Prevention
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A new study suggests that people with gum disease may be almost nine times more likely to die from COVID-19 than people without dental problems.
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The researchers found that those with periodontal disease were also 3.5 times more likely to be admitted to the ICU and 4.5 times more likely to need a ventilator.
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A dentist explains why gum disease may be associated with a more severe case of COVID-19.
From the beginning, doctors have known that COVID-19 is especially dangerous for high-risk groups, including older adults and people with underlying health problems, such as heart disease and asthma. But the research is still discovering new risk factors, which now include gum disease. The condition can affect up to half of American adults and appears to be linked to a higher COVID-19 mortality rate, according to a new study published earlier this month in Journal of Clinical Periodontology.
In the study, the researchers followed 568 patients infected with the new coronavirus, dividing them into two groups: those without major problems (mild symptoms) and those who faced complications such as admission and ventilation in the ICU or, eventually, death. They found that COVID-19 patients with gum disease were nine times more likely to die, 4.5 times more likely to need a ventilator and 3.5 times more likely to be admitted to the ICU than patients without signs of dental problems.
It is not the only science that links coronavirus to gum health; Research from Mexico and the United Kingdom, released in June and November of last year, respectively, also identified periodontal disease as a significant risk factor for severe SARS-CoV-2 infection and death. Newly discovered oral symptoms, such as “COVID tongue”, which causes swelling, inflammation and discoloration of the tongue, further increase the connection between the virus and the mouth.
“We have known for a long time, decades, that oral health is linked to pulmonary and cardiovascular health,” says Kami Hoss, DDS, member of the Board of Directors of the UCLA School of Dentistry and CEO of the San Diego-based practice The Super Dentists. “In fact, what happens in the mouth really affects the health of many parts of the body.”
What is gum disease?
Gum disease – called gingivitis in the early stages and periodontitis in the most advanced, most severe stages – is caused by bacteria in the mouth that infect the tissue around the teeth, which results in inflammation. These bacteria form the plaque that accumulates on our teeth; without proper care, the plaque hardens and spreads below the gum, accelerating the disease process.
The gums become inflamed at first, then begin to detach from the teeth as the disease progresses, explains Dr. Hoss. Eventually, the teeth can become mobile, moving and even falling. Symptoms include swollen gums, tooth sensitivity, bad breath, bleeding and changes in the bite.
Periodontal disease affects just under half of American adults aged 30 and over, according to the Centers for Disease Control and Prevention (CDC). It also becomes more common with age; 70% of people aged 65 and over have some form of gum disease. Men and smokers are more likely to have some form of periodontal disease, but it can affect anyone. Gum disease is also more likely in people with systemic diseases like hypertension, diabetes and respiratory diseases.
OK, so what’s the connection between gum disease and COVID-19?
Even if you go to different types of doctors because of your teeth and body, your teeth we are part of your body – it’s all a system, Dr. Hoss explains. “People have really forgotten that their mouth is connected to their body, and what happens in their mouth affects the body in every way.”
The most recent study mentioned above found high levels of blood markers that indicate inflammation in COVID-19 patients with gum disease, which means that systemic inflammation may be the culprit behind the increased risk of complications.
“When you have gum disease, you have these microbes and bacteria in your mouth that can trigger inflammatory cytokines, which can make the immune system go crazy,” explains Dr. Hoss. These are the protective proteins behind the “cytokine storm”, a super-reactive immune response to COVID-19 that is believed to cause potentially deadly inflammation throughout the body. Gum disease may not cause a cytokine storm, but it could set the stage for one – especially for an unknown disease like COVID-19, which is still being studied.
These same bacteria can also cause COVID-19 complications when patients inhale them into the lungs during the illness, says Dr. Hoss. The resulting secondary infections – in addition to the one that already makes breathing difficult – may require assisted ventilation. Another theory is that ACE2 receptors, which act as a gateway to SARS-CoV-2 and exist in large numbers in the mouth, can become hyperactive in people with gum disease, potentially offering reduced resistance to the virus.
Of all these theories, however, inflammation is more likely to be the determining factor for COVID-19 complications in people with signs of gum disease, explains Dr. Hoss.
Can having gum disease directly lead to a serious COVID-19 infection?
For now, there is no concrete data on whether gum disease increases the likelihood of infection. “There was insufficient evidence to link periodontal disease to an increased risk of COVID-19 infection,” concluded the study’s researchers in the United Kingdom. “However, among COVID-19 positive, there was significantly higher mortality for participants with periodontal disease.”
Although there is a clear correlation between severe periodontal disease and a severe case of COVID-19, its true relationship is probably more complicated than a simple cause and effect. Bacteria and inflammation already present in the gums can aggravate a nascent SARS-CoV-2 infection, explains Hoss, or the gums can serve more as an indicator of overall health.
Gingival disease is also more prevalent in patients with hypertension, cardiovascular disease, diabetes, asthma, pregnancy and cancer, all known comorbidities of COVID-19. The exact relationship between these conditions and oral health remains unknown, according to the Mexico study, but it certainly makes sense for COVID-19 to fit them.
Until more research is completed, however, there is no way to draw a clear association between disease – and no way of saying whether treating periodontal disease can also lower the risk of COVID-19 complications.
What should I do to prevent gum disease?
If your gums bleed when you brush your teeth and floss, this is probably a sign of periodontal disease, explains Dr. Hoss. Swollen gums are also a common first symptom and there may be pain or irritation in some people, although painless gums are more common.
“It can go months and years without being diagnosed, which is why it is so important to see a routine dentist,” says Dr. Hoss. “The best treatment is prevention.”
To keep your mouth in good shape, the CDC recommends brushing twice a day and flossing at least once a day, which can effectively remove the bacteria that cause gum disease. You should also see a dentist at least once a year (preferably every six months), as they‘You will be able to clean the plaque below your gums and monitor serious problems.
Gingivitis patients can keep it under control with proper care of teeth and gums, in addition to the dentist’s intervention; patients with periodontitis may require more extensive dental treatment, medication and corrective surgery to protect their gums. If you are concerned about your gums, visit your dentist, who will give you options to stop or reverse the problem.
“This study is an opportunity to remind people how absolutely critical their oral health is, both in normal times and especially during this pandemic,” says Dr. Hoss, who highlights the importance of visiting the dentist despite COVID-19. “Take care of your oral health – go to the dentist regularly and do a good job at home”.
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