Gum disease linked to Covid-19 complications

Covid-19 patients are at least three times more likely to experience complications if they also have gum disease, according to research published in the Journal of Clinical Periodontology1, the official publication of the European Federation of Periodontology (EFP).

The study of more than 500 patients with Covid-19 found that those with gum disease were 3.5 times more likely to be admitted to intensive care, 4.5 times more likely to need a ventilator, and almost nine times more likely to die compared to those without gum disease.

Blood markers indicating inflammation in the body were significantly higher in Covid-19 patients who had gum disease compared to those who did not, suggesting that inflammation may explain the raised complication rates.

“The results of the study suggest that the inflammation in the oral cavity may open the door to the Coronavirus becoming more violent,” said Professor Lior Shapira, EFP president-elect. “Oral care should be part of the health recommendations to reduce the risk for severe Covid-19 outcomes.”

Periodontitis, a serious form of gum disease, affects up to half of all adults worldwide2. Periodontitis causes inflammation of the gums and, if left untreated, inflammation can spread throughout the body. Covid-19 is associated with an inflammatory response that may be fatal. This study investigated the relationship between periodontitis and Covid-19 complications.

This was a nationwide case-control study conducted in Qatar, which has electronic health records containing medical and dental data. The study included 568 patients diagnosed with Covid-19 between February and July 2020. Of these, 40 had complications (intensive care unit [ICU] admission, ventilator requirement, or death) and 528 did not. Information was collected on gum disease and other factors that might be associated with Covid-19 complications including body mass index (BMI), smoking, asthma, heart disease, diabetes, and high blood pressure. Data was also obtained on blood levels of chemicals related to inflammation in the body.

Of 568 Covid-19 patients in the study, 258 (45%) had gum disease. After adjusting for age, sex, BMI, smoking status, and other conditions, the odds ratios for Covid-19 complications in patients with gum disease, compared to those without gum disease, were 3.67 (95% confidence interval [CI] 1.46–9.27) for all Covid-19 complications, 3.54 (95% CI 1.39–9.05) for ICU admission, 4.57 (95% CI 1.19–17.4) for ventilator requirement, and 8.81 (95% CI 1.00–77.7) for death.

The authors stated: “If a causal link is established between periodontitis and increased rates of adverse outcomes in Covid-19 patients, then establishing and maintaining periodontal health may become an important part of the care of these patients.”

Professor Mariano Sanz of the Complutense University of Madrid, Spain, one of the study’s authors, noted that oral bacteria in patients with periodontitis can be inhaled and infect the lungs, particularly in those using a ventilator. He said: “This may contribute to the deterioration of patients with Covid-19 and raise the risk of death. Hospital staff should identify Covid-19 patients with periodontitis and use oral antiseptics to reduce transmission of bacteria.”

Professor Shapira said that the association between periodontitis and lung diseases including asthma, pneumonia, and chronic obstructive pulmonary disease (COPD) is well established3. He said: “This study adds further evidence to the links between oral health and respiratory conditions. Periodontitis is a common disease but can be prevented and treated.”

Professor Nicola West, EFP secretary general, added: “This study highlights another association between gum disease and our systemic health and reiterates the need for ongoing, lifelong dental care for people susceptible to gum disease and a strong preventive approach to periodontitis for populations as a whole.”

What you can do to prevent gum disease:

  • Brush your teeth carefully more than once a day using a manual or powered toothbrush.
  • Clean between your teeth daily using an interdental brush (or floss if the gaps are too tight).
  • Specific mouth rinses or toothpastes can be used on top of cleaning to reduce inflammation.
  • Do not smoke, maintain a healthy weight, eat a balanced diet, exercise, reduce stress.
  • If you have diabetes, control your blood sugar.

Those seeking more information are advised to visit The British Society of Periodontology and Implant Dentistry’s website:

1) Marouf N, Cai W, Said KN, et al. Association between periodontitis and severity of COVID-19 infection: a case-control study. J Clin Periodontol. 2021. doi:10.1111/jcpe.13435. The article was first published as an accepted article on 1 February 2021. This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination, and proofreading process, which may lead to differences between this version and the version of record.
2) Nazir MA. Prevalence of periodontal disease, its association with systemic diseases and prevention. Int J Health Sci. 2017;11:72–80.
3) Gomes-Filho IS, da Cruz SS, Trindade SC, et al. Periodontitis and respiratory diseases: A systematic review with meta-analysis. Oral Dis. 2020;26:439–446.

Dentists denied Covid-19 loss-of-earnings claim advised to check their insurance policy

The door has been opened for dental practices and other small businesses to make or resubmit an insurance claim for loss of income arising from Covid-19 restrictions last year. At an appeal hearing last week the Supreme Court ruled largely in favour of small businesses which had initially been denied a pay-out by their insurers.

Nathan Poole of specialist dental accountants Ross-Brooke Dental, welcomes the news. “We recommend dentists check their policies, and liaise with their insurance brokers if they think there may be grounds for a claim. Dentists may have been told that no claim was possible previously but this new ruling may open the door.”

The Supreme Court ruling comes after a test case brought by the Financial Conduct Authority (FCA) acting on behalf of policy holders who had made a claim and been denied a pay-out. The case was fast-tracked to the Supreme Court resulting in a detailed and complex ruling.

Poole said most commercial insurance policies prioritise property and equipment damage and business interruption cover associated with closure of business due to fire and flood. However, some also cover interruption from disease or public authority closures or restrictions. While a number of insurers accepted liability under such policies, others disputed liability, leading to a lack of clarity and the FCA’s test case.

He continued: “We have been working with clients to quantify and substantiate their losses which we are finding start from £50k, so substantial sums. Some dentists have already been contacted by their insurer to quantify their claim should this ruling go against them. Now the Supreme Court has ruled in favour of policyholders, we expect to see those claims settled.”

He said: “A number of our dentist clients have already had pay-outs. Obviously every policy has limitations and clauses specifying the insurers liability, but I believe there will be more dentists who find that the door which had previously been closed to them has been opened and a claim is now possible.”

His colleague Linda Giles said: “We don’t advise on insurance policies as we are not authorised to do so but we encourage our clients to use specialist brokers to get the best and most appropriate cover for a dental business. We also encourage clients to review their levels of cover regularly and make sure they understand what’s on offer, so they choose a policy to suit their needs.”

BADN welcomes key worker and vaccine statements

The British Association of Dental Nurses (BADN), the professional association for dental nurses in the UK, has welcomed confirmation that dental teams, including dental nurses, are considered key workers, and will be given priority for COVID vaccinations.

BADN President Jacqui Elsden said “Because government statements did not specifically include dental professionals in their list of key workers, many dental nurses have experienced problems in accessing childcare, leaving them unable to go to work – and many dental employers have been unsympathetic to their situation. Clarification on the key worker status of dental professionals in the latest update from Sara Hurley is therefore most welcome and will help to alleviate the problems currently faced by dental nurses.

“Equally, the news that Prime Minister Boris Johnson this week confirmed that dental professionals will be prioritised for the Covid vaccinations is greatly welcomed and will put many dental nurses’ minds at ease.

“Information on the current situation is included on the Covid pages of our website and updated whenever we receive new information.”

CDO confirms dental professionals and their teams are now being prioritised for a Covid-19 vaccine

Following Boris Johnson’s answer in the House of Commons to Craig Whittaker MP’s question over whether dental team members in patient-facing roles would qualify as ‘health workers’ as part of the Covid-19 vaccination programme, CDO England, Sara Hurley, and deputy CDOs Eric Rooney and Jason Wong have confirmed that dental professionals and their teams are now being prioritised for a Covid-19 vaccine.

“This means that dental teams supporting the NHS, those working in private or mixed practices will all be entitled to a vaccine, this includes specialist practices and clinical dental technicians registered with the CQC,” the CDO and deputies stated. “Dental professionals who work for a NHS trust will fall within the vaccination programme co-ordinated through their trust.​ Locum clinical staff employed by the practice and non-clinical ancillary staff who may have social contact with patients but are not directly involved in patient care (e.g. receptionists and cleaners) are also included. 

“As frontline health professionals, it is important that when you are called to be vaccinated you attend. Private practices are advised to ensure their contact details with the CQC are up to date as a matter of urgency. More detail is in this bulletin.”


Dental Protection has welcomed the announcement that the Covid-19 vaccine will be rolled out to dental professionals as priority.

Raj Rattan, Dental Director at Dental Protection said: “This news will come as a relief for dental professionals across the UK, who are some of the most exposed workers to the virus. The new Covid-19 variant, which is 70% more transmissible, poses a greater threat than ever before.

“Dental professionals always put the interests of their patients first, and remain committed to providing high standards of care. Prioritising dentists and dental teams to receive the Covid-19 vaccine acknowledges the essential healthcare service they continue to provide.”

England: Priority access to Covid-19 vaccine for dentists

Following last week’s authorisation of the Oxford University/AstraZeneca vaccine and updated guidance around increased spacing of second vaccine doses, we are beginning to see an acceleration in the vaccination programme across the UK.

The British Dental Association (BDA) has repeatedly sought reassurance about prioritisation for dentistry, from NHS England, the Office of the CDO and separately across the devolved nations. NHS England’s initial priority, in line with JCVI advice, is for those aged 80 and over, together with care home staff and residents. Frontline health and social care staff are included in the next priority group. NHS England has confirmed that dentists and their teams, both in the NHS and in the private sector, are included in that group of frontline staff and therefore sit in the JCVI’s priority group two.

On Wednesday, having been contacted by some of our members, Craig Whittaker MP challenged Prime Minister Boris Johnson on priority access to the Covid-19 vaccine for dentists and their teams. Mr Whittaker echoed the BDA calls for confirmation that dentists are in vaccination priority group 2 together with all other healthcare workers. The Prime Minister confirmed that all dentists in patient facing roles and members of their teams are eligible for the Covid-19 vaccine. The BDA will continue to push for clear guidance and clarity on timings of the vaccination for all dental teams.

The BDA is aware that some dentists have been approaching their GPs to highlight their status as frontline staff. There are reports of variable responses from GP practices and others involved in vaccination programmes to these approaches from dentists and teams. The BDA has continued to raise that concern with NHS England and understand that clarification will be forthcoming, confirming the position of dentists and teams to those organising vaccination programmes.

Timeframes for vaccination of the primary care workforce will still inevitably, to some extent, depend on local operational arrangements, logistics and availability of vaccine stocks. The BDA anticipates NHS contractors being contacted directly and that up-to-date CQC registration details will be important for private practices.

England and Scotland enter new lockdowns; dentistry ‘unaffected’

On Monday 4th January, Scotland’s First Minister, Nicola Sturgeon, announced that from midnight (5th January), the country would be put into a full lockdown as Coronavirus cases continue to surge. Just hours later, Prime Minister Boris Johnson spoke to the nation in a pre-recorded televised announcement, confirming that England too would enter a new national lockdown – one that resembled more the one from March/April 2020. The new lockdown, which sees schools once again closed in another government U-turn, will reportedly not affect dentistry – on the surface at least.

The original lockdown during the Spring of 2020 saw dental practices closed for almost three months. They were able to reopen from 8th June, although it was a slow start for many as the profession grappled with new SOP measures in efforts to prevent the spread of Covid-19. Patient numbers remain much lower than pre-pandemic, in part due to increased fallow time.

As Scotland enters its latest lockdown, the British Dental Association (BDA) has ‘received confirmation from the Chief Dental Officer that the national lockdown from 5th January will have no impact on dentistry’. The Association has ‘argued that the full range of NHS treatments should not be available while the new virus strain continues to spread significantly. However, the Scottish Government’s position remains unchanged’ as: essential travel includes leaving home for healthcare and dentistry is deemed essential healthcare, meaning it can therefore continue under the revised restrictions announced by the First Minister. The BDA also states that ‘aesthetic treatment is not essential healthcare (and not available on the NHS) and should not be undertaken’.

Scotland’s CDO, Tom Ferris, also reiterated, via the BDA, that if a patient attends a dentist with a concern then the full range of clinical dental care should remain available to the dentist in order to manage the patient’s condition.

Meanwhile, CDO England, Sara Hurley, issued an update immediately following Boris Johnson’s announcement of England’s latest lockdown measures, confirming that ‘dental services are to remain open and see patients’.

Hurley noted that dental professionals are defined by the Government as critical workers, adding: ‘Dentistry is an essential medical service. It is a priority for the NHS. Patients are entitled to travel for medical appointments, include dental. I have included some useful resources in this bulletin for NHS practices to spread the word that dental services are open and seeing patients, please use them.’

The Government guidance on the national lockdown states: ‘The majority of public services will continue and you will be able to leave home to visit them. These include the NHS and medical services like GPs and dentists.’

The BDA also reiterated that ‘services should be carried out in line with the current standard operating procedure (SOPs) . Remote consultation, triage and risk assessment remain key prior to patient attendance for face to face dental care. Social distancing measures remain in place and PPE levels as stated for low, medium and high risk assessed patients remain.’

While dental practices remain open for business unlike last Spring, there will most likely be an impact felt as more patients opt to stay home rather than attend appointments, among other factors. Therefore, the BDA has issued an open letter to Health Secretary Matt Hancock, urging the government to abandon NHS targets that will be ‘impossible to achieve under the new national lockdown, and which risk putting hundreds of practices out of business’.

In addition to patients’ reluctance to continue with dental appointments, the BDA believes that ‘the NHS targets will force dentists to prioritise routine check-ups for the “worried-well” over a time-consuming urgent backlog’. MPs are set to debate the imposition of these targets at a Backbench Business debate on 14 January.

GDC research highlights scale of impact of Covid-19 on dental professionals

New Covid-19 research, released by the General Dental Council (GDC), has found that most dental professionals expect to be able to see fewer patients than normal over the next 12 months, while also expecting an increased demand for their services, adding to the pressures on dental service provision.

As a result of the expected reduced capacity, two thirds expect their income to fall over the coming year, and four out of five report income to have already fallen compared to this time last year (by an average of 45%).

The research, which forms part of a wider programme of work to understand the impact of Covid-19 on dentistry, also found that most dental professionals felt confident to do their job safely. However, a lack of consistency and coordination in the guidance that was issued in the first lockdown led to confusion, localised variances in practice and added stress for professionals.

General Dental Council Executive Director, Strategy, Stefan Czerniawski, said: “Covid-19 has hit dental services hard and dental professionals have made huge efforts to sustain patient care in the face of unprecedented challenges. This report captures the experience of dental professionals in meeting those challenges and their expectations of the year ahead.

“Dental professionals have had to make difficult judgements about how best to support their patients during the pandemic period. At the GDC we recognise that and repeat our commitment to take environmental and human factors relating to Covid-19 into account in approaching any concerns raised with us about those judgements.”

To view the full report and read about the emerging picture from the wider programme of work, visit

Healthwatch report on dentistry and the impact of Covid-19 finds patients were unable to get the care they needed

Healthwatch has released its quarterly report on dentistry, which seeks feedback from NHS patients about their experiences. The briefing, which covers the three-month period from July-September 2020, drew responses from 1,313 people about their experiences of dentistry, compared to 238 people in the previous three-month window.

The feedback received showed that patients were often unable to get the care they needed, leaving them in pain and at risk of serious long-term oral health issues. Since the start of the Covid-19 pandemic and the initial national lockdown, there has reportedly been a significant increase in the number of people facing problems when trying to get an NHS dentist appointment, suggesting the impact the pandemic has had on the profession has been particularly acute.

The report, which can be found here, notes that in addition to dental care access proving difficult for NHS patients, that large numbers of the public are still unable to get an appointment for regular check-ups, hygienist appointments or fillings, and that NHS appointments as a whole are extremely limited because practices are either not taking on new NHS patients or have no available NHS appointments.

The Healthwatch report also highlights that, in some cases, dentists have not been able to continue treatment started before lockdown, meaning people have been left in pain and with unresolved issues, such as broken teeth, and that some been unable to reach their dentist for urgent care. In addition, it is suggested that some practices are prioritising private patients over NHS ones or are only offering non-urgent treatment if NHS patients opt to pay privately instead.

Other issues brought to light by the report claim there has been a inaccurate or misleading information provided by NHS 111 and NHS Choices, as well as dental practice websites, causing confusion. Confusion has also been caused over whether patients have been de-registered: a dental practice cannot de-register someone, but often people who have had a long gap since their last appointment are told they have been, when really what the dental practice means is that there are no available NHS appointments. 

Finally, the report finds that while practices did adapt to new measures once they reopened, not all of them understood how Covid-19 measures would impact some groups of people or didn’t follow all the measures needed to make people feel safe.

The report has already drawn responses from across the dental sector, with Dental Protection defending dentists following its publication. Commenting on the report, Susie Sanderson, Dentolegal Consultant at Dental Protection, reiterated the extremely challenging environment for dental professionals:

Dentists have faced a range of challenges throughout the pandemic, and many have returned to practise in equally challenging circumstances – adapting to additional PPE and new ways of working, worrying about their health and that of their staff and patients, and facing a significant backlog of patients with outstanding treatment due to the unavoidable delays. 45% of UK dentists say their mental wellbeing is worse compared to the start of the pandemic.

“Many dentists have also expressed their frustration that guidelines are not always easy to decipher and adhere to and are having an adverse impact on the operating capacity of the practices. The delays and disruption frustrate patients, but also create stress for dentists, who are doing their best but feel they cannot always act in their patients’ best interests for reasons beyond their control.

“We want to reassure all members that Dental Protection is here to offer support. I would also encourage members experiencing work-related stress to make use of our free counselling service. The service is provided through a third-party partner and is completely confidential.”

Meanwhile, the Association of Dental Groups (ADG) chair, Neil Carmichael, commented:

“Healthwatch England’s report published today on the impact of COVID-19 on dentistry confirms the ADG’s campaign for action be taken to increase access to dentistry. The ADG is seeking a new contract for NHS dentistry where oral health is a higher priority and flexible commissioning is encouraged. We must also recognise the need to recruit more dentists. To deliver dentistry effectively in all regions in England quite simply, more practitioners are required.”

“Healthwatch England’s report has cast a light on a period in dentistry where access was severely curtailed because of restrictions placed on the profession, which has further compounded pre-existing problems. I look forward to Healthwatch England’s positive engagement as we seek a new way of working in NHS dentistry and a comprehensive workforce strategy from Government to fill the vacancies in areas of greatest need.”

GDC highlights importance of clear public safety Covid information

New research, published by the General Dental Council (GDC) – the UK’s regulator of dental professionals, reveals that while most people (61%) feel just as confident about visiting the dentist as they did before the pandemic, almost a third (32%) feel less safe, with worries about Covid safety being cited.

The research, which forms part of a wider programme of work to understand the impact of Covid-19 on dentistry and support the recovery of oral health services, also shows the potential that health inequalities are being created and exacerbated, as people from ethnic minority backgrounds and those with physical or mental health conditions were more likely to have concerns about visiting dental practices in future.

In addition, the report highlights that measures already being taken by dental practices, such as providing clear information in advance of appointments about the COVID-19 control measures that are in place, including staff wearing PPE and extra cleaning before and after appointments, have a real impact on patient confidence.

Stefan Czerniawski, Executive Director of Strategy at the GDC, said: “The dental profession has worked tirelessly to support patients through the extraordinary difficulties resulting from this crisis. The challenge for all of us now is to ensure that patients feel confident in being able to access the dental treatment they need, and it’s important that they continue to hear clear messages that it is safe to return. This research provides rich insights into the factors which influence behaviour and expectations.”

To view the full report and read about the emerging picture from the wider programme of work, visit

In other news, the GDC has updated its Brexit-related information for dental professionals, following updated guidance being received by all the health and care regulators from the Department of Health and Social Care. Following its formal exit from the European Union (EU) on 31 January 2020, the UK entered a transition period which will come to an end at 11pm on 31 December 2020.

How NHS dental staff can join the Covid-19 vaccine team

Understanding that many NHS dental practitioners and dental healthcare staff want to support the Covid-19 Vaccination Programme, the Office of the Chief Dental Officer, England and NHSE have prepared an FAQ document to help clarify how indemnity arrangements will work with regards to participation in the COVID-19 vaccination programme.

Further guidance on recruitment into the Covid-19 vaccination programme is available at Join the Vaccine Team