Metabolic Syndrome and Periodontitis: Is Oxidative Stress a Common Link?

Abstract

A review of pathological mechanisms that can explain the relationship between periodontitis and cardiovascular disease (CVD) is necessary to improve the management of both conditions. Metabolic syndrome is a combination of obesity, hypertension, impaired glucose tolerance or diabetes, hyperinsulinemia, and dyslipidemia. All these have been examined in recent years in terms of their relationship to periodontitis. Reviewed data indicate an association between some of them (body mass index, high-density lipoprotein-cholesterol [HDL-C], triglycerides, high blood pressure, among others) and periodontitis. Oxidative stress may act as a potential common link to explain relationships between each component of metabolic syndrome and periodontitis. Both conditions show increased serum levels of products derived from oxidative damage, with a pro-inflammatory state likely influencing each other bidirectionally. Adipocytokines might modulate the oxidant/anti-oxidant balance in this relationship.

A population-based study on the association between the intake of soft drinks and periodontal disease in Taiwanese adults aged 35–44 years (KCIS no. 33)

“…For instance, glucose-containing carbonated soft drinks increase carbonyl stress burden (3) , which, in turn, may result in a decrease in antioxidant concentration in oral saliva (4) and enhance oxidative nitration in association with the inflammatory reaction (5) . From the biological viewpoint, the inflammatory reaction caused by such oxidative stress is highly associated with systemic diseases, such as metabolic syndrome, diabetes, hypertension, asthma and periodontal disease (PD) (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16) . Oxidative stress (2,3,6,8,9,(13)(14)(15) pertaining to PD may be mediated through advanced glycation end-products that are created through non-enzymatic pathways from monosaccharide substances, dicarbonyls originating from the Maillard reaction, sugar self-oxidation and other molecular pathways (16,17) .…”

Chronic Periodontitis as a Risk Marker for Systemic Diseases with Reference to Cardiometabolic Disorders: Common Pathways in their Progression

“…10 An oxidative stress-enhancing cycle of events with release of reactive oxygen species (ROS) in periodontal tissues could mediate insulin resistance. 11,12 Reversal of the cyclical pro-inflammatory profile in response to LPS, advanced glycaemic end products and nicotine 13,14 by antioxidants improves insulin resistance in mice and humans. 15,16 Multiple virulence factors generated by surface proteins, capsules and fimbriae of the periodontal pathogens Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans (Aa) and others trigger an inflammatory response in the host.…”

“…An association between some of these parameters and periodontal disease has been reported based on oxidative stress-inducing mechanisms and the release of adipocytokines amongst others which could influence redox modulation bi-directionally. 12,72 The adipokines resistin and adiponectin formed in adipose tissue have opposing functions in insulin resistance and inflammation. Large amounts of resistin have been detected in macrophages suggestive of their important role in inflammation.…”

Relationship Between Cardiovascular Risk Factors and Periodontal Disease: Current Knowledge

“…There is increasing evidence linking periodontitis to systemic diseases, such as diabetes, rheumatoid arthritis, and, especially, CVD, hence the search for factors that may explain such relationships. A potential factor which could increase insulin resistance is the production of oxidative stress enhancing ROS in affected periodontal tissues (Bullon et al, 2009). Metabolic syndrome as originally described is a combination of obesity, hypertension, impaired glucose tolerance or diabetes, hyperinsulinemia, and dyslipidemia (elevated triglycerides and decreased high-density lipoprotein-cholesterol [HDL-C] levels).…”