Periodontitis, a common oral disease, is featured with complex etiology, progressive and prognosis varies according to the severity of periodontitis. Exosomes belong a kind of cystic vesicles with biological activity, which widely exist in human body fluids. Exosomes play an irreparable role in signal transmission and material exchange between cells, maintaining cell functions, and regulating body immunity and homeostasis. Exosomes are closely related to periodontitis, and recent study of exosomes has provided new directions and ideas for the diagnosis and treatment of periodontitis. Similarly, as extracellular vesicles, exosomes play a bridging role between periodontitis and some systemic diseases. In this process, exosomes participate in and regulate the process of systemic diseases by carrying nucleic acids, proteins, lipids, etc., and exhibit different bioactive effects according to the different substances carried in exosomes. In this paper, we summarize the latest research progress of exosomes, especially in the periodontitis and some systemic diseases, and review the potential value of exosomes in periodontitis diagnosis and treatments.