Severe generalized periodontitis as a risk factor for serious outcomes of COVID- 19: a structural equation modelling approach

Abstract

Abstract Objectives This study aimed to assess the periodontal condition in COVID-19 patients and determine the multidirectional association between severe generalized periodontitis and COVID-19 outcomes.Materials and Methods Periodontal conditions were clinically assessed in 214 hospitalized patients due to COVID-19, and the course of the disease was registered prospectively from hospital admission. A conceptual model was developed to predict the impact of severe generalized periodontitis on poor symptomatology, intensive care unit (ICU) admission, and death of COVID-19 patients. The model was tested using Structure Equation Modeling (SEM) to predict severe COVID-19 outcomes as affected by periodontitis, when including comorbidities, patient's age, and smoking habit as potential confounding variables.Results Severe generalized periodontitis was diagnosed in 51 (23.8%) patients, and 52 (26.8%) died due to aggravated COVID-19. SEM analysis revealed that severe generalized periodontitis was positively associated with severe-critical COVID-19 symptoms in hospitalized patients [standard coefficient (sc) = 0.166; 95%CI = 0.014–0.319; p = 0.032] and influenced by confounders (age and smoking). Significant associations were observed in the pathway from presentation of severe-critical symptoms to ICU admission (sc = 0.995; 95%CI = 0.924–1.065; p < 0.001) and death (sc = 0.512; 95%CI = 0.392–0.631; p < 0.001].Conclusions Findings suggest that severe generalized periodontitis may play a role in the aggravation of COVID-19 symptoms and the risks of subsequent need for ICU admission and death.Clinical Relevance: These results elucidate the probable course of the relationship between periodontitis and COVID-19, emphasizing the importance of periodontitis as a risk factor and accentuating the needs of prevention and handle of periodontal disease in the inhibition of COVID-19 complications.