Studies: The Link Between Oral Hygiene and Severe COVID-19

I am writing this article today to let you know some important information about the connection between Periodontal Disease (“PD”), and the risk of severe COVID-19 complications.   Knowing PD is associated with severe COVID-19 could help identify risk groups and establish pertinent recommendations.  It can also help you take proactive steps in an effort to reduce the risk to you in case you become infected with COVID-19.

A recent study reported by the National Institutes for Health (NIH), indicates that there is a connection between PD and severe COVID-19.  Another study published in the British Dental Journal (BDJ), concludes the same.

Periodontal disease (PD), or commonly called “gum disease” is characterized by red, sensitive, receding and/or bleeding gums.  PD is actually a group of diseases involving an inflammatory response in your body, and a microbial imbalance starting in your gums, which could lead to diseases throughout your body.  Many studies have shown that a number of diseases, such as diabetes, heart disease, high blood pressure, and kidney disease, are associated with PD.  These studies demonstrate that the underlying cause of all these diseases is sustained systemic inflammation, which is really your body’s immune response to these bacterial insults that have invaded your bloodstream, however the exact mechanisms have not been established completely.

Interestingly, these same factors have been widely associated with progression or severe COVID-19. Inflammatory factors and imbalances in your bacteria levels affect your overall health, according to these studies.  Sadly, however, assessment of oral health history including periodontal status in COVID-19 patients has not been reported.  

This makes complete sense, as disease severity has been attributed to many patient-related medical risk factors. In one of the largest cohort studies to date on 5,700 patients who entered the New York hospital system, Richardson et al. (2020) found that the top risk factors of people with severe COVID-19 symptoms included diseases associated with inflammation, such as hypertension (56.6%), obesity (41.7%), and diabetes (33.8%).   Because of the increase in the severity of COVID-19 symptoms associated with patients who have preexisting inflammatory conditions, anti-inflammatory medications used to treat chronic/autoimmune inflammatory diseases have also been used to treat those with COVID-19.

Other studies have shown that periodontal treatment can lower overall systemic inflammatory markers. If inflammation can be lowered with periodontal treatment, can this type of oral care play a role in decreasing host susceptibility to COVID-19?   In addition to common inflammatory pathways, the British study has suggested that oral disease may exacerbate COVID-19 severity via two additional mechanisms.  Oral bacteria have been implicated in aspirational pneumonia and an increase in viral respiratory infection. Furthermore, respiratory diseases, such as those caused by COVID-19, predispose patients to bacterial superinfections that complicate disease treatment. Oral bacteria have been implicated in those bacterial superinfections.

Can dental treatment decrease the likelihood of developing these superinfections?  Because it is so new, controlled studies examining common inflammatory and pathogenic pathways between periodontal disease and COVID-19 need to be performed to determine the final answers—but if you are concerned that you may have gum disease, a dental professional can help.  But I definitely think so.

Important Tip: Daily tooth brushing and flossing can prevent and even reverse the earliest form of gum disease, called gingivitis.

Left untreated, gingivitis can turn into periodontal disease. The gums pull back from the root of the tooth, creating a tiny pocket that gradually widens. Eventually, the infection and inflammation attack the tissue that holds the tooth to the jawbone, which can cause the tooth to loosen and possibly fall out.

A dentist or hygienist can treat periodontal disease by cleaning the teeth above and below the gum line, a procedure known as scaling and root planning (SRP). They use manual scalers or ultrasound devices to scrape away hardened plaque (tartar). 

Neither procedure requires sedation, and can be performed in both my West Hartford Center dental office and New Britain dental office.

Signs of gum disease

Any of these signs can be a clue that you have periodontal disease:

• swollen, red, or tender gums
• gums that bleed easily
• pus between the teeth and gums
• bad breath
• buildup of hard brown deposits along the gum line
• loose teeth or teeth that are moving apart
• changes in the way dental appliances fit.

If you have any of these issues, contact my office for a checkup. Your loved ones will be glad you did.

Keep smiling,


Dr.Elzbieta W. Basil, DMD is a private practice dentist with offices in West Hartford Center and  New Britain, Connecticut.  She is a Clinical Instructor at the UConn School of Dental Medicine, and has won several awards naming her regional “Best Dentist” and “Top Dentist.” She is an active member of the Connecticut State Dental Association and the American Dental Association. Tel: 860-561-2121