Periodontitis as a Manifestation of Systemic Disease

Periodontitis as a manifestation of systemic disease is included among the specific categories of periodontitis defined in 1999 by the American Academy of Periodontology. This category specifically includes diseases that have some sort of causal relationship with periodontitis, contributing to a weakened resistance to infection or to an abnormality in the gum tissue itself, and thereby increasing the risk of periodontitis. The category explicitly does not include diseases that may have some correlation with periodontitis but cannot be connected in this type of causal relationship, such as coronary disease or erectile dysfunction.

Thus far, it is believed that about 16 diseases can contribute to the likelihood of periodontitis for the reasons clarified above. The systemic condition that is most commonly related to periodontitis is diabetes. Diabetes causes systemic inflammation throughout the body, including thickening of the blood vessels; this reduces blood flow, which weakens the body’s tissues, including the gums and the bones. Diabetes is also characterized by increased amounts of blood sugar, which increases the glucose levels in the saliva. Bacteria in the oral cavity feed on glucose, and an increased amount of glucose in the saliva therefore increases the amount of bacteria in the oral cavity, increasing the likelihood of gum disease. Unfortunately, increased inflammation in the oral cavity can also contribute to increased blood glucose levels, which can create a cycle of disease. Excellent oral hygiene, both at home and with clinical care, combined with management of the blood’s glucose levels, can help keep gum disease associated with diabetes from developing or from worsening.

Periodontitis may also appear in connection with hematologic disorders, which are diseases that affect the blood and the organs that work to make blood. These diseases include complications from chemotherapy or blood transfusions, and they also include certain genetic disorders, which tend to be rare. If a patient has periodontitis as a manifestation of a hematologic disorder, the patient’s dentist should work closely with the patient’s general practitioner to devise and implement treatment plans. If urgent periodontal treatments are necessary during malignancy or active phases of chemotherapy, it is recommended that these treatments focus on antimicrobial therapies rather than mechanical ones.

Genetic disorders associated with periodontitis may cause connective tissue dysfunction, leading to the compromised health of the gums and bone, or they may adversely affect the host’s immune response, leading to an inability to effectively manage infection. While most of these genetic disorders are rare, some of the more well-known genetic disorders that may contribute to periodontitis are Down syndrome and Crohn’s disease. The immunological factors and connective tissue dysfunctions that are associated with these disorders can create an environment that is more conducive to periodontitis, but the presence of a proliferation of pathogens in the oral cavity remains the primary underlying cause of gum disease. Periodontitis can be managed with excellent oral hygiene and periodic dental checkups and professional cleanings. Depending on the nature of the underlying systemic disease, treatment plans may need to be created in conjunction with the patient’s general practitioner, and a complete medical history, including a notation of all medications, is an integral part of any treatment or management plan.