Periodontitis, Low-Grade Inflammation and Systemic Health: A Scoping Review

Abstract

Background and objectives: Periodontitis is a multifactorial chronic inflammatory infectious disease in which an infection is necessary, but not sufficient, for development of the condition. Individual susceptibility strictly linked to the immune and inflammatory response of the organism must also be present. Low-grade inflammation (LGI) is a systemic status of chronic sub-clinical production of inflammatory factors. This condition represents a risk factor for many chronic diseases including diabetes, cardiovascular disease, cerebrovascular disease, neurodegenerative disease and cancer. This scoping review aims to clarify, summarize and disseminate current knowledge on the possible link between periodontitis, LGI and systemic health. Materials and Methods: PRISMA Extension for Scoping Reviews guidelines were followed. An ad-hoc created keyword string was used to search the electronic databases of PubMed/Medline, Embase, The Cochrane Library and ClinicalTrials.gov. A hand search of specialized journals and their reference lists was also performed. Results: 14 studies that respected eligibility criteria were selected and analyzed. There is emerging evidence of strong links between periodontitis, LGI and systemic health. On the one hand, periodontitis influences the systemic status of LGI and on the other hand, the systemic production of inflammatory factors affects periodontitis with a bidirectional connection. Conclusions: LGI and the subsequent onset of a systemic inflammatory phenotype can be considered the common substrate of many chronic inflammatory diseases including periodontitis, with multiple mutual connections between them. Understanding of the biological principles and mechanisms underlying such a complex interrelationship could lead to significant improvements in the field of personalized diagnostics and therapeutic protocols.

Proanthocyanidins and Flavan-3-ols in the Prevention and Treatment of Periodontitis—Immunomodulatory Effects, Animal and Clinical Studies

“…According to the latest concept of periodontitis etiopathology, the development of the disease requires the co-existence of dental plaque that accumulates on the teeth surface and the patient’s immune-inflammatory response [ 2 ]. Periodontal bacteria cause the mobilization of innate immune response (e.g., large phagocytes like macrophages, antigen-presenting dendritic cells (DCs), natural killer (NK) cells and neutrocytes) as well adaptive immunity mechanisms (T cells and B cells) that leads to the release of pro-inflammatory cytokines including interferon-gamma (IFNγ), interleukin-17 (IL-17), tumor necrosis factor-alpha (TNF-α), interleukin-1 and 6 (IL-1 and IL-6) and enzymes including in particular collagenases like matrix metalloproteinases (MMPs) [ 3 ] ( Figure 1 ).…”

Relations of Psychosocial Factors and Cortisol with Periodontal and Bacterial Parameters: A Prospective Clinical Study in 30 Patients with Periodontitis Before and After Non-Surgical Treatment

“…Stress or anxiety have been identified as risk factors of various pathologies that can influence inflammatory processes and lead to the development of inflammatory diseases [ 14 ]. Acute and chronic psychosocial stress seem to play a role in low-grade inflammation in humans and potential relationships between inflammatory response to this acute psychosocial stress and long-term development of diseases such as cardiovascular disease, diabetes mellitus or periodontal diseases could exist [ 33 , 34 ]. In response to acute psychosocial stress, a transient increase in systemic inflammation has been indeed observed with higher responses in people with either depression or a strong decrease in self-esteem or self-confidence [ 34 ] Atherosclerosis is a good example of a pathological process linked to stress and influenced by inflammatory molecules.…”

Proanthocyanidins and Flavan-3-ols in the Prevention and Treatment of Periodontitis - Immunomodulatory Effects, Animal and Clinical Studies

“…Search strategy as well as inclusion, exclusion criteria and data organization are described in first part of review, in which the antimicrobial activity is discussed. According to the latest concept of periodontitis etiopathology, the development of the disease requires the co-existence of dental plaque and the host's immuneinflammatory response [2]. Periodontal bacteria cause the mobilization of innate immune response (e.g.…”

“…Literature provides the data about anti-inflammatory and antioxidant effects of polyphenols which include falvan-3-ols and proanthocyanidins, drawing conclusions that they can play a beneficial role in the prevention and the progress of chronic diseases related to inflammation such as diabetes, obesity, neurodegeneration, cancers, and cardiovascular diseases, among other conditions [5]. Our review focused on the activity a high potent compounds among polyphenols in relation to periodontitis-a disease closely related to the inflammatory diseases mentioned above [2]. 2.…”

“…Structure of untypical proanthocyanidins isolated from fruits of Vitis vinifera used in the study of Huang et al[2].…”