Is there a connection between periodontitis and systemic health disorders?

Periodontitis is a chronic inflammatory gum disease that destroys the tissues supporting your teeth. Research increasingly shows that the inflammation and bacteria from periodontitis can affect the rest of your body. While a clear cause-and-effect relationship is not yet proven, strong associations exist between periodontitis and several systemic health disorders, including heart disease, diabetes, liver disease, and rheumatoid arthritis.

What the research says

Multiple reviews and studies have found connections between periodontitis and systemic health. A 2021 review in Periodontology 2000 states that periodontal disease has been associated with diabetes, cardiovascular disease, Alzheimer disease, rheumatoid arthritis, adverse pregnancy outcomes, and cancer ⁹. The review notes that proposed mechanisms include microbial dysbiosis, bacteremia, and an altered host immune response ⁹.

A narrative review from Vellito explains that periodontitis can contribute to systemic disease through microbial translocation, chronic low-grade inflammation, and immune dysregulation, affecting the cardiovascular, metabolic, respiratory, gastrointestinal, and nervous systems ³. Another review specifically links periodontitis to higher risks of coronary heart disease, stroke, and cardiovascular mortality, though it notes that heterogeneous study designs and residual confounding preclude definitive causal inference ⁷.

For liver health, a systematic review found that periodontitis and specific oral pathogens like Fusobacterium nucleatum are independent risk factors for the progression of non-alcoholic fatty liver disease (NAFLD), cirrhosis, and hepatocellular carcinoma (HCC) ⁶. Additionally, a 2022 review in Periodontology 2000 highlights the association between osteoporosis and periodontitis, noting that systemic low bone mineral density is associated with alveolar bone loss, and that inflammation and aging are common mechanistic links ¹⁰.

While the evidence is strong for associations, most studies are observational and cannot prove that periodontitis directly causes these systemic diseases. Interventional studies showing that treating periodontitis reduces the risk of systemic events are still limited ⁷.

What to ask your doctor

• Could my periodontitis be affecting my risk for heart disease or diabetes?
• Should I be screened for other conditions like NAFLD or osteoporosis given my gum disease?
• What are the best ways to manage my periodontal inflammation to potentially improve my overall health?
• Are there any specific oral hygiene or treatment steps I should take to reduce systemic inflammation?