Periodontal systemic associations: review of the evidence

Abstract

Linden GJ, Lyons A, Scannapieco FA. Periodontal systemic associations: review of the evidence. AbstractAim: To critically appraise recent research into associations between periodontal disease and systemic diseases and conditions specifically respiratory disease, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome and cancer. Methods: A MEDLINE literature search of papers published between 2002 and April 2012 was conducted. Studies that included periodontitis as an exposure were identified. Cross-sectional epidemiological investigations on large samples, prospective studies and systematic reviews formed the basis of the narrative review. A threshold set for the identification of periodontitis was used to identify those studies that contributed to the conclusions of the review. Results: Many of the investigations were cross-sectional secondary analyses of existing data sets in particular the NHANES studies. There were a small number of systematic reviews and prospective studies. There was substantial variability in the definitions of exposure to periodontitis. A small number of studies met the threshold set for periodontitis and supported associations; however, in some of the chronic diseases there were no such studies. There was strong evidence from randomized controlled trials that interventions, which improve oral hygiene have positive effects on the prevention of nosocomial pneumonias. Conclusions: There was substantial heterogeneity in the definitions used to identify periodontitis and very few studies met a stringent threshold for periodontitis. Published evidence supports modest associations between periodontitis and some, although not all, of the diseases and conditions reviewed. There is a need to reach a consensus on what constitutes periodontitis for future studies of putative associations with systemic diseases.

Tooth loss and cognitive functions among older adults

“…The relationship between oral health and medical conditions such as diabetes mellitus, cardiovascular diseases and rheumatoid arthritis has been comprehensively studied and new knowledge has been attained regarding possible co-variation and causality [1][2][3]. The median age of the world's population is increasing; the proportion aged ‡65 is projected to increase by~550 million to 973 million in the coming decades [4].…”

Toll-Like Receptor 9-Mediated Inflammation Triggers Alveolar Bone Loss in Experimental Murine Periodontitis

“…Although a dysbiotic biofilm structure initiates the disease, the periodontal tissue destruction occurs as a result of a dysregulated immune response to the microbial insult (2). Chronic, persistent immune responses to this complex microbiome not only can lead to tooth loss but also are associated with increased risk for several systemic complications, including atherosclerosis, diabetes, adverse pregnancy outcomes, pulmonary diseases, rheumatoid arthritis, and cancer (3)(4)(5)(6)(7)(8). Periodontal research currently focuses primarily on identifying disease biomarkers, understanding mechanisms of pathogenesis, and identifying therapeutic targets to prevent the deleterious effects of periodontal inflammation on both local and systemic tissues.…”

Association between periodontitis and the development of systemic diseases

“…Dental plaque may represent a source of potential respiratory pathogens, particularly in high-risk patients (nursing home residents, older patients, intensive care unit patients and hospitalized individuals requiring mechanical ventilation). Current evidence suggests that oral bacteria, poor oral hygiene and periodontitis may influence the initiation and course of pulmonary infections, including community-acquired, hospital-acquired and ventilatoracquired pneumonia [36,37]. The oral cavity is contiguous with the trachea and may be a portal for respiratory pathogen colonization.…”

“…DM can lead to various complications such as acute/chronic infections, vascular diseases, neuropathy, nephropathy and retinopathy [17,37]. Chronic periodontal disease and DM are common chronic conditions in adults throughout the world [56].…”

“…The effects of a hyperglycemic state include the inhibition of osteoblastic proliferation and collagen production. Several studies have indicated that diabetes is associated with an increased prevalence, extent and severity of chronic periodontitis [37]. For this reason, chronic periodontitis has been defined as the sixth complication of diabetes; thus, doi: 10.7243/2053-5775-2-4 prevention and control of chronic periodontitis must be considered an integral part of diabetes control strategies [70,71].…”