27 June 2022

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Does gum health have a vital importance?

Lara Figini

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Periodontitis is a chronic inflammatory disease caused by a dysbiotic biofilm in genetically predisposed hosts. It is the sixth most frequent disease in the world, affecting 10% of the population in its most severe forms. Since 2016, periodontitis has been linked to 57 systemic diseases and in recent years a large number of studies in the literature have established its role in causing / increasing the severity of these systemic diseases.

Materials and Methods
In a commentary-analysis of the literature, published in the Journal of Dental Research of January 2021, Dr. Morena Petrini, of the University of Chieti, underlines the "vital" importance of maintaining periodontal health, as its impairment or even lack complete involves the onset of chronic local inflammation with a sustained systemic impact for many years and consequences for general health.

Oral pathogens can spread in the vascular system, stimulate the production of cytokines and cross-reactive antibodies, can promote the onset and persistence of systemic inflammation (as patients with periodontitis have increased systemic levels of inflammatory biomarkers, such as proteins C-reactive CRP) and can promote the formation of atheromas and dyslipidemia (Sanz et al. 2020). Periodontitis and cardiovascular disease (CVD) not only share genetic risk factors but also pathophysiological bacterial and inflammatory factors, so that subjects with poor oral hygiene or those with poor response to periodontal treatment have a higher incidence of acute cardiovascular disease. Systemically healthy patients with chronic periodontitis have a higher risk of developing diabetes and those with both diseases (periodontitis and diabetes) show a higher prevalence of related complications (Graziani et al. 2018). In obese patients, periodontitis is associated with an altered production of hormones, including pancreatic hormone with negative effects on blood sugar, appetite, body weight and immune function (Solini et al. 2019).

Results
Epidemiological evidence based on 19 studies and 640,446 subjects showed that periodontitis is significantly associated with the increased risk of all-cause mortality and deaths due to CVD, cancer, coronary heart disease (CHD) and cerebrovascular disease. The relative risk (RR) of periodontal patients for mortality was found to be 2.58 for CHD and 3.11 for cerebrovascular disease compared to a population with periodontal health (Romandini et al. 2021). These results are to be considered solid as such even considering only the high-quality studies: Subjects with periodontitis have more than double the risk of CVD mortality. Interestingly, this association appears to be influenced not by the severity of periodontitis but by age; as this association was more evident in subjects younger than 65 years. However, it should be noted that these data concern only dentate patients with a periodontal ligament still present. However, it is hoped that in future studies the "edentulism" factor will also be taken into consideration to analyze the association between periodontal disease and increased and early mortality.

Conclusions
Based on the data currently present in the literature, it can be concluded that periodontitis is associated with an increased risk of mortality from certain chronic systemic diseases. In the future, studies should focus more on the association between mortality and edentulism, in order to reduce the risk of underestimating the negative effects of periodontitis on systemic health.

Clinical implications
It is crucial to inform patients about the vital importance of gum health and the role of periodontitis in increasing the incidence of chronic diseases, related complications, and mortality; consequently, periodontal status should be monitored, adhering to preventive and therapeutic regimens.

For additional information: The Vital Importance of Gum Health