{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:02:47Z","timestamp":1787018567698,"version":"build-2736575974"},"reference-count":61,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2022,6,30]],"date-time":"2022-06-30T00:00:00Z","timestamp":1656547200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Dent Res"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:p>Since the beginning of 2020, the entire global health care system has been severely challenged by the outbreak of coronavirus 2019 disease (COVID-19). Robust evidence has demonstrated a more severe course of COVID-19 in the presence of several comorbidities, such as cardiovascular diseases, diabetes mellitus, and obesity. Here, we critically appraise the recent research discoveries linking periodontitis to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to severe COVID-19, with a special focus on the associated biological mechanisms and the available epidemiological evidence. SARS-CoV-2 main receptors and coreceptors (ACE2, TMPRSS2, furin, CD147) are overexpressed in periodontal tissues of periodontitis patients, with inflammation, periodontal pathogens, and damage-induced pyroptosis triggering a positive feedback loop. However, meta-analyses of epidemiological studies only indicated a nonstatistically significant tendency for an increased risk of SARS-CoV-2 infection in subjects with periodontitis (odds ratio [OR]\u2009=\u20091.69; 95% CI, 0.91\u20133.13, P\u2009=\u20090.09). Furthermore, periodontitis may worsen clinical COVID-19 courses through multiple direct and indirect pathways, including damage to lower airways due to aspiration of periodontal pathogens, exacerbation of the cytokine storm via the low-grade chronic systemic inflammation, and SARS-CoV-2 dissemination through the ulcerated gingival epithelium with consequent induced pulmonary vessels vasculopathy. Indeed, meta-analyses of epidemiological studies indicated that periodontitis subjects are more likely to experience a more severe course of COVID-19. Specifically, periodontitis was associated with a 4-fold increased odds of hospitalization (OR\u2009=\u20094.72; 95% CI, 1.11\u201320.03, P\u2009=\u20090.04), 6-fold of requiring assisted ventilation (OR\u2009=\u20096.24; 95% CI, 2.78\u201314.02, P\u2009=\u20090.00), and more than 7-fold of death due to COVID-19 complications (OR\u2009=\u20097.51; 95% CI, 2.16\u201326.10, P\u2009=\u20090.00). The breakthrough analyzed here emphasizes the relevance of the mouth-systemic connection as a target to mitigate the current COVID-19 emergency and the future predicted coronavirus pandemics.<\/jats:p>","DOI":"10.1177\/00220345221104725","type":"journal-article","created":{"date-parts":[[2022,7,1]],"date-time":"2022-07-01T02:08:34Z","timestamp":1656641314000},"page":"1430-1440","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":60,"title":["Periodontitis and COVID-19: Biological Mechanisms and Meta-analyses of Epidemiological Evidence"],"prefix":"10.1177","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9395-4967","authenticated-orcid":false,"given":"G.","family":"Baima","sequence":"first","affiliation":[{"name":"Department of Surgical Sciences, C.I.R. 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