Periodontal and Systemic Disease Link
Vonchit John, DDS, MSD
The re-emergence of the focal-infection concept during the last decade has brought a more evidence-based understanding to what is now referred to as the periodontal disease/systemic disease relationship. While this suggests that these disease conditions exist as separate entities, the realization that we are dealing with the patient as a whole is a welcome change to our thought process.
In 2000, the US Surgeon General issued the first Surgeon General’s Report on Oral Health in America.1 This has served as a strong impetus for the continual research and subsequent dialogue that has taken place. It is encouraging to note that this dialogue includes all aspects of dentistry--academic and clinical--among colleagues in dental hygiene. The increased awareness of this association is leading to the development of integrated healthcare teams.
Periodontal disease and the recognition that patients with this condition can be at risk for cardiovascular disease (CVD), adverse pregnancy outcomes, diabetes, pulmonary disease, stroke, and prostate cancer, make the burgeoning load of new research critical. This is especially true as epidemiologic date estimate that approximately 60 million adults in the US have moderate to advanced periodontitis.2
Nationally and globally, CVD is among the leading causes of premature mortality and morbidity among developed nations. In periodontal disease, the overall pathogenic and microbial load is significant in the oral cavity around the tissues of the periodontium. Chronic bacteremia that results due to the microbial load may be a key factor in explaining the association between periodontal disease and CVD. In addition, C-reactive protein, a well-known marker of systemic inflammation, has shown increased levels in the presence of periodontal disease. Accordingly, it appears that educating patients about the relationship between periodontal disease, CVD, and the need for good oral hygiene and a regular dental care must be emphasized.
Preterm births (ie, 12% of births) are associated with many serious long-term problems for the child as well as emotional and financial challenges for the parents. Periodontal infections are reported to be more common in pregnant women than all other obstetric and sexually transmitted infections combined.3 Thus, the relationship between periodontal disease and preterm births is significant. Studies have indicated that the role of inflammation is a key factor and that treatment for periodontal disease should include early education of patients combined with treatment before pregnancy or between pregnancies. In general, treatment during the second trimester of pregnancy is considered the safest.
The relationship between diabetes mellitus and periodontal disease is probably the most exhaustively researched in the arena of oral and systemic health. Both conditions are chronic in nature, with a well-defined influence upon each other, and both may exist in patients without being diagnosed in a timely manner. Accordingly, it is important for the health care team, as well as patients, to be educated about the relationship and made aware of the importance of early diagnosis and treatment.
In addition to these three relationships with periodontal disease, other conditions (eg, pulmonary disease, stroke, prostate cancer) are actively being investigated. This may yet be the tip of the iceberg, as we continue to develop truly integrated healthcare teams.
*Associate Professor and Director, Pre-Doctoral Periodontics, Indiana University School of Dentistry, Indianapolis, Indiana.
- Oral Health in America: A report of the Surgeon General Executive Summary. Rockville, MD: National Institutes of Health; 2000.
- Cobb CM. Diagnosis and treatment of periodontal disease: A crisis of direction. Triage 2005;1:15-20.
- Proceedings and consensus opinion from the global oral and systemic health summit: Present evidence and future directions. Grand Rounds in Oral Systemic Medicine 2007;(suppl):5-19.