Alveolar bone loss and tooth loss are associated with COVID-19 severity but are not independent risk factors. An explorative study

PURPOSE: This study explores the association between alveolar bone loss, tooth loss and severity of COVID-19. MATERIALS AND METHODS: In this retrospective cohort study, we included patients with confirmed COVID-19 who have had a dental panoramic radiograph within a maximum period of 5 years, providing information about alveolar bone loss and tooth loss. The severity of COVID-19 was determined based on the WHO clinical progression scale: (1) Mild/Ambulatory; (2) Moderate/Hospitalized; (3) Severe/Intensive care unit (ICU) or death. RESULTS: 1730 patients were identified with COVID-19 from until October 31, 2020 in the Isala Hospital. Of these patients, 389 ever visited the OMFS department. 133 patients have had an orthopantomograph within a maximum period of 5 years and were included for analysis. The results showed a significant association between alveolar bone loss and COVID-19 severity (p = 0.028). Patients with alveolar bone loss had 5.6 times higher odds to be admitted to ICU or died, compared to ambulatory patients (OR: 5.60; 95%CI: 1.21; 25.99; P = 0.028). More tooth loss was significantly associated with COVID-19 severity (p = 0.047). Per tooth lost, patients had 4.2% higher odds for severe than mild COVID-19 (OR: 1.04; 95%CI: 1.00; 1.09; P = 0.047) and 6.0% higher odds for severe than moderate COVID-19 (OR: 1.06; 95%CI: 1.01; 1.11; P = 0.017). When adjusting for confounders in multivariate analyses, the significant associations of COVID-19 with alveolar bone loss and tooth loss were no longer present. CONCLUSION: In this retrospective explorative pilot study, alveolar bone loss and tooth loss are associated with the severity of COVID-19, however they are not independent risk factors. The current study could contribute to the design of further studies on the relationship between oral health and COVID-19.