Periodontitis as a Manifestation of Systemic Disease

Included in the seven categories of periodontitis that were defined in the American Academy of Periodontology’s 1999 classification system, and also present in the narrower 2017 classification, is periodontitis as a manifestation of systemic diseases. Periodontitis has been linked to no fewer than 16 systemic diseases. These diseases are related to periodontal disease because they can lead to decreased infection resistance, or to a dysfunction that increases susceptibility to inflammation and the destruction inflammation eventually can cause. While there are some diseases that are connected, epidemiologically, with periodontitis, there is no verifiable causative connection. These connected yet not causative diseases include coronary heart diseases, diseases of the blood vessels in the brain, and erectile dysfunction. The confounding conditions present when studying risk factors for systemic diseases and for periodontitis, many of which overlap. Age, gender, smoking, socio-economic status, obesity, and many other factors contribute to diseases of the periodontium and of the larger biological systems; these diseases are not taken into consideration when examining periodontitis as a manifestation of systemic disease, as there is not a cause-and-effect correlation between the diseases. While it is also widely believed that periodontitis can contribute to systemic diseases, as bacteria can enter the bloodstream through inflamed periodontal pockets, periodontitis as a manifestation of systemic disease is a specific category that defines systemic diseases that directly contribute to the presence of periodontitis. Periodontitis may be a result of systemic inflammation that characterizes these systemic diseases, or it may arise because of a weakened immune system, chromosomal disorders, connective tissue defects, or other factors that are directly linked to certain genetic diseases and foster ideal host environments for the development of periodontitis.

Diabetes is one health condition that is directly associated with periodontitis. People with prediabetic levels of fasting glucose also have an increased degree of periodontal inflammation. Periodontitis is also associated with hematologic disorders, including acquired neutropenia and leukemia. When periodontitis is associated with hematologic disorders, it is imperative that treatment planning be coordinated with the patient’s primary care doctor. When hematologic conditions are malignant, periodontal therapies should be avoided during malignant phases or during active chemotherapy. Antimicrobial therapies may be considered when urgent treatment is needed and the patient’s granulocyte counts are low.

Periodontitis is also associated with multiple genetic disorders. These disorders include familial and cyclic neutropenia, Down syndrome, leukocyte adhesion deficiency disorder, Papillon-Lefèvre syndrome, Chédiak-Higashi syndrome, Langerhans cell disease, glycogen storage disease, chronic granulomatous disease, infantile genetic agranulocytosis, Cohen syndrome, types IV and VIII Ehlers-Danlos syndrome, hypophosphatasia, Crohn’s disease, Marfan syndrome, and Klinefelter syndrome. In some cases, the presence of periodontal symptoms may be the first indication of one of these underlying systemic disorders, or it may indicate the progression of one of these diseases. For this reason, it is important for dental health practitioners to be familiar with the characteristics of the range of genetic disorders that impact the tissues of the periodontium Not only can this familiarity facilitate diagnosis, it may also help all medical professionals more completely understand the complexity of genetically occurring systemic disease.