Researchers around the world are combining efforts to increase our understanding of SARS- CoV-2, and recent findings point to the potential role of cytokine storms in the severity of this viral infection. High Interleukin-6 (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, including IL-6 cytokine levels. Periodontitis has been shown to increase cytokine levels locally and systemically so periodontal therapy should produce the reverse.

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. Utilizing the MyPerioID® IL-6 saliva test can help dental professionals assess a patient’s risk based on their genotype.

Periodontal treatment can decrease the burden of systemic inflammation, thus decreasing the risk for pulmonary complications due to COVID-19 for both the systemically healthy and those with systemic conditions. 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.

Based on the potential for gum disease to worsen lung complications in COVID-19 patients and that gum disease progresses silently without obvious symptoms, dentists should promote periodontal screening, plaque control, and periodontal treatment when indicated. A healthy periodontium may help decrease the severity and complications related to COVID-19 infections. Additionally, some variants in the IL-6 gene can put a person at higher risk for gum disease and some suggest a link to significantly higher risk for pulmonary complications of COVID-19. IL-6 testing is simply done with a 30 second swish and gargle saliva collection. Knowing the IL-6 risk can help customize treatment strategies for periodontal disease and possibly, soon, for COVID-19.

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Shervin Molayem DDS
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