The Relationship Between Covid-19 And Periodontitis Severity: A Cohort Study
                                    
                                 
                                
                                    
                                                                                                                                                                                                                        Year 2025,
                                                                                        Volume: 35 Issue: 4,                                                                                                                 277 - 281,                                     21.10.2025                                
                                
                                                                                                                        
                                                                                                                                                
                                                        Fatma Öner
                                                                                                            
                                                
                                                                                                    ,
                                                
                                                                                                                                
                                                                                                                                                
                                                        Yerda Özkan Karasu
                                                                                                                    
                                                                                                            
                                                
                                                                                                    ,
                                                
                                                                                                                                
                                                                                                                                                
                                                        Kamber Kaşali
                                                                                                            
                                                
                                                                                                    ,
                                                
                                                                                                                                
                                                                                                                                                
                                                        Gökhan Özgenç
                                                                                                            
                                                
                                                                                                    ,
                                                
                                                                                                                                
                                                                                                                                                
                                                        Ahmet Burak Türetken
                                                                                                            
                                                
                                                                                                    ,
                                                
                                                                                                                                
                                                                                                                                                
                                                        Erol Emir Ceylan
                                                                                                            
                                                
                                                                                                    ,
                                                
                                                                                                                                
                                                                                                                                                
                                                        Afra Nur Toker
                                                                                                            
                                                
                                                                                                    ,
                                                
                                                                                                                                
                                                                                                                                                
                                                        Hasan Basri Bircan
                                                                                                            
                                                
                                                                                                    ,
                                                
                                                                                                                                
                                                                                                                                                
                                                        Zülal Özkurt
                                                                                                            
                                                
                                                
                                                                                                                                                                                            
                                                                    
                                
                                
                                                                    
                                        Abstract
                                        Objective:  The aim of this study is to examine the relationship between periodontal disease and COVID-19 severity by retrospectively evaluating patient records and periodontal status.
Methods: 344 patients were included in the study. The severity of periodontal disease was determined as healthy, mild, moderate and severe according to NHANES criteria. The Covid-19 severity of the patients was grouped as asymptomatic/mild, moderate and severe according to whether the patients required hospitalization and intensive care.
Results: There was statistically significant relationship was observed between Covid-19 severity and periodontal status (p<0.001).
Conclusion: Periodontitis and the severity of Covid-19 increases, regardless of systemic diseases and age.
                                     
                                
                                                                                                    
                                
                                                                
                                                                
                                
                                                                
                                                                    
                                        References
                                        
                                            
                                                                                                    - 
                                                        1.	Marouf N, Cai W, Said KN, et al. Association between periodontitis and severity of COVID‐19 infection: A case–control study. J Clin Periodontol. 2021;48(4):483-491. doi:10.1111/jcpe.13435
- 
                                                        2.	Andrews M, Gao H, Datta S, Katz J. Increased odds for COVID-19 infection among individuals with periodontal disease. Clin Oral Invest. 2023;27(10):5925-5933. doi:10.1007/s00784-023-05204-x
- 
                                                        3.	Hamza A, Shah N, Azad A, Ghanshyam O, Khan Z. Impact of age, gender and comorbidities affecting the severity of COVID-19 infection in Kashmir. J Family Med Primary Care. 2022;11(4):1519-1524. doi:10.4103/jfmpc.jfmpc_278_21
- 
                                                        4.	Genco RJ, Sanz M. Clinical and public health implications of periodontal and systemic diseases: An overview. Periodontol 2000. 2020;83(1):7-13. doi:10.1111/prd.12344
- 
                                                        5.	Sanz M, Beighton D, Curtis MA, et al. Role of microbial biofilms in the maintenance of oral health and in the development of dental caries and periodontal diseases. Consensus report of group 1 of the Joint EFP/ORCA workshop on the boundaries between caries and periodontal disease. J Clin Periodontol. 2017;44(S18). doi:10.1111/jcpe.12682
- 
                                                        6.	Vos T, Abajobir AA, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2017;390(10100):1211-1259. doi:10.1016/s0140-6736(17)32154-2
- 
                                                        7.	Martonik D, Parfieniuk-Kowerda A, Rogalska M, Flisiak R. The role of TH17 response in COVID-19. Cells. 2021;10(6):1550. doi:10.3390/cells10061550
- 
                                                        8.	Carmona Loayza DA, Lafebre MF. Periodontal disease and COVID-19: Prognosis and potential pathways of association in their pathogenesis. Can J Dent Hyg. 2023;57(1):44-51.
- 
                                                        9.	Tang Y, Liu J, Zhang D, Xu Z, Ji J, Wen C. Cytokine Storm in COVID-19: The current evidence and treatment strategies. Front Immunol. 2020;11. doi:10.3389/fimmu.2020.01708
- 
                                                        10.	Can FK, Özkurt Z, Öztürk N, Sezen S. Effect of IL‐6, IL‐8/CXCL8, IP‐10/CXCL 10 levels on the severity in COVID 19 infection. Int J Clin  Practice. 2021;75(12). doi:10.1111/ijcp.14970
- 
                                                        11.	Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ. Prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res. 2012;91(10):914-920. doi:10.1177/0022034512457373
- 
                                                        12.	Anand PS, Jadhav P, Kamath KP, Kumar SR, Vijayalaxmi S, Anil S. A case‐control study on the association between periodontitis and coronavirus disease (COVID‐19). J Periodontol. 2021;93(4):584-590. doi:10.1002/jper.21-0272
- 
                                                        13.	Zhou Y, Wang W, Sun Y, et al. The prevalence and risk factors of psychological disturbances of frontline medical staff in china under the COVID-19 epidemic: Workload should be concerned. J Affect Disord. 2020;277:510-514.
doi:10.1016/j.jad.2020.08.059
- 
                                                        14.	Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intens Care Med. 2020;46(5):846-848. doi:10.1007/s00134-020-05991-x
- 
                                                        15.	Herold T, Jurinovic V, Arnreich C, et al. Elevated levels of IL-6 and CRP predict the need for mechanical ventilation in COVID-19. J Aller Clin Immun. 2020;146(1):128-136.e4. doi:10.1016/j.jaci.2020.05.008
- 
                                                        16.	Del Valle DM, Kim-Schulze S, Huang HH, et al. An inflammatory cytokine signature predicts COVID-19 severity and survival. Nature Med. 2020;26(10):1636-1643. doi:10.1038/s41591-020-1051-9
- 
                                                        17.	Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppression.  Lancet. 2020;395(10229):1033-1034. doi:10.1016/s0140-6736(20)30628-0
- 
                                                        18.	Cheng W, Hughes FJ, Taams LS. The presence, function and regulation of IL‐17 and Th17 cells in periodontitis. J Clin  Periodontol. 2014;41(6):541-549. doi:10.1111/jcpe.12238
- 
                                                        19.	Graves D. Cytokines that promote periodontal tissue destruction. J Periodontol. 2008;79(8S):1585-1591. doi:10.1902/jop.2008.080183
- 
                                                        20.	Koppolu P, Genady EM, Albdeirat LM, et al. Association between Severity of COVID-19, Periodontal Health and Disease in Riyadh Subpopulation. Int J Mycobacteriol. 2023;12(1):33-37. doi:10.4103/ijmy.ijmy_236_22
- 
                                                        21.	Anand PS, Jadhav P, Kamath KP, Kumar SR, Vijayalaxmi S, Anil S. A case‐control study on the association between periodontitis and coronavirus disease (COVID‐19). J Periodontol. 2021;93(4):584-590. doi:10.1002/jper.21-0272
- 
                                                        22.	Zhu L, Tang Z, Hu R, Gu M, Yang Y. Ageing and inflammation: What happens in periodontium? Bioengineering. 2023;10(11):1274. doi:10.3390/bioengineering10111274
- 
                                                        23.	Ebersole JL, Graves CL, Gonzalez OA, et al. Aging, inflammation, immunity and periodontal disease. Periodontol 2000. 2016;72(1):54-75. doi:10.1111/prd.12135
- 
                                                        24.	Endeshaw Y, Campbell K. Advanced age, comorbidity and the risk of mortality in COVID-19 infection. J National Med Assoc. 2022;114(5):512-517. doi:10.1016/j.jnma.2022.06.005
- 
                                                        25.	Matsuyama R, Nishiura H, Kutsuna S, Hayakawa K, Ohmagari N. Clinical determinants of the severity of Middle East respiratory syndrome (MERS): a systematic review and meta-analysis. BMC Public Health. 2016;16(1). doi:10.1186/s12889-016-3881-4
- 
                                                        26.	Badawi A, Ryoo SG. Prevalence of comorbidities in the Middle East respiratory syndrome coronavirus (MERS-CoV): a systematic review and meta-analysis. International Journal of Infectious Diseases. 2016;49:129-133. doi:10.1016/j.ijid.2016.06.015
- 
                                                        27.	Treskova-Schwarzbach M, Haas L, Reda S, et al. Pre-existing health conditions and severe COVID-19 outcomes: an umbrella review  approach and meta-analysis of global evidence. BMC Med. 2021;19(1). doi:10.1186/s12916-021-02058-6
- 
                                                        28.	Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel Coronavirus–Infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061.
doi:10.1001/jama.2020.1585
- 
                                                        29.	Li L, Huang T, Wang Y, et al. COVID‐19 patients’ clinical characteristics, discharge rate, and fatality rate of meta‐analysis. J Med Virol. 2020;92(6):577-583. doi:10.1002/jmv.25757
- 
                                                        30.	Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. New England J Med. 2020;382(18):1708-1720. doi:10.1056/nejmoa2002032
- 
                                                        31.	Liu R, Han H, Liu F, et al. Positive rate of RT-PCR detection of SARS-CoV-2 infection in 4880 cases from one hospital in Wuhan, China, from Jan to Feb 2020. Clinica Chimica Acta. 2020;505:172-175. doi:10.1016/j.cca.2020.03.009
- 
                                                        32.	Hopkinson NS, Rossi N, El-Sayed_Moustafa J, et al. Current smoking and COVID-19 risk: results from a population symptom app in over 2.4 million people. Thorax. 2021;76(7):714-722.
doi:10.1136/thoraxjnl-2020-216422
- 
                                                        33.	Haffajee AD, Socransky SS. Relationship of cigarette smoking to attachment level profiles. J Clin Periodontol. 2001;28(4):283-295. doi:10.1034/j.1600-051x.2001.028004283.x
- 
                                                        34.	Steffens JP, Wang X, Starr JR, Spolidorio LC, Van Dyke TE, Kantarci A. Associations between sex hormone levels and periodontitis in men: Results from NHANES III. J Periodontol. 2015;86(10):1116-1125. doi:10.1902/jop.2015.140530
- 
                                                        35.	Eke PI, Thornton-Evans GO, Wei L, Borgnakke WS, Dye BA. Accuracy of NHANES periodontal examination protocols. J Dent  Res. 2010;89(11):1208-1213. doi:10.1177/0022034510377793
 
                                     
                                                             
                                                                                
                                
                                
                                    
                                                                                                                                                                                                                        Year 2025,
                                                                                        Volume: 35 Issue: 4,                                                                                                                 277 - 281,                                     21.10.2025                                
                                
                                                                                                                        
                                                                                                                                                
                                                        Fatma Öner
                                                                                                            
                                                
                                                                                                    ,
                                                
                                                                                                                                
                                                                                                                                                
                                                        Yerda Özkan Karasu
                                                                                                                    
                                                                                                            
                                                
                                                                                                    ,
                                                
                                                                                                                                
                                                                                                                                                
                                                        Kamber Kaşali
                                                                                                            
                                                
                                                                                                    ,
                                                
                                                                                                                                
                                                                                                                                                
                                                        Gökhan Özgenç
                                                                                                            
                                                
                                                                                                    ,
                                                
                                                                                                                                
                                                                                                                                                
                                                        Ahmet Burak Türetken
                                                                                                            
                                                
                                                                                                    ,
                                                
                                                                                                                                
                                                                                                                                                
                                                        Erol Emir Ceylan
                                                                                                            
                                                
                                                                                                    ,
                                                
                                                                                                                                
                                                                                                                                                
                                                        Afra Nur Toker
                                                                                                            
                                                
                                                                                                    ,
                                                
                                                                                                                                
                                                                                                                                                
                                                        Hasan Basri Bircan
                                                                                                            
                                                
                                                                                                    ,
                                                
                                                                                                                                
                                                                                                                                                
                                                        Zülal Özkurt
                                                                                                            
                                                
                                                
                                                                                                                                                                                            
                                                                    
                                
                                
                                                                    
                                
                                                                
                                                                
                                                                
                                
                                                                
                                                                    
                                        References
                                        
                                            
                                                                                                    - 
                                                        1.	Marouf N, Cai W, Said KN, et al. Association between periodontitis and severity of COVID‐19 infection: A case–control study. J Clin Periodontol. 2021;48(4):483-491. doi:10.1111/jcpe.13435
- 
                                                        2.	Andrews M, Gao H, Datta S, Katz J. Increased odds for COVID-19 infection among individuals with periodontal disease. Clin Oral Invest. 2023;27(10):5925-5933. doi:10.1007/s00784-023-05204-x
- 
                                                        3.	Hamza A, Shah N, Azad A, Ghanshyam O, Khan Z. Impact of age, gender and comorbidities affecting the severity of COVID-19 infection in Kashmir. J Family Med Primary Care. 2022;11(4):1519-1524. doi:10.4103/jfmpc.jfmpc_278_21
- 
                                                        4.	Genco RJ, Sanz M. Clinical and public health implications of periodontal and systemic diseases: An overview. Periodontol 2000. 2020;83(1):7-13. doi:10.1111/prd.12344
- 
                                                        5.	Sanz M, Beighton D, Curtis MA, et al. Role of microbial biofilms in the maintenance of oral health and in the development of dental caries and periodontal diseases. Consensus report of group 1 of the Joint EFP/ORCA workshop on the boundaries between caries and periodontal disease. J Clin Periodontol. 2017;44(S18). doi:10.1111/jcpe.12682
- 
                                                        6.	Vos T, Abajobir AA, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2017;390(10100):1211-1259. doi:10.1016/s0140-6736(17)32154-2
- 
                                                        7.	Martonik D, Parfieniuk-Kowerda A, Rogalska M, Flisiak R. The role of TH17 response in COVID-19. Cells. 2021;10(6):1550. doi:10.3390/cells10061550
- 
                                                        8.	Carmona Loayza DA, Lafebre MF. Periodontal disease and COVID-19: Prognosis and potential pathways of association in their pathogenesis. Can J Dent Hyg. 2023;57(1):44-51.
- 
                                                        9.	Tang Y, Liu J, Zhang D, Xu Z, Ji J, Wen C. Cytokine Storm in COVID-19: The current evidence and treatment strategies. Front Immunol. 2020;11. doi:10.3389/fimmu.2020.01708
- 
                                                        10.	Can FK, Özkurt Z, Öztürk N, Sezen S. Effect of IL‐6, IL‐8/CXCL8, IP‐10/CXCL 10 levels on the severity in COVID 19 infection. Int J Clin  Practice. 2021;75(12). doi:10.1111/ijcp.14970
- 
                                                        11.	Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ. Prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res. 2012;91(10):914-920. doi:10.1177/0022034512457373
- 
                                                        12.	Anand PS, Jadhav P, Kamath KP, Kumar SR, Vijayalaxmi S, Anil S. A case‐control study on the association between periodontitis and coronavirus disease (COVID‐19). J Periodontol. 2021;93(4):584-590. doi:10.1002/jper.21-0272
- 
                                                        13.	Zhou Y, Wang W, Sun Y, et al. The prevalence and risk factors of psychological disturbances of frontline medical staff in china under the COVID-19 epidemic: Workload should be concerned. J Affect Disord. 2020;277:510-514.
doi:10.1016/j.jad.2020.08.059
- 
                                                        14.	Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intens Care Med. 2020;46(5):846-848. doi:10.1007/s00134-020-05991-x
- 
                                                        15.	Herold T, Jurinovic V, Arnreich C, et al. Elevated levels of IL-6 and CRP predict the need for mechanical ventilation in COVID-19. J Aller Clin Immun. 2020;146(1):128-136.e4. doi:10.1016/j.jaci.2020.05.008
- 
                                                        16.	Del Valle DM, Kim-Schulze S, Huang HH, et al. An inflammatory cytokine signature predicts COVID-19 severity and survival. Nature Med. 2020;26(10):1636-1643. doi:10.1038/s41591-020-1051-9
- 
                                                        17.	Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppression.  Lancet. 2020;395(10229):1033-1034. doi:10.1016/s0140-6736(20)30628-0
- 
                                                        18.	Cheng W, Hughes FJ, Taams LS. The presence, function and regulation of IL‐17 and Th17 cells in periodontitis. J Clin  Periodontol. 2014;41(6):541-549. doi:10.1111/jcpe.12238
- 
                                                        19.	Graves D. Cytokines that promote periodontal tissue destruction. J Periodontol. 2008;79(8S):1585-1591. doi:10.1902/jop.2008.080183
- 
                                                        20.	Koppolu P, Genady EM, Albdeirat LM, et al. Association between Severity of COVID-19, Periodontal Health and Disease in Riyadh Subpopulation. Int J Mycobacteriol. 2023;12(1):33-37. doi:10.4103/ijmy.ijmy_236_22
- 
                                                        21.	Anand PS, Jadhav P, Kamath KP, Kumar SR, Vijayalaxmi S, Anil S. A case‐control study on the association between periodontitis and coronavirus disease (COVID‐19). J Periodontol. 2021;93(4):584-590. doi:10.1002/jper.21-0272
- 
                                                        22.	Zhu L, Tang Z, Hu R, Gu M, Yang Y. Ageing and inflammation: What happens in periodontium? Bioengineering. 2023;10(11):1274. doi:10.3390/bioengineering10111274
- 
                                                        23.	Ebersole JL, Graves CL, Gonzalez OA, et al. Aging, inflammation, immunity and periodontal disease. Periodontol 2000. 2016;72(1):54-75. doi:10.1111/prd.12135
- 
                                                        24.	Endeshaw Y, Campbell K. Advanced age, comorbidity and the risk of mortality in COVID-19 infection. J National Med Assoc. 2022;114(5):512-517. doi:10.1016/j.jnma.2022.06.005
- 
                                                        25.	Matsuyama R, Nishiura H, Kutsuna S, Hayakawa K, Ohmagari N. Clinical determinants of the severity of Middle East respiratory syndrome (MERS): a systematic review and meta-analysis. BMC Public Health. 2016;16(1). doi:10.1186/s12889-016-3881-4
- 
                                                        26.	Badawi A, Ryoo SG. Prevalence of comorbidities in the Middle East respiratory syndrome coronavirus (MERS-CoV): a systematic review and meta-analysis. International Journal of Infectious Diseases. 2016;49:129-133. doi:10.1016/j.ijid.2016.06.015
- 
                                                        27.	Treskova-Schwarzbach M, Haas L, Reda S, et al. Pre-existing health conditions and severe COVID-19 outcomes: an umbrella review  approach and meta-analysis of global evidence. BMC Med. 2021;19(1). doi:10.1186/s12916-021-02058-6
- 
                                                        28.	Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel Coronavirus–Infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061.
doi:10.1001/jama.2020.1585
- 
                                                        29.	Li L, Huang T, Wang Y, et al. COVID‐19 patients’ clinical characteristics, discharge rate, and fatality rate of meta‐analysis. J Med Virol. 2020;92(6):577-583. doi:10.1002/jmv.25757
- 
                                                        30.	Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. New England J Med. 2020;382(18):1708-1720. doi:10.1056/nejmoa2002032
- 
                                                        31.	Liu R, Han H, Liu F, et al. Positive rate of RT-PCR detection of SARS-CoV-2 infection in 4880 cases from one hospital in Wuhan, China, from Jan to Feb 2020. Clinica Chimica Acta. 2020;505:172-175. doi:10.1016/j.cca.2020.03.009
- 
                                                        32.	Hopkinson NS, Rossi N, El-Sayed_Moustafa J, et al. Current smoking and COVID-19 risk: results from a population symptom app in over 2.4 million people. Thorax. 2021;76(7):714-722.
doi:10.1136/thoraxjnl-2020-216422
- 
                                                        33.	Haffajee AD, Socransky SS. Relationship of cigarette smoking to attachment level profiles. J Clin Periodontol. 2001;28(4):283-295. doi:10.1034/j.1600-051x.2001.028004283.x
- 
                                                        34.	Steffens JP, Wang X, Starr JR, Spolidorio LC, Van Dyke TE, Kantarci A. Associations between sex hormone levels and periodontitis in men: Results from NHANES III. J Periodontol. 2015;86(10):1116-1125. doi:10.1902/jop.2015.140530
- 
                                                        35.	Eke PI, Thornton-Evans GO, Wei L, Borgnakke WS, Dye BA. Accuracy of NHANES periodontal examination protocols. J Dent  Res. 2010;89(11):1208-1213. doi:10.1177/0022034510377793