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Periodontal Disease and Systemic Diseases

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Periodontal disease has been hypothesized to have an effect on many different systemic diseases. This site presents some of the research that suggests links to the more common diseases. Different pathways have been suggested to link periodontal diseases to various systemic diseases. Periodontitis activates the immune and inflammatory system, which results in a systemic inflammation. The systemic inflammation might be the plausible explanation of the association between periodontitis and other conditions. We do know that periodontal disease contributes to systemic inflammation and that this has a negative effect on the overall body. Periodontal disease and other systemic conditions share many risk factors such as smoking, diabetes and increasing age. Periodontitis, like many of the systemic diseases, is multifactorial which makes it complex when discussing aetiology, progression and evidence.

Bui et al. 2019, Hedge and Awan 2019, Sabharwal et al. 2018, Herrera et al. 2018, Holmstrup et al. 2017, Igari et al. 2014

Periodontal Disease

Periodontal disease includes gingivitis and periodontitis “Gingivitis is generally regarded as a site‐specific inflammatory condition initiated by dental biofilm accumulation and characterized by gingival redness and oedema and the absence of periodontal attachment loss. Gingivitis is commonly painless, rarely leads to spontaneous bleeding, and is often characterized by subtle clinical changes, resulting in most patients being unaware of the disease or unable to recognize it.”

“Periodontitis is a chronic multifactorial inflammatory disease associated with dysbiotic plaque biofilms and characterized by progressive destruction of the tooth‐supporting apparatus. Its primary features include the loss of periodontal tissue support, manifested through clinical attachment loss and radiographically assessed alveolar bone loss, presence of periodontal pocketing and gingival bleeding.”

Trombelli  et al. 2018, Papapanou et al. 2018

Pancreas

Diabetes

Diabetes is characterised by a decreased ability to metabolise carbohydrates from food and the liver and results in an abnormal level of glucose in the blood circulation. Unstable glucose levels in the blood, both short and long term, will cause serious complications for these patients.

Studies suggest that there is a bi-directional relationship between diabetes and periodontal disease, and this association is well researched. Periodontitis increases the risk of diabetes and diabetes enhances the risk for periodontitis, especially if the diabetes is not well controlled. Diabetic patients with periodontitis are more likely to suffer from diabetic complications such as eye, kidney or heart problems.

Periodontal inflammation negatively affects glycemic control and patients with periodontitis have a higher risk of developing type II diabetes.

Patients with diabetes that undergo periodontal treatment and practice effective oral hygiene daily have decreased blood sugar levels for several months.

Periodontal treatment and good oral hygiene are a benefit for all patients since it reduces the preventable burden of the systemic inflammation associated with periodontal disease.

EFP 2019, Graziani et al. 2018, Sanz et al. 2018, D’Auito et al. 2018, Polak and Shapira 2018

Heart

Cardiovascular Diseases

Atherosclerosis is a condition where plaque builds up in the arteries, which leads to the narrowing and hardening of these vesselsInflammation plays as an important role in the development of all cardiovascular diseases such as stroke and heart attack.

There is strong evidence for an association between periodontal disease and many different cardiovascular diseases. In several studies, DNA from periodontal pathogens have been found in atherosclerotic plaque of patients with chronic periodontitis. Studies indicate that there is an increased risk for different cardiovascular diseases in individuals suffering from periodontal diseases. Elevation of systemic inflammatory markers and activation of the immune system caused by periodontal diseases has a negative effect on arteries. Extensive research confirms these associations, however, it does not confirm causation.

Whilst we lack proof that periodontal treatment will reduce the risk of cardiovascular events, studies support that periodontal treatment and good oral hygiene will result in improved levels of different cardiovascular risk markers and improve the atherosclerotic profile.

Periodontal treatment and good oral hygiene are a benefit for all patients since it reduces the preventable burden of the systemic inflammation associated with periodontal disease.

Aarabi et al. 2018, Carrizales-Sepu´ lveda et al. 2018,  Atarbashi-Moghadan et al. 2018, Li et al. 2017, Xu et al.  2017, Merchant and Virani 2017, Scmitt et al. 2015, Teeuw et al. 2014

Hands

Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disease affecting the body’s joints. The disease is characterised by painful inflammation and deformed joints. The disease might also cause damage in other parts of the body, like salivary glands, nerve tissue, skin and blood vessels. Rheumatoid arthritis, like periodontal disease, is a chronic inflammatory condition with similarities in terms of mechanisms.

There is conflicting evidence regarding a bi-directional link between these diseases, but some research suggests that the systemic inflammation in rheumatoid arthritis patients might increase the development of periodontal disease. We know that one type of oral bacteria, Porphyromonas gingivalis, present in periodontal pockets, has the capacity to develop certain proteins which may contribute to harmful autoantigens that drive this disease.

Rheumatoid arthritis is a complex disease and medications taken by these patients may also affect periodontitis.

There are conflicting results whether periodontal treatment can reduce the rheumatoid arthritis disease activity or not and vice versa.

Periodontal treatment and good oral hygiene are a benefit for all patients since it reduces the preventable burden of the systemic inflammation associated with periodontal disease.

Cosgarea et al. 2018, Cheng et al. 2017, Tang et al. 2017

Stomach

Adverse Pregnancy Outcomes and Low Birth Weight

Many women suffer from pregnancy gingivitis. It usually appears during the second trimester and is connected to hormonal changes in the body. The symptoms of pregnancy gingivitis are the same as bio-film induced gingivitis, but the gingival reaction is excessive in relation to the amount of dental plaque.

There is some evidence that suggests an association between periodontitis and adverse pregnancy outcomes, though the data is weak.

Research carried out during pregnancy has not been able to prove whether periodontal treatment will result in less adverse pregnancy outcomes. However, there might be a positive effect of periodontal treatment in women of high risk of low birth weight or preterm birth.

It is safe to carry out the periodontal treatment during pregnancy, preferably during the second trimester, a good time to emphasise the importance of good oral hygiene.

Pregnancy is also a perfect time to start new and better habits. European Federation of Periodontology (2018) has published guidelines for oral-health professionals but also recommendations for pregnant women.

Periodontal treatment and good oral hygiene are a benefit for all patients since it reduces the preventable burden of the systemic inflammation associated with periodontal disease.

 

Manrique-Corredor et al. 2019, EFP Guidelines 2018, Iheozor-Ejiofor et al. 2017, Corbella et al. 2016

Kidneys

Chronic Kidney Diseases

Chronic kidney disease is a loss of kidney function, with the end therapy being dialysis or a transplant. Systemic inflammation, increasing age, smoking, hypertension and uncontrolled diabetes are some of the risk factors for chronic kidney diseases.

Some evidence suggests a possible association between periodontitis and chronic kidney disease but evidence for a bidirectional link is weak. The mechanisms connecting these two diseases are not fully known, but it is suggested the chronic low-grade systemic inflammation from periodontitis and/or the oral bacteria triggers an inflammatory response and progression of the kidney disease.

Periodontal treatment and good oral hygiene are a benefit for all patients since it reduces the preventable burden of the systemic inflammation associated with periodontal disease.

Kapellas et al. 2019, Chambrone et al. 2013

Head

Neurodegenerative Diseases

Neurodegenerative diseases such as Alzheimer's and Parkinson's are a group of diseases that result in the gradual loss of brain function affecting both physical and mental performance. Neuroinflammation is a component of both conditions.

Alzheimer’s disease is a neurodegenerative form of dementia with unknown aetiology. The disease is characterised by neuronal loss and senile plaque formation in the brain. Some of the risk factors are ageing, family history and stress. One of the main features of Alzheimer’s disease is thought to be the neuroinflammation.

Parkinson’s disease, with gradual degeneration of neurons, will result in movement disorders, cognitive and psychiatric symptoms and in the later stages, dementia.

Current research into the possible associations between neurodegenerative diseases and periodontal disease suggests that the systemic inflammation associated with both conditions could be linked in some way.

Periodontal treatment and good oral hygiene are a benefit for all patients since it reduces the preventable burden of the systemic inflammation associated with periodontal disease.

Singhrao and Olsen 2019, Ranjan et al.2018, Ganesh et al. 2017, Teixeira et al. 2017, Kaur et al. 2016

Lung

Chronic Obstructive Pulmonary Diseases

Chronic obstructive pulmonary disease is an inflammatory condition with impaired lung function, which traps air in the lungs and slowly breaks down the lung tissue. This condition gradually worsens over time. Since a growing part of the population is getting older, it is expected that the number of patients with chronic obstructive pulmonary disease will increase.

Periodontitis and chronic obstructive pulmonary diseases have common risk factors, such as smoking, increasing age, obesity and low socioeconomic status. Some studies have shown a positive association between the diseases.

Different pathways for the association have been discussed and include circulating inflammation and aspiration of oral pathogens into the lungs.

Periodontal treatment and good oral hygiene are a benefit for all patients since it reduces the preventable burden of the systemic inflammation associated with periodontal disease.

Spiropoulou et al. 2019, Moghadam et al. 2017, Hobbins et al. 2017

Cancer

There is an increasing interest in the link between periodontitis and overall cancer risk. Many reviews have reported an association but so far with very low evidence. There are many common risk factors between periodontal disease and cancer such as age, alcohol, smoking and genetics. The systemic inflammation is the main focus, but many studies also look at different oral pathogens as an explanation for the connections between periodontal disease and different types of cancer.

Periodontal treatment and good oral hygiene are a benefit for all patients since it reduces the preventable burden of the systemic inflammation associated with periodontal disease.

Hoare et al. 2019, Corbella et al. 2018

Knee

Psoriasis

Psoriasis is a chronic autoimmune inflammatory skin disease with an unknown aetiology but probably influenced by genetic and environmental factors. Having psoriasis increases the risk of other systemic disorders like diabetes and cardiovascular disease.

There are published studies that suggest that patients with periodontitis have an increased risk of psoriasis, but the data is still very limited. The connection between the two diseases could be the chronic low-grade systemic inflammation associated with periodontal disease.

Periodontal treatment and good oral hygiene are a benefit for all patients since it reduces the preventable burden of the systemic inflammation associated with periodontal disease.

Brooks 2018, Ungprasert et al. 2017

skeleton

Osteoporosis

Osteoporosis results in reduced quality and density of bone. The bone becomes more fragile and porous, which increases the risk of bone fracture. The condition is common among the older population and more common in women than in men.

Risk factors for osteoporosis are age, gender (osteoporosis is most prevalent in postmenopausal women), thin people, ethnicity (white and Asian women at higher risk), genetics, physical inactivity, alcohol consumption, smoking and insufficient intake of calcium and vitamin D.

Research suggests an association between periodontal disease and osteoporosis, especially in postmenopausal women.

Periodontal disease and osteoporosis have some shared risk factors such as age, smoking, genetics, hormone changes, calcium and vit D deficiency, but the underlying mechanism is not known. Some hormones, especially oestrogen, have an impact on bone homeostasis and hormones also seem to play a part in the inflammatory process.

Studies indicate a positive association between osteoporosis and periodontal disease.

Periodontal treatment and good oral hygiene are a benefit for all patients since it reduces the preventable burden of the systemic inflammation associated with periodontal disease.

Goyal et al.2017, Wang and McCauley 2016

Lifestyle

The European Federation of Periodontology (EFP) 2014 Manifesto: “Periodontal Health for a Better life, promoted a fundamental shift in the role of dental health care professionals.  The key element of the manifesto was ‘prevention’ to specifically tackle the chronic inflammatory diseases of ageing. The promotion of lifestyle changes aimed at reducing obesity and smoking and promoting healthy nutrition and exercise.” The dental profession can strengthen public health initiatives by playing a greater role in the prevention and early intervention of chronic and long-term conditions such as heart disease, diabetes and cancer”. Including brief and simple advice on general health promoting lifestyle changes should be a routine part of dental practice. “Dental healthcare professionals and oral health provision have a clear role to play in enhancing general health and well-being.”

Chapple and Wilson 2014

Obesity

Obesity, a chronic metabolic disease, and overweight are a growing global health problems. Obese patients have an increased activation of the inflammatory system that influences other systemic conditions. Many of these patients will, in later life, suffer from diabetes or cardiovascular diseases.

Studies are presenting a low but increased risk for the on-set and progression of periodontal disease in obese and overweight patients. It is uncertain if obesity influences the outcome of periodontal treatment since conflicting results are presented.

Periodontal treatment and good oral hygiene are a benefit for all patients since it reduces the preventable burden of the systemic inflammation associated with periodontal disease.

Martinez Herrera et al. 2017, Keller et al. 2015

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