In the absence of a proven cure or vaccine, surviving COVID-19 is no small task. However, the road to recovery after testing negative for the novel coronavirus infection may not be an easy one as the so-called 'long-haulers' have been known to endure several symptoms such as nerve pain, muscle aches, and brain fog. Now, a new symptom could be joining the list—Falling teeth.
According to a recent report by The New York Times, Farah Khemili, a 43-year-old COVID-19 survivor, lost an adult tooth all of a sudden, sparking fears that it had a connection to her having battled a bout of the infection. Upon reaching out to a support group of survivors online, she learnt that she may not be the only one facing the issue.
"We are now beginning to examine some of the bewildering and sometimes disabling symptoms that patients are suffering months after they've recovered from Covid," said Dr. William W. Li, president and medical director of the Angiogenesis Foundation, a nonprofit organization that conducts research on the health and disease of blood vessels. The investigated symptoms also include cases of teeth loss and dental issues.
Loss of Tooth
The impact of the virus on the circulatory system has been well-documented. Along with it, symptoms such as hair loss and swollen toes have also been reported. However, while chewing on a breath mint, Khemili noticed that a tooth in her lower jaw was wiggling. The following day, it fell out; without any pain or blood. Importantly, she had never lost an adult tooth before.
Concerned, she reached out to an online support group for COVID-19 survivors and learnt that members within the group had not only experienced the same problem but also related dental symptoms such as discoloration of the teeth, chipping, and sensitive gums. Clearly shaken, survivors like herself are worried that these symptoms may have a connection to COVID-19.
No Evidence to Establish Link
While the new symptom appears to be a prevalent one, there is no evidence to substantiate an association between COVID-19 and loss of teeth. In the absence of sufficient data, dentists are convinced that the disease alone could not be responsible for the dental symptoms. "It's extremely rare that teeth will literally fall out of their sockets," said Dr. David Okano, a periodontist at the University of Utah.
Though the link between falling teeth and COVID-19 is yet to be proven, Dr. Okano emphasized that existing dental problems in COVID-19 survivors may be aggravated by the disease as they have recuperated from severe infections and face long-term effects.
Dichotomy of the Manifestation
Khemili, who used to be a smoker, visited her dentist a day after losing her tooth. In spite of being assured that her gums were not infected, she was informed that there was notable bone loss owing to her past smoking history. The 43-year-old from Voorheesville, New York, will require a reconstructive procedure costing nearly $50,000.
The 12-year-old son of Diana Berrent, the founder of a support group on Facebook that Khemili's partner communicated with, had also lost an adult tooth after having gone through a mild case of COVID-19. However, the youngster's orthodontist stated that he had healthy teeth with no underlying dental diseases. This adds to the complexity of the unusual symptom.
Painless and Without the Loss of Blood
Other members of Survivor Corp, the group managed by Berrent, have also reported that they have experienced tooth loss without bleeding or pain. For eg, Eileen Luciano, a member of the group has said that she lost a top molar while flossing in early November. "That was the last thing that I thought would happen, that my teeth would fall out," said Luciano.
According to Dr. Li, the loss of tooth without bleeding was indeed peculiar. However, it offers clues that the blood vessels in the gums may be affected by the disease. It is a known fact that the SARS-CoV-2 virus binds with the ACE2 enzyme to gain entry into human cells.
Along with the lungs, the enzyme is also found in endothelial and nerve cells as well. Hence, Dr. Li averred that it is likely that the coronavirus could have caused damage to the blood vessels that sustain the teeth. This could also serve as an explanation for the lack of pain associated with the loss of teeth in COVID-19 survivors.
Cytokine Storms- An Explanation?
Another possible explanation for the peculiar symptom could be 'cytokine storms'. Cytokines are signaling proteins that moderate the immune system by attracting immune cells to the area of infection. In patients with severe COVID-19, the signaling mechanism is impeded and an erratic response of the immune system or a 'cytokine storm', causes damage to healthy tissues. It is likely that a 'cytokine storm' may be expressing itself in the mouth.
"If a Covid long hauler's reaction is in the mouth, it's a defense mechanism against the virus," stated Dr. Michael Scherer, a prosthodontist in Sonora, California. In addition to this, inflammatory conditions such as diabetes and cardiovascular disease may also be linked to gum conditions among these patients, he appended.
"Gum disease is very sensitive to hyper-inflammatory reactions, and Covid long haulers certainly fall into that category," explained Dr. Scherer. While some dentists seem to dismiss the potential link between COVID-19 and dental symptoms, Dr. Li highlighted the physicians must remain alert to spot unprecedented outcomes of the infection.