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hiv and oral health

HIV, Oral Health and COVID-19

By: 

  • Mark Schweizer, DDS MPH
    Director of Development and Special Projects
    Dental Director Southeastern AIDS Training and Education Center
    Nova Southeastern University College of Dental Medicine

The relationship between oral health and overall health has been well established for many comorbidities including diabetes and cardiovascular disease.

We are still learning about COVID-19 and how it affects people living with HIV. Based on limited data, people with HIV who are on effective HIV treatment have the same risk for COVID 19 as people who do not have HIV.

Older adults and people of any age who have serious underlying medical conditions might be at increased risk for severe illness. This includes people who have weakened immune systems. The risk for people with HIV getting very sick is greatest in

  • People with a low CD4 cell count, and
  • People not on effective HIV treatment (antiretroviral therapy or ART).

Several recent studies indicate that a potential relationship exists between oral health, specifically periodontal disease, and severity of COVID 19 symptoms. A summary of these studies is

  • There is a potential link between SARS CoV 2 and bacterial load, questioning
    whether bacteria may play a role in bacterial superinfecti ons and complications
    such as pneumonia, acute respiratory distress syndrome and sepsis.
  • Bacteria that colonize the mouth are shed into the saliva. The pathogenic
    bacteria within the saliva can then be aspirated into the lower respiratory tract
    and cause or aggravate an infection
  • Comorbidities at highest risk of COVID 19 complications also cause imbalances
    in the oral microbiome and increase the risk of periodontal disease.
  • In addition, high bacterial load in the mouth may exacerbate post viral
    complications

This stresses the importance of patients living with HIV maintaining good oral health and visiting their dentists on a regular basis.

The below diagram illustrates how bacteria from the oral cavity and inflammatory cytokines have affect the lungs.

References:

  1. Botros, Iyer. Ojcius, Is there an association between oral health and severity of COVID-19 complications? Biomedical Journal, Volume 43, Issue 4, 2020,Pages 325-327, ISSN 2319-4170, https://doi.org/10.1016/j.bj.2020.05.016.
  2. Brian, Z., & Weintraub, J. A. (2020). Oral Health and COVID-19: Increasing the Need for Prevention and Access. Preventing chronic disease, 17, E82. https://doi.org/10.5888/pcd17.200266.
  3. Sampson, V., Kamona, N. & Sampson, A. Could there be a link between oral hygiene and the severity of SARS-CoV-2 infections? Br Dent J 228, 971–975 (2020). https://doi.org/10.1038/s41415-020-1747-8.
  4. Viviana Pitones-Rubio, E.G. Chávez-Cortez, Angélica Hurtado-Camarena, Anna González-Rascón, Nicolás Serafín-Higuera, Is periodontal disease a risk factor for severe COVID-19 illness? Medical Hypotheses, Volume 144, 2020, 109969,ISSN 0306-9877, https://doi.org/10.1016/j.mehy.2020.109969.