Covid-19 uses your mouth as a pathway

Patients hospitalized with COVID-19 were more likely to experience respiratory failure if they had gum disease before becoming infected, according to a paper in the Journal of the California Dental Association.

These findings indicate that primary care physicians should discuss oral health with their patients, Shervin Molayem, DDS, one of the study’s authors, told Healio Primary Care.

"The gums that hold our teeth in place have many blood vessels that bacteria can get into and spread throughout the body." The source of the quote is Shervin Molayem, DDS

Molavem and Carla Cruvinel Pontes, DDS, MsC, PhD, both in private dental practice, reviewed more than 100 articles to establish biological pathways between COVID-19 and gum disease. They identified several potential pathways, including:

  • overflow of locally produced inflammatory mediators such as IL-6 — a protein associated with gum disease — to the systemic circulation, causing systemic inflammation;
  • bacteria or bacterial products entering the systemic circulation via the gingival sulcus; and
  • aspiration of oral bacteria that may reach the upper and lower respiratory tract.

“Combined, these pathways can enhance endothelial dysfunction, gut dysbiosis, potentially predisposing to changes in the lungs,” Molayem and Pontes wrote. “Gut dysbiosis and endothelial dysfunction can affect several organs and systems, including the lungs. Circulating cytokines and bacteria can alter the respiratory epithelium, predisposing to infection, inflammation and potential pulmonary complications.”

Molayem and Pontes cited a previous study that demonstrated a “strong association” between the need for mechanical ventilation and high IL-6 serum levels above 80 pg/ml among 40 patients hospitalized with COVID-19, 32.5% of whom required ventilation.

“High IL-6 levels accurately predicted respiratory failure, with 22 times higher risk for respiratory complications,” they wrote.

In addition, a recent meta-analysis showed that patients with severe COVID-19 had a 2.9-fold increase in IL-6 levels compared with patients who had mild-to-moderate COVID-19.

Molayem said that healthy gums do more than protect against COVID-19.

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