During the COVID-19 pandemic, clinical outcomes varied significantly between individuals. While factors like age and pre-existing conditions were clear determinants, research has broadened to explore other potential influences on disease severity, including the role of systemic inflammation. In this context, the state of the oral microbiome and periodontal health has become a subject of scientific investigation. Could the ecological balance in the mouth provide clues about an individual’s inflammatory status and its potential interaction with viral infections? Emerging evidence suggests this is a compelling area for further study.

It is established that a balanced oral microbiome contributes to mucosal health, while dysbiosis is associated with local and systemic inflammation. The severity of COVID-19 has been closely linked to the degree of a patient’s inflammatory response. The oral environment, therefore, represents a point of convergence between viral exposure and the host’s inflammatory landscape.

Potential Mechanisms of Interaction

Research has explored several pathways through which oral health may interact with systemic responses to infection:

1. The Oral Cavity as a Viral Reservoir: The SARS-CoV-2 virus utilizes ACE2 receptors for cellular entry, which are present in oral tissues. The integrity of the oral mucosal barrier may influence initial viral interactions.
2. Baseline Inflammatory Status: Periodontitis is characterized by elevated levels of systemic inflammatory markers, such as IL-6 and CRP. Entering an infection with a pre-existing state of chronic, low-grade inflammation could theoretically influence the trajectory of the body’s immune response to a new pathogen.
3. The Oral-Lung Axis: There is a recognized physiological connection between the upper aerodigestive tract and the lungs. The composition of the oral microbiome may have implications for respiratory health, although the precise mechanisms in the context of viral infections are an ongoing area of research.

Observational Evidence and Correlations

Significant observational studies have reported statistical associations worth noting. For instance, a 2021 study published in the Journal of Clinical Periodontology found that hospitalized COVID-19 patients with a recorded diagnosis of periodontitis had increased odds of experiencing complications, after adjusting for other known risk factors. This type of evidence highlights a correlation that motivates deeper investigation into shared biological pathways, such as inflammation, rather than suggesting direct causation.

Other research analyzing salivary microbiomes has reported differences in microbial diversity and specific bacterial profiles between patients with varying COVID-19 severities. These findings contribute to the broader scientific exploration of the oral microbiome as a potential biomarker for inflammatory susceptibility.

Practical Guidance: Supporting Oral Wellness as Part of a Proactive Health Strategy

While an individual’s oral microbiome is not a deterministic predictor of infection outcomes, maintaining its balance is a foundational component of supporting overall systemic resilience. Here is a protocol for leveraging oral health as part of a holistic wellness plan.

1. Prioritize Periodontal Health Through Professional Care.

• Seek a Comprehensive Evaluation: Schedule a visit with your dentist or periodontist for a full assessment of your gum health, including periodontal probing.
• Complete Recommended Therapy: If periodontitis is diagnosed, non-surgical periodontal therapy (scaling and root planing) is the standard treatment to reduce the bacterial biofilm and associated inflammation.
• Adhere to Maintenance Schedules: Commit to regular periodontal maintenance visits (typically every 3-4 months) to support long-term stability.

2. Maintain Meticulous Daily Oral Hygiene.
Consistent home care is essential for managing oral biofilm and supporting mucosal integrity.

• Brush thoroughly twice daily with a soft-bristled brush.
• Clean between teeth daily using floss, interdental brushes, or a water flosser.
• Stay well-hydrated to support healthy salivary flow.

3. Adopt an Anti-Inflammatory Lifestyle and Dietary Pattern.
Nutrition and lifestyle choices that reduce systemic inflammation also benefit oral ecology.

• Focus on a Whole-Foods Diet: Emphasize vegetables, fruits, lean proteins, and healthy fats. Limit refined sugars and processed carbohydrates.
• Ensure Adequate Vitamin D: Discuss testing and possible supplementation with your physician, as Vitamin D plays a role in immune modulation.
• Avoid Tobacco: Smoking is a major risk factor for periodontitis and negatively impacts respiratory and immune health.

4. Foster Open Communication with Your Healthcare Team.
Be proactive in your health management. Share your complete health history, including any periodontal diagnoses, with your primary care physician, as it contributes to a full picture of your inflammatory and immune status.

Conclusion: Oral Health as a Pillar of Systemic Resilience
The exploration of the oral microbiome’s role in systemic health continues to evolve. While it does not serve as a crystal ball for specific infections, the science clearly indicates that a state of periodontal wellness supports a less inflamed systemic environment. By investing in consistent, professional oral care and healthy daily habits, you actively contribute to your body’s foundational resilience, which is a prudent strategy for navigating any health challenge.

Disclaimer: The information contained in this blog post is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, dentist, or other qualified health provider with any questions you may have regarding a medical condition or before making any changes to your healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read here. The views expressed are based on current research and emerging science but do not constitute definitive medical guidance.

References

1. Marouf, N., Cai, W., Said, K.N., Daas, H., Diab, H., Chinta, V.R., Hssain, A.A., Nicolau, B., Sanz, M. and Tamimi, F., 2021. Association between periodontitis and severity of COVID‐19 infection: A case–control study. Journal of clinical periodontology, 48(4), pp.483-491.

https://onlinelibrary.wiley.com/doi/abs/10.1111/jcpe.13435

2. Soffritti, I., D’Accolti, M., Fabbri, C., Passaro, A., Manfredini, R., Zuliani, G., Libanore, M., Franchi, M., Contini, C. and Caselli, E., 2021. Oral microbiome dysbiosis is associated with symptoms severity and local immune/inflammatory response in COVID-19 patients: a cross-sectional study. Frontiers in microbiology, 12, p.687513.13. How Is the Oral Microbiome Connected to Depression?

https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2021.687513/full

The Periodontal Professor — Prof. Solomon O. Nwhator, BDS (Lagos), PhD (Helsinki), FMCDS, FWACS, Professor of Periodontal Medicine.