Periodontal Disease and Whole Body Health: The Oral-Systemic Link

With the separation of medical and dental care, it is easy to see why the public has a difficult time realizing that dental health has a direct effect on medical health. As an oral health care professional it is important to bring awareness of links between the oral- systemic health, as well as try to create programs that integrate medical and dental care.

Periodontal disease is an inflammatory disease, initiated in response to specific types of bacteria. It is characterized by a complex interaction between the host and biofilm. There is significant evidence to support independent associations between severe periodontal disease and several non-communicable diseases including diabetes, cardiovascular disease, and chronic obstructive pulmonary disease, COPD [1].

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Cardiovascular Health

Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States [7]. The systemic inflammatory or immune response to periodontal infection may increase cardiovascular disease risk. Pathogens from the mouth can enter atherosclerotic plaques via blood stream, which promotes an inflammatory or immune response within the atherosclerotic plaque [2]. A 2012 literature workshop held by European Federation of Periodontology and the American Academy of Periodontology concluded that there was consistent and strong epidemiological evidence that periodontitis imparts increased risk for future atherosclerotic cardiovascular disease. It also concluded that the impact of periodontitis on cardiovascular disease was biologically plausible, due to translocated circulating oral microbiota, which may directly or indirectly induce systemic inflammation that impacts the development of plaque deposits and subsequently, blood clots on arterial walls [1]. Preventing and treating periodontal diseases may promote cardiovascular health.

Diabetes

Approximately 38 million people have diabetes and is the 8th leading cause of death in the United States in 2021 [8]. Diabetes mellitus increases the risk and severity of periodontitis. Periodontal disease can affect both glycemic control and insulin resistance. Periodontal disease and diabetes have a bidirectional relationship. For example, diabetes mellitus has a negative effect on periodontal disease, increasing its prevalence, extent, and severity. Several studies show that patients with either uncontrolled diabetes or uncontrolled blood glucose levels have a 2–3 times higher risk of developing periodontitis (the level of glycemic control being the critical determining risk factor) [3]. Treatment for periodontal disease improves glycemic control, may lead to a reduction in the need for diabetic medications and reduces the severity of known medical complications [4].

Respiratory Health

In 2016, the United States spent $170.8 billion dollars on respiratory diseases [9] and is the leading cause of death and disability [10]. Studies have shown a strong connection between periodontal health and pulmonary disease, as when there is aspiration of bacteria from the oropharynx into the lower respiratory tract, it causes respiratory infection [5]. Lower airway infections, like pneumonia have increasing evidence of direct and indirect links to periodontitis. Many oral pathogens that cause periodontal disease have been implicated in lung infections. Due to the potential connection between periodontal disease and respiratory infections like pneumonia and SARS-CoV-2, oral hygiene and management of periodontitis remain essential to help reduce infection and transmission of SARS-CoV-2 [6].

The Importance of Medical-Dental Integration

If there was more of a reciprocal referral relationship between medical and dental professionals, patients who are at the greatest health risks due to uncontrolled diabetes, cardiovascular disease, and respiratory disease along with untreated periodontal disease, could be identified and treated accordingly. The goal is to improve overall patient health and ultimately eliminate the separation of medical and dental care. We can do so by using one electronic health record to facilitate communication with medical and dental clinics. There should also be cross training of professionals for better understanding of the importance of the mouth. The collaboration and establishment of interprofessional teams can be helpful to address overall health. Medical facilities can investigate in incorporating the integration of a dental component into the facility to be able to treat overall health, which includes the mouth. Medical-dental integration can be vital to our current and future practice as oral health professionals.

Earn an Online Postgraduate Degree in Community Oral Health

Like what you’re learning? Consider enrolling in the Herman Ostrow School of Dentistry of USC’s online, competency-based certificate or master’s program in Community Oral Health.

References

1. Sanz, M., Marco del Castillo, A., Jepsen, S., Gonzales-Juanatey, G., D’Aiuto, F., Bouchard, P., Shechter, M. (2020). Periodontitis and cardiovascular diseases: Consensus report. Journal of Clinical Periodontology, 47(3), 268–288. doi:10.1111/jcpe.1318.
2. Stewart, R., M.D., & West, M., M.D. (2016). Increasing evidence for an association between periodontitis and cardiovascular disease. Circulation, 549-551.
3. Păunică, I., Giurgiu, M., Dumitriu, A. S., Păunică, S., Pantea Stoian, A. M., Martu, M. A., & Serafinceanu, C. (2023). The Bidirectional Relationship between Periodontal Disease and Diabetes Mellitus-A Review. Diagnostics (Basel, Switzerland), 13(4), 681. https://doi.org/10.3390/diagnostics13040681.
4. Turner C. (2022). Diabetes mellitus and periodontal disease: the profession’s choices. British dental journal, 233(7), 537–538. https://doi.org/10.1038/s41415-022-5029-5.
5. Parashar, P., Parashar, A., Saraswat, N., Pani, P., Pani, N., & Joshi, S. (2018). Relationship between Respiratory and Periodontal Health in Adults: A Case-Control Study. Journal of International Society of Preventive & Community Dentistry, 8(6), 560–564. https://doi.org/10.4103/jispcd.JISPCD_304_18.
6. Brock, M., Bahammam, S., & Sima, C. (2022). The relationships among periodontitis, pneumonia and COVID-19. Frontiers in Oral Health, 2 Retrieved from https://www.frontiersin.org/articles/10.3389/froh.2021.801815/full.
7. Heron M. Deaths: Leading causes for 2019. National Vital Statistics Reports; vol 70 no 9. Hyattsville, MD: National Center for Health Statistics. 2021.
8. Centers for Disease Control and Prevention. (2022, October 25). By the numbers: Diabetes in America. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/health-equity/diabetes-by-the-numbers.html.
9. Nurmagambetov T. A. (2023). How Much Does the United States Spend on Respiratory Diseases?. American journal of respiratory and critical care medicine, 207(2), 126–127. https://doi.org/10.1164/rccm.202209-1696ED.
10. Chronic respiratory disease burden. PAHO/WHO | Pan American Health Organization. (n.d.). https://www.paho.org/en/enlace/chronic-respiratory-disease-burden