Neutrophils – The Missing Link

by Fay Goldstep, DDS, FIADFE, FASDA

What a crazy and upside-down world we live in! But if you slow down and pay attention, things may start to come together…

About a year ago I decided to make the theme of this issue of Oral Health – oral inflammation and systemic health concerns. Having read much and written a little on the subject of oral inflammation (and by no means being an expert), I thought it was high time to address this topic comprehensively. This was decided in the time Before COVID (BC). It is hard to remember exactly what BC was like, but we can relive it or actually re-stream it, when we enter the surreal “old normal” of Netflix, Prime Video, etc.

This was a time before ACE2 receptors, spike proteins, and cytokine storms became topics discussed over coffee, that is while Zooming… when people were aware of the benefits and downsides to inflammation, but were not tuned into every nuance of its potential downward spiral to imminent sickness and death.

Having decided on the theme, I found authors with compelling stories to tell, relevant to the day-to-day practice of clinical dentistry and its connection to patient health. Our patients’ oral conditions and our treatment decisions impact their general health in many ways:

Over-usage of systemic antibiotics is leading to drug resistance and new prescription guidelines. Novel prognostic biomarkers for oral dysplasia enhance early cancer detection. Conservative extraction techniques improve bone retention and create the optimal environment for implants. The biologic response to bone graft materials is affected by their chemistry, size, shape, and surface; this influences the development of new biomaterials. Implants require specific maintenance regimens, not necessarily with the traditional oral hygiene tools used for natural teeth. New reliable, valid, and user-friendly periodontal probing options improve the procedure of probing (widely considered the “standard of care”, but often avoided). The pharmacologic treatment for COVID-19 has significant oral health related consequences. Collagen supplementation will not address the root cause of collagen loss in periodontal disease.

Periodontal disease has long been associated with other chronic inflammatory diseases of the body (cardiovascular disease, diabetes, cancer); it can impact the management of these conditions. The question of why this association occurs has puzzled researchers for many years. The answer – the missing link in this mechanism – may have been discovered recently at the University of Toronto’s Dental Research Department. Neutrophils, the white blood cells that are the “first responders” of the innate immune system, may be this link. When periodontal inflammation is present, more neutrophils circulate systemically and are ‘primed’ to be hyper-vigilant. If a secondary infection or other insult occurs in another location (heart, lungs, brain, etc.) the circulating primed neutrophils will over-react and damage these tissues and organs. Primed neutrophils release cytokines (which we are so aware of now) more quickly and this exacerbates the situation. This may also explain why patients with periodontal disease have poorer COVID-19 outcomes. Inflammation connects systemic diseases. The neutrophil may be the missing piece to the puzzle.

The interconnectivity in the body does not stop at the mouth or any other organ. A condition in one location has an effect that reaches far and wide. The mechanism is now clear, as is our impact as oral health clinicians in our patients’ overall wellbeing. Things are coming together.

Best wishes for a better 2021!

About the Editor

Dr. Fay Goldstep sits on the Oral Health Editorial Board (Healing/Preventive Dentistry), has served on the teaching faculties of the Post-graduate Programs in Esthetic Dentistry at SUNY Buffalo, the Universities of Florida (Gainesville), Minnesota (Minneapolis), and has been an ADA Seminar Series speaker. She has lectured nationally and internationally on Soft-Tissue Lasers, Electronic Caries Detection, Healing Dentistry and Innovations in Hygiene and has published numerous textbook chapters and articles on these topics. Dr. Goldstep is a consultant to a number of dental companies, and maintains a private practice in Markham, Canada. She can be reached at

Dr. Fay Goldstep, has lectured nationally and internationally on Proactive/Minimal Intervention Dentistry, Soft-Tissue Lasers, Electronic Caries Detection, Healing Dentistry and Innovations in Hygiene. She has been a contributing author to four textbooks and has published more than 100 articles. She sits on the editorial board of Oral Health. Dentistry Today has listed her as one of the leaders in continuing education since 2002. Dr. Goldstep is a consultant to a number of dental companies, and maintains a private practice in Richmond Hill, Ontario. She can be reached at

To view the full December 2020 issue of Oral Health, please click here!