How Deep Is The Connection Between Gum Disease And COVID-19 Complications?

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A new study published in the Journal of Clinical Periodontology came up with an interesting fact that there is a strong association between periodontitis and the complications of COVID-19. After examining more than 500 COVID-19 patients the researchers could deduce that those who had gum disease were at a greater risk of getting admitted into ICU, or put on a ventilator support and even more likely to die.

Why Did The Researchers Suspect A Connection Between Gum Disease And COVID-19?

Though Coronavirus SARS-CoV-2, the virus responsible for COVID-19, produces mild symptoms in most of the cases and has a fatality rate as low as 2%, it has been reported that 14% of the patients develop severe conditions that need immediate hospitalization and oxygen support. Acute respiratory distress syndrome (ARDS), sepsis, septic shock and multi-organ failure are a few serious complications of COVID-19 and these symptoms are characteristics of cytokine storm syndrome, an exacerbated immune response in which the proinflammatory cytokine levels spike up and there is a lot of tissue damage. Moreover, the severity of COVID-19 has shown to be more in elderly or obese patients and patients with comorbidities (like hypertension and diabetes).

Periodontitis is one of the most common gum diseases and around half the adult population worldwide is affected by mild to moderate form of periodontitis. In a person with severe periodontitis, the attachment between and the supporting tissues is destroyed. This can lead to tooth loss when left unattended. Cases with periodontitis are characterized by chronic inflammation that progresses to cause systemic inflammation. Like COVID-19, severe periodontitis has shown a marked increase in the levels of cytokines like TNF (Tumour Necrosis Factor)-alpha, CRP (C-reactive protein), ferritin and interleukins. Periodontitis has reported to have a strong association with conditions like diabetes, cardiovascular diseases and even premature death.

These similarities between  periodontitis and COVID-19 urged the researchers to conduct a case-control study and assess the extent to which the two are connected with each other.

This Is How They Conducted Their Study

 With the help of the national electronic health records of the State of Qatar dated between February 2020 to July 2020, a case-control study was conducted. Those patients who suffered from the complications of COVID-19 like death, ICU admission or assisted ventilation were identified as cases whereas patients who were discharged from the hospital and did not have any of the major complications were identified as controls.

Periodontal status, including interdental bone loss of both the groups were assessed with the help of dental radiographs uploaded in the electronic health records. Information on the possible risk factors like diabetes, smoking habit and body mass index was taken into consideration. Blood parameters relevant for the disease like concentration of D-dimer, C-Reactive protein, vitamin D and WBC levels were also extracted from the electronic health records for the purpose of assessment. The association between COVID-19 and periodontitis was analysed with the help of logistic regression.

Here Is What They Found In Their Study

A total of 568 patients were analysed out of which  528 patients were discharged without any complications (controls) whereas 40 patients had severe COVID-19 complications (cases). These are the most prominent findings of the study-

  • As expected, patients with severe complications were older and had more comorbidities than those who had minor COVID-19 symptoms.
  • Around 80% of the patients suffering from COVID-19 complications had periodontitis.
  • In the deceased patients, the concentration of CRP, D-dimer and WBC were phenomenally high whereas the lymphocytes were significantly lower than the surviving patients.
  • The concentration of D-dimer, CRP and WBC was also found higher in those admitted to the ICU and those patients who needed assisted ventilation.
  • Around half of the examined patients had periodontitis.
  • Periodontitis showed an association with a greater risk of developing COVID-19 complications, death, ICU admission and assisted ventilation.
  • HBA1c, CRP and WBC blood levels were phenomenally higher in COVID-19 patients who had periodontitis than those who did not have periodontitis.
  • It was also seen that the successful treatment of periodontitis brought a marked improvement in the serum markers of systemic inflammation and enhanced overall metabolic control.

And They Concluded…

On the basis of the above-mentioned findings, the researchers concluded that patients suffering from COVID-19 were 3 times more likely to be admitted to ICU, 4.5 times more likely to be in need for assisted ventilation and 9 times more susceptible to die if they had gum disease along with COVID-19.

Though more research is needed to establish the connection between COVID-19 complications and periodontitis, one thing has become clear that gum disease can aggravate systemic inflammation thereby, worsening the condition of the COVID-19 patients. Hence, this is the right time to give due importance to gum health and ensure that you take good care of them!