ADVICE

Bad oral health may increase your risk of COVID complications

Man with a sore tooth

Not brushing your teeth will get you in trouble with the dentist – but since the arrival of the pandemic, it could lead to bigger problems too. There’s growing evidence that poor oral health raises the risk posed by COVID.

Research shows that people with poor oral health can end up with more severe symptoms if they catch the coronavirus. COVID patients who also have gum disease are 3.5 times as likely to be admitted to intensive care compared to those without. They’re also 4.5 times as likely to need to be put on a ventilator and nine times as likely to die from COVID.

This may seem shocking, but the fact that there’s a link between oral health and COVID is less surprising when considering the link between oral hygiene and other diseases. Bad oral hygiene has been associated with making many other diseases worse. Principally this happens when bad hygiene is sustained for long periods, leading to dysbiosis – where the bacteria in the mouth change from a peaceful state into an aggressive one.

Once the mouth’s bacteria become aggravated, they can cause gum disease, chewing away at the tissues of the mouth and entering the bloodstream. And once there, the bacteria can then flow around the body and settle in various organs, raising levels of inflammation and over time contributing to various specific and chronic conditions.

Indeed, if this happens, there’s barely a part of the body that can’t potentially be affected. Poor oral health can have an impact on the heart, raise blood pressure and make diabetes worse by raising blood sugar levels. It’s been linked to premature births, arthritis, kidney diseases, respiratory disease and even some neurodegenerative diseases, including Alzheimer’s.

So is the same thing happening with COVID?

Possibly. Compared to those with mild or moderate symptoms, people with severe COVID have elevated levels of a specific inflammatory marker (called CRP). Some people with severe COVID also suffer what’s called a “cytokine storm”, where the immune system goes into overdrive fighting off the virus and harms the body’s own tissues at the same time.

Research shows that people with poor oral health also sometimes have elevated levels of CRP and cytokines – which suggests that gum disease can trigger the same sort of zealous immune response as COVID (though to a lesser degree). So if the two diseases are encountered at the same time, with the coronavirus and aggressive mouth bacteria both circling in the blood, then it’s possible that they together might tip the immune response into harming the body’s own tissues, leading to worse outcomes for people.

However, we currently understand little about how exactly oral hygiene and COVID interact, and it could be that they are combining in other ways to make the disease worse too.

For instance, a big problem with COVID and other respiratory viral illnesses are bacterial superinfections. These are where areas directly infected by the virus – such as the lungs and airways – are simultaneously infected with bacteria.

Bacterial superinfections are common in people who have COVID, and they’re significantly more common in people with severe disease. It’s not known precisely what impact they have, but it’s reasonable to assume that these concurrent infections raise the risk of severe disease and death. Throughout the pandemic, studies have found that a large proportion of people dying from COVID – in some cases, 50% – were also infected with bacteria at the same time.

If someone’s oral hygiene is poor, this could raise the risk of a superinfection. Poor oral hygiene means more aggressive bacteria in the mouth, which could then easily be breathed into the airway and lungs to launch a superinfection.

On top of this, poor oral health may also help the coronavirus infect the body. Enzymes from the bacteria that cause gum disease can alter the surface of the mouth and respiratory tract, making it easier for other microbes – such as the coronavirus – to adhere to these surfaces and grow there.

As time passes it will become clearer exactly how oral health affects the progress of COVID. It may be that for some people, all of these mechanisms are at play at the same time.

But for the meantime, there is enough evidence to consider poor oral hygiene a risk factor for complications in those who have COVID – and especially in those who are already suffering with conditions such as diabetes, high blood pressure or cardiovascular disease, as these can be aggravated by poor oral health and are themselves risk factors for COVID.

It’s therefore more important than ever to maintain proper oral hygiene. This means brushing twice a day for at least two minutes with a fluoride-containing toothpaste and visiting the dentist on a regular basis. Hopefully you won’t catch the coronavirus, but if you do, having good oral health and caring for your mouth could significantly reduce your risk of developing severe symptoms.The Conversation

This article is republished from The Conversation under a Creative Commons license. Read the original article.

First published: Nov 2021

Article sources and references

  • Kamel, A., Basuoni, A., Salem, Z. et al. The impact of oral health status on COVID-19 severity, recovery period and C-reactive protein values. Br Dent J (2021). https://doi.org/10.1038/s41415-021-2656-1
    https://www.nature.com/articles/s41415-021-2656-1
  • Marouf N, Cai W, Said KN, Daas H, Diab H, Chinta VR, Hssain AA, Nicolau B, Sanz M, Tamimi F. Association between periodontitis and severity of COVID-19 infection: A case-control study. J Clin Periodontol. 2021 Apr;48(4):483-491. doi: 10.1111/jcpe.13435. Epub 2021 Feb 15. PMID: 33527378; PMCID: PMC8014679.
    https://pubmed.ncbi.nlm.nih.gov/33527378/
  • Hajishengallis G, Lamont RJ. Beyond the red complex and into more complexity: the polymicrobial synergy and dysbiosis (PSD) model of periodontal disease etiology. Mol Oral Microbiol. 2012 Dec;27(6):409-19. doi: 10.1111/j.2041-1014.2012.00663.x. Epub 2012 Sep 3. PMID: 23134607; PMCID: PMC3653317.
    https://pubmed.ncbi.nlm.nih.gov/23134607/
  • Cekici A, Kantarci A, Hasturk H, Van Dyke TE. Inflammatory and immune pathways in the pathogenesis of periodontal disease. Periodontol 2000. 2014 Feb;64(1):57-80. doi: 10.1111/prd.12002. PMID: 24320956; PMCID: PMC4500791.
    https://pubmed.ncbi.nlm.nih.gov/24320956/
  • DeStefano F, Anda RF, Kahn HS, Williamson DF, Russell CM. Dental disease and risk of coronary heart disease and mortality. BMJ. 1993 Mar 13;306(6879):688-91. doi: 10.1136/bmj.306.6879.688. PMID: 8471920; PMCID: PMC1677081.
    https://pubmed.ncbi.nlm.nih.gov/8471920/
  • Rebelo MA, de Castro PH, Rebelo Vieira JM, Robinson PG, Vettore MV. Low Social Position, Periodontal Disease, and Poor Oral Health-Related Quality of Life in Adults With Systemic Arterial Hypertension. J Periodontol. 2016 Dec;87(12):1379-1387. doi: 10.1902/jop.2016.160204. Epub 2016 Jul 29. PMID: 27468793.
    https://pubmed.ncbi.nlm.nih.gov/27468793/
  • Gomes-Filho IS, Cruz SSD, Trindade SC, Passos-Soares JS, Carvalho-Filho PC, Figueiredo ACMG, Lyrio AO, Hintz AM, Pereira MG, Scannapieco F. Periodontitis and respiratory diseases: A systematic review with meta-analysis. Oral Dis. 2020 Mar;26(2):439-446. doi: 10.1111/odi.13228. Epub 2019 Nov 28. PMID: 31715080.
    https://pubmed.ncbi.nlm.nih.gov/31715080/
  • Hojyo S, Uchida M, Tanaka K, et al. How COVID-19 induces cytokine storm with high mortality. Inflamm Regen. 2020;40:37. Published 2020 Oct 1. doi:10.1186/s41232-020-00146-3
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527296/
  • Cornelius J Clancy, Ilan S Schwartz, Brittany Kula, M Hong Nguyen, Bacterial Superinfections Among Persons With Coronavirus Disease 2019: A Comprehensive Review of Data From Postmortem Studies, Open Forum Infectious Diseases, Volume 8, Issue 3, March 2021, ofab065, https://doi.org/10.1093/ofid/ofab065
    https://academic.oup.com/ofid/article/8/3/ofab065/6128788
Go to homepage*Subsequent months will be $2.75