JICDRO is a UGC approved journal (Journal no. 63927)

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Year : 2022  |  Volume : 14  |  Issue : 1  |  Page : 3-5

Dental caries in children and COVID-19 - An interleukin association: A review of a novel concept

1 Department of Pediatric and Preventive Dentistry, Rural Dental College, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
2 Department of Periodontics, Rural Dental College, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
3 Department of Oral Pathology, D.Y. Patil Dental College, D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
4 Department of Pediatric Dentistry, Yogita Dental College, Khed, Maharashtra, India
5 Department of Prosthodontics and Crown and Bridge, MGV Dental College, Nashik, Maharashtra, India

Date of Submission13-Jul-2021
Date of Decision29-Nov-2021
Date of Acceptance13-Jan-2022
Date of Web Publication4-Jul-2022

Correspondence Address:
Dr. Sourabh Ramesh Joshi
Department of Pediatric and Preventive Dentistry, Rural Dental College, Pravara Institute of Medical Sciences, Loni - 413 736, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jicdro.jicdro_45_21

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COVID-19 is a pandemic throughout the world, leading to the hunger of knowledge as well as evidences regarding the corona virus which causes this disease. Interleukins are the chemokines which belong to the family of cytokines which are chemotactic in nature and cause the recruitment of cells of inflammation. In the recent COVID 19 pandemic the adverse outcomes in children, though reported less, has been related to the establishment of a cytokine storm, the components of which are common with the cytokine expression profile of Dental caries and early childhood caries in children. IL-6 levels are raised in the serum of the patients infected with COVID-19. Dental caries in children has been attributed to having its pathophysiology related in a cytokine response. Salivary IL-6 levels have been found to be elevated in children with multiple carious lesions. Hypotheses The present letter aims to propose that the multiple carious lesions can be a biomarker for the patients affected with COVID 19 due to raised IL-6 levels. Evaluation of hypotheses: The authors screened the data on COVID 19 and its association with dental caries in children. This paper is an hypotheses to highlight the importance of raised levels of IL-6 as a biomarker in the saliva of children with carious lesions and those affected with COVID-19. This communication proposes the connection between COVID-19 and dental caries through their cytokine connection to form a translational basis for recommending maintenance of oral hygiene in the COVID era. Thus every dentist must suspect every patient affected with multiple carious lesions to be a carrier of COVID-19.

Keywords: Children, COVID-19, dental caries, interleukins

How to cite this article:
Joshi SR, Pendyala GS, Sarode S, Sarode G, Shetty S, Pustake S. Dental caries in children and COVID-19 - An interleukin association: A review of a novel concept. J Int Clin Dent Res Organ 2022;14:3-5

How to cite this URL:
Joshi SR, Pendyala GS, Sarode S, Sarode G, Shetty S, Pustake S. Dental caries in children and COVID-19 - An interleukin association: A review of a novel concept. J Int Clin Dent Res Organ [serial online] 2022 [cited 2022 Dec 5];14:3-5. Available from: https://www.jicdro.org/text.asp?2022/14/1/3/349755

   Introduction Top

The World Health Organization declared 2019 Coronavirus disease caused by SARS-CoV-2 as a pandemic in March 2020. This disease has affected millions of people throughout the world and has resulted in numerous deaths. Children are also affected by the same, but the severity of infection and mortality rate is lower in children.[1] One explanation is the decreased ability of virus to attach the body linings (e.g., nasal mucosa) as the receptors are less in children.[2],[3] Another explanation is that children are protected by cross-immunity produced by other viruses.[3] It has been also noticed that tendency toward immune dysregulation is less in children.[4] Next is, markers of pro-inflammatory response like C-reactive protein is uncommon in children which is suggestive of reduce the inflammatory response to infection. Finally, reduced expression of angiotensin-converting enzyme 2 receptor which is necessary for binding of the virus further reduces the incidence of COVID-19 in children.[2],[3] Severe form of the disease is uncommon in children and presents overlapping features as Toxic Shock Syndrome and Kawasaki disease, however; the patients may remain asymptomatic. The symptoms of Toxic Shock Syndrome and Kawasaki disease seem to be related to a “cytokine storm” which exhibits itself as elevated serum levels of interleukin-1 (IL-1), IL-6 and tumor node factor alpha (TNF-α).[5] IL-6 is one of the key proinflammatory cytokine at the mucosal sites and has been implicated in the progression of viral infection.[6] The children affected with COVID-19 illness may show fever, myalgia, and sore throat, multiple carious teeth, gingivitis, full-blown oral ulcers, and blisters throughout the oral cavity. This can be attributed to the fact that these patients have altered oral biofilms and bacteria-associated dental caries and periodontal disease are more prevalent.[7]

   The Hypotheses Top

Dental caries can have an association with COVID-19 illness. In both these diseases, interleukins play a key role. Hence, the similarity of interleukin that is released during different phases of these two diseases may present the possible influence of dental caries and COVID-19 on one another.

   Evaluation of the Hypotheses Top

Interleukins play an important role in immunopathology of COVID-19[6] as well as dental caries.[8],[9] Interleukins are soluble proteins secreted by cells to respond against tissue injuries and microbial agents.

Severe form of COVID-19-induced pneumonia and Kawasaki disease in children are marked by excessive production of IL-6 and TNF-α.[6] Marked increased levels of IL-6 and TNF-α suggest innate immune response against viral infection. Severe form of the disease results in capillary damage, alveolar damage, acute lung injury, multiorgan failure, and ultimately death. Limited or no data is available to show the possible association of dental caries and COVID-19. The present hypothesis is to justify the possible association between the two through interleukin association.

It has been shown that the presence of furin in the saliva and in the oropharyngeal secretions of a patient can facilitate the entry of SARS-CoV-2 in the infected pulp of multiple carious teeth when it is exposed to the oral environment.[8] Since dental caries is a complex disease with multifactorial pathophysiology, it is commonly seen in children who are medically fit and unfit of all the age groups. An interesting fact which has been demonstrated is that the elevated salivary IL-6 levels are strongly associated with Early Childhood Caries (ECC), in those children with multiple carious lesions and gingivitis.[9] This gives a credence that elevated IL-6 in the saliva of patients with ECC or with multiple carious lesions and gingivitis mirror the elevated levels in systemic circulation. There is also an evidence to show that the levels of IL-6 decreased in the saliva as the dental treatment was rendered to the children affected by ECC and gingivitis.[9]

The common pathway of inflammatory response in COVID-19 and ECC points toward the related associated outcomes. Although children are less commonly affected by COVID-19, we hypothesize that the children with multiple decayed teeth or those with ECC in which IL-6 levels are raised are more susceptible for COVID-19 or its severest form. Since SARS-CoV-specific immunoglobulin A and IL-6 are secreted in the saliva of animal models,[8],[10] humans are no exception.

Already elevated levels of IL-6 and TNF-α could have been produced fertile ground for the aggravating symptoms of COVID-19. Thus, it will be a pragmatic proposition to envisage multiple carious lesions in children as clinical biomarker of COVID-19. If this contention hold true then awareness and prioritizing the management of multiple carious teeth should be the main focus in pediatric dentistry.

   Conclusion Top

This hypothesis proposes the connection between COVID-19 and dental caries through their cytokine connection. The oral hygiene should be meticulously maintained in COVID-19 era. Since limited data are available, the authors propose to conduct studies to prove the association of dental caries and COVID-19.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Wang L, Wang Y, Ye D, Liu Q. Review of the 2019 novel coronavirus (SARS-CoV 2) based on current evidence. Int J Antimicrob Agents 2020;55:105948.  Back to cited text no. 1
Centers for Disease Control and Prevention. Coronavirus Disease 2019 in Children. Available from: https://www.cdc.gov/mmwr/volumes/69/wr/mm6914e4.htm. [Last acessed on 2020 May 01].  Back to cited text no. 2
Kelvin AA, Halperin S. COVID-19 in children: The link in the transmission chain. Lancet Infect Dis 2020;20:633-4.  Back to cited text no. 3
Lu X, Zhang L, Du H, Du H, Zhang J, Li YY, et al. SARS-CoV-2 infection in children. N Eng J Med 2020;382:1663-5.  Back to cited text no. 4
Jose RJ, Manuel A. COVID-19 cytokine storm: The interplay between inflammation and coagulation. Lancet Respir Med 2020;8:e46-7.  Back to cited text no. 5
Gubernatorova EO, Gorshkova EA, Polinova AI, Drustskaya MS. IL-6: Relevance for immunopathology of SARS-CoV-2. Cytokine Growth Factor Rev 2020;53:13-24.  Back to cited text no. 6
Sampson V. Coronavirus: Oral hygiene risk factor. Br Dent J 2020;228:569.  Back to cited text no. 7
Varadarajan S, Balaji TM, Venkatakrishnan CJ, Jagannathan R, Priya SL, Prabhu VR, et al. The oral cavity may be vulnerable to SARS CoV-2 entry due to certain physiological factors and pathological conditions. Indian J Res Pharm Biotech 2020;8:22-35.  Back to cited text no. 8
Menon MM, Balagopal RV, Krishnan S, Parvathy K, Bhat S, Xavier AM, et al. Evaluation of salivary interleukin-6 in children with early childhood caries after treatment. Contemp Clin Dent 2016;7:198-202.  Back to cited text no. 9
[PUBMED]  [Full text]  
Sabino-Silva R, Jardim AC, Siqueira WL. Coronavirus COVID-19 impacts to dentistry and potential salivary diagnosis. Clin Oral Investig 2020;24:1619-21.  Back to cited text no. 10


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