Periodontitis (Gum Disease) & its Risk Association in Diabetes, Pregnancy & Cardiovascular Disease

The Global Burden of Disease (GBD) study 1990-2010 states that oral diseases have high prevalence rate affecting almost 3.9 billion people worldwide. Severe periodontitis and tooth loss being the 6th and 36th most prevalent conditions respectively.1 “Their impact on individuals and communities is considerable in terms of pain and suffering, impairment of function and reduced quality of life and cost of treatment (FDI, World Dental Parliament, 2012).” World Health Organization (WHO)1 has identified periodontal disease, including gingivitis and destructive periodontitis, as one of the three important dental diseases and one of the major causes of adult tooth loss.2 Periodontitis is a chronic multifactorial infectious and inflammatory disease characterized by progressive destruction of the tooth supporting tissues which leads to tooth loss.3 The focal-infection theory, based on the principles of infectious disease established by Koch and Pasteur, put forth the notion that the invasion of the bloodstream by bacteria from a localised infection (such as periodontal diseases) could spread to distant organs and tissues to cause disease. The criteria for establishing a causal association between the two diseases have been further defined and is principally based on the Bradford Hill criteria which include biological plausibility, epidemiological association, and the impact of intervention on one disease affecting the second.4 In recent years there has been keen interest in potential associations between periodontal disease and various chronic systemic diseases and conditions e.g. cardiovascular disease (CVD) , diabetes , adverse pregnancy outcomes (APO), respiratory disease, chronic kidney disease etc. Predominantly CVD, diabetes and APO (preterm low birth weight, preeclampsia) have been frequently documented in scientific literature. Three possible mechanisms have been postulated to play a role in the distant non-oral manifestations of oral diseases: dissemination of bacterial toxins, metastatic infections, and immunological injury. The word “metastasis is not limited only to cancer cells but infections and inflammation also have the potential to metastasize.5 Periodontitis produces inflammatory responses beyond the periodontium. This oral inflammation triggered by the periodontal infection releases inflammatory mediators and increases the systemic inflammation.