COMMENTARY

Inflammation in Systemic Health and in Periodontal Disease

Anthony M. Iacopino, DMD, PhD

Disclosures

April 07, 2011

In This Article

Comprehensive Care for Periodontal Disease

New knowledge about inflammation in periodontal disease has led to discussion of new approaches to therapy and comprehensive care that includes holistic and interprofessional management of oral and systemic inflammation.[7,8,9] The key points to consider within this new paradigm of patient care are:

  1. Individuals respond differently to periodontal inflammation, systemic inflammatory burden, and anti-inflammatory therapies because of genetics, environment, diet, stress, and lifestyle choices;

  2. Anti-inflammatory therapies may be targeted to reduce/eliminate oral biofilms, dampen the local periodontal inflammatory response, hinder systemic biochemical messengers/mediators, or augment natural body processes to resolve inflammation;

  3. Smoking and visceral fat accumulation around the waist are perhaps the most important determinants of systemic inflammatory burden and response to periodontal inflammation; and

  4. Multidirectional reinforcement of health and wellness messages focused on systemic inflammatory burden need to be coordinated among the dental, medical, and nursing professions as well as nutritionists and caregivers.

The role of the dental professional and the dental team is rapidly changing within the context of overall health and wellness approaches that emphasize reduction of systemic inflammation. Within this paradigm for public health, the dental team will be expected to serve as a referral resource for "high-risk" patients (eg, those with diabetes, cardiovascular disease, and pregnant women) identified by other healthcare professionals (eg, physicians, nurses, pharmacists, allied health workers). Such patients will need to be evaluated for oral health status and provided with care plans that address their individual needs as determined by oral health status, virulence of the oral biofilm, existing systemic diseases/conditions, genetics, environmental factors, and lifestyle choices.

Patients at high risk for elevated systemic inflammation will require more frequent and aggressive prophylaxis and periodontal treatment (ie, as many as 4-6 preventive visits annually and use of biological adjunctives such as antibiotics, host immunomodulators, and local antimicrobials for recalcitrant cases).

Additionally, the dental team will be expected to serve as a portal of entry into the healthcare system for those patients with significant oral inflammation not regularly seeing other healthcare providers through screening and referral for undiagnosed systemic chronic inflammatory diseases/conditions.

Inflammation: What Remains to Be Known

Studies are continuing to investigate inflammation as a common denominator of periodontal disease and chronic diseases of aging. The cumulative damage of cells, tissues, and organ systems mediated through long-standing inflammation is known. The presence of severe periodontal disease contributes significantly to the overall systemic inflammatory burden. At the present time, we cannot definitively conclude that periodontal disease causes systemic illness per se; however, treatment of periodontal disease reduces systemic inflammatory burden, improves the function of vascular elements, and provides better oral health.

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