Is there a link between periodontal disease and COVID? | by pranjal900 | Jan, 2024

The coronavirus pandemic of 2019 greatly impacted all of our world; global, social, mental, and physical health was affected, with strains on the education, sanitation, and healthcare departments. The age-old battle between humans and viruses began years ago, but 2019 had our own healthcare staff and researchers on the frontline scrambling to save an anxious population from an invisible predator.

Within weeks of the announcement of the UK national pandemic, the risk factors of COVID-19 were announced by the World Health Organisation. Risk factors included: old age, lung and heart disease, diabetes etc. Recently, researchers have estimated that periodontal disease has an impact on the risk of developing COVID-19 (1). Periodontal disease, commonly known as gum disease, is an inflammatory condition that affects the gums and teeth. It typically begins with the formation of plaque on the teeth and if it isn’t removed through regular oral hygiene practices like brushing and flossing, the plaque hardens into tartar. The presence of tartar can lead to gingivitis (early-stage periodontal disease) which can be identified by redness, swelling, and bleeding of the gums. The relationship between periodontal disease and COVID may be as a result of the associations between obesity, age and hypertension (2). Research has suggested two reasons behind the link between the conditions:

Reason one:

An enzyme known as Angiotensin converting enzyme II (ACE 2) is shown to be a connecting factor between periodontal disease and coronavirus. ACE 2 is secreted from the epithelial tissue and salivary glands in the mouth (4,5), and this is coexpressed with another enzyme (transmembrane serine protease II). When COVID enters the mouth by passage through the skin in the cheek (3), a “spike protein” is secreted by the epithelial tissues, and this protein binds to a glycoprotein. The interaction between the spike protein and glycoprotein interactions with the two enzymes, infecting the human cells (6,7).

Reason two

Another pathway that could explain the relationship between the diseases are the excessively expressed cytokines (proteins that control the activity of immune cells). The cytokines play a significant role in the development of oral diseases (10). During a COVID-19 infection, there is a great rise in cytokine levels as a result of the sensitive and compromised immune system (8). Coronavirus increases the number of immune (Th17) cells which are then compromised in the pathology of lung infections as a result of COVID-19 “cytokine storm” (9) worsening the health of a patient.

“If left untreated, gum disease can lead to abscesses, and over several years, the bone supporting the teeth can be lost…when gum disease becomes advanced, treatment becomes more difficult. Given the new link with coronavirus complications, the need for early intervention becomes even greater” — Dr Nigel Carter (13)

Moreover, scientists have researched the correlation between oral disease and COVID-19. A study revealed that over 80% of patients who had COVID complications with an additional 43% of patients who did not experience complications had periodontitis. However, whilst the data shown is correlated in a sense, it is important to note that this does not show causation, instead showing a possible relationship between the two variables. (11)

Another experiment involved participants with periodontal diseases who had tested for COVID-19 between March and June 2020. This study aimed to identify the impact of periodontal disease on hospital admission and mortality during the COVID-19 pandemic. 1616 of the patients were COVID-positive, whilst 11637 of the participants were COVID-negative. The researcher asked each of the participants to self-report their symptoms of pain levels, loose teeth or blood from the gums, and the control group included participants who did not complain of any symptoms. The results found that COVID-19-positive participants with painful or bleeding gums had a higher risk of mortality whereas participants with loose teeth did not show a higher risk of hospital admission or mortality compared to the control group. Overall, the study concluded that there was insufficient evidence to report a correlation between periodontal disease and COVID-19 hospital admissions. However, the study found a higher mortality rate for those who had periodontal disease and were also COVID-positive. (12)

Although more research needs to take place in order to confirm the association between periodontal diseases and coronavirus, it is important to acknowledge the impact of factors such as age, respiratory health and diet and how they confound the relationship between dental disease and coronavirus. Additional studies, both in laboratories and in real-world situations need to be assessed; however, with the overall reduction of COVID-19 cases and the shift back into a world pre-lockdown it is difficult to assess this association to its full extent, which leads back to the overall question at hand. Is research into COVID a thing of the past now that we move on from the global pandemic?

Regardless, the importance of maintaining good oral hygiene is of utmost importance in the overall health and wellness of our bodies. Preventative measures for gum disease can include simply properly brushing and flossing and having regular checkups without your dentist. These practices not only contribute to your oral hygiene but play an important role in reducing various health conditions, not only in your mouth but around the body as a whole.


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