Gum disease may increase risk for COVID-19-related respiratory failure
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Patients hospitalized with COVID-19 were more likely to experience respiratory failure if they had gum disease before becoming infected, according to a paper in the Journal of the California Dental Association.
These findings indicate that primary care physicians should discuss oral health with their patients, Shervin Molayem, DDS, one of the study’s authors, told Healio Primary Care.
Molavem and Carla Cruvinel Pontes, DDS, MsC, PhD, both in private dental practice, reviewed more than 100 articles to establish biological pathways between COVID-19 and gum disease. They identified several potential pathways, including:
- overflow of locally produced inflammatory mediators such as IL-6 — a protein associated with gum disease — to the systemic circulation, causing systemic inflammation;
- bacteria or bacterial products entering the systemic circulation via the gingival sulcus; and
- aspiration of oral bacteria that may reach the upper and lower respiratory tract.
“Combined, these pathways can enhance endothelial dysfunction, gut dysbiosis, potentially predisposing to changes in the lungs,” Molayem and Pontes wrote. “Gut dysbiosis and endothelial dysfunction can affect several organs and systems, including the lungs. Circulating cytokines and bacteria can alter the respiratory epithelium, predisposing to infection, inflammation and potential pulmonary complications.”
Molayem and Pontes cited a previous study that demonstrated a “strong association” between the need for mechanical ventilation and high IL-6 serum levels above 80 pg/ml among 40 patients hospitalized with COVID-19, 32.5% of whom required ventilation.
“High IL-6 levels accurately predicted respiratory failure, with 22 times higher risk for respiratory complications,” they wrote.
In addition, a recent meta-analysis showed that patients with severe COVID-19 had a 2.9-fold increase in IL-6 levels compared with patients who had mild-to-moderate COVID-19.
Molayem said that healthy gums do more than protect against COVID-19.
“The mouth is one of the dirtiest parts of the body,” he said. “The gums that hold our teeth in place have many blood vessels that bacteria can get into and spread throughout the body. Pro-inflammatory proteins, such as the IL-6, C-reactive protein and others, can spread throughout the body playing a role in diseases that are not directly related to oral health.”
To stave off disease as much as possible, Molayem recommended that PCPs encourage patients to clean their teeth using a water pick and rinse their mouths with a mixture of one part hydrogen peroxide with two parts of water instead of over-the-counter mouthwash after brushing and flossing.
“This home remedy is recommended by many dentists for patients who want to prevent gum disease because, unlike over-the-counter mouthwash, the residue remains in mouth protecting teeth and gums,” he said.
He also said that PCPs should be probing patients’ mouths to measure the distance between the gum and the bottom of the periodontal pocket. Patients with more than 5 mm in this area should be referred immediately to a dentist or periodontist, as this may be a sign of gum disease.
Perspective
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Nammy Patel, DDS
Gum disease and breathing are huge issues with long-term effects that impact so many other health issues.
Some of the subtle signs that might foreshadow gum disease include dry mouth and mouth breathing (as opposed to breathing through the nose). Besides the usual brushing and flossing, PCPs should encourage mouth breathers to rub coconut oil on their gums to keep their mouth hydrated and possibly prevent gum disease.
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