Periodontitis and pancreatic cancer: the oral–gut microbial axis, pathogenic mechanisms, and potential therapeutic implications

Background Pancreatic cancer is a highly aggressive malignancy with a poor prognosis. Epidemiological studies have suggested a possible association between periodontitis and pancreatic cancer, while microbiome studies have reported alterations in the oral, gut, and pancreatic microbiota.Objective This review examines the evidence linking periodontitis to pancreatic cancer, with particular attention to microbial interactions along the proposed oral–gut microbial axis.Design This narrative review synthesizes current epidemiological, microbiome, and experimental evidence relevant to the potential association between periodontitis and pancreatic cancer.Resluts Experimental studies suggest that periodontitis-associated microorganisms, including Porphyromonas gingivalis and Fusobacterium nucleatum, or their products, may reach the pancreas via digestive or circulatory routes. These microorganisms may influence the development and progression of pancreatic ductal adenocarcinoma through chronic inflammation, immune evasion, virulence factors, microbial metabolites, and the activation of oncogenic signaling pathways. Specific oral and gut microbial features have been investigated as candidate biomarkers. Periodontal treatment, dietary modification, and probiotics have also been studied for their effects on microbial composition and inflammation-related pathways potentially relevant to pancreatic cancer. The clinical relevance of these candidate biomarkers remains to be established, and microbial alterations may either contribute to pancreatic cancer or occur as a consequence of the disease.Conclusions Current evidence supports a possible link between periodontitis and pancreatic cancer, although the role of microbiota in this relationship remains under investigation.