Periodontal disease and COVID-19: Is there a correlation?

By Dr. Alvin Danenberg, DrBicuspid.com contributing writer

February 10, 2022 -- The SARS-CoV-2 virus causing COVID-19 has plunged the world into a major crisis. The disease is characterized by strong infectivity, high morbidity, and high mortality.

Recently, periodontal disease has been identified as a potential risk factor for COVID-19 infections.

From gut to mouth to COVID-19

Dr. Alvin Danenberg
Dr. Alvin Danenberg.

The spread of inflammation from the gut to other organ systems is like the spokes of a bicycle tire spreading out from the hub and ending at the rim. My research has shown that metabolic dysfunction affects the gut, which can tax the immune system leading to chronic systemic inflammation. This inflammation can manifest in many chronic diseases, such as diabetes mellitus, cardiovascular disease, respiratory disease, and neurological disease, as well as periodontal disease.

Once there is an imbalance of gut bacteria, it can weaken the immune system. A weakened immune system can upset the balance in the oral microbiome. And when the oral microbiome becomes unbalanced, it can cause periodontal disease.

Notably, chronic systemic inflammation is a major risk factor in severe forms of COVID-19. On January 6, 2022, the European Journal of Dentistry published a peer-reviewed paper suggesting that the existence of periodontal disease can be a contributing factor in severe COVID-19 infection. And on January 13, 2022, the authors of a Frontiers in Pharmacology study said that COVID-19 has been associated with periodontitis, and that both conditions share an inflammatory and infectious nature.

The oral cavity and periodontal tissues are viable portals for the entry of the SARS-CoV-2 virus. In addition, the cytokines produced by the immune system in periodontal disease can exacerbate a cytokine storm in severe COVID-19 infections.

It is very possible that identifying and treating an unhealthy gut, instituting efficient oral hygiene protocols, and treating any active periodontal disease may assist in mitigating the infection and spread of SARS-CoV-2. Also, if there are other dental irritants causing inflammation in the mouth, then they must be identified and treated appropriately.

Diagnosis and treatment of active periodontal disease

The upper respiratory tract mucosa is the first line of defense and acts as a physical barrier to invading microbes. It also allows the innate and adaptive immune system to fight infections on its surface.

Significant changes take place in both the gut microbiome and airway microbiome when individuals are infected with SARS-CoV-2. Pathogenic bacteria proliferate and beneficial bacteria diminish. Overgrowth of harmful bacteria in the gut may encourage the development of COVID-19 through interaction with angiotensin-converting enzyme 2 (ACE2), mitochondria, and the lung-gut axis.

I've written about improving metabolic dysfunction by improving the foods we eat and making lifestyle changes. Also, I've written extensively about healing the gut and creating a diverse gut microbiome. All will help protect the body from the spread of viral infection and go a long way toward enhancing the immune system's defenses.

But when there is active periodontal disease, treatment must occur concurrently with improvements in diet and repair of the gut. As already suggested in the European Journal of Dentistry study, treating active periodontal disease may reduce one of the risks for the progression of SARS-CoV-2 in the body.

If there are signs of active bone damage around the roots of the teeth with progressing periodontal disease, then it is called periodontitis. Below are two successful treatment options I have used repeatedly for my patients depending on the degree of bone damage:

  • Scaling and root planing: If only slight damage has occurred, then a deep cleaning under the gums may stop the disease. Patients should have no problem going about their normal routine or doing daily oral hygiene protocols.
  • Laser periodontal regeneration: If the bone damage is moderate to severe and is progressing, then laser surgery has proved to be the most effective means to regenerate damaged jawbone. In addition, all unequal chewing pressures must be evened out so no heavy pressures between the chewing teeth are weakening and wiggling the teeth in the jawbone as it heals and regenerates.

Two laser procedures use technologies that have been successful in destroying the offending virulent bacteria causing periodontitis, as well as regenerating the weakened and lost bone around the roots of the teeth:

  • Laser-assisted new attachment procedure (LANAP), Millennium Dental Technologies
  • TwinLight approach, Fotona

I've found both laser procedures are patient friendly. Most patients will have little tenderness in the gum tissues and can return to their normal activities the next day, and over-the-counter ibuprofen or acetaminophen may be all that is necessary to control discomfort.

Bringing it all together

This pandemic has brought about an awareness that our immune system is a critical factor for healing and overall wellness. We can take advantage of this fact. We can become more proactive.

Individually, one important aspect of being proactive is taking care of our oral health. After all, the mouth is a portal for this virus to spread, and existing periodontal disease may make it easier for SARS-CoV-2 to take hold and cause severe disease.

While dentists are the healthcare professionals to diagnose active periodontal disease, other patient factors must be brought under control along with treating active periodontal disease. I wrote about the importance of treating both the gut and the mouth in a prior post. A poor diet and improper oral hygiene will feed the severity of periodontal disease.

Equally important, if periodontal disease is present and not treated, then patients will continue to have an increased risk for COVID-19 severity. I encourage patients to seek out a dentist that will do a thorough periodontal exam.

Dr. Alvin Danenberg has retired from the private practice of periodontics in Bluffton, SC. He continues to be on the faculty of the College of Integrative Medicine and created its integrative periodontal teaching module. He also spent two years as chief of periodontics at Charleston Air Force Base earlier in his career. His website is drdanenberg.com.

The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.


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