Periodontal disease in COVID-19 patients is associated with a higher risk for complications

March 10, 2021

If you are a frequent visitor of our Healthy Thinking section, you have probably noticed our passion for the relationship between oral health and general health. As such, it should come as no surprise that we follow scientific developments regarding COVID-19 and oral health with special interest. Recent findings from a study about gum disease in COVID-19 patients definitely turned our heads.

In this study – recently published in the Journal of Clinical Periodontology – 568 patients with COVID-19 were involved, 40 of which experienced COVID-19 related complications (ICU admission, assisted ventilator requirement or death. Strikingly, 33 of those patients also had periodontal disease. When you convert those figures into a risk estimation, it means that COVID-19 patients are over 3.5 times more likely to have severe complications when they suffer from periodontal disease, even when you adjust that for common risk factors such as age, smoking behavior and conditions such as diabetes and cardiovascular disease.

For health professionals, the knowledge of this clear and significant association between periodontitis and COVID-19 complications should prompt the search for appropriate diagnosis of periodontal health in all patients being diagnosed with SARS-CoV-2 infection. In case of diagnosing a case of untreated periodontitis, they should seek for appropriate therapy. This can only work if there are established links and paths between physicians and dentists working in primary care.

Health planners should be prompted to seriously consider the fact that oral and periodontal health is an integral part of general health. This simple statement does not apply in most of the European countries where diagnosis and treatment of periodontal diseases are not part of the regular services provided by the national health care, mainly in what relates to the treatment of severe periodontitis.

To patients, since the knowledge of this demonstrated association is one more evidence of the relationship between periodontitis and risk of many systemic diseases, patients should be prompted to be aware of their oral and periodontal health and not only implement regular oral hygiene practices, but also seek the advice and care of the oral practitioner to assure their oral and periodontal health.

Professor Mariano Sanz, co-author of the research paper, on the clinical implications of these findings.

The researchers also came up with a possible explanation for this association. They investigated certain biomarkers in the blood that indicate systemic inflammation. COVID-19 patients with periodontal disease showed significantly higher levels of some of those markers, compared to COVID-19 patients without periodontal disease. Remarkably, the same biomarkers were also associated with worse COVID-19 outcome, such as death.

Interestingly, a recent study published in Frontiers in Medicine showed similar findings. The authors compared 1,616 COVID-19 positive cases with 11,637 COVID-19 negative cases. They aimed to assess whether self-reported periodontal disease, indicated by painful or bleeding gums, had an impact on infection, hospital admission and mortality. In their first analysis, periodontal disease did not seem to increase the risk for being COVID-19 positive. However, in a second analysis, COVID-19 positive participants who also had periodontal disease did have an increased risk for death.

In a way, these results may not be as surprising as you would initially think. Periodontal disease has been associated with respiratory conditions before, such as chronic obstructive pulmonary disease (COPD) and pneumonia. In fact, research shows that periodontal treatment is even associated with a decreased risk for pneumonia. The oral microbiome, and its interaction with the host immune system, seems to play an important role in the association between oral health and respiratory conditions.

Of course, it is important to keep in mind that oral health is just one small piece of a very complex puzzle. There are many other factors contributing to severe COVID-19 complications, and many of those have not even been fully identified and unravelled yet. Further research is essential to understand why someone experiences severe complications, while others do not. However, both studies discussed above demonstrate again how taking care of your oral health can help. The good news is, with good oral hygiene measures and supervision by a dentist or dental hygienist, periodontal disease can be prevented and managed very well. Another reason for us to continue our mission to place the mouth back into the body.