Periodontal disease has spread all over the world. According to data published in 2003 by the Italian Periodontology Society, it was revealed that in Italy 60-70% of adults suffer from varying degrees of periodontal disease, and that of these, 10-14% have a severe and advanced form of the disease. The increased incidence is drastic in the 35-44 age bracket, even though in 7-8% of cases, the disease appears at an early age. According to the latest scientific findings, the high concentration of pathogenic bacteria in periodontal lesions causes episodes of bacteraemia and the entering of toxins into the bloodstream, which can be connected to the onset and continuation of major systemic diseases.
Characteristics of periodontitis
Patients who suffer from periodontal disease develop alterations in the inflammatory parameters of the whole body and consequently it can be assumed that inflammation localised at the level of the gums is able to spread to the rest of the body in the bloodstream. In fact, these patients have much higher levels of granulocytes, neutrophils, C-reactive protein and other inflammatory parameters. Suffering from constantly elevated inflammation, also consisting of high C-reactive protein parameters, is considered to be an excellent predictor of the onset of atherosclerotic disease and myocardial infarction.
Periodontitis and systemic diseases
As reported by Haumschild M.S. et al. 2009, epidemiological studies have indicated that more than 15% of the population in the western world suffer from severe forms of periodontal disease. For this reason, there has been increased scientific focus on the connection between oral health and systemic diseases over recent years. Emerging evidence has shown a close link between the effects of chronic inflammation of the mouth and health in general. The relationship between systemic diseases and periodontitis is due to the inflammatory mechanisms involved; therefore, periodontal disease is now considered a risk factor for the development of systemic diseases. Certain systemic diseases can have a devastating impact on oral health. There are more than 100 systemic diseases that have oral symptoms, such as cardiovascular infections, pancreatic cancer, diabetes and nutritional disorders (Haumschild M.S. et al. 2009).
There is a two-way link between diabetes mellitus and periodontal disease. Diabetic patients have a stronger predisposition for periodontal disease and a greater difficulty in controlling their metabolic glucose levels if not treated. Alterations to glucose control in diabetics are caused by the continuous passage of bacterial toxins and bacteria into the blood and an excessive release of inflammatory mediators (Lamster I.B. et al. 2008; Dunning T. 2009; Williams R.C. et al. 2008). The American Diabetes Association has reported that there is a connection between oral health conditions and glucose control and that people with uncontrolled diabetes are subject to major risks of infections with abnormal wound healing and a higher probability of developing periodontitis and cardiovascular diseases.
It has been demonstrated that periodontal bacteria are aetiological factors for the development of cardiovascular disease. A recent study conducted on sclerotic tissue surgically removed and analysed with the most modern biomolecular analysis techniques (real-time PCR), revealed the presence of bacteria such as Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens and Tannerella forsitia. These bacteria were detected in the atheromatous plaques of the coronary arteries in 90% of patients with confirmed periodontal disease. The significant number of periodontal species found in the samples of sclerotic tissue of patients with periodontitis suggests that the presence of these microorganisms in the coronary lesions is not just a coincidence and that, in fact, they contribute to the development of vascular disease (Gaetti-Jardim E. Jr et al 2009).
There are multiple risk factors for developing arteriosclerotic disease (ischaemic heart disease, peripheral arterial disease, and ischaemic stroke). The basis of the pathogenesis of atherosclerosis is the same as that of periodontitis and it has been demonstrated how the extent and consistency of the association between periodontal disease and arteriosclerotic disease is greater in the development of ischaemic stroke (Joshipura K. et al.2009).
Preterm births and female fertility:
The hormonal changes that occur during pregnancy have a direct effect on the periodontium structure, increasing the vascular permeability of the gingival tissues with a more widespread dissemination of bacteria, interleukins and LPS (Novák T. et al. 2009). As demonstrated in several studies, the antigens of Porphyromonas gingivalis have been identified in the placental tissues of subjects suffering from periodontal disease. This is an indication that the placenta may be by-passed by these microorganisms, and therefore periodontitis has been included among the risk factors in the case of preterm births (Katz J. et al 2009). Moreover, a study has recently been conducted in Australia that demonstrates the correlation between female infertility and bacteria of the periodontal disease. (R. Hart et al 2011).
A group of Turkish researchers has discovered that erectile problems are more frequent among males who suffer from periodontitis. In fact, subjects suffering from this disease have a 3.29 times higher chance of suffering from erectile dysfunction compared to those with no gingival problems. (Fatih O. M. et al 2012).