The alarming headline above is one of the findings of a recent study published in the Journal of Clinical Periodontology1. The study adds to research establishing a strong link between periodontitis and COVID-19 complications including ICU admission, the need for ventilator use, and death. The global pandemic has so many people fearful, uncertain, and eager for competent medical advice. So, how do we interpret this information? Should we share this information with our patients? Lastly, how do we educate our patients about the risks without using fear tactics? Below are my thoughts on how to answer these questions.
First, to understand why there is such a strong link between periodontal disease and COVID-19 we need to consider what we already know about periodontal disease and systemic health. The link between periodontal disease and other chronic inflammatory conditions, such as diabetes, cardiovascular disease, respiratory disease, and rheumatoid arthritis is now well established. Because of the link to systemic health, those with periodontitis are also the patients most at risk for COVID-19 complications. A healthy individual may be asymptomatic or only experience mild COVID-19 symptoms. In contrast, a patient with underlying chronic health conditions can find themselves in the ICU in respiratory distress. Studies also propose that when a patient is on a ventilator, the bacteria causing periodontal disease can be aspirated into the lungs2, making it a contributing mechanism in the rapid respiratory decline of COVID-19 patients.
Examining the numbers can provide insight into who would benefit from a discussion about this information. While 50% of the US adult population has some form of periodontal disease, 10% present with severe periodontitis. As you know, periodontitis is an infection damaging the soft tissue and bone that supports the teeth, which can eventually result in tooth loss. On the COVID-19 side of the equation, around 14% of COVID-19 patients require hospitalization and oxygen support, 5% will land in the ICU, and 2% will die. Considering the numbers, a significant portion of the population is at risk for COVID-19 complications in association with their periodontal disease. Since we don’t know who will contract the disease, we should discuss this issue with the majority of our patients, particularly those with systemic health issues.
To communicate this information to patients, I recommend making it part of a broader discussion of the association between periodontal disease and systemic health using the following talking points:
- Periodontal disease is a chronic inflammatory condition that shares common risk factors with most chronic inflammatory diseases such as diabetes, cardiovascular disease, respiratory disease, and rheumatoid arthritis.
- Studies have shown that those most at risk for COVID-19 complications are those with these same conditions.
- The link between periodontal disease and other chronic inflammatory conditions adds another layer of risk for patients who are hospitalized with COVID-19.
- Minimize your risk of COVID-19 complications by taking care of your mouth, including good home care and regular visits with your dentist and hygienist.
To help explain the link between periodontal disease and the rest of the body, our team has developed the chairside patient-education tool below. If you would like laminated copies to use with your patients, please contact us at firstname.lastname@example.org.
Dr. Christopher M. Bingham