Dentist explains unusual link between gum disease and severe COVID-19 infection

Prevention

• A new study suggests that people with gum disease may be nearly nine times more likely to die from COVID-19 than people without dental problems.

• The researchers found that people 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.
  

• Dentist explains why gum disease could be linked to a more serious case of COVID-19.
  

From the start, doctors have known that COVID-19 is particularly dangerous for high-risk groups, including the elderly and people with underlying health conditions such as heart disease and asthma. But research still reveals new risk factors, which now include gum disease. The disease can affect up to half of American adults and appears to be linked to a higher COVID-19 death rate, according to a new study published earlier this month in the Journal of Clinical Periodontology.

In the study, researchers followed 568 patients infected with the novel coronavirus, dividing them into two groups: those without major problems (mild symptoms) and those who faced complications such as admission and ventilation to care. intensive or, possibly, 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’s not the only science linking coronavirus and gum health; research from Mexico and the UK, published 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. Recently discovered oral symptoms such as “COVID tongue,” which causes bumps, inflammation and discoloration of the tongue, further strengthen the link between the virus and the mouth.

“We have known for a long time, for decades, that oral health is linked to lung and cardiovascular health,” says Kami Hoss, DDS, member of the UCLA School of Dentistry Board of Advisors and CEO of the based practice. San Diego. The super dentists. “In fact, what goes on in your mouth has a real impact on the health of many parts of the body.”

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What is gum disease?

Gum disease – called early-stage gingivitis and later, more severe periodontitis – is caused by bacteria in the mouth that infect the tissues around the teeth, resulting in inflammation. These bacteria form the plaque that builds up on our teeth; without proper care, plaque hardens and spreads under the gums, speeding up the disease process.

The gums become inflamed at first, then begin to pull away from the teeth as the disease progresses, says Dr Hoss. Eventually, teeth can become loose, shift, and even fall out. Symptoms include swollen gums, tooth sensitivity, bad breath, bleeding, and bite changes.

Periodontal disease affects just under half of American adults aged 30 and older, according to the Centers for Disease Control and Prevention (CDC). It also becomes more common with age; 70% of people 65 and over suffer from 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 illnesses such as hypertension, diabetes, and respiratory disease.

OK, so what’s the connection between gum disease and COVID-19?

Even if you see different types of doctors for your teeth and your body, your teeth are part of your body – it’s one system, says Dr. Hoss. “People have really forgotten that your mouth is connected to your body and that what goes on in your mouth impacts the body in all kinds of ways.”

The most recent study mentioned above found elevated levels of blood markers indicating inflammation in COVID-19 patients with gum disease, meaning that systemic inflammation could be the root cause of the disease. higher risk of complications.

“When you have gum disease, you have these microbes and bacteria in your mouth that can trigger inflammatory cytokines, which can cause the immune system to become imbalanced,” says Dr. Hoss. These are the protective proteins behind the “cytokine storm,” an over-reactive immune response to COVID-19 that could cause life-threatening inflammation throughout the body. Gum disease might not cause a cytokine storm, but it could set the stage for one, especially for an unknown disease like COVID-19 which is still under investigation.

These same bacteria could also cause complications from COVID-19 when patients inhale them into their lungs during their illness, says Dr Hoss. The resulting secondary infections – in addition to those that already make it difficult to breathe – may require assisted ventilation. Another theory is that ACE2 receptors, which act as an entry point for SARS-CoV-2 and exist in large numbers in the mouth, could become overactive in people with gum disease, potentially offering a reduced resistance to the virus.

However, among all of these theories, it is highly likely that inflammation is the determining factor for complications from COVID-19 in people who show signs of gum disease, says Dr Hoss.

Can gum disease directly lead to severe COVID-19 infection?

As of yet, there is no concrete data indicating whether gum disease increases the likelihood of infection. “There was not enough evidence to link periodontal disease to an increased risk of COVID-19 infection,” the UK study researchers concluded. “However, among COVID-19 positive, there was significantly higher mortality in participants with periodontal disease.”

While there is a clear correlation between severe periodontal disease and a severe case of COVID-19, their true relationship is likely more complicated than just cause and effect. Bacteria and inflammation already present with gum disease could make an incipient SARS-CoV-2 infection worse, says Dr Hoss, or the gums could serve as an indicator of overall health instead.

Gum disease is also more common in patients with hypertension, cardiovascular disease, diabetes, asthma, pregnancy, and cancer, all of which are known to be co-morbidities of COVID-19. The exact relationship between these conditions and oral health remains unknown, according to the Mexican study, but it certainly makes sense that COVID-19 is integrating with them.

Until more research is completed, however, there is no way to establish a clear association between the diseases – and no way to tell whether treating periodontal disease may also reduce the risk of complications. of COVID-19.

What should I do to prevent gum disease?

If your gums bleed when you brush your teeth and floss, it’s probably a sign of periodontal disease, says Dr. Hoss. Swollen gums are also a common first symptom, and aches or pains can occur in some people, although painless gums are more common.

“It can go months and years without being diagnosed, which is why it is so essential to see your dentist regularly,” says Dr. Hoss. “The best treatment is prevention.”

To keep your mouth healthy, the CDC recommended brushing twice a day and floss at least once a day, which can effectively eliminate 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 watch for serious problems.

Patients with gingivitis can keep it at bay with proper dental and gum care, as well as intervention by the dentist; patients with periodontitis may require more extensive dental care, medication, and corrective surgery to protect their gums. If you are worried about your gums, see your dentist, who will offer options to stop or reverse the situation.

“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 stresses 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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