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The Mouth-COVID Connection: Il-6 Levels in Periodontal Disease — Potential Role in COVID-19-Related Respiratory Complications

The Mouth-COVID Connection: Il-6 Levels in Periodontal Disease — Potential Role in COVID-19-Related Respiratory Complications

Shervin Molayem, DDS, and Carla Cruvinel Pontes, DDS, MsC, PhD 

Molayem S, Pontes CC. The Mouth-COVID Connection: Il-6 Levels in Periodontal Disease — Potential Role in 

COVID-19-Related Respiratory Complications [published online ahead of print July 30, 2020]. J Calif Dent 

Assoc doi: 10.35481/jcda-48-10-01. 

Disclaimer: This article has been peer reviewed and accepted for publication in the Journal of the California Dental Association and is posted online before publication 

in October 2020. This article may contain statements, opinions and information that have errors in facts, figures or interpretation.

Researchers around the world are combining efforts to increase our understanding on SARS-CoV-2, and recent findings point to the potential role of cytokine storms in the severity of this viral infection. High IL-6 levels have been linked to significantly higher risk for pulmonary complications and increased need for mechanical ventilation in COVID-19 patients. 

As dental professionals try to establish a new normal in their practices, they play a significant role in decreasing transmission of the coronavirus disease and decreasing inflammation and IL-6 levels because periodontitis has been shown to increase cytokine levels locally and systemically. Periodontitis has been previously associated with increased risk for respiratory conditions, such as chronic obstructive pulmonary disease (COPD), pneumonia and lung function, hence there is biological plausibility for a link between periodontitis, IL-6 levels and COVID-19-related pulmonary problems. The potential mechanisms behind this association include systemic inflammation, bacterial load, gut dysbiosis and endothelial function. 

Genetic variations in the IL-6 gene can also be a relevant risk factor for exacerbated inflammatory response. Findings from pneumonia studies showing lower rates of infection and mortality associated with plaque control suggest that dental care can have a major impact in the coronavirus disease course.Furthermore, for systemically healthy patients and for those who have systemic conditions,periodontal treatment can decrease the burden of systemic inflammation, thus decreasing the risk for pulmonary complication due to COVID-19. Despite the lack of studies on this topic, the importance of oral hygiene and periodontal health for respiratory conditions and COVID-19 infections should not be underestimated. Dentists should promote screening, plaque control and periodontal treatment because a healthy periodontium can help decrease the severity and complications related to COVID-19

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