Periodontal disease – Systemic links

periodontal disease systemic links

How does periodontal disease link to other systemic disease or conditions?

There is no question that there is a link between periodontal disease and a host of medical issues.  From heart disease to low birth weight babies, the data is clear that there is a correlation.  The BIG question is, ” Will treatment of the periodontal disease impact the latter?”

Why so many conditions and periodontal disease have a correlation is because they often are low grade chronic inflammation.  It’s reasonable that an individual’s biochemical response to bacteria in the mouth is causing periodontal disease and that same overreaction is causing other problems elsewhere as well.  Unfortunately, for many conditions the research is showing that periodontal treatment is not having a clinically significant positive impact.  Two examples of diseases that have a correlation, but that treatment doesn’t help are pregnancy issues and heart disease.  However, diabetes appears to be the exception.

Periodontal disease links to Diabetes

A summary review of 10 RCTs shows that periodontal care impacts HbA1c.  Reviewing the literature shows that periodontal treatment leads to a reduction of HbA1c in diabetic patients. It also shows an improvement of periodontal status for three months after treatment.  There is no obvious effect on glycaemic control at six months post treatment.  Vergnes EBD 2015 A new meta analysis finds similar results in EBD Dhingra 2023. Another meta analysis seems to showing it is the hygienist accomplishing the results and not a result of lasers or antibiotics that one might use. Goyal EBD 2023

What is interesting about that time line is that we recommend 3 to 4 month recall for periodontal patients.  Is that just a coincidence that HbA1c levels are better at 3 months and not so much at 6, when we have known that periodontal patients need a 3 or 4 month recall?  I don’t think so.  The results of this study seem to only further support the notion that patients with periodontal disease and diabetes should be on a 3 month recall.    

Periodontal disease links to Pregnancy

Meta-analysis  Leader JADA 2014 July of 11 RCTs of the 13 from a systematic review showed little to no effect if periodontal treatment was completed or not.  This is unfortunate but not surprising.  Not many researchers believed that periodontal disease by itself was causing these issues.  Many believe, myself included, that all of these (heart disease, periodontal disease, preterm birth) are symptoms of an underlying hyper-inflammatory state of the individual’s biochemistry.  It would have been nice to see this have an impact but until we can control the true cause of periodontal tissue (the excessive host response) we are unlikely to see any impact on other conditions. Like many of health issues, Crowder EBD 2023 finds there is an association between periodontal disease and pre-eclampsia. However, as always, correlation is not causation.

Periodontal disease links to Heart disease

For years many dentists have been telling their patients that gum disease (periodontal disease) has a link to heart disease. It likely is since both are low grade chronic inflammatory diseases. However, they are often insinuating treatment can decrease the risk for heart disease.  This is most likely a false statement (summary review EBD 2015 Henschel) and if it isn’t false having periodontal disease is a very small risk factor at best. Recent meta analysis of EBD 2023 Goyal show similar results with no impact on heart disease from periodontal treatment and insufficient evidence to generate any implications for practice. CRP does impact heart disease and periodontal disease causes an increase in CRP. However, the evidence that CRP levels stay low or are clinically significant is questionable.

A new statement from the American heart Association can be summed up by it’s author here.

Dr Peter Lockhart (Carolinas Medical Center, Charlotte, NC), lead author.

“After extensive review of all the literature in this field, we were not able to find any real scientific evidence that periodontal disease causes atherosclerosis or that treating periodontal disease has any long-term effect on atherosclerosis or heart disease. Although we also haven’t proved that the link is not causative,it would seem that if it were causative, it would be a small relationship. And it does not appear to be worth creating too much stress about it.”

“Our message is that while good oral hygiene is obviously still important, patients should not be distracted by periodontal disease in trying to lower their rates of heart attack and stroke. Rather, they should focus on the well-known causes of heart disease such as hypertension, obesity, and high cholesterol. Reducing these things can make a real difference.”
They add: “Although a contribution of periodontal disease to atherosclerotic vascular disease is biologically plausible, periodontal and cardiovascular diseases share multiple risk factors that are prevalent and powerful promoters of disease, including tobacco use, diabetes mellitus, and age.” And “although periodontal interventions result in a reduction in systemic inflammation and endothelial dysfunction in short-term studies, there is no evidence that they prevent atherosclerotic vascular disease or modify its outcomes.”
They further note that “the effects of periodontal-disease therapy on specific inflammatory markers are not consistent across studies, their sustainability over time has not been established convincingly, and determinants of variability in these responses remain poorly understood.”

The actual study 

This ties in with a newer JADA meta-analysis that periodontal treatment doesn’t impact preterm birth rates or low birth weights.

Studies on periodontal disease systemic links

Poster with periodontal disease links to general health

I really like this poster on periodontal disease and it’s impact on the body. It shows how gum disease “may”, “can”, or “will” impact your body. Some links have more evidence than others. However, it shows that poor oral health really does have some influence on a large portion of the body. You can get your own copy of the poster from Implant Seminars. I think I will put one in each hygiene room.

Poster on how periodontal disease links to general health