- A new study suggests that people with gum disease are nearly nine times more likely to die from COVID-19 than people without dental problems.
- 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.
- A dentist explains why gum disease can be linked to a more serious case of COVID-19.
From the beginning, doctors knew that COVID-19 was particularly dangerous for high-risk groups, including older adults and people with underlying health conditions such as heart disease and asthma. But research has still uncovered new risk factors, which now include gum disease. The condition can occur in up to half of American adults, and appears to be linked to a higher COVID-19 mortality rate, according to a new study released earlier this month in the U.S. Journal of Clinical Periodontology.
In the study, researchers followed 568 patients infected with the new coronavirus and divided them into two groups: those who did not have major problems (mild symptoms) and those who had complications such as admission and ventilation of ICU or eventually death. . They found it 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.
This is not the only science linking the coronavirus and gum health; research from Mexico and the United Kingdom, released in June and November 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 lumps, inflammation and discoloration on the tongue, further drive the connection between the virus and the mouth.
“We have known for decades that oral health has been linked to lung and cardiovascular health,” said Kami Hoss, DDS, member of the Board of Counselors at UCLA School of Dentistry and CEO of San Diego-based practice. The Super Dentists. “What happens in your mouth actually affects the health of many body parts.”
What is gum disease?
Gum disease – called early-stage gingivitis, and later in severe, periodontitis – is caused by bacteria in the mouth that infect the tissues around the teeth, resulting in inflammation. Those bacteria form the plaque that builds up on our teeth; without proper care, the plaque is hardened and spreads under the gums, which accelerates the disease process.
Gums are initially inflamed and then begin to pull away from the teeth as the disease progresses, explains dr. Hoss. Eventually, teeth can become movable, move around and even fall out. Symptoms include swollen gums, sensitivity of the tooth, bad breath, bleeding and changes in bite.
According to the Centers for Disease Control and Prevention (CDC), periodontal disease affects just under half of American adults 30 and older. It also becomes more common with age; 70% of people aged 65 and older 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 conditions such as hypertension, diabetes and respiratory diseases.
OK, so what’s the connection between gum disease and COVID-19?
Although you go to different types of doctors for your teeth and body, your teeth is part of your body – it’s all one system, explains dr. Hoss. “People have really forgotten that your mouth is attached to your body, and what happens in your mouth affects the body in all sorts of ways.”
In the most recent study above, high levels of blood markers were shown to indicate inflammation in COVID-19 patients with gum disease, meaning that systemic inflammation may be the culprit behind the higher risk of complications.
“If you have gum disease, you have these microbes and bacteria in your mouth that can cause inflammatory cytokines, which can cause the immune system to disappear,” explains Dr. Hoss. It is the protective proteins behind the “cytokine storm”, an overreactive immune response to COVID-19 that can cause deadly inflammation in the body. Gum disease can not cause a cytokine storm, but it could be the scene for one – especially for an unknown disease like COVID-19 that is still being studied.
The same bacteria can also cause COVID-19 complications if patients inhale it into their lungs during their illness, says Dr. Hoss. The resulting secondary infections – in addition to the infection that makes it difficult to breathe – may require assisted ventilation. Another theory is that ACE2 receptors, which serve as an access point for SARS-CoV-2 and occur in large amounts in the mouth, may become overactive in those with gum disease, which may offer resistance to the virus.
From all these theories, it is likely that inflammation is the driving force for COVID-19 complications in people with signs of gum disease, explains dr. Hoss.
Can a 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 with an increased risk of COVID-19 infection,” the researchers from the UK study concluded. “Among the COVID-19 positives, however, there was a significantly higher mortality rate for participants with periodontal disease.”
Although there is a clear link between severe periodontal disease and a severe case of COVID-19, their true link is likely to be more complicated than simple cause and effect. The bacteria and inflammations that already occur with gum disease can aggravate an emerging SARS-CoV-2 infection, explains Dr. Hoss, or the gums may serve more as an indication of general health.
Gum disease is also more common in patients with hypertension, cardiovascular disease, diabetes, asthma, pregnancy and cancer, although it is known as COVID-19. The exact link between these conditions and oral health remains unknown, according to the Mexico study, but it certainly makes sense that COVID-19 would fit.
Until more research is completed, however, there is no way to draw a clear link between the diseases – and no way to determine whether treatment of periodontal disease can also reduce the risk of COVID-19 complications.
What should I do to prevent gum disease?
If your gums bleed when you brush and floss your teeth, it is probably a sign of periodontal disease, explains dr. Hoss. Swollen gums are also a common first symptom, and in some people pain or soreness can occur, although pain gums are more common.
“It can take months and years without being diagnosed, which is why it is so important to see your dentist regularly,” says Dr. Hoss. “The best treatment is prevention.”
To keep your mouth in good condition, the CDC recommend brush twice a day and floss 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 (ideally every six months) as they‘I will be able to clean the plaque under the gums and monitor it for serious problems.
Patients with gingivitis can keep it at a distance with proper care of tooth and gums, plus dentist intervention; patients with periodontitis may need more extensive dental work, medication, and corrective surgery to protect their gums. If you are worried about your gums, visit your dentist, who will give you the options to stop or reverse the condition.
“This study is an opportunity for us to remind people how absolutely critical their oral health is, both in normal times and especially during this pandemic,” says Dr. Hoss, who emphasizes the importance of visiting the dentist despite COVID-19. “Take care of your oral health – go to the dentist regularly and do good work at home.”
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