perioBy Lorenzo Mordini DDS, MS

An increasing number of research studies are focusing their attention on the association between periodontal and systemic diseases that commonly affect millions of individuals.
There is an abundance of evidence that Periodontitis significantly increases risk for certain systemic diseases such as Cardiovascular Diseases (CVD), Preterm Labor and Low Birth Weight infants, Diabetes Mellitus and Obesity.

For a long time it was thought that bacteria was the factor that linked periodontal disease to other disease in the body; however, more recent research demonstrates that inflammation may be responsible for the association. Therefore, treating inflammation may not only help manage periodontal diseases but may also help with the management of other chronic inflammatory conditions.


Diabetes and periodontal disease have a two-way relationship. Research suggests that diabetic patients are more likely to develop periodontal disease which, in return, can increase blood sugar levels and diabetic complications.
The most plausible reason is the fact that diabetics are more susceptible to infections, especially the uncontrolled conditions. Many investigations were conducted and a famous Swedish periodontist, H. Löe, defined periodontal disease as “the sixth complication of diabetes mellitus”.

“Although it has been recognized for decades that adult diabetics are more likely to develop periodontal disease, only recently has this observation been scientifically established. Data […] demonstrated a significant association between diabetes mellitus (both type 1 and type 2) and periodontal disease […]. Collectively, this evidence has helped establish periodontal disease as a complication of diabetes mellitus”.

Löe H. Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care 1993;16:329-334.

Several studies have shown that periodontal disease has an association with heart disease. Research indicated that periodontal disease increases the risk of heart disease. Yet, a direct cause-and-effect relationship has not been proven. Scientists believe that inflammation and bacteria involved in periodontal disease may be responsible for the association.

“Previous studies have demonstrated an association between periodontal disease severity and risk of coronary heart disease and stroke. We hypothesize that this association may be due to an underlying inflammatory response trait, which places an individual at high risk for developing both periodontal disease and atherosclerosis […]” .

Beck J, Garcia R, Heiss G, Vokonas PS, Offenbacher S. Periodontal disease and cardiovascular disease. J Periodontol 1996;67(suppl.): 1123-1137.

The same authors also suggest that periodontal disease, once established, provides a biological burden of endotoxin and inflammation “which serve to initiate and exacerbate atherogenesis and thromboembolic events. Levels of bone loss and cumulative incidence of coronary heart disease (total and fatal) indicated a biologic gradient between severity of exposure and occurrence of disease”.

Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.
American Academy of Periodontology


Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. Obesity’s direct adverse effects on general health have been identified including altered blood pressure, insulin resistance, dyslipidemia and a state of low-grade inflammation. Scientific literature shows evidence of a positive association between overweight and obesity, and/or excessive body fat and prevalence of periodontitis. Yet, reports of the relationship of body composition and extent and severity of periodontitis are inconclusive.

The odds of having periodontitis if an individual is obese is 1.8 times greater than that if the individual has a normal BMI, whereas the odds is only 1.3 times greater in the overweight compared to those with normal weight


Pregnant women who have severe periodontal disease may be more likely to have a baby that is born too early and too small. However, more research is needed to confirm how periodontal disease may affect pregnancy outcomes.
All infections are cause for concern among pregnant women because they directly relate to the health of the baby. The American Academy of Periodontology recommends periodic periodontal examinations.

“Scientific data demonstrated that severe periodontitis in pregnant mothers is a significant risk factor for preterm delivery leading to low birth weight (LBW) infants (< 2,500 g). A study from Offenbacher et al. demonstrated that “pregnant mothers with severe periodontal disease were at a 7.5 to 7.9 fold increased risk for preterm LBW”.

Offenbacher, S. Periodontal diseases: Pathogenesis. Ann Periodontal 1996;1:821-878.


Researchers have suggested that there is a link between osteoporosis, respiratory disease (Pneumonia) and cancer.
Research has found that bacteria that grow in the oral cavity can travel into the respiratory apparatus and cause respiratory diseases, especially in people with periodontal disease. As far as cancer, it has been found that males with periodontal disease were almost 50% more likely to develop kidney and pancreatic cancer and 30% more likely to develop blood cancers.

Despite the relatively low or unclear cause-effect relationship, Periodontitis is well recognized to be linked with common systemic disease that affect the health of millions of individuals throughout the world.

Dentist, Periodontist and Hygienist play a major role in connection with MD in order to prevent and treat these pathologies as a team.

Periodontal diagnosis, treatment and maintenance are an important piece of the puzzle representing systemic conditions (Diabetes, Cardiovascular Diseases, Obesity and Adverse Pregnancy Events).

At this time, more than ever, the role of dentistry it is not merely restricted on the oral cavity but it includes the patient’s systemic condition.

In particular the Periodontist is encouraged to reach a correct periodontal diagnosis, to identify the etiology, to perform the correct therapy and maintenance as well as to communicate regularly with the medical doctor who will prescribe regular blood test and diet counseling.

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