Recent evidence links periodontal inflammation to systemic dysfunction across cardiovascular, endocrine, renal, respiratory, and neurologic systems, highlighting the importance of oral health in chronic disease management.
According to a narrative review, periodontal disease has been associated with cardiovascular disease, type 2 diabetes, metabolic syndrome, chronic kidney disease, rheumatoid arthritis, respiratory diseases (including pneumonia, COPD, and asthma), adverse pregnancy outcomes, and Alzheimer’s disease. Mechanisms underlying these associations include inflammation, immune dysregulation, and microbial translocation from the oral cavity.
Periodontal pathogens such as Porphyromonas gingivalis have been detected in atherosclerotic plaques, and elevated inflammatory markers (IL-1β, TNF-α, CRP) are linked to endothelial dysfunction and hypertension.
Periodontal therapy improves systemic inflammatory markers and vascular function, but evidence is insufficient to determine whether periodontal treatment prevents long-term cardiovascular events. In type 2 diabetes, the bidirectional relationship is supported by data showing that nonsurgical periodontal therapy reduces HbA1c by approximately 4 mmol/mol (0.40%) at 3 months, although this effect diminishes at 6 months. Metabolic syndrome and obesity may exacerbate periodontal inflammation and bone loss via shared cytokine and oxidative stress pathways.
Periodontal disease is also independently associated with chronic kidney disease; severe periodontitis increases the risk of CKD (odds ratio, 2.39), and elevated CRP in CKD patients is a known predictor of mortality. In rheumatoid arthritis, oral bacterial DNA and citrullinated proteins contribute to pathogenesis, and systematic reviews have identified a higher prevalence of periodontitis in RA patients. Early studies indicate potential improvements in RA disease activity following periodontal treatment, but larger longitudinal studies are required.
Additional associations are noted between periodontitis and respiratory infections, including pneumonia, COPD, and asthma, particularly among hospitalized and institutionalized individuals. In patients with dementia or Parkinson’s disease, impaired self-care and medication effects increase periodontal risk. Periodontitis may modestly increase the risk of adverse pregnancy outcomes, though no consensus exists regarding significance, and current evidence does not support improved pregnancy outcomes following periodontal therapy.
The authors declared having no competing interests.
Source: BDJ