Elsevier

Disease-a-Month

Volume 65, Issue 6, June 2019, Pages 185-192
Disease-a-Month

Effects of periodontal disease on systemic health

https://doi.org/10.1016/j.disamonth.2018.09.011Get rights and content

Abstract

About one in two adults in the United States has periodontal disease. Chronic periodontitis is an oral disease affecting the supporting structures of the teeth leading to progressive loss of the attachment apparatus and bone around teeth. It is characterized by gingival pocket formation and/or gingival recession. The disease is initiated by bacteria and their components like lipopolysaccharide and causes a heightened host inflammatory response. This cascade of inflammatory response ultimately leads to an increased osteoclastic activity and bone loss. Individuals with periodontitis have increased systemic levels of acute phase proteins, plasma antibody levels, coagulation factor, total white blood cell count, neutrophils, C reactive protein (CRP), and cytokines such as INF- gamma (Interferon gamma), TNF-α (Tumor necrosis Factor- Alpha), IL (Interleukin)-1β, IL-2 and IL-6. As periodontitis works on the same chronic inflammation model seen in systemic diseases, there is sufficient evidence to suggest a bi-directional link between the two. This article summarizes the established associations between periodontal disease and systemic health.

Introduction

Periodontitis is a chronic inflammatory disease that affects the gums and the bone surrounding teeth caused by an organized community of bacteria called dental plaque. The bacteria trigger an immune-inflammatory response that ultimately leads to a non-reversible loss of bone supporting the tooth and leads to tooth loss. According to a recent report by Centers for Disease Control and Prevention (CDC) about one out of every two American adult or 64.7 million American adults, aged 30 and have mild, moderate or severe periodontitis. Moreover, in adults 65 and older, prevalence rates increased to 70.1 percent.1

Bacteria and their products in the plaque can affect periodontium either directly or indirectly. The direct pathological effects of bacteria and their products on periodontium include induction of inflammatory response resulting in edema and increase in gingival bleeding. The indirect effects of bacteria predominantly involve host-mediated destructive processes. The bulk of tissue destruction in periodontitis is a result of the mobilization of the host tissues via activation of monocytes, lymphocytes, fibroblasts, and other host cells. Furthermore, bacterial lipopolysaccharides (LPS), is thought to stimulate production of both catabolic cytokines and inflammatory mediators including arachidonic acid metabolites such as prostaglandin E2 (PGE2).These cytokines and inflammatory mediators then result in release of tissue-derived enzymes, the matrix metalloproteinases, that are destructive to the extracellular matrix and bone.

The strong association of periodontitis with several systemic diseases has been attributed to a number of factors, including systemic distribution of periodontal pathogens and systemic leakage of local inflammatory mediators. These mechanisms of the perio-systemic connection have been actively studied and established. The relation between periodontal disease and systemic disease is bi-directional, i.e. periodontal disease can cause adverse systemic outcomes and certain systemic diseases pre-dispose a person to have periodontal disease. This paper will summarize the systemic adverse outcomes that have epidemiological evidence of being associated with periodontal disease.

Section snippets

Pathogenesis

The most biologic plausible pathogenesis that links cardiovascular disease (CVD) and periodontal disease is that of a chronic, low-level inflammation model.2 As described earlier, periodontal disease is initiated by an organized community of aerobic and anaerobic bacteria called dental plaque that accumulates on the tooth surface as a result of poor oral hygiene.3 Over time, this bacterial community multiplies in size and leads to deepening of the periodontal sulcus which is the part of the

Conclusions

There is sufficient evidence to suggest that periodontal disease and systemic health have a two- way relationship, in that, the periodontal disease can cause adverse systemic conditions and that certain systemic diseases cause periodontal disease. It is vital that the physicians and other health care providers educate the patients about this association and to recommend dental care facilitate restoration of oral health in these individuals. The evidence suggests that treatment of one disease

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