Gaps in our Knowledge Regarding COVID-19 and Oral Health

While current evidence highlights an association between periodontal disease, oral hygiene, and COVID-19 severity as well as a biologic plausibility of the possible nature of this relationship,^64,93,94 the true mechanisms of action of the interaction between these diseases is not fully elucidated. Currently, there is scarce data from clinical trials and cohort studies to allow for assessment of the interaction between periodontitis and COVID-19. It is imperative that future studies incorporate measures of dental health and oral assessments as a part of risk factor quantification.

It is also currently unknown what the potential long-term effects of COVID-19 infection may be, including the potential for oral diseases. For instance, evidence that has emerged in the last several decades has identified chronic human papilloma virus infection as a causative agent for oropharyngeal cancer.⁹⁵ As more data becomes available about post-acute COVID-19 infection symptomatology and the potential oral manifestations of such so-called “long haul” COVID-19 infections, we may identify other potential oral impacts of COVID-19 infection. Emerging data focused on post-acute COVID-19 syndrome is reported to affect up to 2.5% of infected individuals at 3 months.⁹⁶ Post-acute COVID-19 syndrome demonstrates approximately a 4:1 preponderance for females.⁹⁷ In such individuals more severe symptom presentation has been associated with alterations in taste and smell and it has been established that changes in taste and smell have been associated with a negative impact on mental health and cognitive impairment.^98,99 As more time post-pandemic unfolds, the scientific community and dental healthcare professionals will learn more about the potential oral implications of COVID-19 infection.¹⁰⁰ Data gathering, including COVID-19 infection and symptoms, is critical to allow dental healthcare professionals to continue to assess oral symptoms and implications of COVID-19 in their patients.