How can periodontitis care affect chronic disease?

How well do medical professionals understand oral health?

When it comes to comprehensive medical care, the interplay between oral health and overall outcomes often goes unnoticed. Medically oriented healthcare professionals may not fully grasp the far-reaching implications of poor dental health on the systemic health of their patients. In considering this overlooked aspect of holistic patient health, the need for an integrated approach to healthcare that recognizes the significant role of dental health in influencing medical outcomes becomes clearer.

What is periodontitis?

Periodontal disease is typically divided into gingivitis (a milder form) and periodontitis, which occurs when gingivitis goes untreated. Dental plaque, bacteria, and their toxins cause pockets to form between teeth and gums, creating a chronic inflammatory response that destroys the alveolar bone that supports teeth and gum tissue.¹

Radiographic depiction

While clinical examination is a fundamental step in establishing the presence of periodontitis, radiographic imaging is equally important in visualizing the severity of damage and guiding appropriate treatment decisions.²

Clinical findings

Common signs and symptoms of periodontitis include:¹

• Red, swollen, receding gums that may bleed easily
• Loose teeth that may shift position
• Pus between gums and teeth
• Persistent bad breath
• Changes in dental structure

Early treatment

Periodontitis is clearly a serious medical condition requiring timely care. But consider this scenario: if a patient presented with a 10 cm by 3 cm by 1 cm inflammatory lesion on the neck, abdomen, or a lower limb, would any considerate healthcare professional simply leave the lesion untreated, perhaps adopting a “watchful waiting” approach as with some slow growing prostate tumors?

Yet with relatively severe periodontitis, millions of patients go untreated yearly.

Periodontitis beyond a disease of the gums

Many healthcare professionals may consider the impact of periodontitis and its management the remit of dentists, who are certainly best placed to care for patients with this condition. But the impacts of periodontitis have been linked to several other chronic diseases. Therefore, all healthcare professionals should be aware of the associations between periodontitis and chronic diseases that may be prevalent in the patients under their care.

Periodontitis has been observed to be both more common in patients with type 2 diabetes, perhaps due to increased susceptibility to infection. A recent review of evidence also suggests that periodontitis is likely a risk factor in type 2 diabetes, possibly via mechanisms involving the pancreas, liver, adipose tissue, and muscle.³ A further point related to type 2 diabetes based on a medical claims database showed that recently diagnosed patients who underwent periodontal interventions saw subsequent healthcare costs over 2 years lowered by hundreds to thousands of US dollars.⁴

Cardiovascular disease, the leading cause of death globally, is also positively associated with periodontitis.⁵ Despite this association, minimal research exists on the impact of periodontal interventions in reducing cardiovascular risk.

Other chronic diseases that have been linked in the literature to periodontitis include neurological conditions like Alzheimer’s disease, chronic respiratory diseases that may be due to aspiration of pathogenic oral bacteria, cancer, rheumatoid arthritis, complications in pregnancy, anemia, and systemic lupus erythematosus.⁶

In sum, periodontitis affects 20–50% of the global population, and around 10–11% have severe disease. It is therefore imperative that all healthcare professionals do their best to ameliorate the effects of this common condition.³

Further reading

Oral health promotion: general dental practice

References

1. American Academy of Periodontology, 2024. Gum Disease Information. https://www.perio.org/for-patients/gum-disease-information/
2. Corbet, 2009. Radiographs in periodontal disease diagnosis and management. https://www.doi.org/10.1111/j.1834-7819.2009.01141.x
3. Su, 2023. Periodontitis as a promoting factor of T2D: current evidence and mechanisms. https://www.doi.org/10.1038/s41368-023-00227-2
4. Nasseh, 2017. The Relationship between Periodontal Interventions and Healthcare Costs and Utilization. Evidence from an Integrated Dental, Medical, and Pharmacy Commercial Claims Database. https://www.doi.org/10.1002/hec.3316
5. Sanz, 2020. Periodontitis and cardiovascular diseases: Consensus report. https://www.doi.org/10.1111/jcpe.13189
6. Martínez-García, 2021. Periodontal Inflammation and Systemic Diseases: An Overview. https://www.doi.org/10.3389/fphys.2021.709438