Oral Health Changes Reported by 70% of Utahn Long-COVID Patients

Oral Health Changes Reported by 70% of Utahn Long-COVID Patients ORAL HEALTH CHANGES REPORTED BY 70% OF UTAHN LONG-COVID PATIENTS

1 in 5 individuals infected with SARS-CoV-2 will develop lasting post-infection complications(1). These complications, referred to as Long COVID, may impact multiple organ systems throughout the body, including the central nervous system (CNS), respiratory, and cardiovascular systems among others (Figure 1). Recent studies have reported oral health changes in Long COVID patients. We anticipate more patients developing Long COVID as the COVID-19 pandemic continues and more patients experience primary infections and reinfection(s). The underlying mechanisms of Long COVID are not well defined and no curative therapies are currently available. The aim of this article to educate the local dental community about oral health changes associated with Long COVID and outline local resources for patients.

Post-COVID Oral Disease (PCoV-OD) In Utah

Fig 2. Oral health changes in Utahn Long COVID

70% of Utahn Long COVID patients surveyed report changes in their oral health. An active survey of Long COVID-19 patients is being conducted by the University of Utah Health. Initial analysis has identified 81 out of 114 (70%) Long COVID patients report changes in their oral health. As detailed in Figure 2, patients are experiencing Dry mouth or change in saliva (68%), Receding, swollen or bleeding gums (63%), Grinding or clenching teeth (51%), Oral or jaw joint pain (44%), Discoloring, chipped, cracked or broken teeth (21%), or Tooth loss or loosening (20%), among other symptoms. Average age of respondents with oral health changes is 52 ± 11 years. There is a strong female predominance in the Long COVID patient population with 9:1 female to male ratio.

Multiple studies have characterized the impact of the SARS-CoV-2 infection on oral health. SARSCoV-2 has been shown to actively infect and replicate within salivary gland tissue(2). Deterioration of oral health in PCoV-OD patients can start occurring months after a SARS-CoV-2 infection(3). Similar to the symptoms reported by the Utahn Long COVID patients, Brandini, et al noted dry mouth, tooth pain, chipped or cracked teeth, gingival recession, oral ulcers, and tooth loss, among other symptoms in a review of oral health issues reported post-SARS-CoV2 infection (4). Early publications of PCoV-OD oral symptoms have additionally described ectasia of the salivary ducts and sialadenitis (5,6). Larger studies are

now required to further characterize Long COVIDoral disease and to decipher the underlying mechanisms of PCoV-OD. One of the challenges will be to differentiate between PCoV-OD and oral health changes due to limited access to dental care during the COVID-19 pandemic.

What is Causing Long COVID and PCoV-OD?

Research into the underlying cause(s) of Long COVID is the focus of numerous research studies in the United States and around the world. Currently there are multiple hypotheses of what may be causing Long COVID, including(7):

As of yet, the underlying mechanisms of Long COVID and PCoV-OD are not well understood. The National Institutes of Health (NIH) recently started the Recover initiative to support basic and clinical research to define the mechanisms of Long COVID and to support the development of targeted therapies (https://recovercovid.org).

Potential Similarities with Sjogren’s Syndrome

We can learn from other similar viral-mediated diseases that impact oral health, namely Sjogren’s Syndrome (SjS). Sjogren’s syndrome (SjS) is a chronic autoimmune disease diagnosed by xerostomia or xerophthalmia, autoantibody profiles (anti-SSA/Ro, anti-SSB/La) and focal inflammation within labial minor salivary gland tissue. With a strong female bias, SjS is most often diagnosed in women in of peri- or post-menopausal ages (40-50s) but is also diagnosed in male and female patients ranging in age from pediatric to geriatric. Similar to Long COVID, SjS patients often report dry mouth, increased caries and inflammation within the oral cavity. The underlying etiology of SjS is attributed to a chronic pathogen exposure in genetically susceptible individuals. The Weller Lab at the University of Utah School of Dentistry studies the salivary gland microbiome and differential profiles present in SjS salivary gland tissue, including Hepatitis Delta Virus (HDV). Chronic presence of viruses in salivary gland tissue can significantly alter the cellular metabolic profile and may contribute to altered saliva flow and/or saliva buffering capacity. The similarities between SjS and PCoV-OD are striking, including oral and systemic symptoms and patient demographics. The one primary difference is the timeline for onset of disease: Sjogren’s syndrome can take years to develop and meet criteria for diagnosis. Long COVID and PCoV-OD appear to have a rapid onset of months post infection. This rapid onset of oral health changes in patients post-SARS-CoV-2 infection warrant increased surveillance in the dental community.

Information on Resources and Clinical Studies

If you know of dental patients that are experiencing Long COVID or PCoV-OD symptoms, please share the local resources below:

COVID-19 Long-Hauler Clinic at the University of Utah Health: https://healthcare.utah.edu/locations/covid-19-clinic/

The Long-term COVID19 Symptom Survey: https://redcap.link/Utah.Long.COVID

Melodie Weller, PhD Virologist, Assistant Professor School of Dentistry, University of Utah Melodie.Weller@hsc.utah.edu, 801-213-2078

References: 1. Bull-Otterson L, et al. Post–COVID Conditions

Among Adult COVID-19 Survivors Aged 18–64 and ≥65 Years - United States, March 2020–

November 2021. MMWR 2022;71:713–717 2. Huang N, et al. SARS-CoV-2 infection of the oral cavity and saliva. Nat Med. 2021 May;27(5):892–903. 3. Lambert N, et al. COVID-19 Survivors’ Reports of the Timing, Duration, and Health Impacts of Post-

Acute Sequelae of SARS-CoV-2 (PASC)

Infection. medRxiv (non-peer reviewed preprint) 4. Brandini DA, et al. Covid-19 and Oral Diseases:

Crosstalk, Synergy or Association? Rev Med

Virol. 2021 Nov;31(6):e2226 5. Gherlone EF, et al. Frequent and Persistent

Salivary Gland Ectasia and Oral Disease After

COVID-19. J Dent Res. 2021 Mar 3 6. Chern A, et al. Sialadenitis: A Possible Early

Manifestation of COVID-19. Laryngoscope. 2020

Nov;130(11):2595–7. 7. Ortona E, et al. Long COVID: To Investigate

Immunological Mechanisms and Sex/Gender

Related Aspects as Fundamental Steps for

Tailored Therapy. Eur Respir J. 2022;59(2):2102245.