Research Topic

Interplay Between Periodontal Diseases and COVID-19: Risk Factors, Immunopathogenesis, Microbiome Dysbiosis and Therapeutic Response

About this Research Topic

Periodontal diseases constitute a group of chronic inflammatory diseases of complex aetiopathogenesis that leads to destruction of periodontal tissues and eventual tooth loss. A dysregulated host immune response against an established dysbiotic microbiota, modulated by genetic, environmental and behavioral host-related risk factors dictate the stages of disease severity and therapeutic response. Periodontal diseases have also been associated with other multi-factorial inflammatory systemic disorders by mechanisms that may involve dissemination of key periodontal pathogens, their virulence byproducts and local inflammatory mediators to distant body sites through the circulatory system and/or the oral-gut axis. The nuances and unique features of different hosts in coping with this network of chronic inflammatory diseases have shifted our way of managing disease toward a personalized approach in the field of Periodontal Medicine. In this context, we have witnessed the impact of the HIV/AIDS epidemic on oral health before the HAART establishment, including the outbreak of necrotizing periodontal diseases. Further data suggest that interactions between the oral microbiome and virome may play a role in the aetiopathogenesis of severe periodontitis; hence, the link between viral infections and periodontal diseases is not a new idea but an ongoing discussion that demands more investigation.

Now we face an unprecedented global outbreak of a viral severe acute respiratory syndrome (COVID-19) caused by a new coronavirus, SARS-CoV-2, with deleterious impact on global health and economics. While the world’s scientific community is making all efforts to learn more about several aspects of COVID-19, investigators have pointed to possible connections between periodontal diseases and severe forms of this viral infection. The ACE-2 receptor is highly expressed on the oral mucosa, making the mouth a potential route of entry and dissemination of SARS-CoV-2. In addition, increased stress and anxiety, changes in lifestyle, financial pressure and delayed access to supportive periodontal therapy due to isolation may also contribute to poor oral hygiene and further periodontal chronic inflammation and attachment loss. The oral-gut axis is another important pathway linking periodontal pathogens to gut dysbiosis and systemic inflammation. Recent findings indicate that SARS-CoV-2 may be spread by fecal-oral transmission. As reported for other viral infections, SARS-CoV-2 may also interact with the oral microbiome leading to a dysbiotic ecosystem that favors the overgrowth of pathobionts related to periodontal destructive diseases.

Plausible hypotheses supporting a potential bi-lateral link between periodontal diseases and COVID-19 are encouraged to be tested. Associations between prevalence and severity of periodontitis or poor oral hygiene and increased risk for developing severe COVID-19 illness or different clinical manifestations of this viral infection have not been explored. The inflammatory processes shared by both diseases may clarify the mechanisms involved in severe tissue destruction seen in these diseases.
Can the virus interact with the periodontal microbiota/environment, causing dysbiosis and establishment of an Inflammatory state? How has the pandemic impacted periodontal treatment, and consequently disease progression, tooth loss and increased costs with restorative dentistry?
Studies should be conducted to evaluate the benefits of professional periodontal therapy/prophylaxis in diminishing dissemination of SARS-CoV-2 and progression of COVID-19 to more severe cases, especially in patients with comorbidities.

We welcome original research, reviews, mini-reviews, hypotheses or case reports that integrate basic and clinical research covering, but not limited to, the following topics:
- Preventive and therapeutic periodontal protocols to mitigate complications of COVID-19, before, during and after viral infection
- Inflammatory network between Periodontitis and COVID-19
- Potential interactions between SARS-CoV-2 and periodontal bacteria/biofilm
- Psychosocial distress and limited access to adequate periodontal care during and post-pandemic: impact on global epidemiology, progression, prognosis and financial burden related to the management of periodontal disease.


Keywords: Periodontal Disease, Microbiome, SARS-CoV-2, COVID-19, Immune-Inflammatory Response


Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

Periodontal diseases constitute a group of chronic inflammatory diseases of complex aetiopathogenesis that leads to destruction of periodontal tissues and eventual tooth loss. A dysregulated host immune response against an established dysbiotic microbiota, modulated by genetic, environmental and behavioral host-related risk factors dictate the stages of disease severity and therapeutic response. Periodontal diseases have also been associated with other multi-factorial inflammatory systemic disorders by mechanisms that may involve dissemination of key periodontal pathogens, their virulence byproducts and local inflammatory mediators to distant body sites through the circulatory system and/or the oral-gut axis. The nuances and unique features of different hosts in coping with this network of chronic inflammatory diseases have shifted our way of managing disease toward a personalized approach in the field of Periodontal Medicine. In this context, we have witnessed the impact of the HIV/AIDS epidemic on oral health before the HAART establishment, including the outbreak of necrotizing periodontal diseases. Further data suggest that interactions between the oral microbiome and virome may play a role in the aetiopathogenesis of severe periodontitis; hence, the link between viral infections and periodontal diseases is not a new idea but an ongoing discussion that demands more investigation.

Now we face an unprecedented global outbreak of a viral severe acute respiratory syndrome (COVID-19) caused by a new coronavirus, SARS-CoV-2, with deleterious impact on global health and economics. While the world’s scientific community is making all efforts to learn more about several aspects of COVID-19, investigators have pointed to possible connections between periodontal diseases and severe forms of this viral infection. The ACE-2 receptor is highly expressed on the oral mucosa, making the mouth a potential route of entry and dissemination of SARS-CoV-2. In addition, increased stress and anxiety, changes in lifestyle, financial pressure and delayed access to supportive periodontal therapy due to isolation may also contribute to poor oral hygiene and further periodontal chronic inflammation and attachment loss. The oral-gut axis is another important pathway linking periodontal pathogens to gut dysbiosis and systemic inflammation. Recent findings indicate that SARS-CoV-2 may be spread by fecal-oral transmission. As reported for other viral infections, SARS-CoV-2 may also interact with the oral microbiome leading to a dysbiotic ecosystem that favors the overgrowth of pathobionts related to periodontal destructive diseases.

Plausible hypotheses supporting a potential bi-lateral link between periodontal diseases and COVID-19 are encouraged to be tested. Associations between prevalence and severity of periodontitis or poor oral hygiene and increased risk for developing severe COVID-19 illness or different clinical manifestations of this viral infection have not been explored. The inflammatory processes shared by both diseases may clarify the mechanisms involved in severe tissue destruction seen in these diseases.
Can the virus interact with the periodontal microbiota/environment, causing dysbiosis and establishment of an Inflammatory state? How has the pandemic impacted periodontal treatment, and consequently disease progression, tooth loss and increased costs with restorative dentistry?
Studies should be conducted to evaluate the benefits of professional periodontal therapy/prophylaxis in diminishing dissemination of SARS-CoV-2 and progression of COVID-19 to more severe cases, especially in patients with comorbidities.

We welcome original research, reviews, mini-reviews, hypotheses or case reports that integrate basic and clinical research covering, but not limited to, the following topics:
- Preventive and therapeutic periodontal protocols to mitigate complications of COVID-19, before, during and after viral infection
- Inflammatory network between Periodontitis and COVID-19
- Potential interactions between SARS-CoV-2 and periodontal bacteria/biofilm
- Psychosocial distress and limited access to adequate periodontal care during and post-pandemic: impact on global epidemiology, progression, prognosis and financial burden related to the management of periodontal disease.


Keywords: Periodontal Disease, Microbiome, SARS-CoV-2, COVID-19, Immune-Inflammatory Response


Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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Submission Deadlines

26 February 2021 Manuscript
26 March 2021 Manuscript Extension

Participating Journals

Manuscripts can be submitted to this Research Topic via the following journals:

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Topic Editors

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Submission Deadlines

26 February 2021 Manuscript
26 March 2021 Manuscript Extension

Participating Journals

Manuscripts can be submitted to this Research Topic via the following journals:

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