Gum Disease: An Overlooked Risk Factor For Death From Covid-19

First, Let’s start with the good news. Here is the latest information from the CDC. The death rate from coronavirus is about gone. This means that the average risk form all-cause mortality is almost back to the same level it was at before the outbreak. Check out the graph below.

Now on to today’s post.

In my post from last week, I discussed comorbidities associated with death from Covid-19. Some of the most common are cardiovascular diseases, diabetes, Alzheimer's, and lung diseases. The people dying from Covid-19 have an average of 2.15 of them. They happen to share common lifestyle risk factors with gum disease (periodontitis). Mainly, poor diet, smoking, lack of exercise, stress, and poor sleep are to blame. (1) Research has drawn an association between periodontitis and other comorbidities, such as rheumatoid arthritis, osteoporosis, Parkinson's disease, Alzheimer's, and psoriasis. 

Gum Disease

According to the American Dental Association, almost 60% of Americans age 65 and above have periodontal disease. (2) The importance of this should not be overlooked since the over 65 age group is most at risk for death from coronavirus. 

The list of comorbidities on the CDC's Coronavirus pages is extensive. Still, distressingly, it does not include any references to oral infections. Adding periodontal disease would significantly increase the average number of comorbidities to 2.75. The reason for my distress is that their public health efforts will fall short. Some of the public is heading the CDC's statistics and trying to eliminate some of their health risks. Those who do and are successful may still have an increased risk of death because they missed addressing gum disease.

Since the devil is in the details, let's take a look at some of the associations between gum disease and the other frequent chronic diseases.

Heart Disease

A Swedish study determined that there was a 49% greater increase of acute myocardial infarction (heart attack) in patients with periodontal disease. (3) A plausible explanation for the connections is that gum disease increases the overall severity of systemic inflammation. Both are diseases of systemic inflammation. Periodontal treatment has been shown to decrease the markers of heart disease. (4) A Korean study demonstrated that periodontal care was significantly associated with a lower incidence of heart disease. (5)

Diabetes

The connection between type 2 diabetes and gum disease is well documented. The relationship is complicated, but two of the main factors are disturbances in the oral and gut flora, and the formation of harmful advanced glycation end products (AGE's). They lead to increased production of proinflammatory cytokines and increased tissue breakdown. (5) The cytokine storm causing death has been well documented with Covid-19. Periodontal therapy reduces AGE's, which are measured using hemoglobin A1c. A large British study showed that for every percentage point decrease in HbA1c, there is a 35% reduction in tissue damage to blood vessels and a 10% lower mortality rate from diabetes. (6)

Alzheimer's Disease

I have written about this link before, and you can read about it here. The primary bacteria associated with gum disease are also connected with Alzheimer's disease. (7) There are no papers on periodontal therapy decreasing Alzheimer's yet. However, the Alzheimer's Disease hypothesis has been expanded to include the involvement of infections, and lifestyle, genetic, and environmental factors. Periodontal disease happens to encompass the exact same elements. (8)

Lung Disease

In patients with poor oral hygiene, lung pathogens are found more frequently in the mouth. Evidence points to improving oral hygiene lowers the death rate from pneumonia, especially in the elderly. (9)

With the kind of evidence just presented, dentists and medical doctors must provide better and more coordinated screening for the prevailing conditions associated with mortality, especially when associated with coronavirus.

The good news is that you don't have to wait for the healthcare industry to catch up. With the knowledge gained today, there is no reason you can't start tackling nagging health problems right now. Since all of the conditions discussed today are related to lifestyle choices, including periodontal disease, changing a few things can have a considerable impact. Diet, sleep, stress, movement, and proper sun exposure are all important lifestyle factors. For more on this, read my post entitled My Recipe for a Happy Healthy Vibrant Human Being.