Does periodontitis only damage teeth? The truth is more complicated than you think

Periodontitis, as a common oral disease that is as famous as tooth decay, is essentially a chronic inflammatory disease. The main target of periodontitis is the tooth-supporting tissues, and it may cause tooth loss, so it is undoubtedly one of the important causes of tooth loss. Based on the above facts, the harm of periodontitis to teeth is not inferior to tooth decay, and may even be greater, so it has received more and more attention from the public. However, periodontitis is not limited to being lethal to teeth, it may also affect overall health. So, what systemic health problems are related to periodontitis?

In fact, there are many systemic health problems that may be associated with periodontitis, including but not limited to diabetes, cardiovascular disease, adverse pregnancy outcomes, respiratory diseases, Alzheimer's disease, rheumatoid arthritis, and chronic kidney disease.

The relationship between TA and periodontitis, confirmed and affirmed

Among many systemic health problems, the correlation between type 2 diabetes mellitus (T2DM) and periodontitis is the most clear and certain. The two are not only related, but also have a mutually influential relationship.

The impact of periodontitis on T2DM is as follows: patients with periodontitis often have poor blood sugar control and an increased risk of diabetes, with patients with severe periodontitis having the highest incidence of diabetes. Accordingly, non-surgical periodontal treatments such as scaling and root planing are likely to improve hyperglycemia; periodontitis also increases the risk of T2DM complications such as proteinuria and end-stage renal disease.

Conversely, T2DM will also have a certain impact on periodontitis, that is, the risk of periodontitis in diabetic patients will increase, and the degree of hyperglycemia is significantly related to the occurrence and severity of periodontitis. Periodontitis has even been regarded as the sixth major complication of T2DM.

They are also associated with periodontitis

In addition to diabetes, periodontitis is also associated with systemic health problems such as cardiovascular disease, adverse pregnancy outcomes, and respiratory diseases.

Currently, periodontitis is considered an independent risk factor for atherosclerotic vascular disease, and patients with periodontitis have a significantly increased risk of cardiovascular disease. Tooth loss, a common complication of severe periodontitis, is even dose-dependent with the risk of cardiovascular disease and stroke. Clinical trials have confirmed that professional dental preventive measures and enhanced periodontal treatment can improve cardiovascular disease indicators in the short term.

Epidemiological studies have found that maternal periodontal disease is positively correlated with adverse pregnancy outcomes such as premature birth, preeclampsia, and low birth weight. Periodontitis, especially severe periodontitis during pregnancy, is an independent risk factor for adverse pregnancy outcomes. Successful periodontal treatment can improve adverse pregnancy outcomes, such as reducing the risk of premature birth.

Periodontitis is also an independent risk factor for chronic obstructive pulmonary disease (COPD). Patients with periodontitis are also at increased risk of developing respiratory diseases such as asthma and bacterial pneumonia.

Another piece of evidence linking infection to cancer

Infection is one of the main factors in the occurrence and development of cancer. Eleven biological factors have been identified as Class 1 carcinogens by the International Agency for Research on Cancer, such as hepatitis B virus (HBV), hepatitis C virus (HCV), human papillomavirus (HPV), and Helicobacter pylori (Hp), which are respectively related to liver cancer, cervical cancer, and gastric cancer.

Periodontitis, as a chronic infectious disease caused by periodontal pathogens, is no exception and may be associated with a variety of cancers. Existing evidence supports that periodontitis is positively correlated with the risk of oral cancer, lung cancer, and pancreatic cancer. Studies have found that the more teeth a patient with periodontitis loses, the higher their risk of oral cancer.

Why does periodontitis affect overall health?

The relationship between periodontitis and systemic health problems is multifaceted and complex. The essence of the correlation between the two may be that seemingly mild local periodontal inflammation can trigger excessive chronic systemic inflammation, thereby damaging the immune system and causing or aggravating other systemic health problems. Related studies have confirmed that periodontitis affects the systemic immune response, that is, the levels of serum inflammatory markers such as C-reactive protein increase as periodontitis progresses.

Part of the reason why periodontitis affects T2DM may be the increase in systemic proinflammatory mediators, which will aggravate insulin resistance; the possible mechanism by which periodontitis affects cardiovascular disease is mild systemic inflammation and redox imbalance mediated by inflammatory markers; periodontitis may affect the systemic immune response of the mother and fetus, leading to premature birth, and oral bacteria may directly translocate into the uterus, causing local inflammation and adverse pregnancy outcomes; the association between periodontitis and oral cancer may be caused by oral microorganisms and immune response mechanisms.

Image source: Reference [4]

It can be seen that periodontitis not only harms teeth, but also has adverse effects on many systemic health problems. Therefore, once you suffer from periodontitis, especially severe periodontitis, you should actively receive professional treatment to minimize the harm.

References

[1] Kalhan AC, Wong ML, Allen F, et al.Periodontal disease and systemic health: An update for medical practitioners[J].Ann Acad Med Singap, 2022, 51(9): 567-574.

[2] Oh JK,Weiderpass E. Infection and cancer: global distribution and burden of diseases[J].Ann Glob Health, 2014, 80(5): 384-392.

[3] Michaud DS, Fu Z, Shi J, et al. Periodontaldisease, tooth loss, and cancer risk[J]. Epidemiol Rev, 2017, 39(1): 49-58.

[4] Sedghi LM, Bacino M, Kapila YL. Periodontal disease: the good, the bad, and the unknown[J]. Front Cell InfectMicrobiol, 2021, 11: 766944.