Periodontal disease and systemic health

Understanding the Systemic Impact of Periodontitis

As dental professionals, we know that periodontal disease is more than a localized oral issue. But how often do we consider its broader implications for systemic health? Growing evidence links periodontal disease to cardiovascular conditions^1-6, diabetes^7-9, Alzheimer’s disease¹⁰ and even pregnancy complications^{11, 12}. 

It's time to integrate the systemic relationship between oral health and overall well-being into our patient communications and clinical approach.

A Global Burden with Systemic Reach

Severe periodontitis affects over 500 million people globally, making it the sixth most prevalent health condition worldwide^13-15. Including milder forms, nearly half of all adults are affected⁵. This is not just a statistic; it's a public health concern. Chronic gum inflammation serves as a persistent source of bacteria and inflammatory mediators that could enter the bloodstream and influence systemic health^1-4,6.

Periodontitis and Diabetes

One of the most well-established connections of periodontitis to systemic health is diabetes. The relationship is bidirectional: diabetes increases susceptibility to gum diseases, and untreated periodontitis can worsen glycemic control^7-9.

The Heart–Gum Association

Cardiovascular disease (CVD) remains the  leading cause of death globally, and periodontitis is increasingly recognized as a contributing risk factor. A consensus report by the European Federation of Periodontology (EFP) and the World Heart Federation concluded that periodontitis increases the risk of atherosclerotic cardiovascular disease (ASCVD), including heart attacks and strokes⁵.

Periodontitis and Heart Disease

The 'Periodontitis and Its Relation to Coronary Artery Disease' (PAROKRANK) study in Sweden reported an association between periodontitis and the first myocardial infarction/ first heart attack^1-3.

The 10 years follow-up of the PAROKRANK study found that individuals with periodontitis had about a 28% higher risk of a first heart attack, even after adjusting for smoking and other risk factors⁴. 

Periodontitis and Stroke

The ARIC study in the U.S. reported that people with severe periodontitis had more than double the risk of ischemic stroke⁵.

Periodontitis and Peripheral Artery Disease

Studies from NHANES and KoGES show that advanced gum disease is associated with a twofold increase in peripheral artery disease⁵.

Periodontitis and Systemic Inflammation

The plausible biological connection between periodontitis and various systemic diseases is inflammation. Severe periodontitis can trigger low-grade chronic inflammation with far-reaching systemic impact⁶. Recent research shows that the oral microbiome in the gums of patients with severe periodontitis is significantly different than those in patients with mild periodontitis, which is associated with systemic inflammation⁶. This critical factor could be the link of oral health issues to cardiovascular disease⁶, stroke⁵, and peripheral artery disease⁵.

Trained immunity and inflammation

Recent research from Radboud University investigated whether periodontitis may contribute to cardiovascular disease through a process called trained immunity. This refers to a form of “memory” in immune cells like monocytes, which become “more reactive” after exposure to bacteria such as P. gingivalis. This effect was demonstrated in an in vitro study. While not observed in circulating immune cells in patients with periodontitis, “reactive” immune cells were visualized in gums and bone marrow tissues by PET scans. This suggests that trained immunity might play a role and requires further investigation¹⁶.

Link of periodontitis and neurodegenerative diseases

Reviews suggest that periodontitis may increase the risk of Alzheimer’s disease by up to five times. The underlying mechanism is thought to be chronic inflammation, which may trigger neuroinflammation through immune, humoral, and neural pathways. Since periodontitis is treatable, it may represent a modifiable risk factor for slowing cognitive decline and neurodegeneration¹⁰.

Gingivitis and Periodontitis during Pregnancy

Hormonal changes throughout a woman’s life, such as puberty, pregnancy, and menopause can significantly affect periodontal health. During pregnancy, 60–75% of women develop gingivitis¹⁷, and those with periodontitis face a twofold increased risk of preterm birth¹². Periodontal pathogens have even been detected in placental tissues, suggesting a direct microbial link¹¹.

Treating Periodontitis: Systemic Benefits

So, what happens when we treat periodontitis? The benefits extend beyond the mouth:

• Reduced Inflammation: Periodontal therapy lowers systemic markers and improves endothelial function, which is beneficial for cardiovascular health^18-23.
• Better Diabetic Control: Treating gum disease can lead to improvements in blood sugar levels^7-9.
• Lower Healthcare Costs: A US insurance study found that patients with diabetes and/or heart disease who received regular dental care had significantly lower medical costs and fewer hospitalizations²⁴.
• Improved Quality of Life: Beyond clinical metrics, patients report better chewing function, self-esteem, and overall well-being after periodontal treatment^25,26.

A Call to Action for Dental Professionals

As dental professionals, we are uniquely positioned to influence both oral and systemic health. The evidence is increasing that periodontitis is not an isolated condition. It is suspected to be a modifiable risk factor for multiple systemic diseases. By prioritizing periodontal diagnostics and care, we’re not just preserving smiles. We are potentially taking preventive measures for serious systemic diseases, supporting healthy pregnancies, and improving chronic disease outcomes.

References

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6. Plachokova AS, et al.: Int J Mol Sci. 2021 May 30;22(11):5876. (clinical study)
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