Periodontal disease and systemic conditions: a bidirectional relationship
The questions that have been raised focusing on the relationship between periodontal diseases and systemic conditions now extend beyond cardiovascular . ing the relationship between periodontal disease and systemic health. Periodontitis, one of the oldest and most common diseases of humans, was once. Periodontol ; Relationship between periodontal disease and systemic health. Garcia RI(1), Henshaw MM, Krall EA. Author information.
It can worsen throughout the course of three stages: Pay close attention to your gums as you are brushing and flossing twice a day. If they are bleeding and feel tender during your oral care routine, have a closer look inside your mouth.
This is the first stage of the disease, known as gingivitis. Take note if your gums appear swollen, red, and appear to be receding away from teeth, as this may indicate the second stage of the disease, periodontitis.
If you feel as though you have a constant bad taste in your mouth, or you often experience bad breath, this is also cause for concern. In advanced periodontitis, the third and most advanced stage of the disease, teeth can also become loose. Found on the teeth, plaque is a community of microorganisms that is complex in nature and, thus, hard to remove once it forms.
Furthermore, a recent clinical study showed that certain bacteria found in plaque actually catalyzes an immune response that creates the onset of periodontal disease.
Oral health truly relates to the overall health of the body! How to prevent it? Daily oral care and wellness is an absolute must, in order to prevent the buildup of bacteria from plaque that contributes to the onset of periodontal disease. Brushing and flossing, when done properly, are effective modes of preventative care. Be sure to choose quality products and have your dentist show you how to brush and floss correctly. There are at least 2 scenarios: If periodontal disease is cleared of all the reasonable risks, the patients can breathe a sigh of relief about the deeper implications of their chronic periodontal disease.
Or, when the researchers fight for a shrinking slice of grant funding, the dental organizations win, because their value increases with the life-or-death research findings which justify the medical necessity of the dental practitioners who treat a common human health scourge: Whoever wins in this battle, it will have a deep impact on the current treatment modalities of periodontal and systemic diseases.
Rather, it is woven deeply into the fabric of the overall health [ 1 ]. Specifically, what is the relationship between periodontal disease and systemic diseases? There are three possibilities: Periodontitis is a marker for systemic disease — along with many others — which show that the patient is at an increased risk, but with no causation.
A causal relationship which requires intervention: Periodontitis is a contributing cause that initiates or aggravates systemic diseases. How Did It All Start? This link came to the forefront in the late s, when the preliminary research in dental journals identified systemic diseases which were also seen in those with periodontal diseases [ 2 ].
In the early s, dentists were being instructed to warn their patients that these systemic diseases could worsen when they had periodontal diseases.
The proposed mechanisms behind the increased risk and the causation theories have tended to be in two camps: By the middle of the 20th century, medicine and dentistry concluded that medical surgery and tooth extraction had no effect on ending the ills.
The more recent trials also negate the focal infection theory. Other large, double-blind, randomized studies Grayston et al and Wells et al. Meanwhile, antibiotics are not recommended routinely during pregnancy, and if they were, there is scant evidence that their prevention of infection would reduce preterm births [ 7 ]. In addition, the speculation that infectious bacteria of necrotic pulps leak out apices and seed elsewhere in the body to cause systemic diseases, has been dismissed by the American Association of Endodontists after decades of debate [ 8 ].
The winds of the microbial causation theory have changed the direction in recent years. The other camp has theorized that inflammatory enzymes from periodontitis lesions which were found to circulate in the bloodstream [ 9 ] may be the culprit [ 10 ]. Could the C-reactive protein and the cytokine markers — which were increased in periodontitis patients — predict strokes and heart attacks?
Another hypothesis is that periodontitis is linked to the presence of fibrinogen and ultimately, thrombogenesis [ 11 ]. Yet, some researchers Danesh J, Wheeler et al. Inflammation is a sign of healing as well as infection and so it may not be as ominous as it has been charged.
Others point out that the inflammation from other sources — for example, sinusitis, allergies, rheumatoid arthritis, and haemorrhoids — all should be guilty of causing systemic disease if this were the case.
The truth emerges in science eventually, and the periodontitis-systemic disease question is no exception. The Pregnant Worry for Their Foetuses Surveys have not been done to assess what dentists are telling pregnant patients, or how dentists perceive about the risks of periodontal disease in the unborn. Therefore, the analysis must turn towards the kinds of messages which dentists are receiving.
The Relationship Between Periodontitis and Systemic Diseases – Hype or Hope?
In published studies, the authors often provide clinical implications in the abstract, discussion, or conclusion sections of their articles; the dental and lay public media distribute these far and wide, but often without discussing the limitations of the study to place it into the right perspective. The hope is to educate the dental community to equip the patients with the research findings that can influence their oral care behaviours.
The outcome, theoretically, would be to prevent morbidity, such as mental retardation, and mortality, such that occurs in greater numbers in low-birth-weight 5. Indeed, some dental researchers echo these sentiments [ 13 ].
This results in there being insufficient evidence as ofto say that periodontal disease is a contributing cause of preterm labour and delivery. According to few authors, the studies so far, show associations of varying strengths between periodontal disease and systemic diseases. That is, if you treat periodontal disease, will it really reduce the systemic disease? The Atherosclerotic Keeping Teeth Clean Media messages which swirl around the public say that the gum disease infection releases bacteria into the bloodstream that causes clots and may cause a heart attack or stroke.
- Protect Your Gums! The Link Between Periodontal Disease and Systemic Health.
- Relationship between periodontal disease and systemic health.
- Periodontal disease and systemic conditions: a bidirectional relationship
It is possible that periodontitis has a causative role in coronary heart disease, but additional studies, especially interventional studies, are needed before this can be assumed [ 17 ]. Some believe that atherosclerotic cardiovascular disease is the most complicated multifactorial disease which is presently known.How Gum Disease Impacts Systemic Health
In the statistics section of many studies, only a sentence is provided, that states: According to Philippe Hujoel, researcher and periodontist, confounding factors especially behaviours such as smoking and factors such as the socioeconomic status, cholesterol medication, lipid profile, Diabetes Mellitus DMgender, a family history of coronary heart disease, stress, obesity, age and blood pressure explain the small associations which are found in most of the studies, as of [ 18 ].
Many of the existing studies have either had small study sample sizes, mild-to-moderate odds ratios 1. Periodontitis and respiratory diseases As early asPotter et al. Oral bacteria can enter the lower respiratory tract by aspiration and cause pneumonia. Severe infections of the lungs can develop after the aspiration of the salivary secretion, especially in patients with periodontitis [ 20 ].
Bacteria may have an influence in the exacerbations of Chronic Obstructive Pulmonary Disease COPD [ 20 ], where the dental plaque may serve as a reservoir of respiratory pathogens.
Inflammation: The Relationship Between Oral Health And Systemic Disease
There are a number of possible mechanisms by which bacteria can influence the pathogenesis of respiratory diseases: Aspiration of oral pathogens PG or AA, for example. Alteration of the mucous surface by salivary enzymes in periodontitis, leading to an increase in the adhesion and colonization of respiratory pathogens [ 20 ].
The periodontal disease-associated enzymes may destroy the salivary pellicles on the pathogenic bacteria [ 20 ]. Alteration of the respiratory epithelium by cytokines from periodontal disease, which facilitate the infection of the epithelium with respiratory pathogens [ 20 ].
Smoking and Periodontitis The effect of smoking on periodontal disease has been studied in detail in a number of reports. Smoking has immunosuppressive effects that impair the host defences by decreasing the motility, chemotaxis and the phagocytosis of the polymorphonuclear leukocytes PMN-L in peripheral blood.
Therefore, the first line of defence against the subgingivally colonized bacteria is endangered. Smokers have a decrease in the antibody production, especially IgG2, which is the most responsible for the colonization of periodontal bacteria, additionally to the smaller percentage of immunoregulatory T-lymphocytes [ 20 ].
Periodontal pathogens evade the specific and non-specific immune defence and they colonize subgingivally.
Smoking increases the adhesion of the microorganisms on epithelial cells. It has been proven that smokers are more easily infected by B forsythus and Porphyromonas gingivalis than non-smokers.
Nicotine has been found on the tooth root surfaces of smokers. Conitine, the main metabolic product of nicotine, can be found in the serum, saliva and the sulcus fluid of smokers. The exposition of fibroblasts to nicotine, leads to a weakening of their proliferation, migration and adhesion to the root surface.