Inflammation in Systemic Health and in Periodontal Disease

Anthony M. Iacopino, DMD, PhD


April 07, 2011

In This Article

Role of Inflammation in Oral and Overall Health

A body of evidence is emerging that supports interrelationships between periodontal disease and inflammatory-driven disease states. Evidence for some of these interrelationships appears stronger than for others. Although causation studies are lacking, current evidence suggests that periodontitis is much more than a localized oral infection. Recent studies indicate that periodontitis causes changes in systemic physiology and blood biochemistry, which alter immune function, serum lipid levels, and inflammatory biomarkers leading to a systemic inflammatory state. However, these changes are reversible with periodontal treatment.[4,5,6,7] The evidence to support these interrelationships is sufficient for governmental authorities, educational institutions, private insurers, and professional associationsto announce a call to action to increase awareness, secure funding, and deepen the investigation of oral-systemic connections.

In periodontal disease, oral bacteria and byproducts of their metabolism invade the deep connective tissues around the teeth.[2] The local host immune response (mediated by neutrophils and macrophages) produces a wide array of inflammatory cytokines (the most notable being the interleukin and tumor necrosis factor alpha class of cytokines, specifically IL-1, IL-6, and TNF-α) that function as very strong biochemical mediators of local tissue destruction. The highly vascular nature of this inflamed tissue serves as a portal of entry into the systemic circulation, and studies have demonstrated transient bacteremia/endotoxemia during masticatory function and even at rest. This may serve as a "systemic exposure" to the oral biofilm, initiating additional production of inflammatory cytokines from circulating immune cells (neutrophils and monocytes). This initial inflammatory signal is processed further in the liver to generate a second set of inflammatory mediators termed acute phase proteins (the most important being C-reactive protein). These proteins amplify the systemic inflammatory signal, producing significant elevations in the level of systemic inflammation.

Systemic Inflammation and Health

Systemic inflammation is believed to be a major threat to satisfactory health and healthy living. Strong associations exist between chronic systemic inflammation and cardiovascular disease, diabetes, cancer, arthritis, dementia, and many other chronic diseases of aging. Two recent publications highlighted the nature of chronic inflammation as part of periodontal disease, as a systemic result of periodontal disease, and as a major negative factor for overall general health.[1,7] The relationship between periodontal disease, inflammation, and general health has been discussed in the literature for several years[6]; however, recent studies have provided more specific and comprehensive evidence for the mechanistic linkages. There is increasing acceptance that periodontal disease shares some of the same chronic inflammatory mechanisms as do other systemic conditions and that periodontal disease increases the overall systemic inflammatory burden leading to exacerbation of these conditions. The following diagram (Figure 2) illustrates this biological cascade and natural history.

Figure 2. Pathogenesis of oral health and systemic disease. CRP = C-reactive protein.


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