Stylised graphic representing coronavirus in the respiratory system

COVID-19 and the oral-systemic health connection

Date: June 2020

Author: Louise Sinclair

As dental practitioners, we already know that oral and systemic health – and disease – are inextricably linked. However, patients tend to be much less aware of this crucial connection. Now, during the COVID-19 pandemic, it’s more important than ever to help them understand, particularly when we consider that so much about this disease is still unknown.

What we do know at present is that certain health conditions, such as diabetes, cardiovascular disease, and obesity, can increase the severity of COVID-19 symptoms in affected patients. These high-risk conditions are also connected to periodontal disease, a condition the Centers for Disease Control and Prevention (CDC) estimate affects as many as 47% of Americans. Each of the sections below contains information we can all readily share with our patients and help them appreciate the importance of their oral health.

Periodontitis and cardiovascular disease

Bacteria from periodontal disease are known to enter the bloodstream and circulate throughout the body, causing chronic, low-grade inflammation that alters the body’s immune response and damages healthy tissues. The bacteria are particularly damaging to the cardiovascular system.

A triad of components work together to cause atherosclerosis, or plaque build-up in the arteries: high levels of low-density lipoprotein, or LDL cholesterol; increased permeability of the arterial lining; and increased binding of LDL to the arterial walls. People with periodontal disease have been found to have up to twice the LDL cholesterol as those with healthy gums. In fact, periodontal bacteria have been found to intensify all three components, creating a triple threat to cardiovascular health.

Periodontitis and diabetes

Patients with periodontal disease are also more likely to have uncontrolled diabetes. According to the American Academy of Periodontology (AAP), severe periodontal disease can increase blood sugar and make it more difficult to control, putting patients with diabetes at a higher risk of diabetic complications.

The connection goes both ways; patients with diabetes are at increased risk of developing periodontal disease, possibly due to their increased susceptibility to infection. In fact, the connection is so strong that the AAP points out in its patient resources information that periodontal disease is often considered a complication of diabetes.

Periodontitis and obesity

OObesity is itself a risk factor for both cardiovascular disease and diabetes, and is associated with multiple diseases and disorders of the airways. The CDC states that severe obesity increases the risk of acute respiratory distress syndrome (ARDS), a major complication of COVID-19 that can intensify symptoms and interfere with the ability to provide care for seriously ill patients.

Making the connection

Patients often regard their oral health as a single entity, detached from the rest of their body and their overall health, but there has never been a more critical time to educate them on the oral-systemic connection. As dental practitioners, we are ideally positioned to help them understand this crucial connection and develop a whole-body approach to their health.