Gum disease linked to severe COVID-19 complications -- including death

By Melissa Busch, DrBicuspid.com associate editor

February 5, 2021 -- Periodontitis may be a risk factor for COVID-19, and it may make patients vulnerable to severe complications, including death, according to a study published on February 1 in the Journal of Clinical Periodontology.

People who had been diagnosed with COVID-19 and also had periodontitis were more than nine times as likely to die than those who didn't have severe gum disease. These patients were also about four times more likely to be admitted to the intensive care unit (ICU) and approximately five times more likely to need assisted ventilation than those who didn't have gum disease, according to the authors.

"This study highlights the importance of periodontal health in the prevention and perhaps even management of COVID-19 complications," wrote senior author Dr. Faleh Tamimi, PhD, from Qatar University and colleagues.

COVID-19 is associated with an aggravated inflammatory response that can result in fatal outcomes. Because one of the main characteristics of periodontitis is systemic inflammation, the researchers set out to explore associations between periodontitis and COVID-19 complications.

In August, research based on the analysis of other novel coronavirus studies cited a link between gum disease and COVID-19 complications. The results suggest that good oral hygiene can prevent bacteria in the gums from entering the bloodstream and triggering inflammation, which prompts the release of the protein interleukin-6 (IL-6). Also, researchers recently found that mouthwash and nasal spray containing povidone iodine may cut SARS-CoV-2 transmission.

The current study included approximately 570 adults who were discharged or died due to COVID-19 before the study end date of August 31, 2020. The participants had active dental records and at least one dental appointment between March 2019 and March 2020. Patients without dental radiographs in their records were excluded because the presence of periodontitis could not be objectively confirmed. Approximately 260 of the participants had periodontitis.

The researchers analyzed the patients' dental radiographs and electronic health records. Periodontitis was defined as bone loss detected at two or more nonadjacent teeth, after excluding factors such as cracked and fractured roots, caries, and impacted third molars.

After adjusting for age, sex, body mass index, smoking, and other conditions, Tamimi and colleagues found the following connections between complications due to COVID-19 and periodontitis.

Complications in patients with COVID-19 and periodontitis, by odds ratio (OR)
Complications Patients with periodontitis
Death OR = 8.81
Needed assisted ventilation OR = 4.57
Admitted to ICU OR = 3.54
All complications OR = 3.67

The results should be taken with caution due to some limitations, including the fact that the study failed to address causality, the authors noted.

Future research should examine the influence of periodontitis and periodontal treatments on SARS-CoV-2 infection to better understand the causal relationships. Understanding the factors underpinning relationships between periodontitis and COVID-19 complications could produce mechanistic targets, risk stratification, and new interventions, they wrote.

"Periodontitis was significantly associated with a higher risk of complications from COVID-19," they concluded.


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