To understand the functional medicine side of dentistry and importantly, how your mouth health relates to your risks associated with COVID-19 – let’s explore the science behind it. I promise this leads to a jaw-dropping (no pun intended) conclusion!
When the COVID 19 pandemic began, the world raced to catch up and learn as much as possible about this disease. Not much was known about risk factors and why some seemingly healthy people had such poor outcomes. In some people SARS-CoV-2 induces an inflammatory response leading to a cytokine storm, which is associated with respiratory failure and mortality. The cytokine storm is historically connected with some of the worst pandemic diseases – such as the flu on 1918-1919 and the plague. The cytokine storm consists of an exaggerated host immune response that is responsible for triggering multiorgan failure. In other words, the person’s immune response to the pathogen, rather than the pathogen itself, can cause death. The New England Journal of Medicine published an article, Cytokine Storm, that gives an excellent overview about the relationship between cytokine release and COVID 19.
A cytokine storm sets off many cascades of inflammatory responses, involving different types of immune system cells – hence the term “storm”. Much is still not known about the role of this process in different disease outcomes. However, one particular piece of the storm – Interluekin-6 (IL-6) is particularly related to COVID 19. Studies, such as this one in the Journal of Infectious Disease, show an association between high levels of IL-6 and respiratory failure, need for mechanical ventilation, and death in COVID 19 patients. Just remember that high IL-6 is bad news.
Dental practitioners have long known about the reservoir of disease that the human mouth can become. Pre-COVID studies have linked periodontitis to severe respiratory conditions, with higher mortality rates. The high viral load found in saliva and mucous membranes has also been fairly obvious – both as a mechanism for testing, and as a high-risk method of transmission. We have all spent months wearing masks because of this – so you know well how saliva transports the virus.
Now, for the big connection – the presence of IL-6 in periodontal disease.
A link between periodontal disease and COVID 19 outcomes has been suspected, theorized, and written about, such as in this article by Drs. Shervin Molayem, DDS and Carla Cruvinel Pontes, DDS, MSc, PhD. This article correlates the high interleukin-6 (IL-6) levels that are found in periodontal disease with the high IL-6 levels in COVID-related cytokine storm. The article explores, in detail, the many different disease processes in the mouth contain high levels of IL-6. The article concludes that a healthy periodontium can help decrease the severity and complications related to COVID-19. Also, that periodontal treatment helps significantly reduce IL-6 levels.
“The improvement in circulating IL-6 levels has been reported for systemically healthy patients and for patients with systemic conditions.” .
The connection was there, but the real-life patient studies have to be conducted and completed.
A new study out this month confirms what Dr. Molayem and others have been working on since the pandemic began – a definitive connection between periodontal health and risk for COVID-19 complications. This peer-reviewed study included 568 COVID 19 positive patients with dental records. 258 of these patients presented with periodontitis. Among those patients, 33 experienced complications, while only 7 of the patients without periodontitis experienced complications.
The association between the data is remarkable –
The evidence can no longer be ignored, and the research supports the mouth-body-COVID connection. Improving periodontal health as functional dental health supports a healthy immune system. A healthy mouth and body are the best tools we have to fight against COVID-19.
We are sure that this is the first of several studies in the world of dental health and COVID risk, and greatly adds to the body of functional dentistry knowledge that is already out there. As a functional dentistry specialty, we strive to impact the health of the entire body through periodontal wellness, every day.
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