PDF: IL-6 levels in Periodontal Disease potential role in COVID19-related Respiratory Complications

Researchers are combining efforts to better understand SARS-CoV-2 and recent findings point to the importance of cytokine storms. Elevated IL-6 levels can predict COVID-19 pulmonary complications.

Dental professionals play a significant role, since periodontitis can increase IL-6 levels locally and systemically. Periodontal treatment have positive effects in systemic inflammation and the importance of oral hygiene and periodontal health for respiratory conditions and COVID-19 should not be underestimated.

In these extraordinary times, dental professionals might need to shift their focus to a general health and systemic inflammation approach. In this context, periodontitis has been linked to increased levels of proinflammatory cytokines, including IL-6, which is a recognized mediator in the periodontal destruction process. 

The ability of nonsurgical periodontal treatment to lower cytokine levels has been highlighted in the dental literature.8,9 Thus, lower IL-6 levels and inflammation resulting from periodontal treatment can potentially protect COVID-19 patients against life-threatening respiratory complications. 

Periodontitis is characterized by an inflammatory process that results in destruction of the periodontium triggered by mediators derived from the adaptive and innate immune response to microorganisms in the biofilm. Cytokines are soluble proteins that attach to cell surfaces through specific receptors, regulating cell function and mediating complex cell interactions involved in periodontal destruction.

In periodontitis, cytokines cause intracellular cascades and phenotypic changes that regulate the amplitude and severity of the host response with interleukin-1β (IL-1β), tumor necrosis factor α (TNF-α) and IL-6 being the most extensively investigated. 

Pneumonia is the infection of the pulmonary parenchyma, which can be caused by bacteria and viruses. It presents high mortality rates worldwide and often affects individuals with impaired immune systems, being usually classified as community-acquired or hospital-acquired (nosocomial). 

In a systematic review from Scannapieco et al. (2003) including nine randomized controlled trial (RCT) and 11 case-control studies, there was a significant association between nosocomial pneumonia and poor oral hygiene.

High serum IL-6 levels can predict COVID-19-related respiratory complications and the need for mechanical ventilation, hence dentists should focus on eliminating underlying conditions that promote systemic inflammation, such as periodontitis and other oral conditions. 

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