Dr Graham Lloyd-Jones
@drgrahamlj.bsky.social
Consultant Radiologist UK.
Medical imaging educator.
Founder/Director of radiologymasterclass.co.uk.
Investigating links between poor oral health and systemic disease | oral microbiome | COVID-19 & LongCOVID.
Oral Health Section Editor - Springer Nature
Medical imaging educator.
Founder/Director of radiologymasterclass.co.uk.
Investigating links between poor oral health and systemic disease | oral microbiome | COVID-19 & LongCOVID.
Oral Health Section Editor - Springer Nature
Not as much as there should have been.
Do you have something in mind?
Or a question?
Do you have something in mind?
Or a question?
July 10, 2025 at 11:59 PM
Not as much as there should have been.
Do you have something in mind?
Or a question?
Do you have something in mind?
Or a question?
True.
Just saying, to study the gut microbiome without also studying the oral microbiome is like studying the tubes of a trombone without its mouthpiece and wondering where the music comes from.
The oral microbiome determines the gut microbiome.
And the oral microbiome translocates systemically.
Just saying, to study the gut microbiome without also studying the oral microbiome is like studying the tubes of a trombone without its mouthpiece and wondering where the music comes from.
The oral microbiome determines the gut microbiome.
And the oral microbiome translocates systemically.
June 4, 2025 at 11:45 PM
True.
Just saying, to study the gut microbiome without also studying the oral microbiome is like studying the tubes of a trombone without its mouthpiece and wondering where the music comes from.
The oral microbiome determines the gut microbiome.
And the oral microbiome translocates systemically.
Just saying, to study the gut microbiome without also studying the oral microbiome is like studying the tubes of a trombone without its mouthpiece and wondering where the music comes from.
The oral microbiome determines the gut microbiome.
And the oral microbiome translocates systemically.
Hi David.
Correct!
But the gut microbiome is downstream from …
The oral microbiome.
See this study from 2021
👇
pmc.ncbi.nlm.nih.gov/articles/PMC...
And remember …
👇
Oral pathobionts have direct systemic vascular entry (bypassing the liver) via oral mucosa/diseased gums.
Correct!
But the gut microbiome is downstream from …
The oral microbiome.
See this study from 2021
👇
pmc.ncbi.nlm.nih.gov/articles/PMC...
And remember …
👇
Oral pathobionts have direct systemic vascular entry (bypassing the liver) via oral mucosa/diseased gums.
Inflammation-type dysbiosis of the oral microbiome associates with the duration of COVID-19 symptoms and long COVID
In the COVID-19 pandemic, caused by SARS-CoV-2, many individuals experience prolonged symptoms, termed long-lasting COVID-19 symptoms (long COVID). Long COVID is thought to be linked to immune dysregu...
pmc.ncbi.nlm.nih.gov
June 4, 2025 at 7:31 PM
Hi David.
Correct!
But the gut microbiome is downstream from …
The oral microbiome.
See this study from 2021
👇
pmc.ncbi.nlm.nih.gov/articles/PMC...
And remember …
👇
Oral pathobionts have direct systemic vascular entry (bypassing the liver) via oral mucosa/diseased gums.
Correct!
But the gut microbiome is downstream from …
The oral microbiome.
See this study from 2021
👇
pmc.ncbi.nlm.nih.gov/articles/PMC...
And remember …
👇
Oral pathobionts have direct systemic vascular entry (bypassing the liver) via oral mucosa/diseased gums.
… to ensure correct language is used to describe a disease (not old and potentially misleading language)
And …
To allow challenges to incorrect concepts, to stop them propagating and becoming fixed dogma in the medical literature.
25/25
And …
To allow challenges to incorrect concepts, to stop them propagating and becoming fixed dogma in the medical literature.
25/25
April 12, 2025 at 11:36 PM
… to ensure correct language is used to describe a disease (not old and potentially misleading language)
And …
To allow challenges to incorrect concepts, to stop them propagating and becoming fixed dogma in the medical literature.
25/25
And …
To allow challenges to incorrect concepts, to stop them propagating and becoming fixed dogma in the medical literature.
25/25
I'm now working with likeminded radiologists on an invited review of #COVID imaging for a major radiology journal.
We propose formation of a system by which all medical/scientific specialties collaborate to build understanding when we encounter a new disease …
24/25
We propose formation of a system by which all medical/scientific specialties collaborate to build understanding when we encounter a new disease …
24/25
April 12, 2025 at 11:36 PM
I'm now working with likeminded radiologists on an invited review of #COVID imaging for a major radiology journal.
We propose formation of a system by which all medical/scientific specialties collaborate to build understanding when we encounter a new disease …
24/25
We propose formation of a system by which all medical/scientific specialties collaborate to build understanding when we encounter a new disease …
24/25
My frustration with the world of medicine (my world) is that we are pathologically unable/unwilling to shift ideas or to see the body holistically.
Our blinkered and siloed approach kills people!
Oral health is the most siloed of all areas of medicine.
23/25
Our blinkered and siloed approach kills people!
Oral health is the most siloed of all areas of medicine.
23/25
April 12, 2025 at 11:36 PM
My frustration with the world of medicine (my world) is that we are pathologically unable/unwilling to shift ideas or to see the body holistically.
Our blinkered and siloed approach kills people!
Oral health is the most siloed of all areas of medicine.
23/25
Our blinkered and siloed approach kills people!
Oral health is the most siloed of all areas of medicine.
23/25
In summary, gum disease bacteria escape the mouth all the time and are directly implicated in biological mechanisms of numerous common diseases of the body including cardiovascular disease, diabetes,
22/25
22/25
April 12, 2025 at 11:36 PM
In summary, gum disease bacteria escape the mouth all the time and are directly implicated in biological mechanisms of numerous common diseases of the body including cardiovascular disease, diabetes,
22/25
22/25
What have I learned from COVID-19? …
That our lack of understanding of the biology of the mouth and the importance of #OralHealth is the biggest missing link in the whole of medicine.
youtu.be/yLhtBZIaAIk
21/25
That our lack of understanding of the biology of the mouth and the importance of #OralHealth is the biggest missing link in the whole of medicine.
youtu.be/yLhtBZIaAIk
21/25
COVID-19 and the Salisbury Oral Care Pathway
YouTube video by Salisbury District Hospital
youtu.be
April 12, 2025 at 11:36 PM
What have I learned from COVID-19? …
That our lack of understanding of the biology of the mouth and the importance of #OralHealth is the biggest missing link in the whole of medicine.
youtu.be/yLhtBZIaAIk
21/25
That our lack of understanding of the biology of the mouth and the importance of #OralHealth is the biggest missing link in the whole of medicine.
youtu.be/yLhtBZIaAIk
21/25
The concept of pathogens escaping the mouth and travelling to the rest of the body is now my major area of interest (writing a book).
20/25
20/25
April 12, 2025 at 11:36 PM
The concept of pathogens escaping the mouth and travelling to the rest of the body is now my major area of interest (writing a book).
20/25
20/25
This question led to hypothesizing that the virus is getting to the lungs from the upper respiratory tract (nose and mouth) via the bloodstream.
And this explains why gum disease is a major risk factor for death from COVID-19.
link.springer.com/article/10.1...
19/25
And this explains why gum disease is a major risk factor for death from COVID-19.
link.springer.com/article/10.1...
19/25
April 12, 2025 at 11:36 PM
This question led to hypothesizing that the virus is getting to the lungs from the upper respiratory tract (nose and mouth) via the bloodstream.
And this explains why gum disease is a major risk factor for death from COVID-19.
link.springer.com/article/10.1...
19/25
And this explains why gum disease is a major risk factor for death from COVID-19.
link.springer.com/article/10.1...
19/25
The pattern of lung disease we saw on medical imaging in people with #COVID-19 tells us that the disease is NOT pneumonia, it is a vasculopathy (disease of blood vessels).
This raises another question …
How does this happen?
18/25
This raises another question …
How does this happen?
18/25
April 12, 2025 at 11:36 PM
The pattern of lung disease we saw on medical imaging in people with #COVID-19 tells us that the disease is NOT pneumonia, it is a vasculopathy (disease of blood vessels).
This raises another question …
How does this happen?
18/25
This raises another question …
How does this happen?
18/25
You might think that medical organisations asked – what are we dealing with?
They didn’t!
They assumed it was just like influenza. They kept calling the disease ‘pneumonia’.
This was a fatal error.
17/25
They didn’t!
They assumed it was just like influenza. They kept calling the disease ‘pneumonia’.
This was a fatal error.
17/25
April 12, 2025 at 11:36 PM
You might think that medical organisations asked – what are we dealing with?
They didn’t!
They assumed it was just like influenza. They kept calling the disease ‘pneumonia’.
This was a fatal error.
17/25
They didn’t!
They assumed it was just like influenza. They kept calling the disease ‘pneumonia’.
This was a fatal error.
17/25
At the outset of the pandemic, ‘experts’ were called on to advise on population level planning.
This is fine (if you like graphs), but we also need a multidisciplinary approach to attempt to understand the biological mechanisms of the disease we are dealing with.
16/25
This is fine (if you like graphs), but we also need a multidisciplinary approach to attempt to understand the biological mechanisms of the disease we are dealing with.
16/25
April 12, 2025 at 11:36 PM
At the outset of the pandemic, ‘experts’ were called on to advise on population level planning.
This is fine (if you like graphs), but we also need a multidisciplinary approach to attempt to understand the biological mechanisms of the disease we are dealing with.
16/25
This is fine (if you like graphs), but we also need a multidisciplinary approach to attempt to understand the biological mechanisms of the disease we are dealing with.
16/25
Not ...
What old language can we use to describe this disease?
But ...
What is different?
What is new?
What don't we understand?
And ...
How can we collaborate to build a multidisciplinary understanding of diseases processes?
15/25
What old language can we use to describe this disease?
But ...
What is different?
What is new?
What don't we understand?
And ...
How can we collaborate to build a multidisciplinary understanding of diseases processes?
15/25
April 12, 2025 at 11:36 PM
Not ...
What old language can we use to describe this disease?
But ...
What is different?
What is new?
What don't we understand?
And ...
How can we collaborate to build a multidisciplinary understanding of diseases processes?
15/25
What old language can we use to describe this disease?
But ...
What is different?
What is new?
What don't we understand?
And ...
How can we collaborate to build a multidisciplinary understanding of diseases processes?
15/25
I am posting this story now so that we (humans) can learn some lessons.
When we encounter a new disease, we should all stop and ask ....
What are we dealing with?
Not ...
How is this similar to other diseases we know about?
14/25
When we encounter a new disease, we should all stop and ask ....
What are we dealing with?
Not ...
How is this similar to other diseases we know about?
14/25
April 12, 2025 at 11:36 PM
I am posting this story now so that we (humans) can learn some lessons.
When we encounter a new disease, we should all stop and ask ....
What are we dealing with?
Not ...
How is this similar to other diseases we know about?
14/25
When we encounter a new disease, we should all stop and ask ....
What are we dealing with?
Not ...
How is this similar to other diseases we know about?
14/25
Here is our conclusion …
(Remember, this is 2020 data which could have been published in early 2021)
13/25
(Remember, this is 2020 data which could have been published in early 2021)
13/25
April 12, 2025 at 11:36 PM
Here is our conclusion …
(Remember, this is 2020 data which could have been published in early 2021)
13/25
(Remember, this is 2020 data which could have been published in early 2021)
13/25
After many attempts to get published we were eventually accepted this month (April 2025!) in an institutional journal.
(Thanks to @UMJBelfast. And thanks especially to my colleague Alastair Watson for not giving up hope of publication.)
bit.ly/4j6fIpx
12/25
(Thanks to @UMJBelfast. And thanks especially to my colleague Alastair Watson for not giving up hope of publication.)
bit.ly/4j6fIpx
12/25
April 12, 2025 at 11:36 PM
After many attempts to get published we were eventually accepted this month (April 2025!) in an institutional journal.
(Thanks to @UMJBelfast. And thanks especially to my colleague Alastair Watson for not giving up hope of publication.)
bit.ly/4j6fIpx
12/25
(Thanks to @UMJBelfast. And thanks especially to my colleague Alastair Watson for not giving up hope of publication.)
bit.ly/4j6fIpx
12/25
The airways of the lungs were NORMAL!
Unlike influenza, there was no inflammation in the lung airways in people with #COVID-19.
The blood vessels were damaged.
And yet the world of medicine carried on treating it as if it were flu.
11/25
Unlike influenza, there was no inflammation in the lung airways in people with #COVID-19.
The blood vessels were damaged.
And yet the world of medicine carried on treating it as if it were flu.
11/25
April 12, 2025 at 11:36 PM
The airways of the lungs were NORMAL!
Unlike influenza, there was no inflammation in the lung airways in people with #COVID-19.
The blood vessels were damaged.
And yet the world of medicine carried on treating it as if it were flu.
11/25
Unlike influenza, there was no inflammation in the lung airways in people with #COVID-19.
The blood vessels were damaged.
And yet the world of medicine carried on treating it as if it were flu.
11/25
This led to an invitation to join the REACT COVID-19 research group based in Southampton, UK. I was initially the sole radiologist on the project.
People from across the world sent me examples of COVID-19 cases. I looked at thousands of images. The same pattern was repeated …
10/25
People from across the world sent me examples of COVID-19 cases. I looked at thousands of images. The same pattern was repeated …
10/25
April 12, 2025 at 11:36 PM
This led to an invitation to join the REACT COVID-19 research group based in Southampton, UK. I was initially the sole radiologist on the project.
People from across the world sent me examples of COVID-19 cases. I looked at thousands of images. The same pattern was repeated …
10/25
People from across the world sent me examples of COVID-19 cases. I looked at thousands of images. The same pattern was repeated …
10/25
In November 2020 I was invited to speak at the @BritSocHaem annual conference.
The talk highlights that #COVID-19 is NOT a pneumonia. It is a pulmonary vasculopathy (disease of the lung blood vessels).
youtu.be/2jROYLwUK20
9/25
The talk highlights that #COVID-19 is NOT a pneumonia. It is a pulmonary vasculopathy (disease of the lung blood vessels).
youtu.be/2jROYLwUK20
9/25
COVID-19 Lung Disease: A Pulmonary Vasculopathy
YouTube video by Radiology Masterclass
youtu.be
April 12, 2025 at 11:36 PM
In November 2020 I was invited to speak at the @BritSocHaem annual conference.
The talk highlights that #COVID-19 is NOT a pneumonia. It is a pulmonary vasculopathy (disease of the lung blood vessels).
youtu.be/2jROYLwUK20
9/25
The talk highlights that #COVID-19 is NOT a pneumonia. It is a pulmonary vasculopathy (disease of the lung blood vessels).
youtu.be/2jROYLwUK20
9/25
So I published informally as a blog on the Radiology Masterclass website and shared my ideas widely.
bit.ly/3E6PX9D
8/25
bit.ly/3E6PX9D
8/25
April 12, 2025 at 11:36 PM
So I published informally as a blog on the Radiology Masterclass website and shared my ideas widely.
bit.ly/3E6PX9D
8/25
bit.ly/3E6PX9D
8/25
In June 2020 I wrote to a UK radiology journal to raise the alert.
The title of my letter was – ‘Acute COVID-19 lung disease: A pulmonary vasculopathy not a pneumonia’
I was told it would be too ‘time-consuming’ to be put forward for publication.
7/25
The title of my letter was – ‘Acute COVID-19 lung disease: A pulmonary vasculopathy not a pneumonia’
I was told it would be too ‘time-consuming’ to be put forward for publication.
7/25
April 12, 2025 at 11:36 PM
In June 2020 I wrote to a UK radiology journal to raise the alert.
The title of my letter was – ‘Acute COVID-19 lung disease: A pulmonary vasculopathy not a pneumonia’
I was told it would be too ‘time-consuming’ to be put forward for publication.
7/25
The title of my letter was – ‘Acute COVID-19 lung disease: A pulmonary vasculopathy not a pneumonia’
I was told it would be too ‘time-consuming’ to be put forward for publication.
7/25
Soon the autopsy papers showed that clotting in the lungs was occurring in the capillaries (the smallest blood vessels). This means that we would not be able to detect clotting in the lungs using standard imaging techniques.
bit.ly/3XSg8aM
6/25
bit.ly/3XSg8aM
6/25
April 12, 2025 at 11:36 PM
Soon the autopsy papers showed that clotting in the lungs was occurring in the capillaries (the smallest blood vessels). This means that we would not be able to detect clotting in the lungs using standard imaging techniques.
bit.ly/3XSg8aM
6/25
bit.ly/3XSg8aM
6/25