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Earlier this month, Farah Khemili put a mint breath in her mouth and noticed a strange sensation: a bottom tooth squirming against her tongue.
Khemili, 43, of Voorheesville, New York, had never lost an adult tooth. She touched the tooth to confirm it was loose, initially thinking the problem might be mint. The next day, the tooth flew out of her mouth and into her hand. There was no blood or pain.
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Khemili survived a fight with Covid-19 this spring, and joined an online support group as she endured a series of symptoms experienced by many other “long carriers”: brain fog, muscle pain and nerve pain.
There is not yet strong evidence that infection can lead to tooth loss or related problems. But among members of her support group, she found others who also described falling teeth, as well as sensitive gums and teeth turning gray or chipped.
She and other survivors baffled by the well-documented effects of Covid-19 on the circulatory system, as well as symptoms such as swollen toes and hair loss, also suspect a link to tooth loss. But some dentists, citing a lack of data, are skeptical that Covid-19 alone could cause dental symptoms.
“It’s extremely rare for teeth to literally fall out of their sockets,” said Dr. David Okano, a periodontist at the University of Utah in Salt Lake City.
But existing dental problems may worsen as a result of Covid-19, he added, especially as patients recover from acute infections and cope with its long-term effects.
And some experts say doctors and dentists need to be open to such possibilities, especially because more than 47% of adults aged 30 or older suffer from some form of periodontal disease, including infections and inflammation of the legs. gums and bones that surround teeth, according to a 2012 report from the Centers for Disease Control and Prevention.
“We are now beginning to examine some of the puzzling and sometimes debilitating symptoms patients suffer months after recovering from COVID,” including these accounts of dental problems and tooth loss, said Dr. William W. Li, president and physician director of the Angiogenesis Foundation, a nonprofit organization that studies blood vessel health and disease.
While Khemili had become more diligent in her dental care, she had a history of dental problems before contracting the coronavirus. When she went to the dentist the day after her tooth came out, he found that her gums were not infected but that she had significant bone loss from smoking. He referred Khemili to a specialist for reconstruction. The dental procedure will likely cost him just under $ 50,000.
On the same day Khemili’s tooth fell out, his partner went to Survivor Corp, a Facebook page for people who have experienced COVID-19. There, he discovered that Diana Berrent, the founder of the page, was reporting that her 12-year-old son had lost one of his adult teeth, months after having had a mild case of COVID-19. (Unlike Khemili, Berrent’s son had normal, healthy teeth with no underlying disease, according to his orthodontist.)
Other members of the Facebook group posted articles about tooth loss without bleeding. A woman lost a tooth while eating ice cream. Eileen Luciano, of Edison, New Jersey, showed an upper molar in early November while flossing.
“It was the last thing I thought would happen, that my teeth would fall out,” said Luciano.
Teeth that fall out without blood are unusual, Li said, and provide a clue that there could be something going on with the blood vessels in the gums.
The new coronavirus is wreaking havoc by binding to the ACE2 protein, which is ubiquitous in the human body. Not only is it found in the lungs, but also on nerve and endothelial cells. Therefore, Li said, it is possible that the virus damaged the blood vessels that keep teeth alive in Covid-19 survivors; it may also explain why those who have lost their teeth do not feel any pain.
It is also possible that the generalized immune response, known as a cytokine storm, is manifesting in the mouth.
“If the reaction of a long COVID transporter is in the mouth, it is a defense mechanism against the virus,” said Dr. Michael Scherer, prosthodontist in Sonora, California. Other inflammatory health conditions, such as cardiovascular disease and diabetes, he said, are also correlated with gum disease in the same patients.
“Gum disease is very susceptible to hyper-inflammatory reactions, and long-haul Covid certainly falls into this category,” Scherer said.
Dentists haven’t seen many of these cases and some reject these individual claims. But doctors like Li say surprises from Covid-19 demand that the profession be on the lookout for unintended consequences of the disease.
“Patients can make new discoveries,” he said, and doctors and dentists need to work together to understand the long-term effects of Covid-19 on teeth.
For now, Khemili is hoping her story serves as an edifying tale. If people don’t take the necessary precautions to protect themselves from the coronavirus, “they might consider something like this.”
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