Woman wearing a mask in public

The Research Study

The Journal of Clinical Periodontology published a study on February 1, 2021 that examines the association of COVID-19 and periodontitis. Researchers began the clinical study on the basis that the coronavirus causes an inflammatory response in the body and note that systemic inflammation is a main factor of periodontitis.

Woman scientist drawing a test tube

Setting Up the Study

The study involved a total of 568 patients, and a total of 258 had periodontitis. Researchers aimed to determine if there was a link between coronavirus severity and a person’s dental habits of brushing and flossing.

Interestingly, out of the 258 participants that had periodontitis, 33 had complications, while just 7 out of 310 without periodontitis experienced complications.

Diving Deep into the Numbers

Complications between COVID-19 sufferers and periodontal health were charted and showed impressive results. The study broke down the patients into two main groups based on their periodontal condition stages:

  1. Stage 0-1
  2. Stage 2-4

Group two includes those that have more severe periodontal conditions.

Stage 0-1 Results

Out of 303 controls, a total of 7 people in this group had complications from the coronavirus. Deaths were just 1, while all seven individuals were admitted to the ICU. Finally, only three of the individuals in this group needed the assistance of a ventilator to help them breathe.

Statistically, the figures for this group, out of a total of 40 complications between both groups, are:

  • 17.5% of cases had complications
  • 7.1% resulted in death
  • 19.4% resulted in ICU admission
  • 15.8% required ventilation

It seems, based on the study and the data presented, that people that have moderate to severe periodontitis had significantly higher risks of complications than those with no or mild forms of periodontal disease.

Discussions and Theories on Why Periodontal Health May Impact COVID-19 Complications

While the study does show that there’s a correlation between periodontal health teeth cleaning and coronavirus, the definite cause remains a topic of debate. There are a lot of theories linking the two together, but it’s vital to understand that patients all had their blood concentration levels analyzed, too.

Studies on the fatal outcomes found the following concentrations to be higher:

C-reactive Protein

Abbreviated as CRP, this is a measurement that’s found in the blood that rises when there’s inflammation present in the body. The levels can also rise when infection occurs. Studies also find that CRP levels are higher in individuals that have chronic periodontitis.

It begs the question that if CRP is found to be much higher in fatal cases, can the higher levels of CRP caused by oral health issues contribute to death?


D-dimer is a small piece of protein, called a fragment, that is caused by a blood clot dissolving. The body will clot and dissolve clots normally in the healing process, but with some disorders, the body can no longer dissolve clots.

Disorders that result in higher D-dimer levels often result in coughing, trouble breathing and chest pain, such as a pulmonary embolism.

It was found that more than 25% of patients that had the coronavirus had elevated levels of D-dimer as long as four months after their initial diagnosis. Periodontitis is known to impact a person’s hemostatic system, causing these levels to possibly rise.

White Blood Cell Count

White blood cells, often abbreviated as WBC, are higher in individuals that suffer from chronic periodontitis, according to numerous studies, including a prominent study in 2014. The reasoning for the higher blood cell count is the presence of severe gum inflammation, which, as a result, causes WBC levels to rise.

WBC levels in the study linking oral health with coronavirus were significantly higher than those that had mild forms of periodontal disease.

There were also lower levels of lymphocytes. Patients that did require ventilators experienced elevated levels of both CRP and D-dimer.

These markers may indicate a key reason why people that have severe periodontal disease also have complications with COVID-19. More research is needed to provide a clearer picture of how oral health may impact the outcome of people that test positive for coronavirus.

Researchers caution that the study needs more data to strongly link the two conditions together, but they suggest that even a causal link of severity of periodontal health and COVID-19 demands a periodontal health routine be established for anyone at-risk of complications from coronavirus or that has already contracted the virus.

Causality isn’t addressed in the study, and there are obvious limitations involved, note the researchers.

The researchers conducting the study recommend further research in the area in an effort to understand the connection between periodontal disease and coronavirus outcome. A better understanding of this relationship can help produce lower risk classification and even novel interventions and perhaps treating recession more effectively.

Take Early Precautions to Improve Oral and Periodontal Health

Periodontal health, and oral health in general, can be maintained with regular screenings with a dentist you can trust. Routine dental visits can catch the disease early on, but you should also:

  • Schedule regular checkups
  • Brush twice daily
  • Floss once daily

Knowing the warning signs of periodontal disease can also help. Early warning signs include teeth that are loose or separating, gums that pull away from the teeth, bleeding when brushing, red or swollen gums or even a change in the way your teeth align when you bite.

Preventing periodontitis during and after the COVID-19 pandemic requires the same diligence: brush, schedule routine dental visits and floss.

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Dr. Gurpreet Sidhu - Dentist at Lighthouse Dental Centre and Blue Water Dental
Dr. Gurpreet Sidhu

With nearly two decades of experience, Dr. Sidhu enjoys helping his patients learn about dentistry. Knowledge is meant to be improved, challenged and shared.

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