
severe Covid
and
periodontal disease
, or
gingivitis
, the chronic inflammation of the tissues that "grip" the teeth.
Googling it is easy to find stories worse than those of the upholsterer, marked by nightmarish images, such as
the
loss
of teeth without bleeding
, an effect of the "late" Covid.
However, it will be explained in these lines, it is isolated information, without accurate scientific proof, so it should be relativized.
In any case, the relationship works, but in reverse: it would be the
periodontal disease
itself
, a condition that, according to the Argentine Society of Periodontology (SAP), has - to some degree - more than
95%
of the adult population (although the majority ignores it), which would
amplify the body's inflammatory response to Covid infection
.
How do you know?
Experts have been finding
periodontal disease bacteria in the lungs
of people who died from coronavirus.
The bridge, there is almost no doubt, exists.
Medical personnel, in the Intensive Care Unit in a clinic in Florencio Varela, province of Buenos Aires.
Photo EFE
For periodontists it is not new.
From the pre-ndemic they know that the
less clean the mouth is
, the wider the
entry route for viruses and bacteria
.
In fact, the relationship of periodontitis with different infectious and cardiovascular diseases and also with diabetes has been proven for years.
Some hard facts about the mouth-Covid relationship can be found in an
April
paper
this year in the prestigious
Journal of Oral Medicine and Dental Research.
It is titled "Association Between Periodontitis and Severe Covid-19 Infection: A Case-Control Study."
Experts from the Complutense universities in Madrid (Spain), the McGill in Montreal (Canada) and the Qatar University studied 568 patients who had had Covid.
The conclusions were overwhelming.
They deduced that periodontal disease had increased
their chances of being
hospitalized for coronavirus
3.5 times
,
the need to receive mechanical respiration 4 times
and
the risk of death
almost
9 times
.
But how does that bridge happen?
Pathogen Highway
According to
Claudio Furman
, specialist in periodontics, co-director of the career devoted to this specialty at Maimonides University and former president of the SAP, “when there is periodontal disease, including gingivitis, which is bleeding from the gums and the first stage of the disease periodontal,
periodontal pockets
are generated
.
The epithelium, which is the skin that covers the inner part of the gum, is
ulcerated
, something that in itself is linked to systemic pathologies of all kinds ”.
“These ulcers are an entry point for all kinds of pathogens.
Viruses are comfortable in bags, which end up being viral reservoirs.
From there to the bloodstream, the relationship is direct
.
And that is why a person who contracts Covid ends up having a faster negative progress of the disease if they also have periodontal disease, "he continued.
There's more: “Added to this,
periodontal disease is itself a systemic inflammation
.
It seems localized in the mouth, but it affects the whole organism.
It is a generalized inflammatory process. "
So, "if the patient with Covid develops Multisystemic Inflammatory Syndrome (
N. del R .: also called“ cytokine storm ”, an excessive immune response of the body against the virus
), that response could be
superimposed and amplified with the inflammation that of by itself it generates periodontitis
”.
Immunothrombosis
All this is also detailed in another
recent
paper
from the same journal, entitled “The Covid-19 route: a proposed oral-vascular-pulmonary route for SARS-CoV-2 infection and the importance of health care measures. oral health".
The Intensive Care Unit of the Alberto Balestrini Hospital, in La Matanza.
Photo Télam
There, a team of British, American and South African scientists delve into the role of the nasal, oral cavities and saliva as entry points and reservoirs for pathogens.
They clarify how this bridge is strengthened if the patient
has periodontal disease
.
"In the
periodontitis, the entry of the virus into the circulation could be facilitated by micro-ulcerations in the epithelium of the bursa.
Poor oral hygiene and the accumulation of dental plaque can further intensify this pathway,
"says the study.
And he remarks: "
From the gingival capillaries, the virus could reach the lungs via the vascular route
, where it would trigger the main known pathological driver of the disease,
immunothrombosis
."
After a detailed review of the operation of this process, the experts conclude with advice that should not be ignored: "Prioritize daily oral hygiene and oral medical care, since
such measures could save the lives of patients with Covid-19
" .
Debate
In the absence of local statistics,
Clarín
asked the American team "
Covid
Survivors
" (
Survivorcorps.com
) if they had received dental reports from their large community, which exceeds 160,000 members.
They reported, based on a survey carried out by Facebook, that
28% of those consulted stated that they had been left with some post-Covid oral sequel.
However, in the light of what has been said, these cases could reflect rather the aggravation of a previous condition rather than the “sudden” appearance of periodontal problems, something that Furman defined as “very unlikely”.
“
The logic indicates that teeth do not come out or loosen from one day to the next
.
Of course, time could indicate something else, but for now, no such thing can be affirmed, ”he said.
Asked about this issue,
Daniel Casim
, head of the bucco-maxillo-facial service of the Garrahan Hospital and surgeon of the Clinic of Attention for Patients of High Medical Risk (CLAPAR-Faculty of Dentistry of the UBA), confirmed to have seen "
very rare cases
last year".
Bleeding gums (or gingivitis) represent the first stage of periodontal disease.
Photo File
“I do not have a scientific work done, but what I saw is that patients who had Covid and who came to my office
had a destroyed mouth
, with loss of bone tissue, rapidly advancing periodontitis, inflammation of the periodontal tissue with loss of insertion and resorption bone, ”he recalled.
For Casim, “it is clear that these patients
suffered significant immunological stress
.
Their defenses lowered, the bacteria in their mouths surely increased and this could have resulted in a deterioration at the periodontal level.
I saw patients with implants almost exposed.
In total, there will have been 10 or 12 cases in the whole year ”.
It would be risky to say that, in addition to the fact that periodontal disease can increase the severity of Covid, something similar happens in reverse.
For now, Furman remarked that "people have to be made aware that
it is not normal for the gums to bleed
. Inflammation is the first symptom. Good hygiene reduces the viral load in the mouth. It is as important as hand washing. ".
ACE
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