Periodontal Medicine: 100 Years of Progress

Abstract

Periodontal medicine is a term used to describe how periodontal infection/inflammation may impact extraoral health. Periodontitis has been linked to over 50 systemic diseases and conditions. As part of the Journal of Dental Research’s Centennial Celebration, this narrative review discusses periodontal medicine research done over the past 100 y, with particular focus on the effects of periodontal disease on 3 pathological conditions: cardiovascular disease, diabetes mellitus, and adverse pregnancy outcomes. We selected 29 total studies that were the “first” of their kind, as they provided novel observations or contributed to shifting paradigms as well as important studies that made strong contributions to progress in understanding relationships to the systemic conditions. These studies were organized in an overview timeline and broken down into timelines by topic: cardiovascular disease ( n = 10), diabetes ( n = 12), and adverse pregnancy outcomes ( n = 7). Overall, the majority of cross-sectional, case-control, and longitudinal studies have revealed positive associations between poor periodontal status and cardiovascular disease, diabetes metabolic control, and a number of adverse pregnancy outcomes, and these associations are upheld in systematic reviews. Findings from randomized controlled trials testing the effects of periodontal therapy on systemic health outcomes were conflicting and inconsistent. While there has been a great deal of progress, we highlight lessons learned and make comments and suggestions on a number of key aspects, including the heterogeneity of case definitions of periodontal disease across studies, accounting for features of the periodontal phenotype that are most relevant to the biological link between periodontitis and systemic outcomes, the role of other comorbid inflammatory conditions, selection of study participants, and timing and intensity of the periodontal intervention.

Clinical application of the new classification of periodontal diseases: Ground rules, clarifications and “gray zones”

“…Substantial evidence from large clinical databases involving >150,000 patients with a chronic inflammatory disease compared with >370,000 controls indicate that the presence of certain chronic inflammatory diseases influences the likelihood of a second chronic disease to be concomitantly manifested . Although there is substantial evidence associating periodontitis with other diseases such as cardiovascular disease, Type II diabetes, and adverse pregnancy outcomes, evidence that treatment of periodontitis will result in predictable benefits with respect to any of those systemic conditions is rather limited . The systemic inflammatory burden of periodontitis is well‐documented, at least as measured by high sensitivity C‐reactive protein (hsCRP) .…”

Poor oral health conditions and cognitive decline: Studies in humans and rats

“…This disease adversely affects oral health and is associated with systematic inflammatory conditions. Indeed, periodontitis has been linked to more than 50 systemic conditions and diseases [12,13]. Nevertheless, a precise understanding of the complex relationship between oral health such as periodontitis and cognitive decline is lacking.…”

Interleukin‑1α and ‑1β assessment in the gingival crevicular fluid of periodontal patients with chronic hepatitis C

“…A large number of systemic conditions can have oral or periodontal manifestations (13). The correlation between PD and various systemic conditions such as diabetes mellitus (DB), cardiovascular disease (CAD), rheumatoid arthritis (RA) and others has been intensely studied and relevant results have been united under the concept of 'periodontal medicine', which offers practitioners a comprehensive perspective of PD pathology, diagnosis and therapeutic strategies (14).…”