From the beginning, doctors have known that COVID-19 is especially dangerous for high-risk groups, including older adults and people with underlying health conditions like heart disease and asthma. But research is still uncovering new risk factors, which now includes gum disease. The condition may affect up to half of American adults, and appears to be linked to a higher COVID-19 death rate, per 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 issues (mild symptoms) and those who faced complications like ICU admission and ventilation 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 require a ventilator, and 3.5 times more likely to be admitted to the ICU than patients without signs of dental issues.
It’s not the only science linking the coronavirus and gum health; research from Mexico and the United Kingdom, respectively released in June and November last year, also identified periodontal disease as a significant risk factor of severe SARS-CoV-2 infection and death. Newly discovered oral symptoms like “COVID tongue,” which causes bumps, inflammation, and discoloration on the tongue, further drive home the connection between the virus and the mouth.
“We’ve known for a long time, decades, that oral health is connected to lung and cardiovascular health,” says Beaufort SC dentist Ashley Covington, DMD, member of the SCDA and ADA. “In fact, what happens in your mouth really impacts the health of many parts of the body.”
What is gum disease?
Gum disease—called gingivitis in early stages and periodontitis in later, more serious ones—is caused by bacteria in the mouth that infect the tissue around the teeth, which results in inflammation. Those bacteria form the plaque that build up on our teeth; without proper care, the plaque hardens and spreads below the gums, speeding up the disease process.
Gums become inflamed at first, then start to pull away from the teeth as the disease progresses. Eventually, teeth can become mobile, shifting around and even falling out. Symptoms include swollen gums, tooth sensitivity, bad breath, bleeding, and changes in bite.
Periodontal disease impacts just under half of American adults 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 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 like hypertension, diabetes, and respiratory diseases.
What is the connection between gum disease and COVID-19?
Even though you go to different types of doctors for your teeth and body, your teeth are part of your body—it’s all one system. People have really forgotten that your mouth is connected to your body, and what happens in your mouth impacts the body in all sorts of ways.
The most recent study mentioned above discovered high levels of blood markers indicating inflammation in COVID-19 patients with gum disease, meaning that systemic inflammation could be the culprit behind the 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 go haywire,” Dr. Covington explains. Those are the protective proteins behind the “cytokine storm,” an overreactive immune response to COVID-19 thought to cause potentially deadly inflammation throughout the body. Gum disease might not cause a cytokine storm, but it might set the stage for one—especially for an unfamiliar illness like COVID-19 that is still being studied.
Those same bacteria might also cause COVID-19 complications when patients inhale them into their lungs during their illness, Dr. Covington says. The resulting secondary infections—on top of the one already making it difficult to breathe—could require assisted ventilation. Another theory is that ACE2 receptors, which act as a point of entry for SARS-CoV-2 and exist in large numbers in the mouth, could become overactive in those with gum disease, potentially offering reduced resistance to the virus.
Out of all of these theories, however, it’s most likely that inflammation is the driving factor of COVID-19 complications in people who have signs of gum disease, Dr. Covington explains.
Does gum disease directly lead to a severe 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 of the United Kingdom study concluded. “However, amongst the COVID-19 positive, there was significantly higher mortality for participants with periodontal disease.”
Although there’s a clear correlation between serious periodontal disease and a severe case of COVID-19, their true relationship is probably more complicated than simple cause and effect. The bacteria and inflammation already present with gum disease could aggravate a nascent SARS-CoV-2 infection, or the gums might rather serve more as an indicator of overall health.
Gum 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, per the Mexico study, but it certainly makes sense that COVID-19 would fit in with them.
Until more research is completed, however, there is no way to draw a clear association between the diseases—and no way to tell if treatment of periodontal disease can also lessen the risk of COVID-19 complications.
How can I prevent periodontal disease?
The best way to prevent gum disease is a no-brainer: take care of your gums! This means brushing your teeth twice a day (and making sure your brush makes contact with your gums), flossing once a day, and going to the dentist for a cleaning every six months. If you’re doing all those things and your gums are still swollen and bleeding, you may need to go to the dentist every three months instead of every six. We’re all different which means our teeth and gums are different as well. Take the necessary measures to keep your gums healthy and pink by talking to your dentist about more frequent visits, anti-bacterial toothpaste, and oral care tips and tricks that may be helpful.
How do dentists treat periodontal disease?
Periodontal disease occurs when there’s a build-up of harmful bacteria underneath the gumline. That bacteria encourages the gums to pull away from the teeth, creating gum recession. When gum recession occurs, our patients sometimes say their teeth are getting “long” which is where the phrase “long in the tooth” comes from. While it may look like the tooth is growing, in reality, the gums are disappearing, revealing more of the tooth’s surface (which is typically buried).
If gum recession is left untreated, the threat of tooth loss can become very real. Without the gums there to help stabilize them, the teeth want to fall out. So, what can a dentist do to prevent that from happening? If your hygienist has just caught some mild gum recession, they’ll recommend a deep cleaning — also known as “scaling.” They’ll use a few special tools to clean out the bacteria under the gums. Most people need a few deep cleanings to get all of the bacteria out. For periodontal patients, we put them on a three-month cleaning schedule so we can regularly check to make sure their gums are getting healthier.
For patients with severe, long-term gum recession, we recommend deep cleanings and a Full Mouth Debridement. With a FMD your dentist may numb areas of your mouth with a local anesthetic. This will be determined by the extent of tartar buildup under the gum line as well as your personal sensitivity level. Next, the plaque and tartar on and around your teeth with hand-held instruments or with an ultrasonic device that uses vibrations and water to blast teeth clean. We may also polish your teeth or recommend additional treatments for more cleaning.
Schedule An Appointment
Allowing us to keeping gum disease in-check for our patients makes life easier, enabling everyone to maintain a healthy smile in the same dentist office. We offer appointments starting at 7:00am and also have after school hours to meet your scheduling needs. We welcome you to our convenient office which is conveniently located on the corner of Sea Island Pkwy & Lady’s Island Dr.. To schedule an appointment contact us at (843) 986-0177 or request one online and we will get back with you promptly.
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