THE MOUTH COVID CONNECTION - watchourvideo.netJul 19, 2018 · THE MOUTH – COVID CONNECTION ....
Transcript of 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.
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
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CURRENT KNOWLEDGE AND
SCIENTIFIC FOUNDATION FOR
CONNECTION BETWEEN
IL-6 levels and periodontitis
Covid-19 and respiratory diseases
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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
UT
H-c
OO
VID
Co
nn
ecti
on
™
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
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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
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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
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CO
VID
-19
US
STA
TS
JULY 2020 - TOTAL >3 MILLION CASES
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CO
VID
-19
US
STA
TS
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CO
VID
-19
US
STA
TS
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D R . S H E RV I N M O L AY E M
IL-6 IN RELATION TO
PERIODONTITIS
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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
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Mo
uth
-CO
VID
Co
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ec
tio
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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
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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
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IN V
IVO
ST
UD
IES
SALIVA increased salivary IL-6 levels in periodontitis
I L - 6 I N P E R I O D O N T I T I S
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
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PE
RIO
DO
NTA
L T
RE
AT
ME
NT
I L - 6 I N P E R I O D O N T I T I S
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.
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SU
MM
AR
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
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D R . S H E RV I N M O L AY E M
RESPIRATORY DISEASES
AND PERIODONTITIS
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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
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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
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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
https://www.svhlunghealth.com.au/conditions/pneumonia
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).
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ASTHMA
PERIODONTITIS X ASHTMA
SOME STUDIES FOUND ASSOCIATION BETWEEN
Asthma and gingival inflammation
Periodontitis (OR= 3.01-3.25)
https://www.svhlunghealth.com.au/conditions/pneumonia
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
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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
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D R . S H E RV I N M O L AY E M
IL-6, VIRAL INFECTIONS
AND COVID-19
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SA
RS
-Co
V-2
MO
UT
H-C
OV
ID C
on
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cti
on™
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
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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
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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
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80% TOCILIZUMAB
Improved clinical outcomes
in severe and critical
COVID-19 patients,
reducing mortality
SARS-CoV-2 AND IL-6 TREATMENT STUDIES
RESULTS AND CONCLUSION
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
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DEXAMETHASONE
reduced 28-day mortality
among those receiving
invasive mechanical
ventilation or oxygen
SARS-CoV-2 AND IL-6 TREATMENT STUDIES
RESULTS AND CONCLUSION
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
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80%
SARS-CoV-2 AND IL-6 TREATMENT STUDIES
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
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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
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D R . S H E RV I N M O L AY E M
BIOLOGICAL
MECHANISMS
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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
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BIOLOGICAL MECHANISMS PERIODONTITIS, LUNG CONDITIONS AND COVID-19 COMPLICATIONS
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
OU
TH
-CO
VID
Co
nn
ec
tio
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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
BIOLOGICAL MECHANISMS PERIODONTITIS, LUNG CONDITIONS AND COVID-19 COMPLICATIONS
G U T D Y S B I O S I S
MO
UT
H-C
OV
ID C
on
ne
cti
on™
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
BIOLOGICAL MECHANISMS PERIODONTITIS, LUNG CONDITIONS AND COVID-19 COMPLICATIONS
CM
OU
TH
-CO
VID
Co
nn
ec
tio
n™
Source: Park KH, Park WJ. J Korean Med Sci. 2015;30(9):1213-1225.
PERIODONTITIS
PERIODONTAL TREATMENT
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
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
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D R . S H E RV I N M O L AY E M
PERIODONTAL
TREATMENT AND COVID-19
MOUTH-COVID Connection™
PE
RIO
DO
NTA
L T
RE
AT
ME
NT
C
OV
ID-1
9 C
OM
PLIC
AT
ION
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
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PERIODONTAL TREATMENT RISK FOR PATIENTS
MO
UT
H-C
OV
ID C
on
ne
cti
on
™
SAFETY FOR PATIENTS
It is worth the risk of going to dental office, considering increased risk for COVID-19
respiratory problems in untreated periodontitis.
D R . S H E RV I N M O L AY E M
IL-6 GENETIC TESTING
MOUTH-COVID Connection™
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™
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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
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Reported: 07/19/2018 14:00Specimen: Oral Rinse(P)Received: 07/18/2018 10:28Accession#: 201807-12481Collected: 07/17/2018Specimen#: 5033032170
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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
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IL-6 GENETIC RISK REPORT
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D R . S H E RV I N M O L AY E M
SOLUTIONS
Mouth-COVID Connection™
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
Mouth-COVID Connection™
DIET Anti-inflammatory foods
Less sugar and processed carbs which increase IL-6
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SO
LU
TIO
NS
DAILY VITAMINS 5000mg Vitamin D3 2000mg Vitamin C 50mg Zinc Turmeric 500mg
Mouth-COVID Connection™
D R . S H E RV I N M O L AY E M
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
Mouth – COVID Connection™
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
PERIODONTAL TREATMENT
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
Mouth-COVID Connection™
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
Systemic inflammation
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
Mouth-COVID Connection™
“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
Mouth-COVID Connection™
D R . S H E RV I N M O L AY E M
THANK YOU FOR YOUR TIME AND
LETS GO SAVE SOME LIVES!
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