Periodontal disease and systemic illness: will the evidence ever be enough?

Abstract

The concept of focal infection or systemic disease arising from infection of the teeth was generally accepted until the mid-20th century when it was dismissed because of lack of evidence. Subsequently, a largely silo approach was taken by the dental and medical professions. Over the past 20 years, however, a plethora of epidemiological, mechanistic and treatment studies have highlighted that this silo approach to oral and systemic diseases can no longer be sustained. While a number of systemic diseases have been linked to oral diseases, the weight of evidence from numerous studies conducted over this period, together with several systematic reviews and meta-analyses, supports an association between periodontitis and cardiovascular disease, and between periodontitis and diabetes. The association has also been supported by a number of biologically plausible mechanisms, including direct infection, systemic inflammation and molecular mimicry. Treatment studies have shown that periodontal treatment may have a small, but significant, systemic effect both on endothelial function and on glycemic control. Despite this, however, there is no direct evidence that periodontal treatment affects either cardiovascular or diabetic events. Nevertheless, over the past 20 years we have learnt that the mouth is an integral part of the body and that the medical and dental professions need to work more closely together in the provision of overall health care for all patients.

Association between periodontal status and idiopathic male infertility

“…Pathogens can cause a remote pathogenic effect by direct action via bacteriemia and by inducing production of several circulating cytokines (37). Increased levels of circulating cytokines, caused by periodontal disease, can trigger C-reactive protein production in the liver (38,39).…”

Periodontitis Increases the Risk of a First Myocardial Infarction

“…The major obstacles are the demands of a very large sample size of screen-detected subjects with periodontitis followed for a long time, probably in the magnitude of decades. 29 Moreover, it may be considered unethical to deny people with established dental disease treatment. A study design that could provide useful information on associations between various risk markers and myocardial infarction would be a carefully conducted case-control study as, for example, demonstrated over the years by the Stockholm Heart Epidemiology Program (SHEEP) a population-based case-referent study of causes of a first myocardial infarction.…”

Microbiological and Clinical Effects of Sitafloxacin and Azithromycin in Periodontitis Patients Receiving Supportive Periodontal Therapy

“…Periodontal infection and inflammation are known to affect systemic health and are associated with diseases such as cardiovascular disease and diabetes mellitus (2)(3)(4). Although periodontal infection is polymicrobial, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia are known as representative periodontopathic bacteria and are called the red complex bacteria (RCB) (5).…”