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Periodontitis Linked to Severe COVID-19 Outcomes

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Periodontitis Linked to Severe COVID-19 Outcomes

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Read the article to know how important is oral healthcare during this pandemic, as it proves to be potentially lifesaving in COVID-19 infection.

Medically reviewed by

Dr. Preetha. J

Published At May 7, 2021
Reviewed AtAugust 2, 2023


COVID-19 pandemic has a far-fledged impact on people who have other diseases, including the oral cavity. As per the research of Mcgill University, Canada (published in the journal of clinical periodontology 2021), people with periodontitis, i.e., gum inflammation and infection, are 8.8 times more likely to die of COVID-19 disease. Additionally, these COVID-19 individuals with periodontitis are 3.5 times more likely to be hospitalized and 4.5 times more likely to require ventilator support.

How Is Periodontitis Linked to Systemic Complications?

Periodontitis is the clinical term for serious infection which occurs in between the teeth and gums due to:

  • Bacterial accumulation.

  • Heavy calculus.

  • Plaque deposits.

Without dental treatment, periodontitis as an independent disease is a proven risk factor for systemic non-communicable diseases like:

Researchers and periodontologists are of the opinion that if left untreated, inflammation due to periodontal disease can spread throughout the body. The main reason for COVID-19 patients proving to have fatal outcomes is due to the fact that increased blood levels of biomarkers which indicate systemic inflammation are more in people suffering from pre-existing gum diseases. Periodontal disease is also a slowly progressive condition that causes pain only after it sets in fully. Hence periodontitis can exacerbate the inflammatory response in patients battling the SARS-COV2 virus.

How Can Oral Hygiene Reduce COVID-19 Severity?

According to the research published in the journal of oral medicine and research, there are emerging evidence models which state that the ingredients prescribed by dentists to follow daily can significantly reduce the viral load concentrate in the saliva, and they are commonly found in:

  • Routine mouthwashes.

  • Simple oral hygiene techniques.

  • Interdental brushing.

  • Careful tooth brushing with a soft brush.

  • Tooth flossing.

  • Warm salt water rinsing.

The researchers of this study propose the link between dental plaque and periodontal disease inflammation to an intensification of the SARS-COV2 virus in the body. Periodontitis, as per the research, is thus an "invisible pandemic," and awareness needs to be created about this during this global pandemic.

What Precautions Are Important While Consulting Your Dentist?

Telemedicine is always beneficial in:

  • Scheduling.

  • Solving.

  • Prescribing the appropriate measures.

  • Solving remedies to the patient's needs or problems.

A telephonic triage or an online consultation with your dental surgeon to get rid of your doubts about your oral health status will definitely be useful. It will be further preventive against complications caused by dental disease in this pandemic crisis. Dental procedures in the dentist's clinic are no exception to the risk of spreading infection because it involves the use of aerosols through:

  • Dental handpieces.

  • Scalers.

  • Syringes.

But as the newer protocols for sterilization and disinfection of dental clinics are now stricter and are followed by dental professionals. It is indeed safe to visit your dental clinic with the necessary precautions like a double mask or N-95 mask and disinfection before and after the dental visit. Especially in emergencies like:

  • Gum bleeding.

  • Severe toothache.

  • Swelling or abscess.

  • Cracked restorations or teeth.

  • In case of trauma and accidents.

What Is the Mechanism of Transmission of the Disease From the Oral Cavity?

Evidence models of the journal of oral medicine and dental research propose the mechanism of direct entry of the SARS-COV2 pathogen into the lung pathway through the oral cavity. Initial observations of the CT scan of the lungs prompted the research teams to investigate the potential entry of the COVID-19 virus into the bloodstream via the gums and salivary load. Individuals who suffer from gum disease, i.e., periodontitis, have a viral load concentrated more than the average individual unaffected by gum disease and hence is a possibility established wherein the viral concentrate in the mouth would be transmitted to the lungs via the medium of saliva into the patient's bloodstream. The collaboration of medical and dental researchers on the study hence propose why this evidence model is more suggestive of the fact why people with gum disease and inflammation are more prone to coronavirus while the others not having periodontal issues are not prone to the pathogen. Apart from the periodontitis link that is being researched upon, the presence of ACE2 (Angiotensin-converting enzyme) receptors on the tongue make the oral cavity a vulnerable barrier that can be easily breached by the SARS-COV2 pathogen. Studies claim the pathogen binds to these ACE2 receptors more, causing inflammatory lesions of the tongue or COVID-19 tongue (imitating the viral manifestations seen on the tongue like any other oral infections).

Does Oral Hygiene Act as an Immune Defense?

More studies are underway to establish the link between periodontitis and COVID-19 severity. But the evidence that the novel coronavirus follows a pathway from the oral cavity is now verified by many research specialists (i.e., from the microbes of the saliva and the blood vessels in the gums to the neck and chest veins before entering the heart, eventually passing into the pulmonary arteries and vessels of the lungs). This theory also shows us that our mouth is rather like a breeding ground for a virus to thrive. Once this oral defense is breached, it makes the virus easier to replicate and follow the pathway into the lungs. The research models hence propose that simple oral hygiene measures we follow on a day to day basis like tooth brushing and mouthwash can be accompanied by what dentists usually suggest to keep the mouth free from plaque by mechanical and chemical methods of plaque control that are enlisted below:

Mechanical Plaque Control Measures:

  • Manual or Electric toothbrushing.

  • Flossing and Interdental brushing.

  • Tongue cleaners.

  • Oral irrigation devices (pulsating oral irrigators like Waterpik or magnetized irrigators like hydro floss).

Chemical Plaque Control Measures:

  • Fluoride releasing toothpaste and dentifrices.

  • Mouthwashes are commonly used on a daily basis.

  • Mouthwashes containing potassium nitrate (for preventing dentinal hypersensitivity).

  • Chlorhexidine and other phenols or essential oils (for preventing gingival inflammation and halitosis or bad breath).

All these are to be suggested by the dentist based on the patient's dental symptoms.


Proper oral hygiene alongside timely consultation and treatment by your dental surgeon can be helpful in mitigating the development of lung disease that is directly affected by the SARS-COV2 pathogen. Mechanical and chemical plaque control also ensures that the risk of deterioration of the patient to severe COVID-19 is reduced.

Frequently Asked Questions


Is Periodontitis Associated With the Severity of COVID-19?

Increased levels of D-dimer, HbA1c, D vitamin, white blood cells, and lymphocytes are found to increase in the blood along with the above-mentioned biomarkers among individuals with severe periodontitis and covid-19.


Is There a Link Between COVID and Gum Disease?

Yes, according to a study done on oral lesions, there will be a cytokine storm, an increase in biomarkers in the blood that are similar to those in individuals affected by COVID-19. Hence, they found a link between gum disease and COVID-19.


Can Dental Problems Be Caused Due to COVID-19 Infection?

Yes, Covid can cause dental issues. It was documented that the oral cavity cells had the viral entry receptor ACE-2. This causes the replication of the virus, resulting in inflammation and destruction of oral tissues, leading to many dental problems.


Who Is More Prone to Develop Severe COVID-19 Disease Sata?

The following individuals are more prone to severe COVID-19 disease
- Older individuals. 
- Affected with 
- type 1 and type 2 diabetes.
- Heart problems.
- Lung diseases. 
- Brain and nervous system conditions.
- Obesity.
- Cancer and blood disorders.
- Weak immune system.
- Chronic kidney or liver diseases.
- Mental health issues.
- Hormonal diseases like Down’s syndrome.


Name the Risk Factors That Are Associated With Severe COVID-19.

Factors related to severe COVID-19 are older individuals, males, obese, and individuals affected with diabetes, hypertension, cardiovascular disease, and other risk factors associated with hospitalization.


Can COVID Bring About Gingivitis?

Yes, COVID-19 can trigger gingivitis because it can increase the oral environment's acidic level, resulting in an increased risk for infections and inflammatory conditions like gum disease.


What Are the Most Common Long-Lasting Effects of COVID?

Organs of the body may get damaged, especially among individuals affected by a severe COVID-19 infection. The heart, kidney, brain, skin, etc. may be affected. Problems related to inflammation and the immune system can occur. These effects may last for very long periods. Other symptoms like dizziness, insomnia, pins and needles, chest pain or tightness, joint pain, depression, anxiety, etc., may be present and long-lasting too.


Why Are Dentists More Prone to COVID?

Dentists are more prone to COVID-19 infection because they contact an individual’s saliva and blood directly while giving treatment. They are also exposed to droplet infections through the mucosal surfaces of the eyes, nose, and mouth. Aerosol is generated during the use of a dental handpiece and air-water syringe. Hence, dentists and others in the dental office are exposed to these aerosols and may get affected.


How Are Some People Immune to COVID?

Some individuals never got infected with COVID-19 despite being exposed several times. This may be because of genetic mutations or genetic-based protection in that particular individual that helped them become immune to the infection.


Why Some People Very Sick With COVID Even Though They Are Vaccinated?

Individuals with weak immune systems and those immunocompromised due to other diseases and medications being taken can get very sick when affected by COVID-19. These individuals get affected and become sick even though they are vaccinated.


How to Combat Chronic Fatigue After COVID?

Chronic fatigue after COVID may be fought by using therapies like meditation, gentle massaging, deep breaths, and relaxation techniques. Along with these therapies, talking to friends and family, doing regular exercises, having a positive mindset, and looking forward to good things happening help relieve fatigue after a COVID-19 infection.


After How Many Days Does COVID Get Worse?

Initially, symptoms appear mild, but 6-7 days after the infection, symptoms may become worse. This may be due to the overreaction of the immune system. When the immune system overreacts, more immune cells are activated, leading to hyper-inflammation. This may be a fatal condition.


Are Individuals With Long-Lasting Effects Due to COVID, Still Contagious?

No, they are not contagious. Though they have few symptoms related to the infection, they generally recover after a week or 10 days. A maximum of 20 days may be the isolation period. They feel tired, and it becomes difficult for them to regain strength. They do not have viruses, and hence they are non-contagious.


How Many Among 100 Individuals With COVID May Get Long COVID?

According to a study, 45% of individuals affected by COVID-19 may get long COVID. But estimation may vary due to various factors involved in determining the status of long COVID, like environmental factors, virus variants, immune systems of individuals, etc.
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Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop



oral hygiene maintenancecovid-19periodontitis
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