Periodontitis May Be Linked With Systemic Diseases

Fabiano M. Serfaty, MD, PhD

May 09, 2022

Periodontitis is a major inflammatory disease of the oral mucosa that progressively affects the integrity of the tissues supporting the teeth. It is associated epidemiologically with several chronic inflammatory disorders, such as cardiovascular disease, type 2 diabetes (T2D), rheumatoid arthritis, inflammatory bowel disease, Alzheimer's disease, nonalcoholic fatty liver disease, and certain cancers.

From a medical and therapeutic standpoint, it is imperative to understand the link between periodontitis and associated comorbidities. A multifactorial chronic inflammatory disease, periodontitis is an exemplar of an imbalanced interaction between the local microbiome and the inflammatory response of the host (dysbiosis). This imbalance contributes to periodontal tissue destruction, leading to bone loss. The main risk factors for the condition are smoking and diabetes.

What Is Periodontal Disease?

Periodontal diseases are mainly the result of infections and inflammation of the gums and bone that surround and support the teeth. In its early stage, called gingivitis, the gums can become swollen and red and may bleed. In its more serious form, periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or even fall out. Periodontal disease is mostly seen in adults. According to the US Centers for Disease Control and Prevention, periodontal disease and tooth decay are the two biggest threats to dental health. Periodontitis is more common in men than women (56.4% vs 38.4%), those living below the federal poverty level (65.4%), those with less than a high school education (66.9%), and current smokers (64.2%).

Although periodontitis is more common in adults and the elderly, the disease can also occur in children and adolescents.

Early diagnosis and treatment are essential to managing the disease. To best manage periodontitis and systemic diseases, patients should see their doctors on a regular basis.

Periodontitis and Chronic Disorders

Several epidemiologic studies have suggested an association between periodontitis and Alzheimer's disease. A recent large retrospective cohort study associated clinical markers of periodontitis with Alzheimer's disease incidence and mortality. A plausible mechanism underlying the link between periodontitis and Alzheimer's disease might be the infiltration of the brain with periodontal pathogens, a hypothesis supported by emerging evidence implicating Porphyromonas gingivalis.

Periodontal disease is commonly seen in people with diabetes and is considered a complication of diabetes. Of note, the relationship between diabetes and periodontal disease is bidirectional, meaning that hyperglycemia affects oral health, while periodontitis affects glycemic control. Research also indicates an association between periodontal disease and increased risk for diabetes-related complications.

A 2018 systematic review confirmed findings that periodontitis is associated with higher A1c levels in persons without diabetes and persons with T2D, worsened complications from diabetes in people with T2D, and a higher prevalence of complications in persons with type 1 diabetes. The study also found that periodontitis is associated with higher prevalence of prediabetes and that severe periodontitis is statistically significantly associated with an increased risk of developing diabetes.

In addition, several previous studies have demonstrated a link between the chronic inflammation seen in periodontitis and the risk of malignant transformation in organs such as the oral cavity, head and neck area, esophagus, stomach, liver, colon, uterine cervix, ovaries, urinary bladder, and lung. It is suggested that the inflammatory response and cell-stimulating signals provide a microenvironment for cell proliferation and differentiation, demonstrating the role periodontal infection plays in the risk of developing cancer.

Implications for Routine Care

Oral health plays a key role in overall health. Therefore, physicians should include an assessment of the patient's mouth when carrying out a clinical examination. The management and prevention of periodontal disease by dental professionals should be considered a critical therapeutic and preventive measure with respect to periodontitis and various associated comorbidities. In line with this premise, clinicians should focus on discouraging people from smoking and should stress the importance of practicing good oral hygiene — from brushing with fluoride toothpaste and using dental floss or dental tape every day, to making appointments with a dentist for routine exams.

This article was translated from Medscape Portuguese Edition.

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