Gum Disease Linked to Severe COVID

Dr Brayden talks about gum disease’s systemic implications

Do your gums bleed when you floss? If your answer is YES, you are not alone. Well over half of US adults have gum disease, and though bleeding is one indicator, it’s likely a majority of people are unaware of their disease.(1) The US surgeon general has called gum disease a “silent epidemic”, and this disease is often ignored despite being highly treatable.(2,3) Because gum disease can affect your overall health and your finances in addition to your mouth, we are reposting this blog series to talk about it. These posts will define what gum disease is, how it interacts with our whole body health, and how it impacts our wallets.

Gum Disease and COVID

We know people who are at “high risk” tend to have the worst COVID symptoms. Many factors can put someone in that “high risk” category, and one of them is gum disease. Several studies have shown that people with gum disease are between three and five times as likely as someone with healthy gums to have severe COVID illness leading to ICU admission or even death. The science is clear: gum disease makes COVID illness worse. Keep reading to find out why!

What exactly is “Gum Disease”?

When we talk about “Gum Disease” we may be referring to two distinct conditions. One is gingivitis, which refers to gum (gingiva) inflammation, or swelling (-itis). When a person has gingivitis, their gums become inflamed, or swollen, with blood and immune system cells. We will discuss the most common reason for this inflammation below. Gingivitis is the first stage of the second even more serious gum disease condition of periodontitis, or periodontal disease.

As opposed to gingivitis, periodontitis refers to inflammation around teeth (perio=around, dont=tooth, itis=inflammation). When inflammation spreads from the tops of gums (gingivitis) to the area surrounding teeth (periodontitis), the classic sign is bone loss, which we measure via radiographs and probing depths. We will discuss the mechanism of bone loss below. 47% of US adults have periodontitis, or periodontal disease, but a large portion of the remaining 53% may have gingivitis, which, without treatment, leads to periodontitis.(1) The scary truth is that gum disease is usually painless and has no symptoms at all during the early stages of gingivitis and mild periodontitis, so it can go unrecognized initially.  Unfortunately, the more advanced the gum disease, the greater the systemic health implications – meaning that gum disease can affect other parts of the body and other diseases as well, some of which we discuss below.

How does Gum Disease Progress?

We can almost think of gum disease in two ways: as an infection, and as an inflammatory process.

Gum Disease as An Infection

Gum disease typically will start as gingivitis. The gums become inflamed due to dental plaque- the sticky matrix of bacteria and food debris that gets stuck to our teeth when we don’t clean them well. Eventually, the soft, sticky plaque hardens into calculus, which also harbors bacteria but can only be removed by a dental hygienist. The bacteria and bacterial products induce an immune response from our gums that tries to eliminate what our body is sensing as an infection.

In fact, when our gums are inflamed and bacteria are present in sticky plaques or clinging to calculus, even the simple act of chewing can cause the release of bacteria or their toxins into our bloodstream creating a condition known as bacteremia, or bacteria in the blood. (4)

Usually the increase of bacteria in the blood is transient, or short-lived. But sometimes metastatic infections can occur and become chronic infections, especially if a person has artificial joints or heart valves, atheromas, or is otherwise immunocompromised.(5) In fact, the species of bacteria present in gum disease have been found to specifically predispose us to “systemic diseases such as cardiovascular disease, oral and colorectal cancer, gastrointestinal diseases, respiratory tract infection and pneumonia, adverse pregnancy outcomes, diabetes and insulin resistance, and Alzheimer’s disease”, as reported in Clinical Microbiology Review.(6) Plaque is just the first stage of bacterial colonization.

The worse the gum disease condition, the higher incidence of bacteremia and risk of complications.(7) And, considering there may be up to a trillion dangerous bacteria per diseased tooth, it’s best to nip gum disease in the bud before it develops!

Gum Disease as an Inflammatory Process

Usually we talk about plaque and bacteria causing gum inflammation. But so can pregnancy, certain drugs, and hormonal changes due to puberty or menopause. Inflammation from gingivitis, when untreated, will cause oxidative stress in our bodies, and cytokines to be released from the epithelial lining of our gum pockets. These cytokines are like a messenger system for our body, and they attract immune cells. This process eventually results in the breakdown of our connective tissue and jawbone loss surrounding our teeth. A dental team would be able to see this bone and tissue loss via radiographs and probing depths . Tissue loss around teeth leads to an increased likelihood of tooth mobility (loose teeth) and, eventually, loss of teeth.

Gum Disease Makes You Sicker

But the inflammation doesn’t just stop around your teeth. Many studies have shown an increase in systemic inflammatory markers as a result of gum disease, meaning that inflammation affects far more than your mouth.(8) This is why people with inflamed gums get sicker than people with healthy gums! We talk more about how gum disease affects speficic illnesses in these blogposts: blood pressure and pregnancy, cancer and diabetes, and gum disease is expensive!

The great news about this sinister inflammatory process is it’s been proven that dental treatment for gum disease will reduce systemic inflammation.(8) If you or a loved one have bodily inflammation, consider making dental treatment a part of your wholistic plan to get healthier in 2023!

At Teuscher Dental, our Focus is to Help You Get Healthy and Stay That Way. Let us know how we can help you on your health journey!

References

1) American Academy of Periodontology. “CDC: Half of American Adults Have Periodontal Disease.” CDC: Half of American Adults Have Periodontal Disease | Perio.org, 4 Sept. 2012, www.perio.org/consumer/cdc-study.htm

2) “Surgeon General’s Report on Oral Health in America.” National Institute of Dental and Craniofacial Research, U.S. Department of Health and Human Services, www.nidcr.nih.gov/research/data-statistics/surgeon-general.

3) Benjamin, Regina M. “Oral Health: the Silent Epidemic.” Public Health Reports (Washington, D.C. : 1974), Association of Schools of Public Health, 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC2821841/.

4) Geerts, Sabine O, et al. “Systemic Release of Endotoxins Induced by Gentle Mastication: Association with Periodontitis Severity.” Journal of Periodontology, U.S. National Library of Medicine, Jan. 2002, www.ncbi.nlm.nih.gov/pubmed/11846202.

5) Parahitiyawa, N B, et al. “Microbiology of Odontogenic Bacteremia: beyond Endocarditis.” Clinical Microbiology Reviews, American Society for Microbiology (ASM), Jan. 2009, www.ncbi.nlm.nih.gov/pmc/articles/PMC2620633/.

6) Forner, Lone, et al. “Incidence of Bacteremia after Chewing, Tooth Brushing and Scaling in Individuals with Periodontal Inflammation.” Journal of Clinical Periodontology, U.S. National Library of Medicine, June 2006, www.ncbi.nlm.nih.gov/pubmed/16677328.

7) Carrizales-Sepúlveda, Edgar Francisco, et al. “Periodontal Disease, Systemic Inflammation and the Risk of Cardiovascular Disease.” Heart, Lung and Circulation, Elsevier, 2 June 2018, www.sciencedirect.com/science/article/pii/S1443950618305973.

8) D’Aiuto, F, et al. “Periodontitis and Systemic Inflammation: Control of the Local Infection Is Associated with a Reduction in Serum Inflammatory Markers.” Journal of Dental Research, U.S. National Library of Medicine, Feb. 2004, www.ncbi.nlm.nih.gov/pubmed/14742655.

9) Marouf, Nadya, et al. “Association between Periodontitis and Severity of COVID-19 Infection: A Case-Control Study.” Journal of Clinical Periodontology, U.S. National Library of Medicine, Apr. 2021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014679/.

10) Larvin, Harriet, et al. “The Impact of Periodontal Disease on Hospital Admission and Mortality during COVID-19 Pandemic.” Frontiers, Frontiers, 1 Jan. 1AD, https://www.frontiersin.org/articles/10.3389/fmed.2020.604980/full.

Gum Disease, Cancer, and Diabetes

If you are reading this, there’s a high chance you have gum disease.1 In previous posts we’ve discussed what gum disease is and how it can affect pregnancy and heart disease. This post will continue that discussion with a focus on cancer and diabetes.

Our hope through these posts is to help you understand how your oral health is a huge part of your overall well-being. Our information is always well researched, as you can see by our references at the bottom. Keep reading, and let us know if you have any questions or comments!

Oral Cancer

Oral cancer is the 8th most common type of cancer in the US, and the majority of head and neck cancer cases are found in the mouth, particularly the sides of your tongue.2 Cancer is one of the many things we screen for at every exam at Teuscher Dental, and part of why regular dental exams are so important and about more than just teeth and gums. Cancerous lesions appearing on the tongue are correlated with gum disease.3 And inflammation in general is thought to contribute to cancer development.  Oral cancer has a high incidence of malignancy, and even when successfully treated can require extensive facial reconstructive surgery to recover from, as exampled by oral cancer survivor Gruen Von Behrens’ before and after photos.4

As stated above, inflammation like that of gum disease can contribute to any type of cancer. That, along with pregnancy complications and heart disease, are just a few of the diseases and complications with direct correlation to gum disease. But research also has demonstrated gum disease links to colorectal cancer, gastrointestinal diseases, respiratory diseases, and Alzheimers to name a few. As more research is done it is all too likely the links will become more clear. Gum disease is no joke.

Diabetes

Both Type I and Type II diabetics are more prone to develop periodontal disease, the advanced form of gum disease, than non-diabetics.5,6 This is especially true for children with diabetes, where gum disease progression happens more quickly and is associated with longer duration of diabetes.7 In advanced gum disease, teeth can be lost due to breakdown of surrounding bone and tissue. Snowballing the problem, we know gum disease is associated with low grade inflammation and oxidative stress. These effects are also known to cause lower saliva output, causing dry mouth, increasing risk for dental caries (cavities) and further tooth loss.8 Aside from poor esthetics, tooth loss is is associated with increased likelihood for dysfunctional dentition- that is, teeth that don’t allow for proper nutritional intake.9 This is a particular problem for diabetic patients. It is a vicious cycle.

Don’t have diabetes? Studies have shown that we can actually predict whether a person is more likely to develop diabetes based on their periodontal health.10,11 While a diagnosis of diabetes depends on blood sugar levels, as with all health conditions there is a spectrum of glycemic control.  All aspects of our body’s health are interrelated.

Comprehensive research shows dental therapy for gum disease moderately decreases blood glucose levels in diabetics.12 . When we understand the strong correlation and the severity of issues associated with diabetes, it becomes clear that dental treatment for gum disease should be a part of a comprehensive diabetes medical treatment plan.

References

1. American Academy of Periodontology. “CDC: Half of American Adults Have Periodontal Disease.” CDC: Half of American Adults Have Periodontal Disease | Perio.org, 4 Sept. 2012, www.perio.org/consumer/cdc-study.htm.

2. “Oral Cancer Facts.” The Oral Cancer Foundation, 28 Feb. 2019, oralcancerfoundation.org/facts/.

3. Tezal, Mine, et al. “Chronic Periodontitis and the Risk of Tongue Cancer.” Archives of Otolaryngology–Head & Neck Surgery, U.S. National Library of Medicine, May 2007, www.ncbi.nlm.nih.gov/pubmed/17515503.

4. Henson, Brian J., et al. “Decreased Expression of MiR‐125b and MiR‐100 in Oral Cancer Cells Contributes to Malignancy.” Wiley Online Library, John Wiley & Sons, Ltd, 24 Apr. 2009, onlinelibrary.wiley.com/doi/abs/10.1002/gcc.20666.

5. Hodge, Penny J, et al. “Periodontitis in Non‐Smoking Type 1 Diabetic Adults: a Cross‐Sectional Study.” Wiley Online Library, John Wiley & Sons, Ltd, 31 Oct. 2011, onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-051X.2011.01791.x.

6. Haseeb, Muhammad, et al. “Periodontal Disease in Type 2 Diabetes Mellitus.” Journal of the College of Physicians and Surgeons–Pakistan : JCPSP, U.S. National Library of Medicine, Aug. 2012, www.ncbi.nlm.nih.gov/pubmed/22868018.

7. Al-Khabbaz, Areej K, et al. “Periodontal Health of Children with Type 1 Diabetes Mellitus in Kuwait: a Case-Control Study.” Medical Principles and Practice : International Journal of the Kuwait University, Health Science Centre, S. Karger AG, 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC5586723/.

8. Bhattarai, Kashi Raj, et al. “The Imprint of Salivary Secretion in Autoimmune Disorders and Related Pathological Conditions.” Autoimmunity Reviews, U.S. National Library of Medicine, Apr. 2018, www.ncbi.nlm.nih.gov/pubmed/29428807.

9. Marina Leite Souza, and Karen Glazer Peres. “Association between Metabolic Syndrome and Tooth Loss.” Journal of the American Dental Association, JADA, Dec. 2019, jada.ada.org/article/S0002-8177(19)30522-7/abstract.

10. Taylor, G W, et al. “Severe Periodontitis and Risk for Poor Glycemic Control in Patients with Non-Insulin-Dependent Diabetes Mellitus.” Journal of Periodontology, U.S. National Library of Medicine, Oct. 1996, www.ncbi.nlm.nih.gov/pubmed/8910827.

11. Demmer, Ryan T, et al. “Periodontal Status and A1C Change: Longitudinal Results from the Study of Health in Pomerania (SHIP).” Diabetes Care, American Diabetes Association, May 2010, www.ncbi.nlm.nih.gov/pubmed/20185742.

12. Chee, B., et al. “Effect of Non-Surgical Periodontal Treatment on Glycemic Control of Patients with Diabetes: a Meta-Analysis of Randomized Controlled Trials.” Trials, BioMed Central, 1 Jan. 1970, link.springer.com/article/10.1186/s13063-015-0810-2.

Gum Disease, Heart Disease, and Pregnancy

Well over half of US adults have gum disease, and though bleeding is one indicator, it is likely a majority of people don’t know of their disease.1,2 It’s a “silent epidemic”, and has significant effects on your systemic health!3

At Teuscher Dental, Our Mission is To Serve you. That means providing you with the best wholistic care available today, always research based and in pursuit of excellence. This post gives a little information on how gum disease relates to Cardiovascular Disease and Pregnancy. Keep reading to learn more!

Heart Disease:

Cardiovascular (CV) disease, more commonly referred to as heart disease, is the leading cause of death in the US. Hypertension, or high blood pressure, is the biggest risk factor for developing Cardiovascular disease (and your blood pressure is something our office checks at every dental exam).  Heart Disease is also highly correlated with gum disease. In fact, a comprehensive study indicated that people with periodontitis are 66% more likely to have a cerebrovascular event like a stroke, and OVER TWO TIMES as likely for those events to be fatal compared with people without gum disease.4

Why does gum disease make cardiovascular disease more dangerous? Research is ongoing, but we know cardiovascular disease can result from increased blood vessel inflammation, which can, in part, be caused by gum disease pathogens.5 Products and toxins from these bacteria also can cause changes in lipid (fat) metabolism, further contributing to CV disease risk.6 When someone already has a form of CV disease, periodontal pathogens preferentially infect atherosclerotic plaques, and studies show that when this infection occurs, multiple species of periodontal pathogens are often present.7,8

Pregnancy

Know anyone who is pregnant? Pregnant patients with gum disease are up to TEN TIMES more likely to have gestation fewer than 28 weeks, that is, a pre-term birth, according to a comprehensive study. The same study suggests that even mild periodontal disease potentially increases pre-term birth risk by over 300%.9  Gum disease also significantly contributes to low-weight births and in-utero infections.10,11 This association and risk is well documented. The good news is that the risk for pre-term and and low weight births is significantly lower for moms who receive dental therapy for gum disease.12 It should be noted that due to hormonal changes, pregnancy gingivitis is normal. But if you are thinking of becoming pregnant, a great way to decrease risk to your baby is to get screened for gum disease beforehand.

We do limit elective dental treatment during pregnancy, but often the risk to the baby (and mom) is actually greater with no treatment, especially if active dental or gum disease is present. If you are interested, the American Pregnancy Association has guidelines for receiving dental treatment during pregnancy. As always, at Teuscher Dental our top priority is your health and that of your growing baby. We will never push you into treatment that is unnecessary or risky. If you have any questions about your dental health during pregnancy, just give us a call!

In our next post we will discuss how gum disease relates to diabetes and oral cancer.

References

1) American Academy of Periodontology. “CDC: Half of American Adults Have Periodontal Disease.” CDC: Half of American Adults Have Periodontal Disease | Perio.org, 4 Sept. 2012, www.perio.org/consumer/cdc-study.htm.

2) “Patients.” ADA Health Policy Institute FAQ – Dental Patients in the U.S., www.ada.org/en/science-research/health-policy-institute/dental-statistics/patients.

3) “Surgeon General’s Report on Oral Health in America.” National Institute of Dental and Craniofacial Research, U.S. Department of Health and Human Services, www.nidcr.nih.gov/research/data-statistics/surgeon-general.

4) Bahekar, Amol Ashok, et al. “The Prevalence and Incidence of Coronary Heart Disease Is Significantly Increased in Periodontitis: a Meta-Analysis.” American Heart Journal, U.S. National Library of Medicine, Nov. 2007, www.ncbi.nlm.nih.gov/pubmed/17967586.

5) Slocum, Connie, et al. “Distinct Lipid A Moieties Contribute to Pathogen-Induced Site-Specific Vascular Inflammation.” PLOS Pathogens, Public Library of Science, journals.plos.org/plospathogens/article?id=10.1371%2Fjournal.ppat.1004215.

6) Hardardottir, I., et al. “Effects of Endotoxin on Lipid Metabolism .” Effects of Endotoxin on Lipid Metabolism , pdfs.semanticscholar.org/a2c1/9025573414d20d3cb2ffbe491493075834ec.pdf.

7) Chiu, B. “Multiple Infections in Carotid Atherosclerotic Plaques.” American Heart Journal, U.S. National Library of Medicine, Nov. 1999, www.ncbi.nlm.nih.gov/pubmed/10539867.

8) Haraszthy, V I, et al. “Identification of Periodontal Pathogens in Atheromatous Plaques.” Journal of Periodontology, U.S. National Library of Medicine, Oct. 2000, www.ncbi.nlm.nih.gov/pubmed/11063387.

9) Offenbacher, S, et al. “Maternal Periodontitis and Prematurity. Part I: Obstetric Outcome of Prematurity and Growth Restriction.” Annals of Periodontology, U.S. National Library of Medicine, Dec. 2001, www.ncbi.nlm.nih.gov/pubmed/11887460.

10) Sánchez, Andrés R, et al. “Maternal Chronic Infection as a Risk Factor in Preterm Low Birth Weight Infants: the Link with Periodontal Infection.” Journal of the International Academy of Periodontology, U.S. National Library of Medicine, July 2004, www.ncbi.nlm.nih.gov/pubmed/15368875.

11) Madianos, P N, et al. “Maternal Periodontitis and Prematurity. Part II: Maternal Infection and Fetal Exposure.” Annals of Periodontology, U.S. National Library of Medicine, Dec. 2001, www.ncbi.nlm.nih.gov/pubmed/11887461.

12) Kim, Arthur J, et al. “Scaling and Root Planing Treatment for Periodontitis to Reduce Preterm Birth and Low Birth Weight: a Systematic Review and Meta-Analysis of Randomized Controlled Trials.” Journal of Periodontology, Centre for Reviews and Dissemination (UK), Dec. 2012, www.ncbi.nlm.nih.gov/pubmed/22376207.