the mouth covid connection - watchourvideo.netjul 19, 2018 · the mouth – covid connection ....

DR. SHERVIN MOLAYEM DDS, LOS ANGELS, USA

I L -6 LEVELS IN PERIODONTAL DISEASE

POTENTIAL ROLE IN COVID19 -RELATED

RESPIRATORY COMPLICATIONS

DR. CARLA CRUVINEL PONTES DDS, PhD, CAPE TOWN, SOUTH AFRICA

THE MOUTH – COVID CONNECTION

This presentation is based on

the peer-reviewed article accepted

for publication in the October 2020

issue of the Journal of the CDA

(California Dental Association).

A preview of the IL-6 article is

available for review by oral

health clinicians, dentists and

COVID-19 researchers here.

Mouth – COVID Connection™

To see a preview of the IL-6 research article, click here.

https://drive.google.com/file/d/1vsjtMIyOaCcllntoVm5ReaOj7wn4wsJG/view?usp=sharing

http://www.mouthcovid.com/

http://www.mouthcovid.com/

Aspiration oral bacteria

Bacteriemia

Systemic inflammation

Local inflammation

High blood levels inflammatory cytokines TNF-α, Il-1β, CRP

IL-6

Gut dysbiosis Changes - Lungs

- Epithelium - Higher risk infection

and complications

Endothelial dysfunction

STRESS

COVID19

DIR

ECT

LIN

K H

IGH

IL-6

PE

RIO

X S

AR

S-C

oV

-2


CURRENT KNOWLEDGE AND

SCIENTIFIC FOUNDATION FOR

CONNECTION BETWEEN

IL-6 levels and periodontitis

Covid-19 and respiratory diseases

Mouth-Covid Connection™

D R . S H E RV I N M O L AY E M

INTRODUCTION

COVID-MOUTH Connection™

INTRODUCTION COVID19 EMERGENCY CRISIS

WHO – January 2020

MILD COLD SYMPTOMS

No major complications

SEVERE SYMPTOMS

Respiratory problems

LIFE-THREATNING

Intensive care, mechanical ventilation

CYTOKINE STORM

German study – IL-6 can predict respiratory failure and need for

mechanical ventilation in hospitalized patients

80%

20%

5%

IL-6

MO

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DENTISTRY COVID-19 AND DENTISTRY

ORAL CAVITY

Is a transmission route

SALIVARY GLANDS

Can function as reservoirs for COVID-19

SALIVA

Infectivity of saliva

OCCUPATIONAL HEALTH ISSUES

Infection control

FINANCIAL ISSUES

PPE, decline in patient number


COVID-19 AND DENTISTRY

GENERAL HEALTH APPROACH TO

TREATING DENTAL PATIENTS

Causes an increase in Systemic

inflammation, cytokines, and IL-6

PERIODONTITIS

Lowers inflammation, cytokines, and IL-6

PERIODONTITIS TREATMENT

These will decrease

severity of respiratory

complications


DENTISTRY COVID-19 AND DENTISTRY

PERIODONTITIS SYSTEMIC INFLAMMATION

HIGH IL-6 LEVELS

RESPIRATORY CONDITIONS

COVID19

Severity of respiratory

complications

Shortage of

healthcare

resources

High

periodontitis

prevalence

High

transmission

SARS-CoV-2

Limited

perio treatment

during pandemic


CO

VID

-19

US

STA

TS

JULY 2020 - TOTAL >3 MILLION CASES


CO

VID

-19

US

STA

TS



IL-6 IN RELATION TO

PERIODONTITIS

MOUTH-COVID Connection™

15

IL-6 AND PERIODONTITIS

INNATE IMMUNITY ADAPTIVE IMMUNITY

PMN MACROPHAGE TH1 TH2 TH17 TREGS

TNF-α, IL-1β, IL-6 IFN-γ, IL-4, IL-17, IL-10, TGF-β CYTOKINES

CELLS

HOST

RESPONSE

P E R I O D O N TA L I N F L A M M AT I O N

REGULATES HOST RESPONSE TO INFECTION,

INJURY, AND ALVEOLAR BONE RESORPTION


16

Mo

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IL-6 SNPs Association Year Country Diagnosis Reference

-572 YES 2019 China CP Zhao et al.

-572 YES 2017 Turkey AP Toker et al.

-174, -572 YES 2017 Brazil AP Gorgun et al.

-174 YES 2017 India CP Kavitha et al.

-572 YES 2017 China CP Shi et al.

-174, -573 NO 2016 Iran CP Salman et al.

– 572 NO 2014 China CP Zhang et al.

–174 YES 2014 Brazil CP Teixeira et al.

–597 YES 2014 India CP Sharma et al.

–174 NO 2014

–1363 YES 2014 China CP Zhang et al.

–572 NO 2011

–174 NO 2010 Turkey AP Erciyas et al.

-572 YES 2010 China CP Jingjin et al.

–572, – 174 NO 2009 Japan CP Kobayashi et al.

–174 YES 2009 England AP and CP Nibali et al.

–1480, –1363 YES 2008 England AP Nibali et al.

–6106 NO 2008

–174 YES 2007 Finland CP Tervonen et al.

–174 YES 2007 Brazil AP and CP Moreira et al.

–174 NO 2006 Sweden CP Jansson et al.

874 NO 2006 Germany CP Babel et al.

–174 YES 2006 Germany CP Babel et al.

–174 NO 2006 USA CP Wohlfahrt et al.

–174 YES 2005 England AP and CP Brett et al.

–373 YES 2005

Japan CP Komatsu et al. –597, –572, –

190, – 174 NO 2005

– 597, – 174 NO 2004 Czech CP Holla et al.

– 572 YES 2004

–174 YES 2003 Brazil CP Trevilato et al.

rs2069837 YES 2016 Brazil CP Farhat et al.

GE

NE

TIC

ST

UD

IES

IL-6

POLYMORPHISMS

AND & RISK FOR

PERIODONTITIS

17

GENETIC STUDIES G E N E T I C S T U D I E S S U M M A R Y

Allele C protective Allele G increases risk

SNQ -174 SNQ -572 Allele C protective

Allele G increases risk

IL -6 gene polymorphisms G

EN

ET

IC S

TU

DIE

S


18

IN V

ITR

O S

TU

DIE

S

I L - 6 I N P E R I O D O N T I T I S

TISSUE

DESTRUCTION

Expression MMPs

Degradation of collagen

fibrinolytic protease

cascade

BONE

LOSS

IL-6 mediates

osteoclast,

osteoblasts and

RANKL expression

in osteoblasts

IL-6

EXPRESSION High inflamed gingiva

Gingival fibroblasts

can produce elevated

IL-6 levels

CELL

PHENOTYPE

Gingival and blood

cells produce high

IL-6 levels

Gingival/blood cells can produce high IL-6 levels

Periodontitis – high IL-6 cell phenotype

IL-6 - destruction through MMPs and osteoclastogenesis


19

IN V

IVO

ST

UD

IES

SALIVA increased salivary IL-6 levels in periodontitis


GINGIVAL CREVICULAR FLUID

IL-6 levels higher in periodontitis

GINGIVAL TISSUES Increased IL-6 levels in periodontitis, mRNA and protein expression

SERUM Most studies show

higher IL-6 levels in periodontitis patients

0.25-41.2 pg/ml up to 216.3 pg/ml

PERIODONTITIS

Increased IL-6

levels locally and

systemically


20

PE

RIO

DO

NTA

L T

RE

AT

ME

NT


SUBSTANTIAL EVIDENCE - PERIODONTAL TREATMENT

Beneficial effect in serum IL-6 levels and systemic inflammation

Decrease in IL-6 levels seen for systemically healthy patients

and for those with systemic conditions

D’Aiuto F, Parkar M, Andreou G, et al. Periodontitis and Systemic Inflammation:. J Dent Res. 2004;83(2):156-160.

de Moura Leite SA, et al. The effect of nonsurgical periodontal therapy on inflammatory and iron marker levels. Braz Oral Res. 2019;33.

Shimada Y, et al. The Effect of Periodontal Treatment on Serum Leptin, Interleukin-6, and C-Reactive Protein. J Periodontol.

2010;81(8):1118.

Lobão WJM, et al. Periodontal outcomes and serum biomarkers after periodontal therapy. An Acad Bras Cienc. 2019;91(2):e20170652.

D’Aiuto F, et al. Periodontal infections cause changes in traditional and novel cardiovascular risk factors. Am Heart J. 2006;151(5):977-

984.

Lima R, et al. Effect of Periodontal Therapy on Serum Levels of IL-6 in Type 2 Diabetics. Int J Periodontics Restorative Dent.

2019;39(1):e1-

Vidal F, et al. Periodontal Therapy Reduces Plasma Levels of Interleukin-6. J Periodontol. 2009;80(5):786-791.

Vidal F, et al. Non-surgical periodontal treatment reduces cardiovascular risk. J Clin Periodontol. 2013;40(7):681-687.

Torumtay G, et al. Effects of periodontal treatment on inflammation and oxidative stress. J Periodontal Res. 2016;51(4):489-498.

Higashi Y, et al. Oral infection-inflammatory pathway. Atherosclerosis. 2009;206(2):604-610.

Teeuw WJ, et al. Treatment of periodontitis improves the atherosclerotic profile. J Clin Periodontol. 2014;41(1):70-79.

Montenegro MM, et al. Randomized controlled trial of the effect of periodontal treatment on cardiovascular risk. J Clin Periodontol.

2019;46(3):321.

Marcaccini AM, et al. Circulating Interleukin-6 and High-Sensitivity C-Reactive Protein Decrease After Periodontal Therapy. J Periodontol.

2009;80(4):594-602. Zhou SY, et al. Effect of non-surgical periodontal therapy on serum levels of TNF-a, IL-6 and C-reactive protein. Chin

J Dent Res. 2013;16(2):145-151.


21

SU

MM

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Y

S T R O N G E V I D E N C E O N I L - 6

I M P O R TA N C E F O R P E R I O D O N T I T I S

GENETICS

IL-6 SNPs can increase susceptibility to periodontitis

CELLS

IL-6 can be produced by a variety of gingival and blood cells

IL-6 LEVELS

Upregulated locally with potential to spread to systemic circulation

Elevated serum levels of IL-6 in periodontitis patients

PERIODONTAL TREATMENT

Decrease local and circulating IL-6 levels in healthy individuals and in those

who present systemic conditions

OTHER CONDITIONS

Pulpitis and periapical lesions can contribute to high IL-6 levels



RESPIRATORY DISEASES

AND PERIODONTITIS


23

CHRONIC OBSTRUCTIVE

PULMONARY DISEASE (COPD)

PERIODONTIT IS X COPD

ROBUST ASSOCIATION (OR=2.08)

Periodontitis – independent risk factor

COPD Patients

Higher prevalence periodontitis

Fewer teeth

More inflammation

Zeng XT, et al. PLoS One. 2012;7(10).

Shen TC, et al. Med (United States). 2015;94(46):e2047.

Bhavsar NV, et al. J Nat Sci Biol Med. 2015;6(1):S93

Chung JH, et al. J Periodontol. 2016;87(8):864-871. 102.

Wang Z, et al. J Clin Periodontol. 2009;36(9):750-755.

Öztekin G, et al. J Chronic Obstr Pulm Dis. 2014;11(4):424


24

PNEUMONIA

PERIODONTIT IS X PNEUMONIA

SIGNIFICANT ASSOCIATION

Pneumonia and poor oral hygiene

Antimicrobial interventions decreased

incidence of pneumonia

COMPREHENSIVE DENTAL CARE

Dramatic decrease on pneumonia

https://www.svhlunghealth.com.au/conditions/pneumonia

Raghavendran K, Mylotte JM, Scannapieco FA. Periodontol 2000. 2007;44(1):164. Scannapieco FA et al.. Annals of Periodontology 2003:54-69. Sabharwal A, et al. Periodontol 2000. 2018;78(1):212-226. 107. Ćabov T, et al. Wien Klin Wochenschr. 2010;122(13-14):397-404. Özçaka Ö, et al. J Periodontal Res. 2012;47(5):584-592. Lorente L, et al. Eur J Clin Microbiol Infect Dis. 2012;31(10):2621-2629. Akutsu Y, Matsubara H, Shuto K, et al. Surgery. 2010;147(4):497-502. Seguin P, Laviolle B, Dahyot-Fizelier C, et al. Crit Care Med. 2014;42(1):1-8. Juthani-Mehta M et al. Clin Infect Dis 2015;60(6):849-57. Hollaar VRY, et al. BMC Geriatr. 2017;17(1):128.

Take Home Point: In hospitalized patients, intense dental therapy can help prevent respiratory infections


25

PULMONARY FUNCTION

PERIODONTIT IS X LUNG FUNCTION

SIGNIFICANT ASSOCIATION

Periodontal status and missing teeth

associated with lung function, airflow

limitation, reduced lung volume

PERIODONTAL THERAPY

Improved lung function


Peter KP, et al. J Periodontol. 2013;84(12):1717-1723. Holtfreter B, Richter S, Kocher T, et al. Eur Respir J. 2013;42(6):1524. Lee W, Fu E, Li C, et al. J Clin Periodontol. May 2020. Zhou X, et al. J Clin Periodontol. 2014;41(6):564-572. Lee E, Lee SW. Med. 2019;55(9).


26

ASTHMA

PERIODONTITIS X ASHTMA

SOME STUDIES FOUND ASSOCIATION BETWEEN

Asthma and gingival inflammation

Periodontitis (OR= 3.01-3.25)


Moraschini V, et al. J Periodontol. 2017;89(4):1-20. Ferreira MKM, Ferreira R de O, Castro MML, et al. Life Sci. 2019;223:74. Soledade-Marques K, et al. Oral Dis. 2017:1-7.

POTENTIAL CONFOUNDERS

Use of inhalers, mouth breathing, lower saliva


27

SEVERE COVID-19

Respiratory

complications are main

cause for hospitalization,

ventilation and mortality

PERIODONTITIS

Affects COPD, lung

function, pneumonia

for COVID-19

COVID-19

Periodontitis and poor

plaque control can affect

respiratory complications

in COVID-19 patients

COPD - risk factor

DENTAL CARE

Oral hygiene, screening

and periodontal therapy

are very important

01 02 03 04

RESPIRATORY DISEASES AND PERIODONTITIS SUMMARY



IL-6, VIRAL INFECTIONS

AND COVID-19

COVID-MOUTH Connection™

29

SA

RS

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Cold-like or no

symptoms

RISK FACTORS Age >70

Respiratory disease

Diabetes

Cardiovascular

disease

Cancer MILD/MODERATE

SYMPTOMS

INTENSIVE CARE

MECHANICAL

VENTILATION

80%

80%

20%

Hospitalization

SEVERE

SYMPTOMS

5%

MORTALITY RATES 0.25-3% SEVERE CASES UP TO 60.5%

30

SA

RS

-Co

V-2

A N G I O T E N S I N C O N V E R T I N G

E N Z Y M E 2 ( A C E 2 ) R E C E P TO R S

80%

Present in many cells and tissues including

lungs, heart, blood vessels, kidneys, liver, GI

tract and salivary glands

ACE2 present in epithelium in the nose, mouth

and lungs.

ACE2 abundant on type 2 pneumocytes in

alveoli, where oxygen is absorbed and waste

carbon dioxide is released.

Source: The Conversation, CC BY-SA

Mouth-COVID Connection™

http://creativecommons.org/licenses/by-sa/4.0/



31

SA

RS

-Co

V-2

C Y TO K I N E S TO R M , I L - 6 A N D

D I S E A S E S E V E R I T Y

80%

Source: https://www.enzolifesciences.com/

IL-6 is a crucial mediator in infections,

together with IL1β and TNF-α

Viral infections can increase IL-6 expression

- Some viruses can evade immune response

and increase IL-6 levels

- Genetic IL-6 polymorphisms can lead to

high IL-6 levels

COVID-19 & iL-6

High IL-6 levels can worsen alveolar

capillary blood gas exchange in the lungs

and oxygen diffusion, contributing to

fibrosis and pulmonary failure


https://www.enzolifesciences.com/

32

80%

STRONG ASSOCIATION

Need for ventilation and IL-6 levels >80 pg/ml

SARS-CoV-2 AND IL-6

RESULTS AND CONCLUSION

High IL-6 levels predicted respiratory failure

22X higher risk for respiratory complications STUDY CHARACTERISTICS

N=40 hospitalized COVID19 patients

32.5% deteriorated, mechanical ventilation


33

80% TOCILIZUMAB

Improved clinical outcomes

in severe and critical

COVID-19 patients,

reducing mortality

SARS-CoV-2 AND IL-6 TREATMENT STUDIES


90.5% of patients recovered after

average of 13.5 days

STUDY CHARACTERISTICS

N=20 hospitalized COVID19 patients given TOCILIZUMAB

HUMANIZED IL-6 RECEPTOR MONOCLONAL ANTIBODY

It binds to IL-6 receptors, preventing IL-6 from altering

cellular behavior and ultimately improving inflammation


34

DEXAMETHASONE

reduced 28-day mortality

among those receiving

invasive mechanical

ventilation or oxygen



Dexamethasone reduced deaths by

- 1/3 in those receiving mechanical

ventilation

- by 1/5 in those receiving oxygen

STUDY CHARACTERISTICS

N=2104 randomly allocated, dexamethasone 6mg/day 10 days

N= 4321 received usual care

DEXAMETASONE: down regulates IL-6 and other cytokines,

shifts towards anti-inflammatory direction


35

80%


INDICATION

Prevention of asthma attacks

INHALED CORTICOSTEROIDS – THE SILVER BULLET?

ONGOING COVID-19 STUDIES

Ciclesonide – 1 in the US, 1 in France

Upcoming studies: Sweden, Canada,

South Korea, STOIC trial (Oxford)

RATIONALE

Reduces viral replication, pulmonary

inflammation, immunosuppression

More effective than systematic steroids

CURRENT EVIDENCE - COVID-19

2 in vitro studies, 1 case series


36

SARS-CoV-2 AND IL-6 SUMMARY

INFLAMMATION

Sources of inflammation

should be eliminated to

prevent lung

complications, such as

periodontitis

CYTOKINE STORM

Severity related to

cytokine storms

IL-6 – key for lung

complication

Predicts need for

ventilation

TREATMENT

Treatments targeting

cytokine storms being

evaluated

None 100% successful

01 02 03



BIOLOGICAL

MECHANISMS


38

BIOLOGICAL MECHANISMS PERIODONTITIS, LUNG CONDITIONS AND COVID-19 COMPLICATIONS

SYSTEMIC INFLAMMATION

https://www.svhlunghealth.com.au/conditions/pneumonia Source: Hajishengallis G. Nat Rev Immunol. 2015 Jan;15(1):30-44.

INFLAMMATORY

MEDIATORS

Local production

of cytokines (IL-6)

IMMUNE CELL

ACTIVATION

Further release of

of cytokines (IL-6)

BACTERIEMIA

Upregulates

inflammatory

mediators

IMMUNE

COMPLEXES

Increase expression

of inflammatory

mediators


39


B A C T E R I A L L O A D - 1 0 0 M I L . B A C T E R I A I N 1 M M 3 O R A L B I O F I L M

CM

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ICU – mechanical ventilation decreases

clearance of oral secretions, increasing

bacterial load and risk for pneumonia

Oral secretions can adhere to lung epithelium, promote infection

Oral pathogens found in lung fluids

ASPIRATION

Enzymes can alter lung epithelium and bacterial surfaces, facilitating

adherence to mucosa

ENZYMES

Can modulate adhesion of pathogens to pulmonary

epithelium

CYTOKINES

50% COVID19 deaths had 2nd infection

from underlying chronic conditions,

oral biofilm can be reservoir

40


G U T D Y S B I O S I S

MO

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SWALLOWING

OF SALIVA

P.gingivalis can withstand acids and colonize colon in vitro

Viral infections can promote colonization of oral bacteria

PATHOGENS REACH THE GUT LOCAL

ALTERATIONS

ENDOTOXEMIA

SYSTEMIC

INFLAMMATION


CM

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Source: Park KH, Park WJ. J Korean Med Sci. 2015;30(9):1213-1225.

PERIODONTITIS


Improve acetylcholine-induced vasodilation in

hypertensive and normal patients

Positive effect on endothelial dysfunction

irrespective of patient’s general condition

ENDOTHELIAL DYSFUNCTION

Can link increased severity in COVID-19 patients

with diabetes, hypertension and lung disease

COVID-19

E N D O T H E L I A L D Y S F U N C T I O N

Aspiration oral bacteria

Bacteriemia


Local inflammation

High blood levels inflammatory cytokines TNF-α, Il-1β, CRP

IL-6

Gut dysbiosis Changes - Lungs

- Epithelium - Higher risk infection

and complications

Endothelial dysfunction

STRESS

COVID19

DIR

ECT

LIN

K H

IGH

IL-6

PE

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AR

S-C

oV

-2



PERIODONTAL

TREATMENT AND COVID-19


PE

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NTA

L T

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C

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ID-1

9 C

OM

PLIC

AT

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S

IMPORTANCE – DENTAL CARE

Reduction of IL-6 levels

Decrease in systemic inflammation

DENTAL CLINICS CLOSURE

Higher burden of inflammation

PERIODONTITIS

Link to CV diseases, diabetes,

hypertension, respiratory conditions

Higher risk for complications COVID-19

GOOD ORAL HYGIENE

Crucial to prevent pneumonia,

decrease mortality


PERIODONTAL TREATMENT RISK FOR PATIENTS

MO

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SAFETY FOR PATIENTS

It is worth the risk of going to dental office, considering increased risk for COVID-19

respiratory problems in untreated periodontitis.


IL-6 GENETIC TESTING


IL-6 GENETIC TEST

174 IL-6 POLYMORPHISM

G/G genotype increases risk for severe periodontitis

Exacerbated inflammatory response and result in

high IL-6 levels

12.000 SALIVARY TESTS BY ORAL DNA LABS®

45.2% of periodontitis patients have high risk (G/G)

41.0% have intermediate risk (C/G)

13.8% have low risk (C/C)

TREVILATTO ET AL. (2003)

GG genotype

71% of severe periodontitis

50% of moderate periodontitis patients

Trevilatto PC, et al. J Clin Periodontol. 2003;30(5):438-442. Mouth – COVID Connection™

1 of 4

OralDNA Labs, A Service of Access Genetics, LLC, 7400 Flying Cloud Drive, Eden Prairie, MN 55344 Phone: 855-672-5362; Fax: 952-942-0703 www.oraldna.comCLIA#: 24D1033809 CAP#: 7190878

Web enabled system provided by:

Reported: 07/19/2018 14:00Specimen: Oral Rinse(P)Received: 07/18/2018 10:28Accession#: 201807-12481Collected: 07/17/2018Specimen#: 5033032170

ALERT2™

FINAL REPORT

Sample, Report Ordering Provider Sample InformationDate Of Birth: 09/20/1970(47 yrs)Gender: FemalePatient Id:789Patient Location:Test Location A

Ronald McGlennen MD7400 Flying Cloud DriveEden Prairie, MN 55344855-672-5362

SUMMARY OF TEST RESULTS

The MyPerioPath test measures 11 types of bacteria known to cause periodontitis®

(gum disease) and increased risk for cardiovascular disease. These bacteria are

also associated with diabetes, adverse pregnancy outcomes, rheumatoid arthritis,

and other systemic illnesses.

8 of the 11 bacteria types were detected in the submitted sample. 6 of these are

above the treatment threshold level.

The levels of Aa are of particular concern. This bacterial type is associated with an

earlier age of onset, and an aggressive clinical course.

MyPerioPath®

Oral Bacteria Profile

High Risk Moderate Risk Low Risk

107

106

105

104

103

LQ

The MyPerioID test determines the nucleotide sequence at one region of the®

Interleukin 6 gene, a key marker of a person's immune system and inflammation

response.

Your test result shows a G/G genotype, which is categorized as high risk for

periodontal inflammation.

This result implies a greater lifetime risk of chronic periodontitis, and for other

conditions such as heart disease, arthritis, diabetes and some cancers.

MyPerioID IL-6®

Gene Marker Risk Category

Interleukin 6 HIGH

Integrative Summary / Treatment Considerations

The combination of these two test results show the signs of an existing or emerging periodontal infection and the likelihood of a heightened or

increased inflammatory response to those high and moderate risk bacteria.

Based on these test results, we recommend that you seek dental consultation and treatment.

Your treatment options include various approaches to remove plaque above and below the gumline using scaling and root planing or lasers, and the

selective use of tray delivery systems for disinfectants or local and systemic use of antibiotics.

A follow-up test is recommended to monitor the effectiveness of current treatments and to determine the type and frequency of future care.

Discover the Facts...what you may not know about oral bacteria and how it relates to overall health

A heart attack is triggered by the blockage of one of the arteries that supply the heart muscle withoxygen rich blood. Occlusion of the coronary arteries are now known to be caused not only bydeposition of bad cholesterol, but by the migration and entrapment of oral bacteria, such asPorphyromonas gingivalis, or Pg. In a recent review article by Drs. Brad Bale and Amy Doneen, theydescribe how oral bacteria can no longer be viewed as associated with heart attacks, but as a cause.Bale, BF, Doneen, A L, Vigerust, DJ. High-risk periodontal pathogens contribute to the pathogenesis of atherosclerosis PostgradMed J. 2017 Apr;93(1098):215-220.

Learn more by visiting www.oraldna.com

PL-000 -

ORAL DNA LAB SAMPLE REPORT


IL-6 GENETIC RISK REPORT



SOLUTIONS


GOOD ORAL HYGIENE, RINSES, AND SCREENING -Can reduce bacterial load and Identify periodontitis patients

-Povidone Iodine rinse

-Hydrogen peroxide rinse

PROFESSIONAL CLEANING

AND PERIO TREATMENT

-Scaling, root planing, irrigation

-Refer to periodontist to

evaluate for perio disease and

possible osseous surgery.

Lab Tests

Genetic IL-6 test can provide

risk assessment

Checking IL-6 and CRP

levels in blood test

VIRTUAL CONSULTATIONS AND MOBILE DENTISTRY For patients who want to avoid leaving their homes

SO

LU

TIO

NS


DIET Anti-inflammatory foods

Less sugar and processed carbs which increase IL-6

vvdd

SO

LU

TIO

NS

DAILY VITAMINS 5000mg Vitamin D3 2000mg Vitamin C 50mg Zinc Turmeric 500mg



TAKE-HOME MESSAGE

Mouth - COVID Connection™

• Gum disease can make lung disease worse.

• Inflammation in the gums can contribute to body’s overall inflammation.

• Bacteria in the gums travel through the body and spreads the harmful,

• When IL-6 levels are high, it is a predictor for respiratory failure, putting

• COVID-19 is more severe in the presence of inflammation.

• Poor plaque control can negatively affect the lungs of hospitalized

• Gum disease also indirectly affects Covid-19 patients via its proven


OUR STUDY FOUND A LINK BETWEEN COVID-19

COMPLICATIONS & CHRONIC GUM DISEASE

Inflammatory IL-6 protein.

COVID patients at a 22X higher risk of being placed on a ventilator.

COVID-19 patients.

harmful affects on lung function in COPD and pneumonia.

Periodontitis can increase IL-6 levels. Certain genetic

variations of IL-6 gene can increase the risk to severe

periodontitis, genetic testing can identify patients at high risk

SYSTEMIC INFLAMMATION

Can be aspirated and affect lung function, increasing the risk

for pneumonia, COPD and potentially COVID19-related

pulmonary complications

ORAL BACTERIA

Related to cytokine storm. High IL-6 levels increase risk for

mechanical ventilation by 22x, being a predictor for

respiratory complications

CORONAVIRUS DISEASE

Beneficial for systemically healthy patients and for those

with other conditions, it decreases IL-6 levels and

inflammation


Prevention of COVID19 complications can have a huge

impact on healthcare systems

COVID-19 COMPLICATIONS

Can improve general health and decrease the risk to

COVID-19 problems

PERIODONTAL HEALTH, PLAQUE CONTROL

TAKE-HOME MESSAGE


57

CONCLUSIONS

IL-6 LEVELS

High serum IL-6 levels

predict COVID19

complications and need

for ventilation

PERIODONTITIS

Risk factor for respiratory

diseases and COVID-19

complications patients

Increases IL-6 levels

BIOLOGICAL LINKS


Bacterial load

Gut dysbiosis

Endothelial function

DENTAL CARE

Control of inflammation

Oral hygiene and perio

therapy improve health,

protect against COVID-

19 complications

01 02 03 04


“We are taught to analyze body systems and parts

separately and to change one area at a time. Such

an approach often ignores the interconnectedness

of the systems in the human body”

—DR. JOHN LAUGHLIN



[email protected]

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