Periodontitis as a Manifestation of Systemic Disease
Many systemic diseases are linked to periodontitis, specifically because they contribute to an overall weakened resistance to infection and inflammation, or to an abnormality of the connective tissues that affects the gums and increases the likelihood of destruction of these tissues. It is estimated that more than 15 diseases are included in this categorization. Because of the significance of these connections, periodontitis as a manifestation of systemic diseases is included in the seven categories of periodontitis that were chronicled in 1999 by the American Academy of Periodontology. It is important to make a distinction between these secondary diseases and other diseases that may seem epidemiologically associated with periodontitis but do not have a causative connection in which they may contribute to periodontitis. For example, periodontal bacteria can enter the circulatory system through ulcerated periodontal pockets and contribute to arterial plaque that leads to cardiac disease; this is not periodontitis as a manifestation of systemic disease, but rather periodontitis as a possible cause of, or contributing factor to, systemic disease.
Periodontal diseases are extremely common; it is estimated that almost half people over 30 in the United States have some form of periodontal disease, and this number increases with the age of the population. Periodontitis is manifested by periodontal pockets that form between the gums and the teeth when the collagen fibers of the periodontium break down because of inflammation. Eventually, periodontitis results in resorption of the alveolar bone and destruction of the gingival tissue. While it usually progresses slowly, its destruction is generally irreversible unless intercepted in its earliest stages. Because it is painful and largely asymptomatic in its earliest stages, however, it often escapes diagnosis unless patients adhere to recommended frequency of dental checkups, as routine dental checkups include assessments for gingivitis and periodontitis. If left untreated, periodontitis can lead to loss of the teeth and gradual dissolution and reshaping of the bones of the jaw, contributing to a sunken appearance in the face.
The most common disease that is associated in this way with periodontitis is diabetes. The thickening of the blood vessels associated with both type I and type II diabetes impedes the effective removal of waste from the tissues throughout the body and weakens these tissues, including the bones and the gums. Diabetes also leads to higher blood sugar levels throughout the body, including in the mouth. These heightened glucose levels in the fluids in the mouth encourage bacterial growth that leads to gum disease. People with prediabetic conditions, like impaired fasting glucose, are similarly prone to periodontitis.
Periodontitis is also associated with diseases that affect the blood; the most common hematologic diseases that manifest in periodontitis are neutropenia and leukemia. When periodontitis is a manifestation of a hematologic disorder, the patient’s physician and medical team should be consulted when planning treatment for periodontitis. When the hematologic condition is malignant or during active chemotherapy, traditional treatments for periodontitis should be avoided.
Other diseases that may contribute to manifestations of periodontitis include a variety of genetic disorders that affect the connective tissue, the body’s ability to control inflammation, the immune system, and a number of other systemic issues. These genetic disorders range in familiarity from Crohn’s disease, to Down syndrome, to rare disorders like Chédiak–Higashi syndrome and hypophosphatasia.