04/10/2020 – 11:33
The Mundgesundheitsstiftung GmbH
An effective barrier through the oral mucosa and an intact oral immune system are extremely important to protect against infection with SARS-CoV-2, according to a current statement by Chinese scientists. The WHO also warns of higher complication rates in diabetes patients with COVID-19 infection. At least this applies to older patients and those with other comorbidities, according to the Robert Koch Institute. With a simple saliva test, everyone can determine at home how fit their oral immune system is. People with diabetes in particular suffer from periodontitis, often unnoticed. This weakens the immune system, making it easier for bacteria and viruses to penetrate the body. Against the background of the corona pandemic, measures to optimize oral hygiene are therefore more important than ever, and knowledge of the oral immune system is paramount.
The oral cavity as a source of bacterial infections
Infection with the SARS-CoV-2 virus poses a major challenge to the immune system. An additional bacterial infection puts an enormous strain on the body and contributes to a more severe course of COVID-19. Because these bacteria can lead to pneumonia and sepsis (1).
The oral cavity in particular is a focus for pathogenic germs that can get into the body from there and lead to serious complications. If an illness-causing germ gets from the mouth into the lower respiratory tract, it can cause serious infections there, as an Italian study shows. (2)
The good news: Effective dental hygiene measures reduce the risk of pneumonia by up to 66 percent, as shown by a large-scale population study with 100,000 people over a period of 11 years. (3)
Periodontitis and diabetes are mutually beneficial
Periodontitis and diabetes are common, complex and chronic diseases that are closely related. Not only are people with diabetes more likely to have periodontitis, but they are also more likely to have more severe periodontitis. The worse the blood sugar is set, the more pronounced the severity. (5)
A recent Greek study found that over a quarter of all dental patients have high blood sugar levels without knowing it. A simple saliva test for aMMP-8 (activated matrix metallo-proteinase-8), which determines the oral immune system and collagen breakdown in the mouth, uncovered this. The aMMP-8 test is therefore suitable as a screening test for previously undiagnosed diabetes and poorly adjusted blood sugar levels. (6)
The oral cavity is the entry point for SARS-CoV-2
Researchers found in February that the oral cavity is the main entry point for the SARS-CoV-2 virus. Because most of the receptors that the virus needs to get into the body are in the mouth. There the virus multiplies and gets into the lungs. That is why a healthy oral immune system is the first hurdle for the virus. This is why the authors of the study are calling for new prevention concepts for oral health. (7)
A healthy oral immune system and oral hygiene measures can be an important building block for a mild course of a COVID-19 infection. Experts recommend regularly checking the condition of the oral immune system using an appropriate test.
Why are bacterial infections with COVID-19 so dangerous and affect every second person?
Infection with SARS-CoV-2 places a heavy burden on the body and its immune system. An existing bacterial infection in the mouth puts additional strain on the immune system. According to the World Health Organization (WHO), 20 percent to 50 percent of the world’s population suffers from an unknown bacterial infection in the mouth. Adolescents are already affected. This may be related to severe courses of COVID-19 disease in young patients. (8th)
Since almost half of the world’s population is affected by an infection in the mouth, it makes sense to check the condition of the oral immune system with a suitable test.
The aMMP-8 saliva test detects bacterial infections of the oral cavity
The aMMP-8 saliva test (PerioSafe Home) developed by researchers from the University of Helsinki and German biotech experts has proven in more than 400 studies worldwide that it reliably detects the condition of the oral immune system and related diseases such as diabetes and chronic heart diseases. (5) (6) (9)
The enzyme aMMP-8 (active matrix metalloproteinase-8) is responsible for tissue breakdown in the mouth. Inflammation in the mouth and periodontitis lead to permanently increased aMMP-8 concentrations. The collagen breakdown caused by this makes the oral mucosa permeable and pathogens can penetrate the body more easily.
In the wake of the corona epidemic, the aMMP-8 self-test provides an important component in prevention. A healthy oral immune system and oral hygiene measures can therefore contribute significantly to a milder course of a COVID-19 infection.
Experts recommend testing the oral immune system
Experts recommend that especially patients with diabetes or chronic heart diseases should regularly determine their aMMP-8 values in order to take preventive measures in good time. With the aMMP-8 self-test, this can be done quickly and easily at home.
“Only deficits that you know can be optimized. In my opinion, knowledge of the oral immune status is of similar importance to regular blood sugar monitoring,” said Prof. Dr. Dr. Andreas Pfützner from the Diabetes Center in Mainz. In a new publication, he confirmed the importance of oral prevention in connection with COVID-19 in diabetes patients. Prevention measures should therefore include the mouth and throat area. The established diagnostic aMMP-8 test is well suited for the identification of particularly vulnerable patients. Current recommendations for the prevention of COVID-19 disease should be expanded to include aspects of measuring and rehabilitation of the mouth and throat area and regular daily disinfection of this area. (10)
The German Society for Periodontology (DG PARO) and the German Society for Dental, Oral and Maxillofacial Medicine (DGZMK) have been recommending the aMMP-8 test since 2015 for people with obesity, diabetes and suppressed immune systems, especially outside of dental practice. (11) The a-MMP-8 self-test is therefore particularly important in times of the corona pandemic, as many dental practices are only open to emergencies.
What can I do as a patient – suitable preventive measures
Washing hands is important – good oral hygiene is essential.
If the aMMP-8 value is increased, there are suitable measures to support the oral immune system. This includes thorough and regular oral hygiene – ideally professional dental hygiene. Given the current situation, this is often impossible.
However, everyone can take prophylactic measures:
– aMMP8 measurement of the oral immune system (twice a year)
– regular brushing of teeth (two to three times a day)
– daily cleaning of the interdental spaces (interdental brushes, dental floss)
– Regular use of suitable antimicrobial mouthwash solutions
The same measures basically apply to people who have already been diagnosed with a viral infection with SARS-CoV-2. It is important to take all measures to prevent the spread of a bacterial infection in the already weakened immune system.
About DMS – The Oral Health Foundation
DMS – The Oral Health Foundation provides educational and public relations work, both for doctors from various areas and for patients in the corresponding risk groups. The foundation has committed itself to maintaining health and preventing periodontitis and peri-implantitis as well as associated general diseases such as diabetes, chronic heart diseases, rheumatism and infertility.
The foundation promotes interdisciplinary cooperation between medicine and dentistry for the purpose of early diagnosis and timely therapy of periodontal inflammation and destruction processes. For this purpose, the foundation carries out intensive educational and public relations work, both with colleagues from various areas of the medical and dental field (e.g. internists, diabetologists, general practitioners, cardiologists, rheumatologists, gynecologists, periodontists and dentists), as well as with patients in the corresponding risk groups.
Interdisciplinary cooperation and inflammation prevention can make a significant contribution to improving oral health – for the benefit of the patient.
- (1) Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Fei Zhou, Ting Yu, Ronghui Du, Guohui Fan, Ying Liu, Zhibo Liu, et al.; Published:March 11, 2020 DOI: http://ots.de/DZOk1L - (2) Elevated Matrix Metalloproteinase Levels in Bronchi Infected with Periodontopathogenic Bacteria. Luca Bernasconi, Liza L. Ramenzoni, Ahmed Al-Majid, Gabrielo M. Tini, Sereina M. Graber, Patrick R. Schmidlin, and Sarosh Irani. PLoS One. 2015; 10(12): e0144461. doi: 10.1371/journal.pone.0144461 - (3) The Association of Periodontal Treatment and Decreased Pneumonia: A Nationwide Population-Based Cohort Study. Li-Chiu Yang, Yih-Jane Suen, Yu-Hsun Wang, Tai-Chen Lin, Hui-Chieh Yu and Yu-Chao Chang. Int. J. Environ. Res. Public Health 2020, 17, 356; doi:10.3390/ijerph17010356 - (4) Consensus of Chinese experts on protection of skin andmucous membrane barrier for health-care workers fighting against coronavirus disease 2019. Yicen Yan et al.2020. Dermatologic Therapy. 2020;e13310 - (5) Diabetes and periodontal disease: a two-way relationship. L. Casanova, F. J. Hughes and P. M. Preshaw. British Dental Journal 2014; 217: 433-437. DOI: 10.1038/sj.bdj.2014.907 - (6) Prediabetes/Diabetes Can Be Screened at the Dental Office by a Low-Cost and Fast Chair-Side/Point-of-Care aMMP-8 Immunotest; Andreas Grigoriadis, Timo Sorsa, Ismo Räisänen, Pirjo Pärnänen, Taina Tervahartiala, and Dimitra Sakellari; Diagnostics 2019, 9, 151; doi:10.3390/diagnostics9040151 - (7) High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Xu, Hao & Zhong, Liang & Deng, Jiaxin & Peng, Jiakuan & Hongxia, Dan & Zeng, Xin & Li, Taiwen & Chen, Qianming. (2020). International Journal of Oral Science. 12 - (8) Active Matrix Metalloproteinase-8 Point-of-Care (PoC)/Chairside Mouthrinse Test vs. Bleeding on Probing in Diagnosing Subclinical Periodontitis in Adolescents. Ismo T. Räisänen , Timo Sorsa, Gerrit-Jan van der Schoor, Taina Tervahartiala, Peter van der Schoor, Dirk-Rolf Gieselmann and Anna Maria Heikkinen. Diagnostics 2019, 9, 34; doi:10.3390/diagnostics9010034 - (9)Neutrophil proteolytic activation cascades: a possible mechanistic link between chronic periodontitis and coronary heart disease. Hatem Alfakry, Ernst Malle, Chintan N Koyani, Pirkko J Pussinen, Timo Sorsa. Innate Immunity 2015; 22:1. - (10) Warum sind Diabetiker durch das Coronavirus (CoV-2) besonders gefährdet - Möglichkeiten für die orale Diagnostik und bedarfsgerechte Prävention für Patienten und Fachärzte. Andreas Pfützner, Timo A. Sorsa, Solomon O. Nwhator, Ismo T. Räisänen, Dimitra Sakellari, Jan Kunde, Bernd Kleine-Gunk, Roland Frankenberger. 2020. Zur Publikation eingereicht - (11) Parodontitis-Diagnostik mit dem Entzündungsmarker MMP-8. Gemeinsame Wissenschaftliche Mitteilung der Deutschen Gesellschaft für Parodontologie (DG PARO) und der Deutschen Gesellschaft für Zahn-, Mund- und Kieferheilkunde (DGZMK). 2015. https://www.dentognostics.de/wp-content/uploads/2020/04/Pressem itteilung-2016.pdf
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