Periodontal status may play role in COVID-19 severity

Brendan Day, Dental Tribune International

Thu. 8. October 2020

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LOS ANGELES, U.S.: The link between periodontal disease and systemic conditions such as cardiovascular disease is, by now, well established in the scientific literature. A new review study has now suggested that untreated periodontal disease may be indirectly related to the intensity of COVID-19-related complications, highlighting the need for good oral health during these difficult times.

As outlined in the review, a recent study conducted in the German city of Munich found that elevated levels of interleukin-6 (IL-6), a pro-inflammatory cytokine, acted as a powerful predictor for respiratory failure and the eventual need for mechanical ventilation among patients who had been hospitalized with COVID-19. When left untreated, periodontal disease frequently leads to an increase of this pro-inflammatory cytokine. According to Dr. Shervin Molayem, a Los Angeles-based periodontist and co-author of the review, it is therefore “not an overstatement to conclude that periodontal disease can increase the risk of respiratory complications in COVID-19 patients.” Conversely, lowering IL-6 levels can potentially reduce the likelihood of these complications from occurring, he added.

“From the existing literature, we know that simply by performing a scaling and root planing procedure on a patient with periodontal disease, we can lower IL-6 levels by, on average, 3 pg/ml,” Molayem told Dental Tribune International.

Oral hygiene correlates with reduced complications

As reported by DTI back in June, a study published in the British Dental Journal highlighted the importance of improved oral hygiene during a SARS-CoV-2 infection, since it can reduce the bacterial load in the mouth and the associated risk of a bacterial superinfection. Patients reported to have a severe case of COVID-19 had associated higher levels of inflammatory markers and bacteria, leading the study’s authors to conclude that poor oral hygiene may be a risk factor for COVID-19 complications.

In the view of Molayem, provided that they are practicing appropriate infection control, dental practitioners should thus encourage their patients to continue receiving periodontal treatment and other forms of specialized care.

“Though it may seem obvious that the mouth is not separate from the body and that oral bacteria can have negative effects on other organs, delaying dental treatment underestimates the interconnectedness between the mouth and body,” he noted. Molayem added that conducting a serum test could quickly and easily measure a patient’s IL-6 levels to make sure that they are within normal limits.

The review, titled “The mouth–COVID connection: Il-6 levels in periodontal disease—potential role in COVID-19-related respiratory complications,” was published in the October 2020 issue of the Journal of the California Dental Association.

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