Relationship between periodontal disease and COVID-19: literature review




Chronic periodontitis; Cytokines; Angiotensin 2 conversion enzyme; SARS-COV-2.


COVID-19 (corona virus disease 2019) is a respiratory infection caused by SARS-COV-2 in which 14% of cases progress to severe conditions, 5% require intensive care units and 2% progress to death. The oral cavity is one of the gateways to the virus's entry into the host. Periodontitis is the 6th most prevalent disease in the world and is a chronic inflammatory disease that affects the supporting tissues of the tooth. The scientific literature has sought evidence on a possible association between periodontitis and COVID-19. This study aims to search for information available in the literature that confirms an association between diseases. A search was performed in medline/pubmed databases with the combination of the descriptors: "periodontitis" or "periodontal disease" or "gum disease" and "COVID-19" or "SARS-COV-2" or "novel coronavirus" published between August 2021 and January 2022, in English and Portuguese. We found 67 articles, of which 20 were selected, based on title, abstract and language, only 14 studies were chosen to make up the review, according to availability of the full text on the web and type of work, prioritizing research and literature reviews. Patients with periodontitis and COVID-19 present: shared risk factors, presence of inflammatory markers in high amounts and the presence of Sars-Cov-2 in the oral cavity, evidencing the highest chances of developing severe conditions of the disease. Future studies are needed to confirm the direct association between periodontitis and COVID-19, which has not yet been fully established.


Acharya, A. B., Thakur, S., Muddapur, M. V., & Kulkarni, R. D. (2017). Cytokine ratios in chronic periodontitis and type 2 diabetes mellitus. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 11(4), 277–278.

Aquino-Martinez, R., & Hernández-Vigueras, S. (2021). Severe COVID-19 lung infection in older people and periodontitis. In Journal of Clinical Medicine (10(2), 1–17). MDPI.

Badran, Z., Gaudin, A., Struillou, X., Amador, G., & Soueidan, A. (2020). Periodontal pockets: A potential reservoir for SARS-CoV-2? Medical Hypotheses, 143.

Campisi, G., Bizzoca, M. E., & lo Muzio, L. (2021). COVID-19 and periodontitis: reflecting on a possible association. Head and Face Medicine, 17(1).

Carrizales-Sepúlveda, E. F., Ordaz-Farías, A., Vera-Pineda, R., & Flores-Ramírez, R. (2018). Periodontal Disease, Systemic Inflammation and the Risk of Cardiovascular Disease. Heart, Lung and Circulation, 27(11), 1327–1334.

Casillas Santana, M. A., Arreguín Cano, J. A., Dib Kanán, A., Dipp Velázquez, F. A., Munguía, P. D. C. S., Martínez Castañón, G. A., Castillo Silva, B. E., Sámano Valencia, C., & Salas Orozco, M. F. (2021). Should We Be Concerned about the Association of Diabetes Mellitus and Periodontal Disease in the Risk of Infection by SARS-CoV-2? A Systematic Review and Hypothesis. Medicina (Kaunas, Lithuania), 57(5).

Chapple, I. L. C., & Genco, R. (2013). Diabetes and periodontal diseases: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. Journal of Periodontology, 84(4-s), S106–S112.

Cordeiro, A. M., Oliveira, G. M., Rentería, J. M., & Guimarães, C. A. (2007). Revisão sistemática: uma revisão narrativa. Revista Do Colégio Brasileiro de Cirurgiões, 34(6), 428–431.

Curtis, M. A., Diaz, P. I., & van Dyke, T. E. (2020). The role of the microbiota in periodontal disease. In Periodontology 2000 (83(1), 14–25). Blackwell Munksgaard.

Epidemiology Working Group for NCIP Epidemic Response, C. C. for D. C. and P. (2020). The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi = Zhonghua Liuxingbingxue Zazhi, 41(2), 145–151.

Farias, L. S., Silva, M. F. C., Rocha, E. P., & Cunha, P. de O. (2021). Relação entre a Covid-19 e a Doença Periodontal: O que sabemos após 1 ano de pandemia? – Revisão de Literatura. Brazilian Journal of Health Review, 4(6), 26783–26791.

Fernandes Matuck, B., Dolhnikoff, M., Maia, G. V. A., Isaac Sendyk, D., Zarpellon, A., Costa Gomes, S., Duarte-Neto, A. N., Rebello Pinho, J. R., Gomes-Gouvêa, M. S., Sousa, S. C. O. M., Mauad, T., Saldiva, P. H. do N., Braz-Silva, P. H., & Silva, L. F. F. da. (2021). Periodontal tissues are targets for Sars-Cov-2: a post-mortem study. Journal of Oral Microbiology, 13(1).

Gupta, S., Mohindra, R., Chauhan, P. K., Singla, V., Goyal, K., Sahni, V., Gaur, R., Verma, D. K., Ghosh, A., Soni, R. K., Suri, V., Bhalla, A., & Singh, M. P. (2021). SARS-CoV-2 Detection in Gingival Crevicular Fluid. Journal of Dental Research, 100(2), 187–193.

Herrera, D., Serrano, J., Roldán, S., & Sanz, M. (2020). Is the oral cavity relevant in SARS-CoV-2 pandemic? Clinical Oral Investigations, 24(8), 2925–2930.

Kara, C., Çelen, K., Dede, F. Ö., Gökmenoğlu, C., & Kara, N. B. (2020). Is periodontal disease a risk factor for developing severe Covid-19 infection? The potential role of Galectin-3. In Experimental Biology and Medicine (245(16), 1425–1427). SAGE Publications Inc.

Kassebaum, N. J., Bernabé, E., Dahiya, M., Bhandari, B., Murray, C. J. L., & Marcenes, W. (2014). Global Burden of Severe Periodontitis in 1990-2010. Journal of Dental Research, 93(11), 1045–1053.

Larvin, H., Wilmott, S., Wu, J., & Kang, J. (2020). The Impact of Periodontal Disease on Hospital Admission and Mortality During COVID-19 Pandemic. Frontiers in Medicine, 7.

Mahallawi, W. H., Khabour, O. F., Zhang, Q., Makhdoum, H. M., & Suliman, B. A. (2018). MERS-CoV infection in humans is associated with a pro-inflammatory Th1 and Th17 cytokine profile. Cytokine, 104, 8–13.

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

Marsh, P. D., & Devine, D. A. (2011). How is the development of dental biofilms influenced by the host? Journal of Clinical Periodontology, 38, 28–35.

Michael, G., Newman, H. T., Perry, R., & Klokkevold, F. A. C. (2016). Carranza periodontia clínica (12th ed.).

Petersen, P. E., & Ogawa, H. (2012). The global burden of periodontal disease: towards integration with chronic disease prevention and control. Periodontology 2000, 60(1), 15–39.

Pitones-Rubio, V., Chávez-Cortez, E. G., Hurtado-Camarena, A., González-Rascón, A., & Serafín-Higuera, N. (2020). Is periodontal disease a risk factor for severe COVID-19 illness? Medical Hypotheses, 144, 109969.

Sanz, M., del Castillo, A. M., Jepsen, S., Gonzalez-Juanatey, J. R., D’Aiuto, F., Bouchard, P., Chapple, I., Dietrich, T., Gotsman, I., Graziani, F., Herrera, D., Loos, B., Madianos, P., Michel, J. B., Perel, P., Pieske, B., Shapira, L., Schechter, M., Tonetti, M., & Wimmer, G. (2020). Periodontitis and Cardiovascular Diseases. Consensus Report. Global Heart, 15(1), 1.

Schenkein, H. A., Papapanou, P. N., Genco, R., & Sanz, M. (2020). Mechanisms underlying the association between periodontitis and atherosclerotic disease. Periodontology 2000, 83(1), 90–106.

Seymour, G. J., Ford, P. J., Cullinan, M. P., Leishman, S., & Yamazaki, K. (2007). Relationship between periodontal infections and systemic disease. Clinical Microbiology and Infection, 13, 3–10.

Sukumar, K., & Tadepalli, A. (2021). Nexus between COVID-19 and periodontal disease. In Journal of International Medical Research (49(3)). SAGE Publications Ltd.

Takahashi, Y., Watanabe, N., Kamio, N., Kobayashi, R., Iinuma, T., & Imai, K. (2021). Aspiration of periodontopathic bacteria due to poor oral hygiene potentially contributes to the aggravation of COVID-19. Journal of Oral Science, 63(1), 1–3.

Tamimi, F., Altigani, S., & Sanz, M. (2022). Periodontitis and coronavirus disease 2019. In Periodontology 2000. John Wiley and Sons Inc.

Thounaojam, N. (2019). Effects of chronic periodontitis in serum ferritin levels before and 1 month after nonsurgical periodontal therapy: An intervention study. International Journal of Preventive and Clinical Dental Research, 6(2), 32.

World Health Organization. (2020). COVID-19 Weekly Epidemiological Update Global epidemiological situation.

Wu, C., Chen, X., Cai, Y., Xia, J., Zhou, X., Xu, S., Huang, H., Zhang, L., Zhou, X., Du, C., Zhang, Y., Song, J., Wang, S., Chao, Y., Yang, Z., Xu, J., Zhou, X., Chen, D., Xiong, W., & Song, Y. (2020). Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Internal Medicine, 180(7), 934.

Yang, Y., Shen, C., Li, J., Yuan, J., Wei, J., Huang, F., Wang, F., Li, G., Li, Y., Xing, L., Peng, L., Yang, M., Cao, M., Zheng, H., Wu, W., Zou, R., Li, D., Xu, Z., Wang, H., & Liu, Y. (2020). Plasma IP-10 and MCP-3 levels are highly associated with disease severity and predict the progression of COVID-19. Journal of Allergy and Clinical Immunology, 146(1), 119-127.e4.

Zhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z., Xiang, J., Wang, Y., Song, B., Gu, X., Guan, L., Wei, Y., Li, H., Wu, X., Xu, J., Tu, S., Zhang, Y., Chen, H., & Cao, B. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet, 395(10229), 1054–1062.



How to Cite

PAGLIUSE, B.; PEDRIALI, M. B. B. P.; ITO, F. A. N.; MAIA, L. P.; COSTA, P. P. Relationship between periodontal disease and COVID-19: literature review . Research, Society and Development, [S. l.], v. 11, n. 11, p. e420111132483, 2022. DOI: 10.33448/rsd-v11i11.32483. Disponível em: Acesso em: 25 feb. 2024.



Health Sciences