The Two-Way Association of Periodontal Infection with Systemic Disorders: An Overview
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Tooth loss is associated with increased risk of total death and death from upper gastrointestinal cancer, heart disease, and stroke in a Chinese population based cohort. Relationship between self-assessed masticatory disability and 9-year mortality in a cohort of community-residing elderly people.
J Am Geriatr Soc. Touger-Decker R, van Loveren C. Sugars and dental caries. Am J Clin Nutr. Since the serum levels of total cholesterol, low-density lipoprotein cholesterol, and triglycerides have been observed to be higher in periodontal patients, periodontitis may also be a risk factor for hyperlipidemia [ 25 ].
The hyperactivity of white blood cells which is caused by the hyperlipidemia may also increase the production of oxygen radicals that are often linked with the development of periodontitis, and this decline in the antioxidant ability in periodontitis patients could also trigger the development of insulin resistance [ 18 ]. Such variations in the phenotype of immune cells due to the elevated levels of lipids and serum proinflammatory cytokines in chronic periodontitis may also support the two-way correlation between the two diseases [ 26 ] Figure 2.
However, it still remains to be fully revealed if and how periodontitis provokes the higher lipid levels or higher lipid levels influence the periodontitis. Periodontal Infections and Other Systemic Diseases There has been a significant interest in the possible association between oral and systemic diseases in the past few decades [ 27 — 29 ], especially after the case-control study by Mattila et al.
Decreased mastication due to oral pain and tooth loss could also result in reduced acetylcholine synthesis which may cause several learning and memory problems [ 42 ]. In addition to the incidences of hypertension and diabetes mellitus, the number of lost teeth has also been found to be higher in patients with silent infarctions and cerebral white matter changes, as compared to healthy group, thereby hinting that periodontal infections may also be a predictor of stroke and cognitive impairment [ 43 ].
Although the precise role and underlying mechanisms of periodontal infections in the pathology of systemic diseases still remain to be completely established, several hypotheses have been proposed based on the findings of various clinical and epidemiological investigations Figure 3 [ 544 — 46 ].
The primary factor includes the shared risk factors among oral infection and systemic diseases, such as genetic or environmental factors including age, smoking, lifestyle, and socioeconomic status. Another mechanism is the systemic inflammation against the local infection or circulating bacteria and associated higher levels of circulating inflammatory biomarkers which could play a contributing role in systemic disease.
Also, the significant role of infection and inflammation in diseases such as atherosclerosis, cardiovascular disease CVDand coronary heart disease CHD also underscores the possible etiological role of periodontal infections in these diseases [ 283047 — 50 ].
The pathogens from periodontal pockets may also enter into the connective tissues, endothelial cells, and the bloodstream and thus could lead to the formation of thrombus by platelet aggregation degrading collagen [ 51 — 53 ].
Chronic periodontal infections can contribute to atherogenesis either directly by triggering the platelet aggregation and invasion causing damage to endothelial cells or indirectly by stimulating the synthesis of intracellular adhesion molecules and production of antibodies against bacterial LPS thereby causing a discrepancy of the immune system [ 5455 ].
Potential consequences of periodontal disease leading to stroke, infarction, atherosclerosis, and other neuropathological complications. Periodontitis and Fatty Liver In addition to insulin resistance, obesity, diabetes, and oxidative stress, periodontal diseases may also be implicated in the pathogenesis of nonalcoholic fatty liver disease NAFLD and nonalcoholic steatohepatitis NASH.
For instance, the incidences of P. Further, observation of a lower serum albumin levels in P. Interestingly, periodontal treatment has been found to improve the liver functional parameters such as serum aspartate aminotransferase and alanine aminotransaminase in NAFLD patients, again signifying the fact that P.
Periodontal Disease and Respiratory Infections Poor oral health may also predispose the host to respiratory diseases, particularly in high-risk patients such as residential nursing patients, hospitalized patients, elderly, smokers, and the underprivileged.
In periodontal infections, the aspiration or hematogenous spread of bacteria from the oropharynx into the lower respiratory tract and the consequent infection of respiratory ducts can easily cause respiratory infections such as pneumonia and chronic obstructive pulmonary diseases [ 6364 ] Figure 4.
Association between periodontal diseases and systemic diseases
Since the oral cavity is adjacent to the trachea, it could be an easy entrance for the immigration and colonization of respiratory pathogen. Further, the cytokines and enzymes induced from the inflamed periodontal tissues may also relocate into the lungs and trigger local inflammatory processes and lung infections [ 34 ]. Also, in periodontal diseases, poor oral hygiene may result in a higher concentration of oral pathogens in the saliva, and these pathogens may be aspirated into the lung overcoming the immune defenses and assist the pulmonary pathogens in inhabiting the upper airways.
- Mediators of Inflammation
- Periodontitis and systemic diseases: A literature review
Generally, in healthy scenarios, the respiratory tract is capable of defending against aspirated bacteria. However, in periodontal diseases, the disturbed oral hygiene, reduced salivary flow, decreased cough reflex, dysphagia, and other disabilities can predispose the patients to a high risk for pulmonary infections [ 69 — 74 ].
Possible role of periodontal infection in respiratory diseases. Periodontal Diseases and Cancer s A number of clinical and epidemiological studies have observed higher risks of oral, gastrointestinal, lung, and pancreatic cancers in subjects with periodontal disease, thereby linking oral bacteria with the etiology of these cancers. In addition to tobacco and alcohol consumption, a poor oral hygiene could also be a possible risk factor for oral cancers [ 7576 ]. Several case-control studies have found tooth loss to be associated with a higher oral cancer risk [ 7778 ], indicating that tooth loss may contribute to oral cancers either by promoting the initiated tumors or by some other complex mechanism s.
Several reports have also suggested that oral bacteria could contribute to the cancers of upper gastrointestinal tract including aerodigestive tract, esophagus, and stomach, possibly through the similar inflammatory mechanisms as that of Helicobacter pylori [ 79 — 82 ].
However, available evidences are inadequate, and hence further studies are awaited to validate a definite association between periodontal diseases and gastrointestinal cancers. Periodontal Diseases and Adverse Pregnancy Outcomes Approximately half of the perinatal deaths or congenital neurological deficits are caused as a result of premature births [ 83 ].
Incidences of intrauterine infection and inflammation are known to be a significant contributor to majority of the preterm deliveries [ 83 ]. Several clinical and observational investigations, however, have failed to observe any significant association between periodontal disease and the occurrence of preterm births or low-birth weight, and hence more investigations are requisite to resolve this paradox [ 90 — 93 ].
Periodontal Diseases and Overall Health: The Nonclinical Links In addition to the various clinical, immunological, or molecular mechanisms that link periodontal infection with the systemic health, periodontal diseases may also have an indirect effect on the overall health status of the patient which could further exaggerate the health complications.
Since periodontal disease leads to oral pain and teeth loss, it may result in poor mastication, less appetite, and less food intake which can cause nutritional deprivations. The oral pain may also cause sleep deprivation, thereby causing an upset behavior and hypertension. Bad breath and oral pain may also negatively affect the social routine of the patient and reduce the social and physical activities of the patient.The Connection Between Diabetes and Periodontitis
The high cost of treatment regimen may also disturb the socioeconomic status of the patient. All these factors such as oral pain, teeth loss, bad breath, deprived nutrition and sleep, reduced physical and social activities, and depression may altogether make the patient more vulnerable to low self-esteem, hypersensitivity, and weakened immune system and hence may adversely affect the overall health.