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What Is Periodontal Disease?
Periodontitis is defined as “an inflammatory disease of the supportive tissues of the teeth caused by specific microorganisms or groups of specific microorganisms, resulting in progressive destruction of the periodontal ligament and alveolar bone with increased probing depth formation, recession, or both”.
What Causes Periodontal Disease?
Periodontal health is influenced by a number of factors such as oral hygiene, genetic and epigenetic factors, systemic health, and nutrition.
The major microorganisms implicated in periodontal diseases include:
- Porphyromonas gingivalis.
- Prevotella intermedia.
- Tannerella forsythia.
- Treponema denticola.
Additionally, Fusobacterium nucleatum, Prevotella species, Eikenella corrodens, Peptostreptococcus micros, and Campylobacter rectus have also been found in periodontal pockets.
It has been suggested that an aggressive immune response leading to the release of inflammatory cytokines against the microorganisms causes the destruction of the periodontal tissues.
- Poor oral hygiene practices – brushing, flossing, tongue scraping.
- High-sugar, high-saturated fat, low-polyols, low-fiber and low-polyunsaturated-fat intake.
- Poor metabolic health (see below)
In one study after four weeks of increasing omega-3 fatty acids, and foods rich in vitamins C, D, and antioxidants all inflammatory parameters decreased in the experimental group to approximately half that of the baseline values.
Bone formation and periodontal regeneration are also affected by numerous vitamins, minerals, and trace elements.
What Are Symptoms Of Periodontal Disease?
- Bad breath or bad taste that won’t go away.
- Red or swollen gums.
- Tender or bleeding gums.
- Painful chewing.
- Loose teeth.
- Sensitive teeth.
- Gums that have pulled away from your teeth.
- Any change in the way your teeth fit together when you bite.
Can periodontal disease cause other health issues?
Periodontal bacteria have been detected in the gut of patients with IBD.
Periodontitis is associated epidemiologically with several chronic disorders, such as cardiovascular disease, type 2 diabetes mellitus (T2DM), rheumatoid arthritis, inflammatory bowel disease (IBD), Alzheimer disease, nonalcoholic fatty liver disease and certain cancers.
Whereas an imbalanced interaction between the periodontal microbiome/microbiota and the inflammatory response of the host can readily explain local tissue destruction in periodontitis, it has been largely uncertain whether and how this imbalanced relationship can causally link periodontitis and extra-oral comorbidities.
Periodontitis could contribute to Alzheimer disease pathology also by increasing systemic inflammation.
How Does Periodontal Disease Cause Other Health Issues?
The authors discuss how periodontal bacteria or locally activated lymphocytes may disseminate to extra-oral tissues, where they may cause inflammatory and functional complications, for example:
- Endothelial cell dysfunction.
- Bone marrow alterations.
- Gut dysbiosis.
- Immune suppression
These may then aggravate or in certain cases even initiate comorbid pathologies.
Periodontitis can cause low-grade systemic inflammation, which may influence the development of comorbidities.
In comparison with healthy controls, patients with severe periodontitis have elevated levels of pro-inflammatory mediators (such as IL-1, IL-6, C-reactive protein (CRP) and fibrinogen) and increased neutrophil numbers in the blood.
Moreover, periodontitis-associated systemic inflammation could also be mediated by swallowed oral bacteria, which, under certain conditions, cause gut dysbiosis and increased gut permeability with subsequent endotoxaemia and systemic inflammation. In this regard, most of the bacterial species of the gut microbiome associated with liver cirrhosis are of oral origin35
Conversely, systemic diseases such as T2DM can promote susceptibility to periodontitis by increasing the inflammatory burden on the periodontium or by modulating the periodontal microbiome.
Conclusions
Epidemiological, clinical interventional and experimental studies collectively offer sufficient evidence that periodontitis adversely impacts systemic health through biologically plausible mechanisms. Although clinical intervention studies suggest that local periodontal treatment decreases the serum levels of inflammatory factors and improves metabolic control, lipid profile and other surrogate markers of systemic disease, clear evidence that successful treatment of periodontal disease can reduce the risk or incidence of epidemiologically associated conditions is lacking
References
- Local and systemic mechanisms linking periodontal disease and inflammatory comorbidities (click here)
