Orale Immunkompetenz in der Corona-Pandemie vs. Systemrelevanz der Zahnmedizin

Zusammenfassung

Die Covid-19-Pandemie hat das deutsche Gesundheitssystem im Jahr 2020 vor erhebliche Herausforderungen gestellt. In diesem Zusammenhang ist es bemerkenswert, dass für die Zahnmedizin kein sogenannter Rettungsschirm aufgespannt wurde. Dies bedeutet, dass nach Ansicht der Bundesregierung Zahnärzte als nicht systemrelevant eingestuft wurden und somit offiziell auch nicht zu den Ärzten gehören. Diese Annahme ist grundfalsch und gefährlich, wie im Folgenden anhand eines wichtigen Beispiels erörtert wird.

Das SARS-CoV-2-Virus führt bei infizierten Personen zu einem Beschwerdebild von leichten Erkältungszeichen bis hin zu lebensbedrohlichen beatmungsbedürftigen COVID-19-Pneumonien. Ein besonderes Risiko für schwere Verläufe haben Menschen höheren Alters sowie Patienten mit Diabetes, Bluthochdruck und anderen schweren Erkrankungen. Die Haupteintrittspforte für das SARS-CoV-2-Virus in den menschlichen Körper ist u. a. die orale Mukosa, denn die Viren reichern sich dort bevorzugt an und der ACE2-Rezeptor wird dort hochgradig exprimiert. Dieser Penetrationsweg erklärt die häufigeren schweren Verläufe bei älteren Diabetespatienten, deren Immunsystem bereits generell beeinträchtigt ist. Diabetes mellitus induziert eine chronische systemische Entzündung, die sich gerade im Mundbereich regelmäßig als Parodontitis manifestiert. Bei Diabetikern zwangsläufig oft auftretende Hyperglykämien schwächen die Mukosa-Barriere zusätzlich. Es ist daher dringend ratsam, bei Präventionsmaßnahmen für Diabetespatienten den Mund- und Rachenraum nicht zu ignorieren. Neben der parodontalprophylaktischen Betreuung ist gerade in Absenz von Zahnärzten die aktivierte Matrix-Metalloproteinase 8 (aMMP8) ein etablierter Biomarker. Die aktuellen Empfehlungen zur Prävention der SARS-CoV-2-assoziierten COVID-19-Erkrankung sollte daher um die Aspekte der Messung und Sanierung des Mund- und Rachenraums sowie einer regelmäßigen Desinfektion der oralen Mukosa erweitert werden.

Abstract

The Covid-19 pandemic has presented significant challenges for the German health system in 2020. In this context, it is noteworthy that no so-called parachute has been put on for dentistry. This means that, in the view of the Federal Government, dentists have been classified as non-systemically important and therefore officially do not belong to the doctors. This assumption is fundamentally wrong and dangerous, as discussed below on the basis of an important example.

The SARS-CoV-2 virus leads to symptoms ranging from mild colds to life-threatening COVID-19 pneumonia in infected individuals. People of older age as well as patients with diabetes, high blood pressure and other serious illnesses have a particular risk of severe history. The main gateway for the SARS-CoV-2 virus into the human body is, among other things, the oral mucosa, because the viruses accumulate there preferably and the ACE2 receptor is highly expressed there. This penetration pathway explains the more frequent severe histories in older diabetes patients whose immune system is already generally impaired. Diabetes mellitus induces chronic systemic inflammation, which manifests itself regularly as periodontitis, especially in the oral area. In diabetics, often occurring hyperglycaemias further weaken the mucosa barrier. It is therefore strongly advisable not to ignore the mouth and throat space when preventive measures for diabetes patients. In addition to periodontal prophylactic care, the activated matrix metalloproteinase 8 (aMMP8) is an established biomarker, especially in the absence of dentists. The current recommendations for the prevention of SARS-CoV-2-associated COVID-19 disease should therefore be extended to include the aspects of measurement and rehabilitation of the oral and throat space as well as regular disinfection of oral mucosa.

Schlüsselwörter

Corona - Covid-19 - Pandemie - Zahnmedizin - Immunkompetenz

Key words

Corona - COVID-19 - pandemic - dentistry - immunocompetence

Publication History

Article published online:
09 November 2020

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