Section: Oral Systemic Link

This review found that while the definitions used to identify periodontitis were fairly heterogeneous, very few studies met a stringent threshold for periodontitis. Published evidence supports modest associations between some, although not all, of the diseases and conditions reviewed: respiratory disease, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome and cancer.

This introductory article examines the potential mechanisms that may play a role in the associations between periodontitis and the systemic conditions being considered in the EFP/AAP Workshop in Segovia, Spain. Three basic mechanisms have been postulated to play a role in these interactions: metastatic infections, inflammation and inflammatory injury, and adaptive immunity. The potential role ... Read more

Further investigation is necessary to fully translate basic research into clinical studies and practice regarding potential biological pathways underlying the possible association between periodontal disease and adverse pregnancy outcomes. Understanding the systemic virulence potential of the individual's oral microbiome and immune response may be a distinctly different issue from categorizing the nature of the challenge ... Read more

Research into possible associations between periodontitis and various systemic diseases and conditions do not imply causality, and establishment of causality will require new studies. Precise and community-agreed case definitions of periodontal disease states must be implemented systematically to enable consistent and clearer interpretations. Studies should focus on robust disease outcomes and avoid surrogate endpoints.

There is consistent and strong epidemiologic evidence that periodontitis imparts increased risk for future cardiovascular disease; and while in vitro, animal and clinical studies support the interaction and biological mechanism, intervention trials to date are not adequate to draw further conclusions. Well-designed intervention trials on the impact of periodontal treatment on prevention of atherosclerotic cardiovascular ... Read more

Despite the lack of evidence that periodontal bacteria obtained from human atheromas can cause atherosclerosis in animal models of infection, attainment of proofs 1 to 6 (out of 7) provides support that periodontal pathogens can contribute to atherosclerosis. Gathered data were categorized into 7 "proofs" of evidence that periodontal bacteria: 1) disseminate from the oral ... Read more

Inflammatory mechanisms may be thought to act in concert to increase systemic inflammation in periodontal disease and to pomote or exacerbate atherogenesis. However, proof that the increase in systemic inflammation attributable to periodontitis impacts inflammatory responses during atheroma development, thrombotic events or myocardial infarction or stroke is lacking.

This review included evidence for an increased risk of atherosclerotic cardiovascular disease (ACVD) in patients with periodontitis compared to patients without; however, this may not apply to all groups of the population. There is insufficient evidence for an association between periodontitis and the incidence of secondary cardiovascular events.

Periodontal therapy triggers a short-term inflammatory response followed by (a) a progressive and consistent reduction of systemic inflammation and (b) an improvement in endothelial function. There is, however, limited evidence that these acute and chronic changes will either increase or reduce cardiovascular disease (including coronary heart disease, stroke, congestive heart failure and peripheral artery disease) ... Read more

This review of the molecular and cellular processes that may potentially link periodontal disease and diabetes included the pathogenic roles of cytokines and metabolic molecules (e.g., glucose, lipids) and the role of periodontal bacteria. Paradigms for bidirectional relationships between periodontitis and diabetes are discussed and opportunities for elaborating these models are considered. There is a ... Read more