In a study of more than 500 Covid patients, those with gum disease were nine times more likely to die of Covid compared with those not suffering from it. They were also three and a half times more likely to be admitted to ICU and four and a half times more likely to need a ventilator.
What links gum disease and severe Covid is inflammation. This inflammation also greatly increases your risk of Alzheimer's (which I've mentioned previously) and also diabetes. It is also linked to AF, as has also been mentioned on this site.
So it's time to get scrubbing, people!
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MarkS
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For some of us Mark it is a way of life. Fifty plus years of NHS dentistry saw to mine and the last 25 it has been fire fighting and damage limitation.
Denplan spreads mine since I have three monthly hygiene visits.
Hi Mark
As you suspected the Times article is behind a paywall. Hopefully I have captured it in it’s entirety.
WHY THE HEALTH OF YOUR GUMS COULD SAVE YOUR LIFE
Poor oral hygiene is bad for your teeth. It also hugely increases your chance of dying from Covid-19. Only 17 per cent of UK adults have completely healthy gums
Bleeding gums when brushing your teeth might seem a common and trivial inconvenience, but research shows that it can put you at serious risk of developing severe or fatal Covid-19 as well as other illnesses such as dementia, diabetes and heart disease.
About eight in ten over-35s have had some level of gum disease that causes bleeding, according to the European Federation of Periodontology. At its mildest level this is called gingivitis. If it is not treated, the more serious gum infection called periodontitis develops. This afflicts up to half of British adults. It can cause pain and tooth loss as well as bleeding, but the damage can go much further.
This month a study of more than 500 Covid-19 patients established a worrying association between periodontitis and serious complications and death from coronavirus. It found that those with gum disease are almost nine times more likely to die compared with those not suffering from it. Covid-19 patients with periodontitis are also three and a half times more likely to be admitted to intensive care and four and a half times more likely to need a ventilator, says the study in the Journal of Clinical Periodontology.
What links periodontitis and severe Covid-19 is inflammation, the study suggested. For periodontitis does not just cause gums to be inflamed and bleed — it can spark a harmful chronic inflammatory response throughout the body. The study of Qatari Covid-19 patients’ medical and dental records found that those who had gum disease had significantly higher levels of inflammatory substances circulating in their bloodstream than those without periodontitis.
Severe and fatal Covid-19 is strongly associated with a hyperreactive inflammatory immune-system response that runs like wildfire in the patient’s body. This wreaks havoc on the lungs and other vital organs. When a person’s body is chronically inflamed by gum disease, an immune-system overreaction to coronavirus may be more likely and more severe, says the international team of researchers that conducted the study.
In an international survey conducted in 2010, severe periodontitis was found to be the sixth most prevalent health condition in the world and the most common chronic inflammatory disease. Severe periodontitis involves pain and tooth loss. It afflicts 10 per cent of cases. As a 2017 report in the British Dental Journal starkly warns: “Gum disease is an infection that irreversibly destroys the bone that holds your teeth in place . . . When insufficient bone remains to support your teeth they will start to drift or fall out.”
One clearly cannot ignore tooth loss. Mild periodontitis is easier to ignore. When we do, we let two serious health threats thrive: chronic inflammation and the bacterial infection that causes it. Both spread from the gums throughout the body.
“The Covid study is another pointer to the fact that you need to have a healthy mouth for your overall health,” says Nicola West, the secretary general of the European Federation of Periodontology, professor of periodontology and the head of restorative dentistry at Bristol University. “The mouth is a window on the body. Bacteria in the mouth get into the bloodstream where they can harm the rest of the body. This explains why gum disease has been linked with diabetes, cardiovascular disease and dementia.”
A research study led by West found that in people with severe periodontitis half of the bacteria in their bloodstream originated in their infected gums. The study, published last month in the journal Frontiers in Cellular and Infection Microbiology, also reported other research that has found gum-disease bacteria present in the brains of people who have died from Alzheimer’s disease. The brains of people who died without Alzheimer’s were free of this infection.
Numerous studies have shown an association between chronic bodily inflammation and dementia. West’s research suggests that inflammatory periodontitis bacteria may be a direct culprit. “Our study also suggests that as you get older and your immune system becomes less effective, gum-disease bacteria can cross the blood-brain barrier,” she says. And gum disease becomes more prevalent in mid-life, West warns, with half of periodontal disease occurring in people aged over 65.
Since the 1990s studies have linked gum disease bacteria with another inflammatory condition: type 2 diabetes. In 2020 Harvard University researchers reported in the journal Diabetes Care that when they treated diabetic patients’ periodontitis, they also reduced the severity of their diabetes by restoring some of their bodies’ ability to control blood-sugar levels healthily.
Numerous population studies have also linked periodontitis with an increased risk of cardiovascular disease, heart attacks and strokes. Once again, systemic inflammation is believed to be the link. In 2007 an international collaboration involving investigators from University College London reported how gum-disease bacteria in the bloodstream harm the lining of people’s arteries by making them chronically inflamed.
Their study, in The New England Journal of Medicine, intensively treated the gums of 61 patients with severe periodontitis and inflamed arterial linings. Six months later the investigators reported that the more the patients’ gum disease had improved, the healthier were their arteries.
So how do we keep gum bugs at bay? Should we adopt intricate mouth-care tactics involving special angles of brushing and exotic potions, as recommended by YouTube influencers? Not at all, says Damien Walmsley of the British Dental Association. “The best things that anyone can do to prevent gum disease are entirely basic: brush two times a day for two minutes using a fluoride toothpaste and cut down on sugar in your diets.”
To prevent gum disease, we should brush twice a day and clean between our teeth
To prevent gum disease, we should brush twice a day and clean between our teeth.
That’s hardly onerous. Nevertheless surveys consistently show that a third of us manage to brush our teeth but once a day. About 2 per cent never brush at all. This helps to explain why data from the Office for National Statistics shows only 17 per cent of UK adults have completely healthy gums.
Walmsley adds that, over and above twice-daily brushing, we may also use interdental brushes to clean between our teeth once a day or floss if the spaces between teeth are too tight for a brush. If our gums bleed, he says, that’s not a message to leave sore areas alone. “The right treatment is to make sure you clean those areas.”
West concurs. “We simply ask people to clean their teeth as best they can. The better your oral hygiene the better your chances.”
Diet also appears to be crucial. Last year a study in the journal Nutrition Reviews showed that vitamin C deficiency significantly raises our risk of periodontitis. And earlier reports by Harvard Medical School researchers in the former Journal of the American Dietetic Association found that eating natural polyunsaturated fats, as found in peanut butter, can protect against gum disease.
West stresses: “It’s important that you have a vitamin-rich diet. It is also important to maintain a healthy weight. Maintaining your overall physical health supports healthy gums, which in turn supports your overall physical health. It’s a beneficent cycle.”
Crucially, she adds, we should seek professional help whenever gum problems arise. “Half of gingivitis cases go on to become periodontal disease. You need to stop it early. Everyone can see it in the form of bleeding gums. Once the gum disease is ongoing you need professional help.”
If you’ve become a stranger to your dental practice during the pandemic, it’s time to put that to rights, West says. “All dental practices should be open now. It is really important that you go back to be checked up with the dentist — and also the dental hygienist too.”
Absolutely it did Y!Then I had a go at the study linked below by MarkS. I wanted to be able to decode it (and it is beautifully written), but after 2 hours I got distracted and google surfed my way to wikipaedia and stories about Lawrence of Arabia.
In isolation, this article makes no reference to potential confounding factors in trying to relate gum disease to Covid morbidity and mortality. The most obvious would seem to be obesity and heavy smoking which are independent risk factors for severe Covid.
If it were the case that obese smokers had gum disease, it would presumably be necessary to control for each to draw a meaningful conclusion.
Do you have a link to the original study in the journal of peri-odontology?
Section 2.3 says that adjustments their models were adjusted for possible confounders including age, sex, smoking, BMI, diabetes and comorbidities. Having said that, there might be other confounders not allowed for. People with good oral hygiene could be expected to follow other good health lifestyles such as Vit D. I'd be interested in your thoughts.
Thanks Mark for the link to the Journal of Clinical Periodontology.
What a pleasure to read such a well written and constructed paper. It’s a small study, and I hope the authors will come back with updated and perhaps more statistically significant results.
One thing I struggled with was that periodontitis was identified in the 12 months before patients were recruited. In the richest country in the world with very likely the finest health care facilities in the world, is it really credible that cases of periodontitis in patients in the study had not already been treated and eliminated before admission with COVID-19?
I’ve probably just missed the “fine print”, but if not, are the study conclusions still valid?
I’m a great believer in the link between inflammation and disease and am well known to bore everyone rigid in my advocacy of statin treatment. Our descendants will wonder how we could add fluoride to our drinking water, but not a soupçon of atorvastatin.
Badger, yes the paper was generally quite well written. However there were typos, e.g. Table 1: "Adequate weight >=25" and "overweight/obese < 25" whereas the arrows should be the other way round (that's a bugbear of mine). Also under Assisted Ventilation which had a total number of cases of 20, there were 366 of adequate weight!! That indicates a certain sloppiness which shouldn't be down to a particular language issue.
Certainly, inflammation was a key factor. Those surviving had one tenth of the amount of CRP as those dying. They did measure Vit D - those dying had 12 ng/ml and those surviving 22.
However the study was quite small and I still wonder whether there were other confounders not allowed for. Level of education would be an interesting one.
The level of periodontitis was surprising for a country such as Qatar. The figures are worse for the UK however.
Might their be a general correlation between low vit D and gum disease? No mention of Co enzyme Q 10 in the article. This is a supplement that helps a lot with gum health. I am one of those naughty people who only clean their teeth at night ( though this was said to be perfectly ok by the dentist I had in Brum years ago! Before that I did them twice a day) and I use non fluoride toothpaste as floxies try to avoid all forms of fluoride. I do floss my teeth though and I have taken Q10 or Ubiquinol for over 25 years. My gums never bleed and my main dental problem is bruxism caused by a fear of the dentist as a teenager and a refusal to have braces.
I don't know if this is relevant or not but in mid-Jan I had my 3rd ever hygienist appointment and I'm in my mid 70's. She was genuinely surprised how good things were. However, she did suggest I change my cleaning regime to water floss first and rinse. Then clean with toothpaste for 2 mins, spit out the remainder BUT don't rinse. Sounds relatively simple.
But for some unknown reason the frequency of my AF episodes has changed. The gap between episodes was 3-4 days free of AF, but after the change it's jumped to 7-9 days. I can't understand it as nothing else has changed. Could it be sheer coincidence that my saliva is producing less inflammation in my stomach.
You're right about not rinsing after brushing as the toothpaste will carry on working after you have brushed, my teeth used to bleed a little when I rinsed after brushing but they dont anymore.
It's fairly well controlled and I've not had an episode for months as I'm very careful with weight for one thing and diet but overall health is key I think and that includes teeth and anything else thats inflammatory such as poor sleep patterns etc
It's a gadget that you fill with water. It is able to pump it out of a long narrow jet which you direct at the gaps between your teeth. On mine I'm able to change the pressure to spray the soft skin in front of your gums and of course your tongue. Mine is made by Panasonic model: EW1211A so google that to find out more.
As I say though, it's purely coincidence that my AF may have been improved by using it differently and not rinsing out my toothpaste.
I can only think that really well flushing of the mouth plus the slight chemical effect of the toothpaste remnants helps in reducing contamination (inflammation) of the stomach. Whether that's true or not I don't know but it's strange my AF frequency has improved without any other lifestyle changes. Let's see whether it continues.
Yes very relevant to us all. I think I also read CoQ10 supplement is good for gums/teeth, which I take anyway with a Magnesium compound to keep AF at bay.
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