Volume 7, Issue 11, November – 2022 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Association Between Periodontal Health and

Systemic Health: A Review Article
1 2
Dr. Udhaya Soundharya Mangai T, BDS Dr. Preethi. R, BDS
Intern Intern
Department of Periodontics and Implantology Department of Periodontics and Implantology
Thai Moogambigai Dental College and Hospital Thai Moogambigai Dental College and Hospital
Dr. M.G.R. Educational and Research Institute Dr. M.G.R. Educational and Research Institute
Chennai, Tamilnadu, India Chennai, Tamilnadu, India
3 4
Dr. T.Sri Ranjani, BDS Dr. Uma Sudhakar, MDS, Ph.D.
Intern Vice Principal
Department of Periodontics and Implantology Department of Periodontics and Implantology
Thai Moogambigai Dental College and Hospital Thai Moogambigai Dental College and Hospital
Dr. M.G.R. Educational and Research Institute Dr. M.G.R. Educational and Research Institute
Chennai, Tamilnadu, India Chennai, Tamilnadu, India

Abstract:- Most current studies recommends that characteristics that promote vulnerability to both
periodontal diseases correlated with systemic diseases atherosclerosis/thrombosis and chronic periodontitis. [1].
which includes cardiovascular disorders, respiratory
diseases, pregnancy, endocrine diseases, musculoskeletal When a periodontal infection is present, inflammatory
system, nervous system, renal system and malignancy. mediators such C-reactive protein, TNF-, PGE2, IL-1, and
The periodontal pathogens and its metabolic by products IL-6 are produced. These mediators speed up the
promotes the development of systemic diseases. A better advancement of pre-existing atherosclerotic plaques and are
understanding of oral microorganisms can contribute to also linked to an increase in the incidence of harmful
the oral cavity to diagnose and possibly help in treating cardiovascular disorders [2]. Furthermore, numerous
the systemic disease. investigations have shown that periodontal infections can
cause platelet aggregation and atheroma development [3].
Keywords:- Microorganisms, Oral Cavity, Periodontal These systemic markers of inflammation are thought to
Health, Systemic Diseases. function as predictors of current and upcoming
cardiovascular events and illnesses.
I. INTRODUCTION
Patients with periodontal disease generally have
Oral cavity is the gateway to general health and mirror elevated fibrinogen levels and white blood cell counts.
for well-being. General health and Oral health have a Individuals with poor oral health may have large elevations
synergistic and dynamic relationship. Dental caries, in coagulation factor VIII / von Willebrand factor antigen,
endodontic and periodontal diseases are bacterially induced raising the likelihood of thrombus formation. Periodontal
diseases which are originated by dysbiotic microbiomes. The infection may also promote increased blood viscosity and
focal sepsis theory suggested that these infections play a thrombogenesis, increasing the risk of central and peripheral
major role in the etiology of several systemic diseases. vascular illness.
Periodontal disease is one of the familiar inflammatory
diseases and is a constant potential source of infection that Periodontium functions as an endotoxin reservoir when
damages the gums and the jawbone, which is caused due to periodontitis is present. Endotoxins enter the systemic
the periodontal ligament loss leading to destruction of circulation easily during normal activity, causing damage to
alveolar bone. It is been postulated that the complex interplay the vascular endothelium and generating a variety of
between bacteria and its host responses results in periodontal deleterious cardiovascular consequences.
diseases. The goal of this article is to view into depth of the
various systemic disorders in relation to periodontal disease. Furthermore, in a study of 1163 men, a link between
edentulousness and serum antibodies against P.gingivalis and
II. CARDIOVASCULAR DISEASES A.actinomycetemcomitans and coronary heart disease was
discovered [4]. An further investigation verified the presence
An individual with periodontal disease have significant of bacterial DNA in 42 atheromatous plaques extracted after
chance of developing cardiovascular disease than those endarterectomy. P. gingivalis was the most often discovered
without periodontal disease. It can be the result of either bacteria in this investigation, followed by A.
indirect or direct periodontal infection; an alternative actinomycetemcomitans, T. forsythia, Eikenella corrodens,
pathway may be related to genetic and other host Fusobacterium nucleatum, and Campylobacter rectus [5].

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Volume 7, Issue 11, November – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Human atherosclerotic plaques included DNA from IV. PREGNANCY
periodontal infections such P. gingivalis, A.
actinomycetemcomitans, Prevotella intermedia, and T. Maternal infections are linked to unfavourable
forsythia, indicating that oral pathogens may spread to distant pregnancy outcomes include preterm labour, preterm
parts of the body [6]. premature rupture of the membranes, pre-eclampsia,
miscarriage, intrauterine growth retardation, low birth
Alveolar bone loss and aortic atherosclerosis are linked weight, stillbirth, and neonatal sepsis. Pregnant women are
to bacterial infection, as evidenced by P. gingivalis and more prone to periodontal disease than non-pregnant ones
Treponema denticola [6]. because of hormonal changes in their bodies.

Patients with periodontitis have a much higher In order to explain the unfavourable pregnancy
prevalence and incidence of cardiovascular disorders. outcomes, two distinct pathways have been postulated.

III. RESPIRATORY DISEASES The first mechanism is that oral pathogens directly
migrate from an unhealthy oral cavity across the placenta and
People with periodontitis have 4.8 times more chances into the intra-amniotic fluid and fetal circulation [10]. The
to have respiratory disease than people without periodontitis second mechanism is that endotoxins or inflammatory
mediators produced during periodontal disease may spread
The respiratory pathogen can colonise the mouth cavity throughout the body and affect fetal growth [11].
because it is portable and next to the trachea. Patients with
periodontal disease appear to have higher levels of pathogens Preterm labour is caused by uterine muscle contraction
in their saliva and dental plaque, which can lead to aspiration brought on by bacterial infection and its microbial
of such pathogens into the upper airway from the oropharynx. byproducts, such as LipoPolySaccharides (LPS), which
encourages the activation of cell-mediated immunity and its
Lung infections have been linked to a number of oral subsequent production of cytokines like interleukins (IL-1,
pathogens, including Actinomyces israelii, Capnocytophaga IL-6), tumour necrosis factor (TNF-a), and prostaglandins
species, Chlamydia pneumoniae, E. corrodens, F. nucleatum, (PDE2) [12].
Fusobacterium necrophorum, P. gingivalis, P. intermedia,
and Streptococcus constellatus. C. pneumoniae is well- Infection causes aberrant production of the
studied respiratory pathogen and is associated with asthma, physiological mediators of parturition, which can cause births
bronchitis and chronic obstructive pulmonary disease. and also contributes to low birth weight.

Lemierre's syndrome, which begins with pharyngitis F. nucleatum is frequently seen in intrauterine infections
and progresses to respiratory tract infection, was discovered along with other oral subspecies. Patients who had premature
to be caused by the common oral infections F. nucleatum and deliveries also have P. gingivalis (and its endotoxins) in their
F. necrophorum. placentas [12].

The genetic similarity of respiratory pathogens isolated Recent research has shown that pregnant women with
from dental plaque and Broncho alveolar lavage fluid from periodontal disease have a higher risk of developing
the same individuals supports the idea that dental plaque may gestational diabetes mellitus than pregnant women with
serve as a substantial reservoir for respiratory pathogens [8]. healthy gums. [13]. Until now, the findings have been helpful
in developing preventative strategies for pregnant women
The analysis of samples from the tongue, supragingival with periodontal disease. Females may develop gingival
dental plaque, and tracheal aspirate revealed that 70% of the inflammation prior to menstruation as well as during
bacteria recovered from the tracheal aspirate were also ovulation due to elevated levels of progesterone, which
present in the dental biofilm. According to the authors, the inhibits collagen fibre repair and causes blood vessel
tooth biofilm serves as a reservoir for respiratory germs. dilatation. Lack of oestrogen lowers bone density after
menopause, which can lead to the loss of alveolar bone and
Salivary inflammatory indicators and GCF levels are eventual tooth loss.
higher in covid and post-covid patients, who also have more
periodontal destructions. To support this claim, more V. ENDOCRINE DISEASES
investigation is needed.
Diabetes mellitus is a chronic metabolic illness defined
In periodontitis, salivary enzymes modify the mucus by hyperglycemia caused by a deficiency in insulin synthesis
surface, which increases the adherence and colonisation of by pancreatic cells (type 1 diabetes), insulin resistance (type
respiratory infections. The destruction of salivary pellicles on 2 diabetes), or a combination of both.
pathogenic bacteria by periodontal disease-associated
enzymes, as well as the modification of respiratory Bacteria from periodontal disease enter the circulation
epithelium by periodontal disease-associated cytokines, and trigger the body's immune system. These stimulated
enhances infection of the epithelium by respiratory pathogens immune cells release inflammatory biological signals that
[9]. have a damaging impact on the entire body.

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Volume 7, Issue 11, November – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Periodontal disease can aggravate the body's resistance Alzheimer's disease is distinguished by the presence of
to insulin by raising levels of cytokines, C-reactive protein, activated glial cells, which release high levels of
TNF-, interleukin-6, and fibrinogen. This can prolong a state inflammatory cytokines.
of chronic systemic inflammation [14].
Aside from the direct harm produced by -amyloid
The cells responsible for insulin generation in the plaques and tau aggregates, the innate immune response seeks
pancreas are destroyed by prolonged high levels of cytokines, to remove these aggregates from the brain but instead
which can cause Type 2 diabetes even in people who have no aggravates neurodegeneration. As a result, pro-inflammatory
other risk factors for diabetes. cytokines are shown to be increased in older patients with
periodontitis and Alzheimer's disease [20].
The non-surgical periodontal treatment enhances the
metabolic regulation of diabetic patients, which influences a However, immunosuppressive cytokines and the IL-1
decrease in glycine and glycemic haemoglobin levels [15]. receptor antagonist can shield the brain from additional harm
and slow the progress. The discovery of lipopolysaccharide
However, if diabetes is not controlled, the recurrence of (LPS) from periodontal infections including P. gingivalis and
periodontal disease becomes more common and difficult to T. denticola in short-term postmortem human brains with
control. The link between periodontal disease and diabetes is Alzheimer's disease raises the possibility that these
well recognised. pathogens' virulence factors may contribute to the
development of brain inflammation and Alzheimer's disease.
VI. MUSCULOSKELETAL SYSTEM Bacteria such as T. denticola and C. pneumoniae were found
in postmortem Alzheimer's disease brains, implying that, in
There is an increased chance of developing rheumatoid addition to inflammatory mediators, some periodontal
arthritis in people with moderate to severe periodontitis. infections may infiltrate the brain via the blood-brain barrier
[21].
Periodontal disease may play a causative role in the
development and maintenance of the autoimmune The symptoms of Alzheimer's disease and these
inflammatory response that characterises rheumatoid periodontal bacteria appear to be related, but further research
arthritis. The basic pathogenic processes of RA and is required to draw a firm conclusion of Alzheimer's disease.
periodontal disease are similar [16].
VIII. RENAL SYSTEM
Both disorders are thought to be driven by a poorly
controlled inflammatory response, which results in oxidative Periodontal disease and chronic renal disease have a
stress-induced tissue injury [17]. mutually reinforcing association. It was discovered by
(Ioannidou and Swede) that those with CKD had a 30–60%
Alveolar bone loss and tooth loss are common in RA higher risk of experiencing mild periodontitis [22].
patients and are also consequences of periodontal disease.
There is also a significant link between systemic bone mass According to a different study by Ioannidou et al.,
and oral bone loss. Mexican Americans with impaired kidney function had a
twice as high risk of developing periodontal disease as those
VII. NERVOUS SYSTEM: with normal renal function [23].

Age-related cognitive decline affects geriatric Similar findings were made by Iwasaki et al. in their
individuals' behaviour, particularly oral hygiene practises. study of older Japanese people , which linked periodontitis to
decreased kidney function [24].
The Third NHANES-III data analysis found that people
with poor cognitive function had high levels of the Ricardo et al. discovered that CKD patients with
periodontitis-related blood marker (increased P. gingivalis periodontitis had a 35% higher risk of mortality than CKD
IgG) [18]. patients without periodontitis [25].

Furthermore, a recent study by Kamer and colleagues In-depth research is still required to firmly establish this
demonstrated that clinical AL can encourage amyloid truth.
deposition in the brain, which can result in cognitive
impairment [19]. IX. MALIGNANCY

Alzheimer's disease is a neurological condition that The chance of acquiring haematological, lung, renal,
impairs memory, thinking, language, and learning abilities in pancreatic, and periodontal malignancies was found to be
a progressive and irreversible manner, eventually leading to significantly correlated with periodontitis.
death.

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ISSN No:-2456-2165
Patients with Oral Squamous Cell Carcinoma (OSCC) Arterioscler Thromb Vasc Biol, 23 (2003), pp. 1250-
and Esophageal Squamous Cell Carcinoma (ESCC) were 1254
shown to have considerably higher levels of the periodontal [5]. E. Figuero, M. Sanchez-Beltran, S. Cuesta-Frechoso,
pathogen P. gingivalis [26, 27]. J.M. Tejerina, J.A. del Castro, J.M. Gutierrez, et al.
Detection of periodontal bacteria in atheromatous
P. gingivalis has been shown to encourage the invasion plaque by nested polymerase chain reaction J
and metastasis of oral squamous cells in OSCC by Periodontol, 82
upregulating the production of matrix metalloproteinase 9 (2011), pp.1469-1477
(pro-MMP9) [26]. Oral F.nucleatum has the potential to [6]. V.I. Haraszthy, J.J. Zambon, M. Trevisan, M. Zeid, R.J.
move and colonise the human gastrointestinal tract, causing Genco Identification of periodontal pathogens in
harmful inflammatory illnesses. As the fourth most common atheromatous plaques J Periodontol, 71 (2000), pp.
cancer in the world, colorectal carcinoma (CRC) is linked to 1554-1560
high levels of F. nucleatum and Clostridium difficile in the [7]. Scannapieco FA. Role of oral bacteria in respiratory
intestinal microbiota of affected individuals [28]. infection. J Periodontol. 1999 Jul;70(7):793-802.
[8]. S.M. Heo, R.S. Sung, F.A. Scannapieco, E.M. Haase
The potential of F. nucleatum to modify the lumen Genetic relationships between Candida albicans strains
microbiota, mediate cytokine release, and activate isolated from dental plaque, trachea, and
tumorigenesis-related pathways provides a pro-inflammatory bronchoalveolar lavage fluid from mechanically
milieu that may hasten the course of neoplasia in colorectal ventilated intensive care unit patients J Oral Microbiol,
adenoma-carcinoma [29]. 3 (2011), p. 6362
[9]. Bosnjak A, Plancak D, Curilovic Z. Advances in the
Research is currently ongoing and calls for conclusive relationship between periodontitis and systemic
evidence of a link between periodontal diseases and cancer. diseases. Acta Stomatol Croat. 2001;35:267–71
[10]. 10. G. Hajishengallis Periodontitis: from microbial
X. DISCUSSION immune subversion to systemic inflammation Nat Rev
Immunol, 15 (2015), pp. 30-44
Poor oral hygiene is strongly correlated with a buildup [11]. J.L. Ebersole, J. Stevens, M.J. Steffen, D. Dawson Iii,
of dental plaque, a high prevalence, and a worsening of M.J. Novek Systemic endotoxin levels in chronic
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