Association Between Periodontitis and All-cause and Cancer Mortality

Retrospective Elderly Community Cohort Study

Ping-Chen Chung; Ta-Chien Chan


BMC Oral Health. 2020;20(168) 

In This Article


Periodontitis is a process in which periodontal bacteria[1] and viruses[2] lead to a host immune-inflammatory response in periodontal tissues that causes periodontal pocket formation, attachment loss and bone loss. Numerous studies have pointed out the relationship between periodontitis and systemic diseases such as cardiovascular disease,[3] diabetes,[4] respiratory disease, especially chronic obstructive pulmonary disease,[5] and chronic kidney disease.[6] Furthermore, periodontitis is also associated with several types of cancers such as lung,[7] esophageal,[8] pancreatic,[9] kidney,[10] and haematological cancer.[11] Periodontal infection induces inflammation that may increase the risk of tumor-promoting effects.[12,13]

Periodontitis is a serious public health issue throughout the world. In 2010, severe periodontitis was the sixth most prevalent condition globally.[14] Globally, the prevalence of severe periodontitis peaked at age 60 to 64 years old, and the global age-standardized prevalence of severe periodontitis was 9.8% (95% uncertainty interval, 8.2 to 11.4%) in 2017.[15] The prevalence of periodontitis significantly increased from 11.5% in 1997 to 19.59% in 2013 in Taiwan. The pattern of mean age for periodontitis decreased from 1997 to 2013 (mean age ± standard deviation: 54.46 ± 14.47 and 45.51 ± 16.58 years old, respectively).[16] A cross-sectional nationwide survey on periodontal conditions in Taiwan between 2007 and 2008 revealed that the prevalence of a value of 3 or greater on the community periodontal index ((CPI) ≥3), which is used to measure the periodontal status and record bleeding, calculus and pocket depth, among those 65 to 74 years old and above 74 years old was 72.7 and 76.7% respectively.[17,18] Severe periodontitis is related to poor oral health conditions which can lead to tooth loss, unclear speaking, difficulty chewing and swallowing, poor nutrition, and poor quality of life.[19]

Pathogenic microorganisms such as Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia lead to chronic inflammation and destruction of periodontal soft and hard tissues.[20] The spread of bacteria and inflammatory mediators from the oral cavity can elevate and sustain systemic inflammatory conditions and damage to various organs.[9,21] The inflammatory reaction directly or indirectly induces cell proliferation and the release of reactive oxygen species and other metabolites that can promote cancer initiation.[21,22]

Thus, the primary goal of periodontal therapy is to arrest the inflammatory disease process. Regardless of age, nonsurgical and surgical periodontal treatments for periodontal disease are effective therapies, removing subgingival biofilm and doing plaque control to maintain periodontal health.[23,24] The aim of this study was to assess the association between periodontitis and all-cause mortality, all-cancer and specific cancers' mortality in a health examination cohort of the elderly in the communities.