SUSCEPTIBILITY OF PERIODONTITIS PATIENTS TO COVID-19 INFECTION: A CRITICAL APPRAISAL BASED-ON CLINICAL AND BIO-MOLECULAR ANALYSES

Abstract

Periodontitis, an oral bacterial dysbiosis-induced inflammatory disease on dental supporting tissue, has been reported to reach 73% of the population in Indonesia. Accumulating evidence shows that periodontitis is closely associated to systemic disease through direct bacterial invasion, inflammation, and oral-gut connection pathways. Meanwhile, at the moment, the world is suffering from Corona Virus Disease-19 (COVID-19). It affects host inflammatory response resulting in fatal outcomes. The binding of SARS-CoV-2, a COVID-19 virus, to Angiotensin-Converting Enzyme 2 (ACE-2) receptor in the oral cavity and nasopharyngeal is identified to be the initiation of COVID-19 infection. However, a preliminary study suggested a novel infection route by using its spike protein to bind to the Cluster of Differentiation 147 (CD 147) and transmembrane serine protease 2 (TMPRSS2) on cell membranes, not necessarily ACE-2. In this sense, studies demonstrated that buccal and sub-gingival component of periodontal pocket oral epithelial cells and gingival epithelium derived from periodontitis patients display high expression of CD 147. In the level of clinical aspect, many studies investigate the potential correlation of periodontitis to COVD-19 complication and severity. In the present study, we highlight the possible mechanism by which periodontitis links to COVID-19 in a critical appraisal based on clinical and bio-molecular analyses. In conclusion, periodontitis and COVID-19 share inflammatory reaction aspect. Further, periodontitis could be a risk factor for COVID- 19 as the severe periodontitis patient may have tendency of COVID-19 complication even worse.