Is there a connection between COVID-19 and gum disease?

By now, you must be tired of hearing the same old COVID-19 narratives and its long term effects on our health. As of now, we know that only a small percentage of COVID-19 cases turn critical, and the presence of conditions such as diabetes, hypertension, obesity, asthma, and more¹ has been linked to severe coronavirus-induced conditions like pneumonia, acute respiratory distress syndrome (ARDS), multiple organ dysfunction, and even death.

Interestingly, did you know that the factors associated with gum disease are likewise related to the progression of severe coronavirus disease? 

The belief is that since inflammatory and dysbiotic factors, as well as comorbidities, affect our bodies’ systemic health, bad periodontal health can indicate impending COVID-19 complications.

Similarly, here are some crucial findings² by researchers from McGill University:

• Periodontitis is linked to severe COVID-19 illness.
• Individuals with PD are 8.8 times more likely to die as a result of COVID-19.
• Individuals greatly reduce the risk of gum infection by practising good oral habits.
• Periodontitis causes an inflammatory response that is linked to other systemic issues, which in turn, are factors that lead to COVID-19 complications.

What does this mean for those with gum disease and test positive for COVID-19? Allow me to explain further.

First, what is gum disease, or PD?

Gum disease or periodontitis (PD) is a severe gum infection that can lead to tooth loss and other serious health complications. Periodontitis, which falls under the umbrella of gum disease, is a serious gum infection that when left untreated, damages both the soft tissue and bone that supports your teeth.

Periodontal diseases refer to a group of chronic inflammatory diseases, including gingivitis and periodontitis. The condition is associated with the following risk factors such as:

• Age
• Poor oral hygiene
• Tobacco smoking
• Obesity
• Diabetes
• Medication
• Hypertension
• Asthma
• Liver diseases, and more

PD and severe COVID-19 illness seem to share similar risk factors! Most comorbidities (the presence of multiple conditions in your body) and risk factors reported in cases of severe COVID-19 seem to also aggravate the development of PD.

What are these common risk factors?

Shared risk factors between gum disease and severe COVID-19 illness

Ageing

Ageing is a degenerative process that can lead to various autoimmune, infectious, or inflammatory conditions, including gum disease. According to the World Health Organisation (WHO), PD mainly affects adults above the age of 65, as this demographic commonly presents with these additional risk factors:

• Poor oral hygiene habits
• Presence of chronic diseases
• Use of medications
• Smoking
• The lack of timely dental treatment
• Lowered immune response
• Multimorbidity

Clearly, ageing is a risk factor in linking PD and severe COVID-19 complications.

Gender

Interestingly, various studies have suggested that men are more prone to severe forms of PD than women, due to differences in immune response and function, behaviour, environmental factors, and more.

Obesity

Unsurprisingly, obesity is one of the highest risk factors when it comes to developing PD. The main consequence of obesity is systemic inflammation as:

• Adipose tissue typically secretes low levels of proinflammatory cytokines. Cytokines contribute to the development of PD and alter the response to bacteria in gingival tissue.
• Individuals with obesity experience greater oxidative stress; this is key since oxidative stress is increased in PD and can definitely contribute to its progression.

Additionally, increased inflammatory factors reported in obesity also contribute to amplifying the risk of developing severe COVID-19. It is, therefore, possible that those with the conditions of obesity and PD are at an increased risk of developing severe COVID-19 complications.

Smoking

Smoking is a major risk factor when it comes to developing PD, and affects the progression, severity and response to treatment of this condition.

Smoking also causes an individual to be 1.4 times more susceptible to severe COVID-19 symptoms. What this means is like obesity, it is also possible that those who smoke and have PD are at an increased risk of COVID-19 complications.

Are there other connections between COVID-19 and gum disease?

There are also less inconclusive studies that suggest the following –which are strongly associated with PD– might be contributing factors to the prevalence of COVID-19:

Pregnancy

Studies over the last few years suggest the vulnerability of pregnant women to PD due to an affected inflammatory response. Furthermore, it has been established that increased progesterone levels in pregnant women trigger the gingival response causing dysbiosis.

Concluding the connections between COVID-19 and gum disease

There is initial evidence that suggests that PD is a risk factor for COVID-19, especially since PD is widely associated with several conditions such as diabetes, old age, and asthma, and is indicative of our overall systemic health. 

Periodontitis is also associated with a higher risk of ICU admission, need for assisted ventilation, and even death in COVID-19 patients³.

PD also contributes to a large inflammatory load on the body and removing this inflammatory burden from your system is always a good idea! Thus, I would say that treating gum disease is imperative; Covid-19 or not! However, considering the initial studies between COVID-19 and periodontal disease, it is now more important than ever to schedule an appointment with a periodontist, especially if you experience symptoms such as:

• Bad breath 
• Pus from your gums 
• Blood on your toothbrush
• Spitting blood when you floss or brush
• Gums that feel tender whenever touched
• Purplish, dusky red, or bright red gums
• Gums that bleed easily
• Swollen, puffy gums

References

1. Pitones-Rubio, V., Chávez-Cortez, E. G., Hurtado-Camarena, A., González-Rascón, A., & Serafín-Higuera, N. (2020). Is periodontal disease a risk factor for severe COVID-19 illness?. Medical hypotheses, 144, 109969. https://doi.org/10.1016/j.mehy.2020.109969
2. https://www.medicalnewstoday.com/articles/gum-disease-linked-to-severe-covid-19-outcomes#Causality-undetermined
3. Marouf, N., Cai, W., Said, K. N., Daas, H., Diab, H., Chinta, V. R., Hssain, A. A., Nicolau, B., Sanz, M., & Tamimi, F. (2021). Association between periodontitis and severity of COVID-19 infection: A case-control study. Journal of clinical periodontology, 48(4), 483–491. https://doi.org/10.1111/jcpe.13435