Dr. Al Danenberg ● Nutritional Periodontist
January 23, 2022 [printfriendly]
COVID-19
The SARS-CoV-2 virus causing COVID-19 infections 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.
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.
From Gut to Mouth to COVID-19 Infection
Follow this inflammatory trail as it spreads from the gut to other parts of the body!
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 its rim.
As you know, 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 diseases, respiratory diseases, neurological diseases as well as periodontal disease. Chronic systemic inflammation is a major risk factor in severe forms of COVID-19.
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.
I wrote about the importance of treating the gut and the mouth in this Blog Post. A poor diet and improper oral hygiene will feed the severity of periodontal disease.
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 COVID 19 infection.[1]
And on January 13, 2022, COVID-19 and Periodontitis: A Dangerous Association? was published in Frontiers in Pharmacology.
The oral cavity and periodontal tissues are viable portals for the entry of the SARS-CoV-2 virus. In addition, the cytokines that are 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 as I described in this PDF, they must be identified and treated appropriately.
So, what is causing periodontal disease? And how do we deal with this aggressive gum infection?
Diagnosis & 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 COVID-19. Pathogenic bacteria proliferate and beneficial bacteria diminish. Overgrowth of harmful bacteria in the gut may encourage the development of COVID-19 in the host through interaction with ACE2, mitochondria, and the lung-gut axis.[2]
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. Improving the diet and the gut will go a long way to enhance the immune system’s defenses.
But when there is active periodontal disease, this must be treated concurrently with improving the diet and repairing of the gut. As already suggested in the European Journal of Dentistry[3], treating active periodontal disease may reduce one of the risks for the progression of SARS-CoV-2 in the body.
Here is a graphic comparing healthy gums in healthy jawbone around a tooth to unhealthy gums and damaged jawbone from advanced periodontal disease called periodontitis.
Steps to Effectively Treat Periodontal Disease
Periodontal Exam
First, a dentist must do a thorough periodontal exam that measures the depths of infected spaces (called “pockets”) around the teeth, the stability of the teeth in the bone, the balance of biting forces between the upper and lower teeth, and the degree of damage to the jawbone surrounding the roots of each tooth.
Gingivitis Treatment
If there are signs of inflammation in the gum tissues but no bone damage, the disease is called gingivitis. A general mouth and tooth cleaning by the hygienist, instruction in proper oral hygiene methods, and improvement of the diet and healing of the gut will treat this disease very well. Here is my PDF about how to clean your mouth effectively and efficiently daily.
Sometimes, heavy biting pressures of the teeth must be evened out.
Periodontitis Treatment
If there are signs of active bone damage around the roots of the teeth with progressing periodontal disease, it is called periodontitis. Here are two successful treatment options I have used repeatedly for my patients depending on the degree of bone damage – (1) Scaling & Root Planing and (2) Laser Periodontal Regeneration
(1) Scaling & Root Planing
If only slight damage has occurred, a deep cleaning under the gums may take care of stopping the disease. This is called a scaling and root planing. Your gum tissues are numbed so that discomfort is not an issue. Following the procedure, the gums may feel slightly tender, but this should not be a problem. You should have no problem going about your normal routine or doing your normal oral hygiene protocols daily.
If there are heavy biting forces between your upper and lower teeth that may wiggle the tooth in the bone, these heavy forces will need to be evened out.
Here is an animated video demonstrating Scaling & Root Planing:
Scaling and Root Planing Animation
(2) Laser Periodontal Regeneration
However, if the bone damage is moderate to severe and is progressing, then laser surgery has proven 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.
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. Also, over-the-counter ibuprofen (Advil) or acetaminophen (Tylenol) may be all that is necessary to control discomfort.
Here are two animations of two different laser procedures for treating periodontitis:
#1. Millennium Technology LANAP
(Laser Assisted New Attachment Procedure)
#2. Fontana Twin Light Periodontal Procedure
Bringing All This Together
COVID-19 is with us. It is destroying our body, our economy, and social structure. Individually, we need to be proactive. 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.
Your dentist is the healthcare professional to determine if you have active periodontal disease. As I have described in my Blogs in the past, other factors must be brought under control along with treating active periodontal disease. But if periodontal disease were present and not treated, it would continue to be a high-risk factor in the severity of SARS-CoV-2.
My recommendation is to seek out a dentist that will do a thorough periodontal exam. Most dentists are trained to do this. But periodontists are specialized dentists that often do the most comprehensive exam to determine the severity and extent of this disease. If you need help selecting the right dentist (not all are created equal!), I wrote this post containing 10 questions you should ask your dentist to ensure you are getting the proper examination.
As always, I’m here to help if you need direction or a second opinion. I was a practicing periodontist for 40+ years, and now I see patients via Zoom consultations. I can work with your dentist to provide a treatment plan so you can get your dental and gut health back on track.
[1] https://pubmed.ncbi.nlm.nih.gov/34991165/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8727742/
[3] https://pubmed.ncbi.nlm.nih.gov/34991165/
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