References (Periodontal Disease: A Hidden Risk Factor for Cardiovascular Health)

Aleksijević, L. H., Aleksijević, M., Škrlec, I., Šram, M., Šram, M. & Talapko, J. Porphyromonas gingivalis virulence factors and clinical significance in periodontal disease and coronary artery diseases. Pathogens 11, 1173 (2022). https://doi.org/10.3390/pathogens11101173.

Paquette, D. W. Periodontal infection and cardiovascular disease. Nihon Shishubyo Gakkai Kaishi 44, Supplement2_41 (2002).
Periodontal infections may contribute to cardiovascular disease through systemic inflammation and microbial dissemination. Observational studies show associations between periodontal disease and atherosclerosis, though causality remains unclear. Improved definitions of infectious exposure in recent studies support a link, but interventional trials are needed to confirm whether treatment reduces cardiovascular risk.

Gadsby, R. The association of periodontal disease, diabetes and cardiovascular disease. Br. J. Diabetes Vasc. Dis. 8, 191–196 (2008).
Periodontitis is linked to increased risk of coronary heart disease and diabetes. Mechanistic evidence implicates systemic inflammation and shared risk factors, while epidemiological studies show consistent associations. Further research is necessary to define the population-level impact and guide preventive strategies.

Brun, A. et al. Periodontitis: An underestimated risk of cardiovascular diseases. Medecine/Sciences 40, 1–8 (2024).
Chronic periodontitis may promote atherosclerosis through low-grade systemic inflammation and recurrent bacteremia. Evidence indicates that periodontal treatment can improve cardiovascular health parameters, supporting integrated preventive strategies for oral and systemic disease.

Dumitrescu, A. L. Influence of periodontal disease on cardiovascular diseases. Rom. J. Intern. Med. 43, 1–2 (2005).
Individuals with periodontitis may have elevated risk for cardiovascular diseases independent of traditional risk factors. The inflammatory mechanisms of periodontal disease may exacerbate systemic vascular inflammation, though more interventional studies are required to assess causal relationships.

Rahimi, A. & Afshari, Z. Periodontitis and cardiovascular disease: A literature review. ARYA Atherosclerosis 17, 2362 (2021).
Periodontitis is associated with myocardial infarction, hypertension, heart failure, and peripheral artery disease. Treatment of periodontal disease may help improve cardiovascular outcomes, but further studies are required to establish definitive causal links.

Eno Belinga, L. et al. Association between periodontal diseases and cardiovascular diseases in Cameroon. J. Public Health Afr. 9, 761 (2018).
Observational data indicate that both gingivitis and periodontitis are associated with increased prevalence of cardiovascular diseases. These findings highlight the importance of oral health management in reducing cardiovascular risk in the population.

Osiak, J. et al. Oral microbial dysbiosis in cardiovascular diseases. J. Educ. Health Sport 41, 1–13 (2023).
Oral dysbiosis may contribute to cardiovascular disease through immune activation, inflammatory mediators, and bacterial translocation into circulation. Preventive strategies including oral hygiene, diet, and periodontal care could mitigate these systemic effects.

Humagain, M. et al. Periodontal infections and cardiovascular disease: Is it a mere association? Kathmandu Univ. Med. J. 4, 15 (2006).
Evidence supports a link between periodontal infection and cardiovascular disease, with inflammation as a key mediator. Epidemiologic studies suggest that oral health maintenance may benefit systemic cardiovascular outcomes.

Gianos, E. et al. Oral health and atherosclerotic cardiovascular disease: A review. Am. J. Prev. Cardiol. 7, 100179 (2021).
Poor oral health is increasingly recognized as a contributor to atherosclerotic cardiovascular disease. Mechanistic pathways include systemic inflammation and shared risk factors, highlighting the need for preventive oral health strategies.

Dave, S. et al. Cardiovascular disease and periodontal diseases: commonality and causation. Compend. Contin. Educ. Dent. 25, 7 Suppl 1 (2004).
Periodontal inflammatory processes may amplify systemic inflammation, contributing to atherosclerosis and cardiovascular risk. This review emphasizes the need to understand oral-systemic links for comprehensive disease prevention.

Ettinger, G. et al. The influence of the human microbiome and probiotics on cardiovascular health. Gut Microbes 5, 983775 (2014).
Microbial populations, including oral pathogens, can influence cardiovascular health through inflammatory and metabolic pathways. Probiotics may offer therapeutic potential to modulate these effects and reduce cardiovascular risk.

Martos, R. & Márton, I. Correlations between dental-oral infections and cardiovascular disease. Fogorvosi Szemle 101, 3 (2008).
Chronic oral infections act as sources of systemic inflammation, potentially contributing to atherogenesis and cardiovascular disease progression. Controlling local oral infections may reduce systemic inflammatory burden.

Liccardo, D. et al. Periodontal disease: A risk factor for diabetes and cardiovascular disease. Int. J. Mol. Sci. 20, 1414 (2019).
Periodontitis triggers systemic inflammation that exacerbates cardiovascular and metabolic disorders. Evidence suggests a bidirectional relationship, with improved oral health potentially reducing disease severity and progression.

Gheorghita, D. et al. Periodontal disease, a risk factor for atherosclerotic cardiovascular disease. Orv. Hetil. 160, 11 (2019).
Chronic periodontal infections serve as reservoirs for proinflammatory mediators and bacterial toxins, promoting systemic inflammation and atherogenesis. Periodontal treatment may reduce cardiovascular risk through inflammation modulation.

Carrizales-Sepúlveda, E. F. et al. Periodontal disease, systemic inflammation and the risk of cardiovascular disease. Heart Lung Circ. 27, 11 (2018).
Periodontal inflammation can trigger systemic inflammatory responses that exacerbate atherosclerosis. The severity of periodontal disease correlates with cardiovascular risk markers, suggesting potential benefits from periodontal intervention.

Demmer, R. T. & Desvarieux, M. Periodontal infections and cardiovascular disease: The heart of the matter. J. Am. Dent. Assoc. 137, 10 SUPPL. (2006).
Evidence supports associations between periodontal infections and vascular disease. Emerging data suggest that improved oral care could positively impact cardiovascular outcomes, though large-scale clinical trials are needed.

Guiglia, R. et al. The association between periodontal diseases and cardiovascular diseases: A narrative review. Panminerva Med. 50, 4 (2008).
Periodontal disease may influence cardiovascular risk through systemic inflammatory responses and microbial mechanisms. Current evidence is suggestive but not definitive, emphasizing the need for longitudinal studies.

Qi, J. et al. Periodontal antibodies and all-cause and cardiovascular disease mortality. J. Dent. Res. 99, 1 (2020).
Serum antibodies against specific periodontal pathogens are associated with all-cause and cardiovascular mortality. These findings suggest that immune responses to oral microbes may predict systemic disease outcomes.

Bassani, B. et al. Neutrophils’ contribution to periodontitis and periodontitis-associated cardiovascular diseases. Int. J. Mol. Sci. 24, 15370 (2023).
Neutrophil dysfunction in periodontitis can promote chronic inflammation and systemic comorbidities, including cardiovascular disease. Targeting neutrophil-mediated pathways may reduce disease progression and systemic impact.

Sanchez, P. et al. Oral healthcare and cardiovascular disease: A scoping review of current strategies and implications for nurses. J. Cardiovasc. Nurs. 32, 3 (2017).
Maintaining oral health in cardiovascular patients may reduce systemic inflammation and improve outcomes. Nurses play a key role in promoting oral health, although strategies in cardiac care remain underdeveloped.

Ahmed, U. & Tanwir, F. Association of periodontal pathogenesis and cardiovascular diseases: A literature review. Oral Health Prev. Dent. 13, 1 (2015).
Periodontal bacteria and inflammation may contribute to atherosclerosis and cardiovascular disease. Interventional studies indicate that periodontal treatment can lower systemic inflammatory markers and potentially reduce cardiovascular risk.

Shanker, J. & Kakkar, V. V. Role of periodontal infection in cardiovascular disease: A current perspective. Arch. Med. Sci. 5, 2 (2009).
Inflammation and immune responses induced by periodontal pathogens are key contributors to cardiovascular pathology. Clinical and animal studies support a mechanistic link, highlighting the potential systemic benefits of periodontal therapy.

F., Bromo et al. Oral health as prevention for cardiovascular diseases: ESOHAR study. Ital. J. Med. 7, 2013.
Educational interventions on oral hygiene can reduce shared risk factors for periodontal and cardiovascular diseases. Family-based oral health promotion may contribute to long-term cardiovascular risk reduction.

Carramolino-Cuéllar, E. et al. Relationship between the oral cavity and cardiovascular diseases and metabolic syndrome. Med. Oral Patol. Cir. Bucal 19, 3 (2014).
Poor oral hygiene is moderately associated with cardiovascular disease and metabolic syndrome. The inflammatory response may mediate these effects, underscoring the importance of maintaining oral health for systemic outcomes.

Ionel, A. et al. Risk and protective factors in periodontal disease and cardiovascular pathology. Clujul Med. 88, 2015.
Periodontitis prevalence correlates with cardiovascular disease and diabetes. Healthy lifestyles and sustained oral care appear protective, supporting the link between oral and systemic health.

Ionel, A., Lucaciu, O., Moga, M., Ilea, A., Buhatel, D., Feurdean, C., Sava, A., Sarbu, A., Pop, A., Bondor, C., Campian, R. S. Risk and protective factors in periodontal disease and cardiovascular pathology. Clujul Medical 88 (2015).
Chronic periodontitis is highly prevalent and strongly associated with systemic conditions, particularly cardiovascular disease and diabetes. Lifestyle factors, such as physical activity and general health habits, appear protective, suggesting the importance of integrated preventive approaches in public health.

Beck, J. D. & Offenbacher, S. The association between periodontal diseases and cardiovascular diseases: a state-of-the-science review. Annals of Periodontology / the American Academy of Periodontology 6, 1–14 (2001).
Evidence from case-control, cross-sectional, and longitudinal studies indicates that periodontitis may increase cardiovascular risk through systemic inflammation and microbial involvement. Most studies were limited by crude periodontal measures, highlighting the need for molecular epidemiology studies to better assess mechanistic pathways.

Nesse, W., Spijkervet, F. K. L., Abbas, F., Vissink, A. [Links between periodontal disease and general health. 1. Pneumonia and cardiovascular disease]. Nederlands Tijdschrift voor Tandheelkunde 113, 5 (2006).
Oral pathogens can translocate to systemic sites, contributing to pneumonia and cardiovascular disease. Periodontal interventions and preventive oral care may reduce systemic inflammatory burden, supporting the concept of oral-systemic health integration.

Morón-Araújo, M. Periodontitis and its relationship with cardiovascular diseases. Promotion of cardiovascular health from the dental office. Revista Colombiana de Cardiologia 28, 5 (2021).
Periodontitis promotes systemic inflammation that increases cardiovascular risk. Dental offices serve as strategic points for preventive care and education to mitigate systemic complications, emphasizing the dual role of oral and cardiovascular health management.

Bouchard, P., Boutouyrie, P., D’Aiuto, F., Deanfield, J., Deliargyris, E., Fernandez-Avilés, F., Hughes, F., Madianos, P., Renvert, S., Sanz, M. European workshop in periodontal health and cardiovascular disease consensus document. European Heart Journal, Supplement 12, SUPPL. B (2010).
Expert consensus confirms strong epidemiological associations between periodontal disease and cardiovascular disease but finds insufficient evidence that periodontal interventions directly reduce cardiovascular events. Oral health promotion is encouraged as part of general systemic health maintenance.

Rughwani, R. R., Cholan, P. K., Victor, D. J. Contemporary Consortium of Periodontal Diseases and Atherosclerotic Cardiovascular Diseases – A Narrative Review. Journal of Clinical and Diagnostic Research (2022).
Periodontal infections serve as reservoirs of microbial endotoxins that enter circulation, triggering systemic inflammation. This review emphasizes shared pathogenic mechanisms linking periodontitis with atherosclerotic cardiovascular disease and highlights the importance of maintaining oral hygiene in high-risk patients.

De Angelis, F., Basili, S., Giovanni, F., Trifan, P. D., Di Carlo, S., Manzon, L. Influence of the oral status on cardiovascular diseases in an older Italian population. International Journal of Immunopathology and Pharmacology 32 (2018).
Oral health status, including tooth loss and periodontal index scores, is significantly associated with cardiovascular disease risk among older adults. Coordination between dental and medical professionals is critical for early identification and prevention of cardiovascular complications.

Postolache, T. T., Makkar, H., Wadhawan, A., Dagdag, A., Reynolds, M. A., Merchant, A. T. Periodontal, metabolic, and cardiovascular disease: Exploring the role of inflammation and mental health. Pteridines 29, 1 (2018).
Inflammatory pathways link periodontal disease to metabolic and cardiovascular conditions, with mental health potentially modulating these effects. Longitudinal and interventional studies are needed to explore causal mechanisms and identify preventive strategies across clinical domains.

Gupta, M., Chaturvedi, R., & Jain, A. (2015). Role of cardiovascular disease markers in periodontal infection: Understanding the risk. Indian Journal of Dental Research, 26(3), 162–873. doi:10.4103/0970-9290.162873
This study investigated the correlation between serum and gingival crevicular fluid (GCF) levels of inflammatory mediators sCD40L and MCP-1 in patients with severe chronic periodontitis. Both markers strongly correlated before and after periodontal therapy, suggesting a mechanistic link between periodontitis severity and systemic cardiovascular risk.

Zykova, A.S., Opravin, A.S., & Soloviev, A.G. (2024). Periodontitis as a risk factor for cardiovascular disease development: systematic review. Parodontologiya, 29(1), 806. doi:10.33925/1683-3759-2024-806
This systematic review of 32 studies confirmed a relationship between inflammatory periodontitis and cardiovascular diseases (CVD), including myocardial infarction and hypertension, highlighting the role of systemic inflammation from periodontal pathogens as a contributing factor.

Codella, R., Della Guardia, L., Terruzzi, I., Solini, A., Folli, F., Varoni, E.M., Carrassi, A., & Luzi, L. (2021). Physical activity as a proxy to ameliorate inflammation in patients with type 2 diabetes and periodontal disease at high cardiovascular risk. Nutrition, Metabolism and Cardiovascular Diseases, 31(8), 1045–1054. doi:10.1016/j.numecd.2021.04.022
This perspective explored a “three-way relationship” linking periodontal disease, type 2 diabetes, and cardiovascular risk, proposing that physical activity can reduce systemic inflammation and potentially attenuate the progression of both conditions.

Shetty, D., Dua, M., Kumar, K., et al. (2012). Oral Hygiene Status of Individuals with Cardiovascular Diseases and Associated Risk Factors. Clinics and Practice, 2(4), e86. doi:10.4081/cp.2012.e86
In 200 Indian adults with CVD, poor oral hygiene correlated with higher prevalence of periodontitis, supporting the hypothesis that periodontal care may reduce cardiovascular risk and improve systemic health outcomes.

Tabeta, K., Yoshie, H., & Yamazaki, K. (2014). Current evidence and biological plausibility linking periodontitis to atherosclerotic cardiovascular disease. Japanese Dental Science Review, 50(3), 123–134. doi:10.1016/j.jdsr.2014.03.001
This review summarized mechanistic evidence linking periodontitis to atherosclerotic cardiovascular disease (ACVD), emphasizing inflammatory mediators, bacterial pathogens, and altered lipid metabolism as plausible contributors to vascular pathology.

Sridhar, R., Byakod, G., Pudakalkatti, P., & Patil, R. (2009). A study to evaluate the relationship between periodontitis, cardiovascular disease and serum lipid levels. International Journal of Dental Hygiene, 7(2), 123–130. doi:10.1111/j.1601-5037.2008.00318.x
In a cohort of 120 subjects, periodontitis did not significantly alter serum lipid profiles or exacerbate periodontal tissue destruction in patients with coronary heart disease, suggesting lipid-independent pathways in periodontal–cardiovascular associations.

Febbraio, M., Roy, C.B., & Levin, L. (2022). Is There a Causal Link Between Periodontitis and Cardiovascular Disease? A Concise Review of Recent Findings. International Dental Journal, 72(1), 45–53. doi:10.1016/j.identj.2021.07.006
Recent intervention studies fail to confirm causality between periodontitis and CVD despite strong epidemiologic association, highlighting the need for high-quality, blinded trials with cardiovascular outcomes.

Lazureanu, P.C., et al. (2021). Saliva pH and flow rate in patients with periodontal disease and associated cardiovascular disease. Medical Science Monitor, 27, 931362. doi:10.12659/MSM.931362
Severe periodontal disease was linked to reduced salivary flow and acidity, and these parameters correlated with the presence of cardiovascular disease. Oral hygiene interventions improved both salivary markers and periodontal status.

Dhadse, P., Gattani, D., & Mishra, R. (2010). The link between periodontal disease and cardiovascular disease: How far we have come in last two decades? Journal of Indian Society of Periodontology, 14(3), 150–157. doi:10.4103/0972-124x.75908
This review critically evaluated epidemiologic and interventional studies on periodontitis and cardiovascular disease, concluding that chronic low-grade inflammation may mediate cardiovascular risk but heterogeneity remains across studies.

Kapellas, K., et al. (2014). Associations between periodontal disease and cardiovascular surrogate measures among Indigenous Australians. International Journal of Cardiology, 173(2), 335–340. doi:10.1016/j.ijcard.2014.02.015
In Indigenous Australians, extent of periodontal pocketing correlated with arterial stiffness (pulse-wave velocity), indicating a subclinical impact of periodontitis on cardiovascular function.

Ionel, A., et al. (2016). Assessment of the relationship between periodontal disease and cardiovascular disorders: A questionnaire-based study. Clujul Medical, 89(4), 523–531. doi:10.15386/cjmed-639
Periodontitis was identified as a predictive factor for atherosclerotic coronary artery disease, with lifestyle factors such as smoking and low fruit intake modulating risk.

RBR-66tr7h (2020). Systemic Effect of Periodontal Therapy on Risk Markers of Acute Cardiovascular Events. WHO Trial Registry. https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-66tr7h
This clinical trial evaluated the impact of non-surgical periodontal therapy on cardiovascular biomarkers, aiming to establish whether different therapeutic protocols influence systemic risk.

Zadik, Y., et al. (2009). Erectile dysfunction might be associated with chronic periodontal disease: Two ends of the cardiovascular spectrum. Journal of Sexual Medicine, 6(4), 1002–1009. doi:10.1111/j.1743-6109.2008.01141.x
This study suggests an association between chronic periodontal disease and erectile dysfunction, potentially mediated via systemic inflammation and endothelial dysfunction, linking oral and cardiovascular health.

Glickman, L.T., et al. (2009). Evaluation of the risk of endocarditis and other cardiovascular events on the basis of the severity of periodontal disease in dogs. Journal of the American Veterinary Medical Association, 234(4), 486–494. doi:10.2460/javma.234.4.486
In a canine cohort, severity of periodontal disease was associated with cardiovascular events such as endocarditis, highlighting parallels between human and animal systemic impacts of oral inflammation.

Dembowska, E., et al. (2022). Evaluation of Common Factors of Periodontitis and Cardiovascular Disease in Patients with the Acute Coronary Syndrome. International Journal of Environmental Research and Public Health, 19(13), 8139. doi:10.3390/ijerph19138139
Periodontitis and acute coronary syndrome shared common risk factors, including hypertension, diabetes, and smoking. Targeted oral prophylaxis was suggested for primary and secondary cardiovascular prevention.

Etta, I., et al. (2023). Mouth-Heart Connection: A Systematic Review on the Impact of Periodontal Disease on Cardiovascular Health. Cureus, 15, e46585. doi:10.7759/cureus.46585
Systematic review demonstrating that periodontal diseases contribute to systemic inflammation and endothelial dysfunction, with potential but unproven independent effects on cardiovascular outcomes.

Bezamat, M. (2022). An updated review on the link between oral infections and atherosclerotic cardiovascular disease with focus on phenomics. Frontiers in Physiology, 13, 1101398. doi:10.3389/fphys.2022.1101398
The review highlighted the potential pleiotropic genetic and inflammatory mechanisms linking oral infections and atherosclerotic cardiovascular disease, advocating for phenomics-based prospective studies.

Men, B., Li, Y., & Jiang, S. (2024). Updates on the Role of Periodontitis-Related Epigenetics, Inflammation, Oral Microbiome, and Treatment in Cardiovascular Risk. Journal of Inflammation Research, 17, 2024. doi:10.2147/JIR.S449661
This review emphasized epigenetic modulation, oral microbiome dysbiosis, and treatment interventions as critical factors connecting periodontitis to cardiovascular risk.

Kuo, L.C., Polson, A.M., & Kang, T. (2008). Associations between periodontal diseases and systemic diseases: A review of the inter-relationships and interactions with diabetes, respiratory diseases, cardiovascular diseases and osteoporosis. Public Health, 122(4), 417–433. doi:10.1016/j.puhe.2007.07.004
A comprehensive review detailing inter-relationships between periodontal diseases and systemic conditions, including cardiovascular disease, emphasizing clinical implications and integrated management.

Frisbee, S.J., et al. (2010). Association between dental hygiene, cardiovascular disease risk factors and systemic inflammation in rural adults. Journal of Dental Hygiene, 84(4), 205–215.
Self-reported dental hygiene was independently associated with systemic inflammation markers such as CRP and sICAM-1, suggesting preventive dental care as part of cardiovascular health strategies.

Delange, N., et al. (2018). Periodontal disease and its connection to systemic biomarkers of cardiovascular disease in young American Indian/Alaskan natives. Journal of Periodontology, 89(2), 157–165. doi:10.1002/JPER.17-0319
Moderate periodontal disease in otherwise healthy young adults was associated with elevated IL-6 levels, suggesting early systemic inflammatory changes even before clinical cardiovascular disease onset.

Pejcic, A., et al. (2023). Tooth loss and periodontal status in patients with cardiovascular disease in the Serbian population: A randomized prospective study. International Journal of Dental Hygiene, 21(2), 120–128. doi:10.1111/idh.12663
Greater tooth loss, primarily due to periodontitis, was significantly associated with cardiovascular disease, reinforcing the link between oral and systemic health.

Skilton, M.R., et al. (2011). The effect of a periodontal intervention on cardiovascular risk markers in Indigenous Australians with periodontal disease: The PerioCardio study. BMC Public Health, 11, 729. doi:10.1186/1471-2458-11-729
Intensive periodontal therapy in Indigenous Australians improved subclinical cardiovascular risk markers, supporting intervention-based mitigation of systemic risk from periodontal disease.

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Sanz, M., D’aiuto, F., Deanfield, J., Fernandez-Avilés, F. European workshop in periodontal health and cardiovascular disease - Scientific evidence on the association between periodontal and cardiovascular diseases: A review of the literature. European Heart Journal, Supplement 12, SUPPL. B (2010). doi:10.1093/eurheartj/suq003.
Chronic periodontal disease (PD) may confer independent risk for cardiovascular disease (CVD), though causality remains debated. Epidemiological studies indicate weak but significant associations. Surrogate measures of infective load and subclinical atherosclerosis suggest that PD may influence cardiovascular health, and preventive dental care could reduce risk and improve quality of life.

Goyal, L., Gupta, S., Dewan, M., Singla, M. Is periodontal therapy an effective treatment modality for preventing or managing cardiovascular disease in patients with periodontitis? Evidence-Based Dentistry 24, 1 (2023). doi:10.1038/s41432-023-00868-6.
Limited evidence from randomized trials exists regarding the effect of periodontal therapy on primary or secondary prevention of CVD. Some studies suggest scaling and root planing (SRP) with antibiotics may influence cardiovascular outcomes, but overall findings are insufficient to inform clinical practice, highlighting the need for more robust trials.

Mosley, M., Offenbacher, S., Phillips, C., Granger, C., Wilder, R. S. North Carolina cardiologists' knowledge, opinions and practice behaviors regarding the relationship between periodontal disease and cardiovascular disease. Journal of Dental Hygiene: JDH 88, 5 (2014).
Survey of cardiologists revealed limited understanding of periodontal disease etiology and its potential impact on CVD. Most respondents expressed interest in interprofessional education and collaboration between dental and medical professionals to improve patient outcomes.

Amaral, C. O. F., Pereira, L. C., Guy, N. A., Amaral Filho, M. S. P., Logar, G. A., Straioto, F. G. Oral health evaluation of cardiac patients admitted to cardiovascular pre-surgery intervention. RGO - Revista Gaúcha de Odontologia 64, 4 (2016). doi:10.1590/1981-863720160003000082979.
Assessment of 75 pre-surgical cardiac patients showed poor oral health, with a high proportion requiring invasive periodontal and restorative treatments. Inadequate oral care may create infectious foci with systemic health implications, emphasizing the importance of pre-surgical dental evaluation.

Tonetti, M. S., Van Dyke, T. E. Periodontitis and atherosclerotic cardiovascular disease: Consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. Journal of Clinical Periodontology 40, SUPPL. 14 (2013). doi:10.1111/jcpe.12089.
This consensus report confirms consistent epidemiologic evidence linking periodontitis to increased risk of atherosclerotic cardiovascular disease (ACVD). Intervention studies suggest periodontal treatment can reduce systemic inflammation and improve endothelial function, though clinical outcomes for ACVD prevention require further trials.

Sanchez, P., Everett, B., Salamonson, Y., et al. The oral health status, behaviours and knowledge of patients with cardiovascular disease in Sydney Australia: A cross-sectional survey. BMC Oral Health 19, 1 (2019). doi:10.1186/s12903-018-0697-x.
Surveyed CVD patients demonstrated high prevalence of oral health problems, poor dental knowledge, and limited access to dental care. Findings highlight the need for oral health education and integration of preventive dental practices within cardiac care programs.

Park, S. Y., Kim, S. H., Kang, S., Yoon, C. H., Lee, H. J., Yun, P. Y., Youn, T. J., Chae, I. H. Improved oral hygiene care attenuates the cardiovascular risk of oral health disease: A population-based study from Korea. European Heart Journal 40, 14 (2019). doi:10.1093/eurheartj/ehy836.
A large population-based cohort study demonstrated that poor oral health, including periodontal disease, dental caries, and tooth loss, increases risk of major cardiovascular events. Frequent tooth brushing and regular professional dental cleaning significantly reduced cardiovascular risk, suggesting improved oral hygiene can mitigate CVD risk associated with oral disease.

Gómez-González, J. M., del Canto-Díaz, M., Jacobo-Orea, C., Alobera-Gracia, M. A., del Canto-Pingarrón, M. León (Spain) Health professionals’ knowledge and clinical practice towards the relationship between cardiovascular diseases and periodontal disease. Journal of Clinical and Experimental Dentistry 15, 6 (2023). doi:10.4317/jced.60529.
Survey of 100 healthcare professionals revealed low awareness of the link between periodontal disease and CVD, limited training, and a need for collaborative education between medical and dental fields to improve preventive care.

Mucci, L. A., Hsieh, C. C., Williams, P. L., Arora, M., Adami, H. O., De Faire, U., Douglass, C. W., Pedersen, N. L. Do genetic factors explain the association between poor oral health and cardiovascular disease? a prospective study among Swedish twins. American Journal of Epidemiology 170, 5 (2009). doi:10.1093/aje/kwp177.
Using a twin study design, this research found tooth loss and periodontal disease are associated with increased CVD risk independent of genetic factors, suggesting shared pathogenetic mechanisms between poor oral health and cardiovascular outcomes.

Helmi, M., Goodson, J. M., Hasturk, H., Natto, Z. S. Annual alveolar bone loss in subjects with cardiovascular disease adjusting for associated systemic diseases and risk factors: A retrospective study. BMC Oral Health 20, 1 (2020). doi:10.1186/s12903-020-1015-y.
CVD patients experienced higher annual alveolar bone loss than those without CVD, highlighting the importance of prioritizing periodontal assessment and preventive care in high-risk cardiovascular populations.

Lazureanu, P. C., Popescu, F. G., Stef, L., Focsa, M., Vaida, M. A., Mihaila, R. The Influence of Periodontal Disease on Oral Health Quality of Life in Patients with Cardiovascular Disease: A Cross-Sectional Observational Single-Center Study. Medicina 58, 5 (2022). doi:10.3390/medicina58050584.
Among 147 CVD patients, 77.5% had periodontal disease, which was associated with lower oral-health-related quality of life (OHIP-14 scores). Lack of proper oral hygiene further worsened outcomes, emphasizing the need for awareness and preventive strategies.

Morón-Araújo, M. La periodontitis y su relación con las enfermedades cardiovasculares. Promoción de la salud cardiovascular desde el consultorio dental. Revista Colombiana de Cardiología 28, 5 (2022). doi:10.24875/rccar.m21000085.
This review underscores the association of clinical periodontitis with CVD through systemic inflammation and metastatic bacterial spread. Dental offices are key settings for preventive cardiovascular and oral health interventions.

Ramírez, J. H., Arce, R. M., Contreras, A. Periodontal treatment effects on endothelial function and cardiovascular disease biomarkers in subjects with chronic periodontitis: Protocol for a randomized clinical trial. Trials 12 (2011). doi:10.1186/1745-6215-12-46.
A randomized trial protocol designed to evaluate whether scaling and root planing plus local chlorhexidine improves endothelial function and systemic biomarkers of CVD in patients with moderate to severe periodontitis.

Chipirliu, O., Crăciun, M. V., Matei, M. N. Comparative Clinical Study on Periodontal Health Status and Early Diagnosis of Periodontal Diseases Quantified through Clinical Periodontal Indices on a Group of Children and Adolescents with and without Cardiovascular Diseases. Pediatric Reports 16, 1 (2024). doi:10.3390/pediatric16010001.
Children and adolescents with CVD had significantly worse periodontal indices compared to healthy controls, indicating a bidirectional interaction between systemic cardiovascular conditions and oral health. Early diagnosis and management improved outcomes.

Herrera, D., Sanz, M., Shapira, L., et al. Association between periodontal diseases and cardiovascular diseases, diabetes and respiratory diseases: Consensus report of the Joint Workshop by the European Federation of Periodontology (EFP) and the European arm of the World Organization of Family Doctors (WONCA Europe). Journal of Clinical Periodontology 50, 6 (2023). doi:10.1111/jcpe.13807.
Consensus report highlighting independent associations of periodontitis with CVD, diabetes, COPD, and COVID-19 complications. Emphasizes the importance of collaboration between oral health professionals and family doctors for early detection and management of non-communicable diseases.

Gualtero, D. F., Lafaurie, G. I., Buitrago, D. M., et al. Oral microbiome mediated inflammation, a potential inductor of vascular diseases: a comprehensive review. Frontiers in Cardiovascular Medicine 10 (2023). doi:10.3389/fcvm.2023.1250263.
Review showing that oral microbiome dysbiosis and translocation of periodontal pathogens can trigger systemic inflammation, endothelial dysfunction, and atherosclerosis, linking oral health to cardiovascular disease pathogenesis.

Güvenç, K. K., Fentoğlu, Ö., Calapoğlu, M., Aksoy, F., Orhan, H. Periodontal and cardiovascular therapies modify specialized pro-resolving lipid mediator (sPRLM) (LPXA4, PD1, RvE1, RvD1, and MaR1)-mediated pathway: the first pilot clinical study. Clinical Oral Investigations 27, 9 (2023). doi:10.1007/s00784-023-05174-0.
Pilot study shows combined periodontal and cardiovascular therapies reduce inflammation via modulation of specialized pro-resolving lipid mediators (sPRLMs), highlighting a mechanistic link between oral and cardiovascular health interventions.

King, S., Church, L., Garde, S., Chow, C. K., Akhter, R., Eberhard, J. (2022). Targeting the reduction of inflammatory risk associated with cardiovascular disease by treating periodontitis either alone or in combination with a systemic anti-inflammatory agent: protocol for a pilot, parallel group, randomised controlled trial. BMJ Open, 12(11). doi:10.1136/bmjopen-2022-063148.

This protocol describes a randomized controlled trial designed to investigate whether periodontal treatment alone or combined with the anti-inflammatory drug colchicine reduces systemic inflammation in patients with both periodontitis and cardiovascular disease. The primary outcome is hsCRP levels, with secondary outcomes including lipid profiles, periodontal parameters, and feasibility measures.

Martínez-García, M., Castrejón-Pérez, R. C., Rodríguez-Hernández, A. P., Sandoval-Motta, S., Vallejo, M., Borges-Yáñez, S. A., Hernández-Lemus, E. (2021). Incidence of arterial hypertension in people with periodontitis and characterization of the oral and subgingival microbiome: A study protocol. Frontiers in Cardiovascular Medicine, 8. doi:10.3389/fcvm.2021.763293.

This study protocol outlines a 5-year cohort investigation in Mexico City to assess how periodontitis and the oral microbiome influence the development of hypertension. It includes microbiome sequencing, lifestyle and nutritional assessments, and explores implications for public health interventions.

Ford, P. J., Raphael, S. L., Cullinan, M. P., Jenkins, A. J., West, M. J., Seymour, G. J. (2010). Why should a doctor be interested in oral disease? Expert Review of Cardiovascular Therapy, 8(10). doi:10.1586/erc.10.109.

This review emphasizes the emerging evidence linking periodontal disease with systemic conditions like cardiovascular disease and type 2 diabetes. Oral treatment can reduce systemic inflammatory burden and improve endothelial function, highlighting the relevance of oral health for general health outcomes.

Thomopoulos, C., Tsioufis, C., Soldatos, N., Kasiakogias, A., Stefanadis, C. (2011). Periodontitis and coronary artery disease: a questioned association between periodontal and vascular plaques. American Journal of Cardiovascular Disease, 1(1).

This article critically examines the epidemiological association between periodontitis and coronary artery disease. While mechanisms such as systemic inflammation and immune responses may link the two, clinical recommendations remain cautious, emphasizing oral hygiene as part of overall health.

Del Pinto, R., Pietropaoli, D., Munoz-Aguilera, E., D’Aiuto, F., Czesnikiewicz-Guzik, M., Monaco, A., Guzik, T. J., Ferri, C. (2020). Periodontitis and hypertension: Is the association causal? High Blood Pressure and Cardiovascular Prevention, 27(4). doi:10.1007/s40292-020-00392-z.

This review explores the association between periodontitis and hypertension, discussing potential causal mechanisms including systemic inflammation, immune dysregulation, and genetic predisposition, suggesting periodontal therapy as a potential adjunct to cardiovascular risk management.

Panagakos, F. S. (2012). Periodontal disease and systemic health. Dental Nursing, 8(3), 130–135. doi:10.12968/denn.2012.8.3.130.

This article reviews the bidirectional association between periodontal disease and systemic conditions such as diabetes and cardiovascular disease, emphasizing the role of inflammation in mediating systemic effects.

Rastogi, P., Singhal, R., Sethi, A., Agarwal, A., Singh, V. K., Sethi, R. (2012). Assessment of the effect of periodontal treatment in patients with coronary artery disease: A pilot survey. Journal of Cardiovascular Disease Research, 3(2). doi:10.4103/0975-3583.95366.

This pilot study demonstrated that non-surgical periodontal therapy significantly reduces systemic inflammatory markers (hsCRP, WBC) in patients with coronary artery disease, highlighting potential cardiovascular benefits of periodontal treatment.

John, V., Alqallaf, H., De Bedout, T. (2016). Periodontal disease and systemic diseases: An update for the clinician. Journal (Indiana Dental Association), 95(1).

This review summarizes current understanding of the links between periodontal disease and systemic diseases including cardiovascular, endocrine, respiratory, musculoskeletal, and reproductive disorders, emphasizing clinical implications for patient management.

Andreu, R., del Riego, S. S. (2020). Effects of topical doxycycline on inflammatory markers in periodontal disease. Clinical Sciences Research and Reports, 3(1). doi:10.15761/csrr.1000130.

This article discusses the interplay between periodontal infection, inflammation, and systemic disease, reviewing evidence on topical doxycycline’s effects on inflammatory markers and cardiovascular risk.

Kale, P. P., Mani, A., Anarthe, R., Mustilwar, R. (2022). Role of annular pentameric molecule: C-Reactive protein in periodontal disease and its association with systemic health. Journal of Cellular Biotechnology, 8(1). doi:10.3233/JCB-210049.

This manuscript provides a concise overview of C-Reactive Protein as a biomarker linking periodontal inflammation with systemic conditions including cardiovascular disease and adverse pregnancy outcomes.

 

Shen, D., Wu, Y., Zhao, L. (2021). Roles of periodontal pathogens in the pathogenesis of atherosclerosis. Chinese Journal of Stomatology, 56(6). doi:10.3760/cma.j.cn112144-20210222-00085.

This review highlights the role of periodontal pathogens in cardiovascular disease, particularly how bacterial infection and immune mechanisms promote atherosclerosis.

Kusumawardani, B. (2013). Penyakit periodontal dan komplikasi kehamilan. J. K. G Unej, 10(3).

This study reviews the mechanisms linking periodontal disease to adverse pregnancy outcomes, including immune dysregulation and direct bacterial colonization of the placenta.

César Neto, J. B., Rosa, E. F., Pannuti, C. M., Romito, G. A. (2012). Smoking and periodontal tissues: A review. Brazilian Oral Research, 26(SPL. ISS.1). doi:10.1590/S1806-83242012000700005.

This review discusses the impact of smoking on periodontal disease prevalence, severity, and treatment outcomes, highlighting smoking cessation as critical for oral and systemic health.

Archana, V., Ambili, R., Nisha, K. J., Seba, A., Preeja, C. (2015). Acute-phase reactants in periodontal disease: Current concepts and future implications. Journal of Investigative and Clinical Dentistry, 6(2). doi:10.1111/jicd.12069.

This article explores the role of acute-phase reactants, particularly C-reactive protein, in periodontal disease and systemic health, underscoring their clinical and prognostic significance.

Lundergan, W., Parthasarathy, K., Knight, N. (2024). Periodontitis and Alzheimer’s disease: Is there a connection? Oral, 4(1). doi:10.3390/oral4010006.

This review examines evidence linking chronic periodontal inflammation to neurodegenerative processes, particularly Alzheimer’s disease, through inflammatory and microbial pathways.

Pamuk, F., Kantarci, A. (2022). Inflammation as a link between periodontal disease and obesity. Periodontology 2000, 90(1). doi:10.1111/prd.12457.

This review explores mechanistic pathways connecting obesity, systemic inflammation, and periodontal disease, emphasizing potential pharmacological interventions.

Jared, H., Boggess, K. A. (2008). Periodontal diseases and adverse pregnancy outcomes: A review of the evidence and implications for clinical practice. Journal of Dental Hygiene, 82(3).

This article reviews literature linking periodontal disease to adverse pregnancy outcomes, highlighting gaps in evidence and strategies for oral health management in pregnancy.

Erickson, L. E. (2016). The mouth-body connection. Generations, 40(3).

This article highlights the influence of oral health and salivary function on systemic conditions such as diabetes, cardiovascular and pulmonary disease, advocating for integrated patient care.

Balakesavan, P., Gokhale, S. R., Deshmukh, V., Williams, R. C. (2013). Periodontal disease and overall health: An update. European Journal of General Dentistry, 2(02). doi:10.4103/2278-9626.112304.

This review examines systemic implications of periodontitis, including associations with cardiovascular disease, diabetes, adverse pregnancy outcomes, and respiratory infections, emphasizing clinical relevance.

Zeeman, G. G., Veth, E. O., Dennison, D. K. (2001). Focus on primary care periodontal disease: Implications for women's health. Obstetrical and Gynecological Survey, 56(1). doi:10.1097/00006254-200101000-00024.

This review discusses the emerging evidence linking periodontal disease to systemic conditions such as diabetes, cardiovascular disease, and reproductive health, stressing the need for prospective and interventional studies.

Santinoni, C. S., Magrin, G. L., da Cruz, A. C., Bianchini, M. A., Zimmermann, G. S., Benfatti, C. A. M., Magini, R. S. (2024). [Mini-review] Periodontal medicine: Impact of oral health on general health. Qeios. doi:10.32388/nmub5a.

This mini-review highlights the bidirectional links between periodontal disease and systemic conditions, including diabetes, cardiovascular disease, and pregnancy complications, and emphasizes the importance of multidisciplinary care.

Sharma, P. (2020). An update on the links between periodontal health and general health. Primary Dental Journal, 8(4). doi:10.1308/205016820828463799.

This article explores associations between systemic health and periodontal status, including the effects of diabetes, smoking, diet, and stress, and discusses holistic strategies to improve both oral and systemic health.

Ajonuma, L. C. (2010). A potential role of Chlamydia pneumoniae in the pathogenesis of periodontal disease in adolescents and adults. International Journal of Adolescent Medicine and Health, 22(2).

This paper hypothesizes the involvement of Chlamydia pneumoniae in periodontal disease pathogenesis, potentially improving understanding and guiding future treatment strategies.

 

Fiorillo, L. (2019). Oral health: The first step to well-being. Medicina (Lithuania), 55(10). doi:10.3390/medicina55100676.

This article emphasizes the systemic implications of oral health, highlighting the link between periodontal disease and multi-organ complications, including cardiovascular and metabolic disorders.

Fiorillo, L., Cervino, G., Laino, L., D'Amico, C., Mauceri, R., Tozum, T. F., Gaeta, M., Cicciù, M. (2019). Porphyromonas gingivalis, periodontal and systemic implications: A systematic review. Dentistry Journal, 7(4). doi:10.3390/dj7040114.

This systematic review examines how P. gingivalis, a key periodontal pathogen, contributes to systemic diseases including rheumatoid arthritis, cardiovascular conditions, and neurodegenerative disorders, highlighting the dentist's role in prevention.

Klinge, B. (2021). The oral–systemic link: Oral infection/inflammation and the relation to general health. Annals of Medicine, 53(sup1). doi:10.1080/07853890.2021.1896879.

This presentation reviews evidence linking periodontitis with comorbidities such as cardiovascular disease, diabetes, and rheumatoid arthritis, emphasizing shared inflammatory pathways and the importance of interdisciplinary care.

Mawardi, H. H., Elbadawi, L. S., Sonis, S. T. (2015). Current understanding of the relationship between periodontal and systemic diseases. Saudi Medical Journal, 36(2). doi:10.15537/smj.2015.2.9424.

This review critically evaluates evidence linking periodontal disease to systemic conditions, particularly cardiovascular disease, and emphasizes the importance of informing clinicians about potential health impacts.

Johnston, N. (2011). Periodontal disease: systemic consequences in wider focus. Veterinary Times 41, 22.

Untreated periodontal disease in small animals can have systemic effects impacting liver, kidneys, cardiovascular system, and lungs. Similar patterns are observed in aging humans, providing lessons for veterinary care. Oral pain and neoplasia also influence systemic health. Early intervention and management of periodontal disease are critical for overall patient well-being.

Zhang, Y., Wang, X., Li, H., Ni, C., Du, Z., & Yan, F. (2018). Human oral microbiota and its modulation for oral health. Biomedicine and Pharmacotherapy 99, 10.1016/j.biopha.2018.01.146.

The oral microbiome comprises diverse niches with complex microbial communities (bacteria, fungi, viruses, archaea, protozoa) that influence both oral and systemic health. Dysbiosis contributes to dental caries, periodontal disease, and systemic conditions like diabetes and cardiovascular diseases. Microbiome-targeted interventions are emerging as novel strategies for maintaining oral health.

Kidambi, S., & Patel, S. B. (2008). Diabetes mellitus: considerations for dentistry. J. Am. Dent. Assoc. 139, 10.14219/jada.archive.2008.0364.

Diabetes mellitus affects oral tissues, especially the microvasculature and supporting structures of teeth. Periodontal disease is linked to increased cardiovascular morbidity in diabetic patients, highlighting the bidirectional relationship between oral and systemic health.

Shrihari, T. G. (2012). Potential correlation between periodontitis and coronary heart disease—An overview. Gen. Dent. 60, 1.

Periodontal bacteria and inflammatory mediators (IL-1, TNF-α) can enter systemic circulation, promoting chronic low-grade inflammation and potentially contributing to atherosclerosis and coronary heart disease. Addressing periodontal health may benefit public health and patient care.

Shetty, M. S., & Shetty, Y. S. (2015). Probiotics and oral health: myth or reality? J. Health Allied Sci. NU 5, 03. 10.1055/s-0040-1703910.

Probiotics have been increasingly studied for oral health applications. Clinical evidence suggests beneficial effects against dental caries, periodontal disease, halitosis, and systemic conditions such as diarrhea and cardiovascular diseases. Oral probiotic therapy represents a promising adjunct to conventional care.

Isola, G., Santonocito, S., Lupi, S. M., Polizzi, A., Sclafani, R., Patini, R., & Marchetti, E. (2023). Periodontal health and disease in the context of systemic diseases. Mediators Inflamm. 2023, 10.1155/2023/9720947.

Emerging evidence links periodontitis to systemic conditions including cardiovascular disease and diabetes. DNA sequencing has revealed dissemination of oral pathogens to distant sites such as the colon and reproductive tissues, suggesting shared etiopathogenetic pathways.

Nicolin, V., Costantinides, F., Vettori, E., Berton, F., Marchesi, G., Rizzo, R., & Di Lenarda, R. (2020). Can periodontal disease be considered linked to obesity and lipoinflammation? Clin. Rev. Bone Miner. Metab. 18, 1–3. 10.1007/s12018-020-09273-4.

Obesity-related lipoinflammation contributes to systemic inflammation, increasing the risk of periodontitis. Approximately 70–80% of overweight individuals demonstrate adipose tissue turnover promoting inflammatory reactions, highlighting the interplay between obesity and periodontal disease.

 

Ferguson, J. E., Hansen, W. F., Novak, K. F., & Novak, M. J. (2007). Should we treat periodontal disease during gestation to improve pregnancy outcomes? Clin. Obstet. Gynecol. 50, 2. 10.1097/GRF.0b013e31804c9f05.

Periodontal disease in pregnancy may influence low birth weight, preterm delivery, and preeclampsia. While interventions are safe, outcomes are variable, necessitating further research to optimize maternal periodontal care.

Ariyamuthu, V. K., Nolph, K. D., & Ringdahl, B. E. (2013). Periodontal disease in chronic kidney disease and end-stage renal disease patients: a review. CardioRenal Med. 3, 1. 10.1159/000350046.

Periodontal inflammation is associated with elevated systemic inflammatory markers in CKD and ESRD patients. Evidence for reduced cardiovascular events after periodontal therapy is limited, but systemic inflammation remains a major concern.

Nguyen, A. T. M., Akhter, R., Garde, S., Scott, C., Twigg, S. M., Colagiuri, S., Ajwani, S., & Eberhard, J. (2020). The association of periodontal disease with the complications of diabetes mellitus. Diabetes Res. Clin. Pract. 165, 10.1016/j.diabres.2020.108244.

Periodontal disease increases the risk of diabetic complications, including retinopathy, nephropathy, neuropathy, cardiovascular events, and mortality. The review emphasizes the importance of oral health management in diabetes care.

Cardoso, E. M., Reis, C., & Manzanares-Céspedes, M. C. (2018). Chronic periodontitis, inflammatory cytokines, and interrelationship with other chronic diseases. Postgrad. Med. 130, 1. 10.1080/00325481.2018.1396876.

Chronic periodontitis elevates pro-inflammatory cytokines (TNF-α, IL-1, IL-6), contributing to systemic inflammatory states and linking periodontal disease to cardiovascular disease, diabetes, cancer, and respiratory conditions.

Theriault, H., & Bridge, G. (2023). Oral health equity for rural communities: where are we now and where can we go from here? Br. Dent. J. 235, 2. 10.1038/s41415-023-6058-4.

Rural populations face disproportionate oral health challenges. Interventions like mobile clinics, teledentistry, and education have improved outcomes, but public health policies are essential to address systemic inequities.

Shankarram, V., Narayanan, L., Selvan, T., Sudhakar, U., Moses, J., & Parthiban, S. (2015). Detection of oxidative stress in periodontal disease and oral cancer. Biomed. Pharmacol. J. 8, 2. 10.13005/bpj/819.

Oxidative stress is implicated in periodontitis and oral cancer. Local inflammation contributes to systemic oxidative damage, linking oral pathology to broader health outcomes.

 

Čižmárová, B., Tomečková, V., Hubková, B., Hurajtová, A., Ohlasová, J., & Birková, A. (2022). Salivary redox homeostasis in human health and disease. Int. J. Mol. Sci. 23, 17. 10.3390/ijms231710076.

Saliva reflects dynamic systemic changes and oxidative stress. Salivary antioxidants can serve as diagnostic and prognostic markers for oral and systemic diseases.

Haidrus, R., Nayak, S. U., & Kamath, D. G. (2020). Impact of nutrient-gene-interaction on periodontal disease: an overview. Indian J. Forensic Med. Toxicol. 14, 4. 10.37506/ijfmt.v14i4.11520.

Macronutrients, micronutrients, and trace elements modulate inflammatory pathways affecting periodontal and systemic diseases. Nutrient–gene interactions may influence chronic disease progression.

Raj, C. S., & Anitha, A. (2017). Pre-term low birth weight and periodontal disease. World J. Pharm. Res. 6, 275.

Maternal periodontitis may contribute to preterm birth and low birth weight through systemic inflammation caused by gram-negative microorganisms.

Assery, N. M., Jurado, C. A., Assery, M. K., & Afrashtehfar, K. I. (2023). Peri-implantitis and systemic inflammation: a critical update. Saudi Dent. J. 35, 5. 10.1016/j.sdentj.2023.04.005.

Peri-implantitis elevates systemic inflammatory markers and may impact overall health, highlighting the need for monitoring and research on systemic implications of localized oral inflammation.

Debnath, K., Nisha, S., Das, D., Goswami, N., & Barai, S. (2023). Periodontal health—the Gordian knot in public health: the Indian standpoint. J. Clin. Diagn. Res. 10.7860/jcdr/2023/58562.18050.

In India, periodontal health is a pressing public health concern. Challenges include limited awareness, accessibility, and infrastructure. Policies and oral health programs are critical to address this systemic issue.

Fang, C., Wu, L., Zhu, C., Xie, W. Z., Hu, H., & Zeng, X. T. (2021). A potential therapeutic strategy for prostatic disease by targeting the oral microbiome. Med. Res. Rev. 41, 3. 10.1002/med.21778.

Oral dysbiosis may contribute to systemic diseases, including prostatic disorders. Targeting oral pathogens offers a potential therapeutic strategy, illustrating the oral-systemic axis.

Srivastava, R., Chandra, C., Jha, V., Dubey, A., Sharma, T., & Goel, T. (2022). Periodontal health is the key for overall health. Asian J. Oral Health Allied Sci. 12, 10.25259/ajohas_11_2021.

Periodontitis driven by plaque-associated anaerobic bacteria (Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Porphyromonas gingivalis) contributes to systemic diseases such as cardiovascular disease, diabetes, nephropathy, and osteoporosis. Effective periodontal treatment may improve systemic outcomes.

Khanna, S. S., Dhaimade, P. A. & Malhotra, S. Oral health status and fertility treatment including IVF. J Obstet Gynecol India 67, 1025–1032 (2017). Periodontitis may act as a chronic focus of infection, contributing to bacteremia and potentially affecting fertility and IVF outcomes in women, with limited evidence also linking male factor infertility to poor oral health.

Yamashita, Y., Furuta, M. & Kiyohara, Y. Approach to reveal the association between oral and systemic health. J Natl Inst Public Health 63, 45–52 (2014). Highlights the bidirectional relationship between periodontal disease and systemic conditions such as diabetes, obesity, metabolic syndrome, cardiovascular disease, and adverse pregnancy outcomes, emphasizing preventive care in adults.

Chapple, I. L. C. & Wilson, N. H. F. Manifesto for a paradigm shift: Periodontal health for a better life. Br Dent J 216, 217–222 (2014). Advocates for dental professionals to engage in preventive medicine targeting chronic systemic diseases through behavior change and health promotion.

Kim, J. & Amar, S. Periodontal disease and systemic conditions: A bidirectional relationship. Odontology 94, 10–21 (2006). Provides evidence linking periodontal disease to systemic illnesses including cardiovascular disease, diabetes, adverse pregnancy outcomes, and osteoporosis.

Monsarrat, P. et al. Clinical research activity in periodontal medicine: A systematic mapping of trial registers. J Clin Periodontol 43, 465–473 (2016). Systematic mapping reveals growing diversity of systemic conditions studied in periodontal medicine, including cardiovascular disease, diabetes, preterm birth, and rare disorders such as ankylosing spondylitis.

Meyer, M. S., Joshipura, K., Giovannucci, E. & Michaud, D. S. A review of the relationship between tooth loss, periodontal disease, and cancer. Cancer Causes Control 19, 895–907 (2008). Summarizes associations between periodontitis/tooth loss and cancers of the oral cavity, upper gastrointestinal tract, lung, and pancreas, accounting for confounders like smoking.

Keleş, G. Ç. et al. The role of periodontal disease on acute phase proteins in patients with coronary heart disease and diabetes. Turk J Med Sci 37, 27–34 (2007). Demonstrates that periodontitis elevates CRP and fibrinogen levels, indicating systemic inflammation in CHD and diabetic patients.

 

Varela-López, A. et al. Nutraceuticals in periodontal health: A systematic review on the role of vitamins in periodontal health maintenance. Molecules 23, 1226 (2018). Reviews vitamins C and D as key modulators of oxidative stress, immunity, and bone metabolism in periodontal disease.

Bresolin, A. C. et al. Effectiveness of periodontal treatment on the improvement of inflammatory markers in children. Arch Oral Biol 59, 628–635 (2014). Demonstrates that full-mouth scaling and root planing improve both periodontal clinical parameters and systemic inflammatory markers such as IL-6, total cholesterol, and fibrinogen.

ChiCTR-IOR-17011552. The effect of pre-conception periodontal treatment on decreasing adverse pregnancy and birth outcomes and pathogenic mechanism. WHO Clinical Trials Registry (2017). Explores whether periodontal therapy prior to conception reduces low birth weight and preterm birth through modulation of systemic inflammation.

Beltran-Aguilar, E. D. & Beltran-Neira, R. J. Oral diseases and conditions throughout the lifespan. II. Systemic diseases. Gen Dent 52, 162–169 (2004). Reviews oral manifestations of systemic disease and emphasizes the dentist’s role in prevention, diagnosis, and interdisciplinary care.

Özdemir, E. Ç. & Uzunkaya, M. Evaluation of the awareness of physicians and dentists of the relationship between periodontal status and systemic diseases. Cumhuriyet Dent J 25, 123–132 (2022). Highlights the need for increased awareness among healthcare providers about periodontal-systemic disease links.

Lauritano, D. et al. Why should patients with systemic disease and tobacco smokers go to the dentist? J Biol Regul Homeost Agents 30, 123–130 (2016). Discusses periodontitis risk factors including tobacco use and systemic diseases, and the role of periodontal therapy in systemic health.

Shimizu, Y. et al. Association between periodontitis and chronic kidney disease by functional atherosclerosis status among older Japanese individuals: A cross-sectional study. J Clin Periodontol 50, 567–577 (2023). Establishes that periodontitis is associated with CKD in older adults with functional atherosclerosis, highlighting vascular interactions.

Fischer, R. G. et al. Periodontal disease and its impact on general health in Latin America. Section V: Treatment of periodontitis. Braz Oral Res 34, e026 (2020). Reviews the systemic benefits of non-surgical and surgical periodontal therapy, including reduction in systemic inflammatory markers.

 

Haumschild, M. S. & Haumschild, R. J. The importance of oral health in long-term care. J Am Med Dir Assoc 10, 395–400 (2009). Emphasizes oral health’s influence on quality of life and healthcare costs in older adults.

Jin, L. J., Chiu, G. K. C. & Corbet, E. F. Are periodontal diseases risk factors for certain systemic disorders – What matters to medical practitioners? Hong Kong Med J 9, 111–119 (2003). Explores clinical implications of periodontal medicine for cardiovascular disease, diabetes, pregnancy outcomes, and pulmonary infections.

Santacroce, L., Carlaio, R. & Bottalico, L. Does it make sense that diabetes is reciprocally associated with periodontal disease? Endocr Metab Immune Disord Drug Targets 10, 45–53 (2012). Reviews bidirectional interactions between diabetes and periodontal health.

Nyvad, B. & Takahashi, N. Integrated hypothesis of dental caries and periodontal diseases. J Oral Microbiol 12, 1710953 (2020). Proposes that ecological imbalance in oral microbiota underlies periodontal inflammation, linking diet, hyperglycemia, and systemic disease risk.

Verma, A. K. Periodontal disease with diabetes or diabetes kidney disease. Int J Trend Sci Res Dev 3, 19176 (2018). Highlights increased oral inflammatory burden and poor oral health outcomes in diabetic nephropathy patients.

Kassier, S. M. Periodontal disease and non-communicable diseases. Strength of bidirectional associations. J Dent Assoc S Afr 71, 550–558 (2016). Summarizes bidirectional links between periodontitis and systemic NCDs including cardiovascular disease, diabetes, obesity, and respiratory conditions.

Gupta, P. & Jan, S. M. A survey on the general awareness of inter-relationship between periodontal disease and systemic health among Jammu population. Quest J Med Dent Sci Res 7, 45–52 (2020). Confirms public awareness of periodontal-systemic health links, with higher knowledge in females and middle-aged adults.

Genco, R. J. & Sanz, M. Clinical and public health implications of periodontal and systemic diseases: An overview. Periodontol 2000 83, 7–21 (2020). Provides a comprehensive summary of periodontitis associations with diabetes, cardiovascular disease, pregnancy complications, metabolic disorders, cancer, and cognitive decline.

Kaur, S., Khurana, P. & Kaur, H. A survey on acquaintance, orientation and behavior of general medical practitioners toward periodontal diseases. J Indian Soc Periodontol 19, 308–314 (2015). Reveals inadequate knowledge among medical practitioners regarding periodontal-systemic disease associations.

 

Fischer, R. G. et al. What is the future of Periodontal Medicine? Braz Oral Res 35, S2:102 (2021). Reviews evidence for periodontal infection/inflammation impacting systemic diseases, highlighting directions for future epidemiological and intervention studies.

Cullinan, M. P., Ford, P. J. & Seymour, G. J. Periodontal disease and systemic health: Current status. Aust Dent J 54, 117–130 (2009). Summarizes epidemiologic and mechanistic evidence linking poor oral health to systemic conditions, noting the need for interventional studies to establish causality.

Santoso, O. Infeksi periodontal sebagai faktorrisiko kondisi sistemik. ODONTO: Dent J 6, 141–152 (2019). Confirms periodontal infection as a potential systemic risk factor through pro-inflammatory mediators affecting cardiovascular, metabolic, and respiratory health.

Xin, X., He, J. & Zhou, X. Oral microbiota: a promising predictor of human oral and systemic diseases. West China J Stomatol 33, 711–719 (2015). Highlights oral microbiota as a biomarker for systemic conditions including diabetes, cardiovascular disease, cancer, and preterm birth, enabling personalized health predictions.

Pirkko Pussinen, Susanna Paju, Paivi Mantyla, Timo Sorsa (2007). Serum Microbial- and Host-Derived Markers of Periodontal Diseases: A Review. Current Medicinal Chemistry 14(22), 2349–2365. doi:10.2174/092986707781745604.
This review details serum markers of periodontitis, including pathogen-derived markers and host immune responses. Antibodies to periodontopathic bacteria are highlighted as the most specific systemic markers. The authors advocate for serum-based screening methods to facilitate early detection of periodontitis by general physicians.

S. L. Gaffen, M. C. Herzberg, M. A. Taubman, T. E. Van Dyke (2014). Recent advances in host defense mechanisms/therapies against oral infectious diseases and consequences for systemic disease. Advances in Dental Research 26(1), 21–32. doi:10.1177/0022034514525778.
Explores innate and adaptive immune mechanisms in oral infections, including periodontitis and candidiasis. Highlights the systemic implications of oral infections and potential immunomodulatory therapies, such as proresolvins and epithelial cell gene therapy, for both oral and systemic disease prevention.

Alexander V. Guskov, Alexander A. Oleynikov, Alexander A. Nikiforov, Valeria G. Logunkova, Dmitry G. Zhukovets, Oksana A. Laut, Tatiana A. Vasileva (2023). Influence of factors of systemic inflammation and endothelial dysfunction in somatic pathologies on the success of dental implantation (literature review). Applied Information Aspects of Medicine 26(3), 73–84. doi:10.18499/2070-9277-2023-26-3-73-84.
Highlights how systemic inflammation, metabolic disorders, and endothelial dysfunction influence dental implant success. Emphasizes the need for thorough patient assessment, including laboratory evaluation and management of systemic conditions, to improve osseointegration outcomes.

Ira B. Lamster, Michael Pagan (2017). Periodontal disease and the metabolic syndrome. International Dental Journal 67(2), 67–75. doi:10.1111/idj.12264.
Reviews the association between periodontitis and metabolic syndrome (MetS). Dysglycemia and obesity are the strongest contributors to periodontal risk. Periodontal therapy may reduce systemic inflammation, suggesting potential integration of dental care into MetS management.

Santoso Oedijani (2019). INFEKSI PERIODONTAL SEBAGAI FAKTORRISIKO KONDISI SISTEMIK. Infeksi Periodontal Sebagai Faktorrisiko Kondisi Sistemik 6(2), 45–56.
Summarizes evidence linking periodontal infections with systemic conditions such as cardiovascular disease, diabetes, pregnancy complications, and respiratory diseases. Focuses on inflammatory mediators like IL-1, IL-6, TNF-α, and PGE2 as mechanisms connecting oral and systemic health.

Pablo Jasma, Patricio Sánchez (2019). Porphyromonas gingivalis and its impact on periodontal health and systemic diseases. A concise review. International Journal of Medical and Surgical Sciences 6(1), 12–20. doi:10.32457/ijmss.2019.010.
Reviews P. gingivalis as a key periodontal pathogen capable of immune evasion and dysbiosis. Explores its role in systemic conditions, including cardiovascular inflammation and Alzheimer’s disease via NLRP3 inflammasome activation.

Joseph Katz, Moshe Y. Flugelman, Avishai Goldberg, Marc Heft (2002). Association Between Periodontal Pockets and Elevated Cholesterol and Low Density Lipoprotein Cholesterol Levels. Journal of Periodontology 73(5), 494–500. doi:10.1902/jop.2002.73.5.494.
Demonstrates that periodontal pockets in men are associated with elevated total cholesterol and LDL, supporting epidemiologic links between periodontitis and cardiovascular risk.

Revan Birke Koca-Ünsal, Ahmet Özer Şehirli, Serkan Sayiner, Umut Aksoy (2022). Relationship of NLRP3 inflammasome with periodontal, endodontic and related systemic diseases. Molecular Biology Reports 49(11), 8501–8514. doi:10.1007/s11033-022-07894-0.
Details the role of NLRP3 inflammasome in periodontal and periapical inflammation, highlighting its contribution to systemic diseases such as diabetes, cardiovascular disease, and Alzheimer’s, and its potential as a therapeutic target.

Mary P. Cullinan, Gregory J. Seymour (2013). Periodontal disease and systemic illness: Will the evidence ever be enough? Periodontology 2000 62(1), 217–231. doi:10.1111/prd.12007.
Reviews epidemiologic and mechanistic evidence linking periodontitis to cardiovascular disease and diabetes. Suggests modest systemic benefits of periodontal treatment but notes the need for further interventional studies to confirm impact on systemic outcomes.

Jørgen Slots, Joanna J. Kamma (2001). General health risk of periodontal disease. International Dental Journal 51(6), 381–392. doi:10.1002/j.1875-595X.2001.tb00854.x.
Analyzes periodontal pathogens as potential contributors to systemic chronic disorders. Highlights Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis as key species but notes the evidence linking periodontal infection to cardiovascular events remains inconsistent.

Matthieu Minty, Thibault Canceil, Matteo Serino, Remy Burcelin, François Tercé, Vincent Blasco-Baque (2019). Oral microbiota-induced periodontitis: a new risk factor of metabolic diseases. Reviews in Endocrine and Metabolic Disorders 20(4), 451–465. doi:10.1007/s11154-019-09526-8.
Reviews the oral microbiome’s role in periodontitis and metabolic disorders. Dysbiosis, particularly Porphyromonas, can exacerbate insulin resistance, linking oral health with systemic metabolic regulation.

W. J. Loesche, N. S. Grossman (2001). Periodontal disease as a specific, albeit chronic, infection: Diagnosis and treatment. Clinical Microbiology Reviews 14(4), 727–752. doi:10.1128/CMR.14.4.727-752.2001.
Describes periodontal disease as a chronic bacterial infection, primarily by Porphyromonas gingivalis, Bacteroides forsythus, and Treponema denticola. Highlights the potential to reduce cardiovascular risk by targeted antimicrobial periodontal therapy.

Gregori M. Kurtzman, Robert A. Horowitz, Richard Johnson, Ryan A. Prestiano, Benjamin I. Klein (2022). The systemic oral health connection: Biofilms. Medicine (United States) 101(46), e30517. doi:10.1097/MD.0000000000030517.
Emphasizes the systemic impact of oral biofilms, linking periodontal dysbiosis to multiple conditions, including cardiovascular disease, diabetes, and Alzheimer’s. Advocates integrated dental-medical care for systemic health improvement.

Mohammed Jafer (2015). The periodontal status and associated systemic health problems among an elderly population attending the outpatient clinics of a dental school. Journal of Contemporary Dental Practice 16(10), 781–787. doi:10.5005/jp-journals-10024-1787.
Assesses periodontal health in elderly patients and its systemic correlations. Moderate periodontitis was prevalent, but no clear association with diabetes or cardiovascular disease was observed, highlighting the complexity of systemic links.

Alina Ormenisan, Alexandra Balmos, Mihai Vlad Golu, Despina Bereczki Temistocle, Alina Baldean, Emanuela Tegla, Arpad Torok, Gabriela Beresescu (2018). Is there a relationship between obesity and periodontal diseases? Revista de Chimie 69(10), 2817–2824. doi:10.37358/rc.18.10.6599.
Cross-sectional study demonstrating significant association between chronic periodontitis and obesity metrics (BMI, waist circumference), supporting obesity as a systemic risk factor affecting periodontal health.

Mitu De, Manisha Bhattacharya, Animita C. Saha, Indrani Basu, Sayak Ganguli, Santi Ranjan Dey (2019). Influence of Oral Microbiome on Human Health: an Overview. International Journal of Advancement in Life Sciences Research 2(1), 1–12. doi:10.31632/ijalsr.2019v02i01.003.
Reviews the oral microbiome’s systemic impact, linking dysbiosis to periodontal diseases and conditions such as diabetes, cardiovascular disease, and ASD. Emphasizes metagenomics as a tool to map host-microbiome interactions.

Artur Falcao, Pedro Bullón (2019). A review of the influence of periodontal treatment in systemic diseases. Periodontology 2000 79(1), 117–134. doi:10.1111/prd.12249.
Summarizes evidence that periodontal therapy may influence systemic outcomes, including cardiovascular, metabolic, and inflammatory conditions, underscoring the importance of oral care in comprehensive healthcare.

Hafsa Feroze, Syed Akbar Abbas Zaidi, Waheed Gul Shaik, Talha Tanveer, Misbah Ali, Mehmil Aslam (2022). Dentists Knowledge about Association of Systemic Health with Periodontal Disease. Pakistan Journal of Medical and Health Sciences 16(5), 1506–1511. doi:10.53350/pjmhs221651506.
Survey study highlighting dental professionals’ awareness of systemic health links with periodontitis. Most dentists recognized associations with diabetes, cardiovascular disease, and obesity, demonstrating growing clinical understanding of oral-systemic interactions.

Davide Pietropaoli, Rita Del Pinto, Claudio Ferri, Jackson T. Wright, Mario Giannoni, Eleonora Ortu, Annalisa Monaco (2018). Poor Oral Health and Blood Pressure Control Among US Hypertensive Adults. Hypertension 72(6), 1320–1327. doi:10.1161/hypertensionaha.118.11528.
Analyzes hypertensive adults, showing periodontitis is associated with higher systolic BP and reduced antihypertensive treatment success. Suggests periodontal health may complement systemic blood pressure management.

Mealey, B. L. & Rose, L. F.. Diabetes mellitus and inflammatory periodontal diseases. Curr. Opin. Endocrinol. Diabetes Obes. 15, 135–141 (2008). doi:10.1097/MED.0b013e3282f824b7
Periodontal diseases are increasingly recognized as contributors to systemic conditions, particularly diabetes mellitus. Chronic periodontal inflammation is associated with systemic inflammatory markers and increased risk of cardiovascular events, adverse pregnancy outcomes, and altered glycemic control. Intervention via periodontal therapy can reduce oral bacterial load, decrease inflammation, and improve glycemic control, emphasizing the need for coordinated care between dentists and physicians.

Kurtzman, G., Horowitz, R., Johnson, R., Prestiano, R. & Klein, B.. Oral Biofilms and their Connection to Systemic Health. Med. Res. Arch. 10, 3148 (2022). doi:10.18103/mra.v10i9.3148
Oral biofilms, even without overt periodontal disease, may impact systemic health by circulating bacteria and byproducts. Increasing evidence links these biofilms to cardiovascular disease, diabetes, cancers, and other systemic disorders. Coordinated dental and medical care is essential to mitigate systemic complications arising from oral microbial dysbiosis.

Loesche, W. J.. The antimicrobial treatment of periodontal disease: Changing the treatment paradigm. Crit. Rev. Oral Biol. Med. 10, 301–316 (1999). doi:10.1177/10454411990100030101
The paradigm shift from non-specific to specific plaque hypothesis emphasizes targeting pathogenic bacteria rather than solely removing inflamed tissue. Evidence suggests that treating periodontal infections may reduce systemic risks, including cardiovascular disease, highlighting the importance of antimicrobial therapy in modern periodontal care.

Alexia, V., Chloé, V., Pierre, B. & Sara, L. D.. Periodontal Diseases and Systemic Disorders: What Do Our Doctors Know? A General Practitioner's Survey Conducted in Southern France. J. Evid.-Based Dent. Pract. 17, 234–243 (2017). doi:10.1016/j.jebdp.2017.05.007
A survey of general practitioners revealed awareness of links between periodontal diseases and diabetes or cardiovascular disease but gaps in knowledge regarding obesity and respiratory/joint conditions. Education is crucial to enable timely referral of high-risk patients to periodontists.

Parihar, A. S., Katoch, V., Rajguru, S. A., Rajpoot, N., Singh, P. & Wakhle, S.. Periodontal Disease: A Possible Risk-Factor for Adverse Pregnancy Outcome. J. Int. Oral Health 7, 102–108 (2015).
Periodontal pathogens contribute to systemic inflammation linked to preterm birth, low birth weight, and pre-eclampsia. Maternal periodontal health management before and during pregnancy may reduce maternal and perinatal morbidity.

Shangase, S. L., Mohangi, G. U., Hassam-Essa, S. & Wood, N. H.. The association between periodontitis and systemic health: an overview. S. Afr. Dent. J. 68, 12–16 (2013).
This review highlights the complex associations between periodontitis and systemic conditions, advocating a multidisciplinary approach to patient care. While causal links remain to be fully clarified, periodontal treatment improves quality of life and may reduce systemic disease burden.

Räisänen, I. T., Umeizudike, K. A., Pärnänen, P., Heikkilä, P., Tervahartiala, T., Nwhator, S. O., et al. Periodontal disease and targeted prevention using aMMP-8 point-of-care oral fluid analytics in the COVID-19 era. Med. Hypotheses 144, 110276 (2020). doi:10.1016/j.mehy.2020.110276
Periodontal disease exacerbates systemic inflammation and may increase severity of COVID-19. Point-of-care diagnostics, such as aMMP-8 assays, enable early detection and intervention, particularly in vulnerable populations or areas lacking dental infrastructure.

Bush, B. C. & Donley, T. G.. A model for dental hygiene education concerning the relationship between periodontal health and systemic health. Educ. Health 15, 91–102 (2002). doi:10.1080/13576280110110004
An educational framework was developed to train dental and medical personnel to recognize systemic risks associated with periodontal inflammation, enabling improved patient screening, education, and coordinated care.

Paquette, D. W., Madianos, P., Offenbacher, S., Beck, J. D. & Williams, R. C.. The concept of "risk" and the emerging discipline of periodontal medicine. J. Contemp. Dent. Pract. 1, 42–54 (1999). doi:10.5005/jcdp-1-1-42
Periodontal medicine explores bidirectional relationships between periodontitis and systemic diseases. Evidence supports that periodontitis triggers local and systemic inflammatory responses, forming a foundation for targeted prevention strategies.

Tungland, B.. Oral Dysbiosis and Periodontal Disease: Effects on Systemic Physiology and in Metabolic Diseases, and Effects of Various Therapeutic Strategies. In Human Microbiota in Health and Disease (Elsevier, 2018). doi:10.1016/b978-0-12-814649-1.00010-7
Dysbiosis in the oral microbiome underlies periodontitis and contributes to systemic diseases affecting cardiovascular, renal, hepatic, and reproductive systems. Therapeutic strategies aim to restore microbial balance and prevent downstream systemic effects.

Davidopoulou, S., Pikilidou, M., Yavropoulou, M. P., et al. Aggravated Dental and Periodontal Status in Patients with Sickle Cell Disease and Its Association with Serum Ferritin. J. Contemp. Dent. Pract. 22, 1012–1020 (2021). doi:10.5005/jp-journals-10024-3189
Patients with sickle cell disease exhibited worsened periodontal health and higher caries prevalence, likely linked to systemic inflammation reflected by elevated ferritin. Emphasizes need for proactive dental management in systemic conditions.

Burcham, Z. M., Garneau, N. L., Comstock, S. S., et al. Patterns of Oral Microbiota Diversity in Adults and Children: A Crowdsourced Population Study. Sci. Rep. 10, 9971 (2020). doi:10.1038/s41598-020-59016-0
This large population study confirmed associations between oral microbiota composition and factors such as age, oral hygiene, weight status, and family relatedness. Treponema was more prevalent in adults with poor dental care and in obese children, reinforcing the link between microbiome, health habits, and systemic risk.

Saini, R., Saini, S. & Saini, S. R.. Periodontitis: A risk for delivery of premature labor and low-birth-weight infants. J. Nat. Sci. Biol. Med. 1, 40–45 (2010). doi:10.4103/0976-9668.71672
Inflammatory mediators from periodontal pathogens may enter the bloodstream, adversely affecting fetal development. Periodontal disease is a significant independent risk factor for preterm birth and low birth weight, highlighting the need for preventive dental care in pregnancy.

Faden, A. A., Alsalhani, A. B., Idrees, M. M., et al. Knowledge, attitudes, and practice behavior of dental hygienists regarding the impact of systemic diseases on oral health. Saudi Med. J. 39, 1190–1198 (2018). doi:10.15537/smj.2018.11.23267
Dental hygienists in Saudi Arabia exhibited limited knowledge of oral-systemic disease relationships. Education and training are critical for integrating systemic disease considerations into routine dental practice.

Yost, S., Duran-Pinedo, A. E., Krishnan, K. & Frias-Lopez, J.. Potassium is a key signal in host-microbiome dysbiosis in periodontitis. PLoS Pathog. 13, e1006457 (2017). doi:10.1371/journal.ppat.1006457
Potassium levels in the periodontal pocket act as a signaling element in microbial dysbiosis, altering host immune responses and increasing virulence of the oral microbial community, offering potential mechanistic insight into periodontitis progression.

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Rajendran & Jayakumar (2021) reviewed chitosan-based biomaterials for periodontal therapy, highlighting their versatility in various formulations—nanoformulations, gels, hydrogels, scaffolds, membranes, and fibers. Chitosan’s biodegradability, drug/growth factor incorporation, and structural support make it a promising agent to enhance treatment outcomes in multistage periodontal regeneration.

Radaelli et al. (2021) discussed the potential systemic impact of peri-implantitis, suggesting that, analogous to periodontitis, peri-implant lesions may influence systemic health via inflammatory cytokines (IL-1, IL-6, IL-10) and matrix metalloproteinases. While hematological and biochemical alterations have been reported, evidence remains limited, and further research is required.

Wilder et al. (2008) examined oral–systemic disease education in U.S. dental hygiene programs, finding that diabetes, tobacco use, and cardiovascular disease were most emphasized. Despite confidence among program directors, only 9% believed nurses and physicians were knowledgeable about oral–systemic links, highlighting the need for more evidence-based educational resources.

Isola (2020) emphasized that oral and periodontal diseases can severely impair function and aesthetics, particularly in vulnerable populations. Periodontitis is linked with systemic conditions, including cardiovascular disease, diabetes, lung disease, and pregnancy complications, suggesting that diet, nutrition, and nutraceuticals may indirectly influence both oral and systemic health.

AlSharrad et al. (2019) reported low awareness of the relationship between periodontal diseases and systemic conditions (diabetes, cardiovascular disease, adverse pregnancy outcomes) among physicians and dentists in Saudi Arabia and Kuwait. Periodontists had the highest awareness, underscoring the need for improved interdisciplinary collaboration.

Narendran et al. (2023) surveyed medical practitioners in India, finding 75% aware of periodontitis and 74% aware of its link with cardiovascular diseases. About 88% referred patients to dentists, indicating generally good knowledge of oral–systemic interrelationships and highlighting the importance of collaborative care between medical and dental professionals.

Zenobia & Darveau (2022) reviewed the role of oral endotoxins, particularly from Porphyromonas gingivalis, in systemic inflammation. They highlighted how gingival inflammation can prime neutrophils, which re-enter circulation and exacerbate distal inflammatory conditions, potentially explaining links between oral and systemic diseases such as cardiovascular disease, diabetes, Alzheimer’s, and rheumatoid arthritis.

Jain et al. (2021) provided an overview of periodontitis as a major contributor to systemic disorders, including cardiovascular disease, diabetes, respiratory disorders, adverse pregnancy outcomes, autoimmune diseases, and cancer. The review emphasized that bacterial pathogens and their metabolites can enter systemic circulation, underscoring the importance of early therapeutic interventions to prevent systemic complications.

Journal of the American Dietetic Association (2003) highlighted the integral connection between nutrition and oral health. Malnutrition contributes to periodontal disease, while chronic diseases influenced by diet—such as diabetes and cardiovascular disease—also manifest oral complications. Collaboration between dietetics and dentistry is crucial for prevention and comprehensive care.

Skamagas et al. (2008) discussed diabetes as both a risk factor and a consequence of periodontitis. Periodontal inflammation can worsen glycemic control and cardiovascular outcomes, highlighting the role of oral health professionals in diabetes management.

Kajikawa et al. (2022) reviewed complement-targeted host-modulation therapy in periodontal disease, focusing on the C3-targeting drug AMY-101. Complement overactivation contributes to periodontal inflammation, and AMY-101 demonstrated efficacy in reducing gingival inflammation and holds potential for peri-implant inflammatory conditions.

Zhao et al. (2022) investigated salivary ACE2 and TMPRSS2 in relation to periodontitis and systemic health. ACE2 levels correlated with severity of periodontal disease, while TMPRSS2 was linked to metabolic parameters, suggesting salivary biomarkers could monitor oral and systemic conditions, including obesity and cardiovascular disease.

Lockhart et al. (2012) examined the association between periodontal disease and atherosclerotic vascular disease (ASVD). While observational studies support an association independent of confounders, there is no evidence of causality. Short-term periodontal interventions reduce systemic inflammation but do not currently modify ASVD outcomes.

Gaudilliere et al. (2019) analyzed systemic immune consequences of chronic periodontitis, showing exaggerated proinflammatory responses in neutrophils and monocytes, which were reversible after local periodontal treatment. This highlights the systemic impact of periodontitis and the potential benefit of treatment.

Sung et al. (2019) reported that periodontitis correlates with cognitive impairment in US adults, suggesting oral health as a modifiable risk factor for neurocognitive decline.

Chang et al. (2016) found a positive association between periodontal disease and pancreatic cancer risk, particularly in individuals aged 65 and older, independent of other comorbidities, indicating the systemic oncogenic potential of chronic oral inflammation.

Mankar et al. (2018) summarized mechanisms linking periodontitis to systemic conditions, including cardiovascular disease, diabetes, adverse pregnancy outcomes, and insulin resistance. Periodontal infection may act as an initiator or propagator of systemic inflammation.

Miyata et al. (2019) reviewed the impact of periodontal disease in patients receiving dialysis, highlighting increased inflammation, altered nutrient and bone metabolism, and immune dysregulation. Proper oral care in these patients can improve quality of life and survival.

Zainoddin et al. (2013) demonstrated that systemic conditions like hypertension and diabetes mellitus are prevalent in patients with periodontal disease, stressing the need for medical-dental collaboration.

Verma & Dhruvakumar (2021) surveyed nursing students, finding limited awareness (23%) of the oral–systemic link, indicating the need for better education to improve general health outcomes via oral health promotion.

Iordache et al. (2017) examined periodontal disease in patients with ankylosing spondylitis, finding impaired oral health associated with systemic inflammation. Anti-TNF therapy improved both periodontal and systemic inflammatory markers, underscoring the interplay between systemic inflammation and oral health.

Lesmana, D., Tjahajawati, S., and Lubis, V.T. (2016). SALIVA AS A POTENTIAL DIAGNOSTIC OF BIOMARKER OF ORAL AND SYSTEMIC DISEASES. Dentika: Dental Journal, 19(2), doi:10.32734/dentika.v19i2.460.
Saliva, secreted by major and minor glands, serves as a protective and lubricative fluid in the oral cavity. Beyond its physiological roles, saliva holds significant promise as a non-invasive biomarker for diagnosing caries, periodontal disease, tumors, autoimmune, infectious, cardiovascular conditions, and more, offering advantages over serum in cost and sample collection.

Martinon, P., Fraticelli, L., Giboreau, A., Dussart, C., Bourgeois, D., and Carrouel, F. (2021). Nutrition as a key modifiable factor for periodontitis and main chronic diseases. Journal of Clinical Medicine, 10(2), doi:10.3390/jcm10020197.
This review highlights how dietary patterns influence periodontal disease (PD) and chronic conditions. Western diets high in sugar and saturated fats increase PD risk, whereas Mediterranean and plant-rich diets are protective. Certain vitamins, minerals, and polyphenols may prevent PD, and probiotics/prebiotics can enhance oral health. Changes in periodontal health may serve as early indicators for systemic disease risk.

Leung, T.J.T., Nijland, N., Gerdes, V.E.A., and Loos, B.G. (2022). Prevalence of Periodontal Disease among Patients at the Outpatient Clinic of Internal Medicine in an Academic Hospital in The Netherlands: A Cross-Sectional Pilot Study. Journal of Clinical Medicine, 11(20), doi:10.3390/jcm11206018.
Among 345 patients, severe PD prevalence was 16.2%, with total PD at 53.6%. Cardiovascular disease (CVD) patients had significantly higher PD rates. Although multimorbidity slightly increased PD risk, larger studies are needed to confirm its association with systemic disease.

Grant, W.B., van Amerongen, B.M., and Boucher, B.J. (2023). Periodontal Disease and Other Adverse Health Outcomes Share Risk Factors, including Dietary Factors and Vitamin D Status. Nutrients, 15(12), doi:10.3390/nu15122787.
PD and systemic diseases share risk factors such as diet, obesity, and low vitamin D. While PD is not a direct cause of these outcomes, its early diagnosis can prompt lifestyle modifications. Anti-inflammatory, plant-based diets and optimal vitamin D levels are recommended to reduce PD severity and other health risks.

Uwitonze, A.M., et al. (2018). Periodontal diseases and adverse pregnancy outcomes: Is there a role for vitamin D? Journal of Steroid Biochemistry and Molecular Biology, 180, doi:10.1016/j.jsbmb.2018.01.010.
Maternal PDs are linked to preterm birth and low birth weight through inflammatory cytokines and bacterial endotoxins. Vitamin D deficiency may exacerbate PD, and supplementation during pregnancy could reduce adverse outcomes. Collaborative antenatal dental care is critical.

Gomes-Filho, I.S., et al. (2021). Periodontitis and its higher levels of severity are associated with the triglyceride/high density lipoprotein cholesterol ratio. Journal of Periodontology, 92(11), doi:10.1002/JPER.21-0004.
This cross-sectional study in Brazil found that periodontitis, especially moderate and severe forms, is positively associated with a high TG/HDL-C ratio, suggesting a link between periodontal severity and systemic metabolic dysregulation.

Joshipura, K., Ritchie, C., and Douglass, C. (2000). Strength of evidence linking oral conditions and systemic disease. Compendium of Continuing Education in Dentistry, 30(Suppl).
Dental diseases, especially chronic periodontal disease and tooth loss, may contribute to systemic outcomes including cardiovascular events, pregnancy complications, and respiratory conditions. Associations are partly due to shared risk factors, but bacteremia, endotoxins, and inflammatory mediators may also play a role.

Steigmann, L., et al. (2020). Biosensor and Lab-on-a-chip Biomarker-identifying Technologies for Oral and Periodontal Diseases. Frontiers in Pharmacology, 11, doi:10.3389/fphar.2020.588480.
Emerging oral biosensors and lab-on-chip technologies offer non-invasive diagnostic capabilities for periodontitis and systemic conditions. These innovations may enable early detection, risk stratification, and precision oral medicine, improving patient outcomes.

Priyamvara, A., et al. (2019). Importance of Oral Health in Pregnancy: A Mini-symposium. Current Women’s Health Reviews, 15(3), doi:10.2174/1573404815666190107095920.
Hormonal changes during pregnancy increase susceptibility to gingivitis and periodontitis, which can affect cardiovascular, endocrine, and respiratory systems. Maintaining oral health through regular dental care and awareness mitigates these risks and prevents adverse pregnancy outcomes.

Seinost, G., et al. (2020). Periodontal treatment and vascular inflammation in patients with advanced peripheral arterial disease: A randomized controlled trial. Atherosclerosis, 313, doi:10.1016/j.atherosclerosis.2020.09.019.
In PAD patients with severe periodontitis, periodontal therapy improved oral health but did not significantly reduce vascular inflammation. This study highlights that while periodontal intervention is safe and effective locally, systemic inflammatory outcomes may require additional or complementary strategies.

Padial-Molina, M., Gonzalez-Perez, G., Martin-Morales, N., Sanchez-Fernandez, E., O'Valle, F., Galindo-Moreno, P. (2024). Periostin in the relation between periodontal disease and atherosclerotic coronary artery disease: A pilot randomized clinical study. Journal of Periodontal Research, 59(3), 10.1111/jre.13229.
A pilot randomized trial investigated whether periodontal treatment affects local and systemic markers of cardiovascular disease. Periodontal surgery significantly increased periostin locally in gingival crevicular fluid (GCF), but systemic inflammatory markers did not show significant changes, suggesting localized effects without confirmed systemic cardiovascular benefit.

Rath, S.K., Mukherjee, M., Kaushik, R., Sen, S., Kumar, M. (2014). Periodontal pathogens in atheromatous plaque. Indian Journal of Pathology and Microbiology, 57(2), 10.4103/0377-4929.134704.
This study confirmed the presence of periodontal pathogen DNA—including Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, and Tannerella forsythia—in coronary atheromatous plaques, establishing a microbial link between periodontitis and coronary artery disease.

Carallo, C., Fortunato, L., de Franceschi, M.S., Irace, C., et al. (2010). Periodontal disease and carotid atherosclerosis: Are hemodynamic forces a link? Atherosclerosis, 213(1), 10.1016/j.atherosclerosis.2010.07.025.
Worse periodontal indices correlated with higher carotid plaque presence and altered wall shear stress, highlighting a possible interplay between local inflammation and hemodynamic factors in atherosclerosis.

Kiswanjaya, B., Boel, T., Priminiarti, M., Iskandar, H.H.B. (2017). The relationship between oral health condition and systemic disease in healthy Indonesian population. Journal of International Dental and Medical Research, 10(Specialissue).
Poor oral hygiene was significantly associated with elevated systemic CRP levels, indicating that even subclinical periodontal conditions can drive systemic inflammation.

Pavankumar, S., Yellarthi, P.K., et al. (2023). Evaluation of periodontal status in women with polycystic ovary syndrome versus healthy women: a cross-sectional study. Journal of Yeungnam Medical Science, 40, 10.12701/jyms.2023.00143.
Women with PCOS exhibited higher periodontal indices (GI, CPI, LA) despite similar oral hygiene scores, supporting a synergistic effect of systemic endocrine conditions and periodontitis on inflammatory status.

Jaramillo, A., et al. (2013). Association between periodontal disease and plasma levels of cholesterol and triglycerides. Colombia Medica, 44(2), 10.25100/cm.v44i2.1123.
Untreated periodontitis in Colombian patients altered serum lipid profiles, with associations between antibodies against P. gingivalis, T. forsythia, and A. actinomycetemcomitans and HDL/TG levels, reinforcing a systemic metabolic impact of oral infection.

Babic, A., et al. (2015). Periodontal bone loss and risk of epithelial ovarian cancer. Cancer Causes and Control, 26(6), 10.1007/s10552-015-0575-7.
Periodontal bone loss did not increase ovarian cancer risk overall but suggested a protective association in women younger than 69, indicating age-dependent interactions between oral health and cancer risk.

Balaji, S., Lavu, V., Rao, S. (2018). Chronic periodontitis prevalence and the inflammatory burden in a sample population from South India. Indian Journal of Dental Research, 29(2), 10.4103/ijdr.IJDR_335_17.
High prevalence of chronic periodontitis (42.3%) in urban children (<18 years) demonstrated significant inflammatory burden, influenced by lifestyle factors such as smoking and oral hygiene scores.

Wilder, R.S., et al. (2009). Periodontal–Systemic Disease Education in U.S. and Canadian Dental Schools. Journal of Dental Education, 73(1), 10.1002/j.0022-0337.2009.73.1.tb04638.x.
Survey highlighted that most dental students understand oral–systemic links (e.g., CVD, diabetes), but interprofessional collaboration remains limited.

Katz, J., Wallet, S., Cha, S. (2010). Periodontal disease and the oral-systemic connection: "is it all the RAGE?". Quintessence International, 41(3).
Review emphasized the role of RAGE signaling in linking chronic periodontal inflammation to systemic diseases such as cardiovascular disease, diabetes, Alzheimer’s, and cancer.

Martelli, M.L., et al. (2017). Periodontal disease and women’s health. Current Medical Research and Opinion, 33(6), 10.1080/03007995.2017.1297928.
Comprehensive review highlighted bidirectional links between periodontitis and systemic conditions with female predominance (osteoporosis, infertility, CVD, AD), underscoring oral health importance in women.

Mahendra, J., et al. (2022). Influence of Systemic Conditions on Periodontium-Exploring the Oral Systemic Connection: A Mini-Review. Ijdrd, 4(March).
Emphasized periodontitis as a continual source of infection affecting cardiovascular, pulmonary, endocrine, musculoskeletal, and reproductive health, advocating integrated dental-medical care.

Demmer, R.T., et al. (2008). Refining exposure definitions for studies of periodontal disease and systemic disease associations. Community Dentistry and Oral Epidemiology, 36(6), 10.1111/j.1600-0528.2008.00435.x.
Defined optimal periodontal exposure metrics (e.g., attachment loss, pocket depth, tooth loss) for robust correlations with systemic disease markers like HbA1c, fibrinogen, and carotid intima-media thickness.

Vadvadgi, V.H., et al. (2021). Oral Health: A Guide for Your Health as a Periodontist’s Point of View. Journal of Pharmaceutical Research International, 33.
Review underscored that pathogens like A. actinomycetemcomitans, T. forsythia, and P. gingivalis may disseminate systemically, impacting cardiovascular, metabolic, and obstetric outcomes.

Cotič, J., et al. (2017). Oral health and systemic inflammatory, cardiac and nitroxid biomarkers in hemodialysis patients. Medicina Oral, Patologia Oral y Cirugia Bucal, 22(4), 10.4317/medoral.21629.
Hemodialysis patients exhibited compromised oral health associated with elevated CRP and cardiac biomarkers, emphasizing the role of oral care in chronic systemic disease.

Lee, S., et al. (2018). Association between periodontitis and blood lipid levels in a Korean population. Journal of Periodontology, 89(1), 10.1902/jop.2017.170111.
Women with low HDL and high LDL cholesterol had higher periodontitis risk, demonstrating sex-specific interactions between lipid metabolism and periodontal disease.

Kang, J., et al. (2023). Periodontal disease in people with a history of psychosis: Results from the UK biobank population-based study. Community Dentistry and Oral Epidemiology, 51(5), 10.1111/cdoe.12798.
Individuals with psychosis had higher prevalence of periodontal disease, and risk factors included smoking, older age, female sex, and comorbid cardiovascular or respiratory disease.

Williams, R.C., et al. (2008). The potential impact of periodontal disease on general health: A consensus view. Current Medical Research and Opinion, 24(6), 10.1185/03007990802131215.
Consensus review concluded that periodontitis may contribute to cardiovascular disease and diabetes severity, recommending oral health education as part of systemic disease prevention strategies.

ML, M., et al. (2017). Periodontal disease and women’s health. Current Medical Research and Opinion, 33(6).
Echoed previous findings on the link between periodontal disease and systemic conditions with a female bias, reinforcing the importance of oral care in mitigating adverse systemic outcomes.

Kalhan, A. C., Wong, M. L., Allen, F., & Gao, X. (2022). Periodontal disease and systemic health: An update for medical practitioners. Annals of the Academy of Medicine, Singapore, 51(9), 503. doi:10.47102/annals-acadmedsg.2021503.
This narrative review synthesizes emerging evidence linking periodontal disease to systemic conditions including diabetes, cardiovascular disease, respiratory disease, Alzheimer’s disease, rheumatoid arthritis, and chronic kidney disease. The bidirectional relationships, particularly between diabetes and periodontitis, highlight the systemic inflammatory impact of oral disease. The review emphasizes the importance of integrated, patient-centric care combining dental and medical management.

Ricardo, A. C., Athavale, A., Chen, J., Hampole, H., Garside, D., Marucha, P., & Lash, J. P. (2015). Periodontal disease, chronic kidney disease and mortality: Results from the third national health and nutrition examination survey. BMC Nephrology, 16(1). doi:10.1186/s12882-015-0101-x.
This prospective study of 10,755 adults demonstrates that periodontal disease and chronic kidney disease (CKD) independently and jointly increase all-cause and cardiovascular mortality. Patients with both conditions exhibited more than double the risk of death, underscoring the clinical importance of managing oral health in CKD populations.

Wahid, A., Chaudhry, S., Ehsan, A., Butt, S., & Khan, A. A. (2012). Bidirectional relationship between chronic kidney disease & periodontal disease. Pakistan Journal of Medical Sciences, 29(1), 2926. doi:10.12669/pjms.291.2926.
This review highlights a bidirectional association between periodontitis and CKD. Periodontal inflammation contributes to systemic inflammatory burden, exacerbating CKD, while CKD induces oral manifestations such as gingival hyperplasia and xerostomia. Evidence suggests that non-surgical periodontal therapy may improve systemic inflammation and quality of life in patients on hemodialysis.

Aydindoğan, S., Velioğlu, E. M., & Hakkı, S. S. (2023). Behçet’s Disease and Periodontal Disease. Current Oral Health Reports, 10(2), 332-345. doi:10.1007/s40496-023-00332-5.
This review explores the interaction between periodontal disease and Behçet’s disease (BD), a chronic autoinflammatory condition. Poor oral health in BD patients exacerbates systemic inflammation, and periodontal therapy improves disease severity and overall quality of life, emphasizing the need for oral care as part of multidisciplinary BD management.

Larvin, H., Kang, J., Aggarwal, V. R., Pavitt, S., & Wu, J. (2022). The additive effect of periodontitis with hypertension on risk of systemic disease and mortality. Journal of Periodontology, 93(7). doi:10.1002/JPER.21-0621.
A UK Biobank study (n = 244,393) demonstrates that periodontitis in hypertensive individuals amplifies risks of cardiovascular and respiratory diseases. The additive effects suggest that periodontal management may mitigate systemic disease risks, especially in hypertensive populations.

Jayaraman, B. G., Farjana, N., & Keerthana, S. A. (2019). Chronic periodontitis and hypertension: A systematic review. Indian Journal of Public Health Research and Development, 10(12), 292-292. doi:10.37506/v10/i12/2019/ijphrd/192292.
A systematic review establishes a positive association between chronic periodontitis and elevated blood pressure. Intensive periodontal therapy reduces systemic inflammatory markers and systolic blood pressure, supporting the role of oral health interventions in cardiovascular risk reduction.

Khaptanova, V. A., Golmenko, A. D., Khaptanov, A. Y., & Gamayunov, D. Y. (2021). Relationship of coronary heart disease and comorbide dental background. Acta Biomedica Scientifica, 6(4). doi:10.29413/ABS.2021-6.4.8.
This study emphasizes the link between periodontal disease and coronary artery disease, noting that systemic inflammation from oral pathology may exacerbate cardiovascular risks. Comprehensive periodontal treatment is recommended to reduce systemic inflammatory load.

Hagh, L. G., Zakavi, F., Hajizadeh, F., & Saleki, M. (2014). The association between hyperlipidemia and periodontal infection. Iranian Red Crescent Medical Journal, 16(12), 6577. doi:10.5812/ircmj.6577.
In a case-control study, patients with periodontitis exhibited elevated cholesterol and triglycerides, suggesting a potential link between hyperlipidemia and periodontal infection. Further research is needed to clarify causality and implications for cardiovascular disease.

Altas, N., Boyama, B., & Çakmak, B. (2020). The association between hyperemesis gravidarum and periodontal disease in pregnancy. European Journal of General Dentistry, 9(3), 184-192. doi:10.4103/ejgd.ejgd_184_19.
This study finds higher gingival inflammation in pregnant women with hyperemesis gravidarum (HG) compared to controls. Findings suggest that poor oral hygiene due to nausea may exacerbate periodontal disease, highlighting the need for preventive oral care in HG patients.

Tai, Y. H., Chen, J. T., Kuo, H. C., Chang, W. J., Wu, M. Y., Dai, Y. X., Liu, W. C., Chen, T. J., Wu, H. L., & Cherng, Y. G. (2021). Periodontal disease and risk of mortality and kidney function decline in advanced chronic kidney disease: a nationwide population-based cohort study. Clinical Oral Investigations, 25(11), 3924-3935. doi:10.1007/s00784-021-03924-6.
This population-based study shows that periodontal disease does not significantly predict long-term mortality, end-stage renal disease, or major adverse cardiovascular events in advanced CKD patients, suggesting that oral interventions may have limited effect in late-stage disease.

Beck, J. D., Papapanou, P. N., Philips, K. H., & Offenbacher, S. (2019). Periodontal Medicine: 100 Years of Progress. Journal of Dental Research, 98(10), 1081–1095. doi:10.1177/0022034519846113.
A centennial review of periodontal medicine highlights over 50 systemic conditions linked to periodontitis, including cardiovascular disease, diabetes, and adverse pregnancy outcomes. While periodontal therapy shows variable effects on systemic health, the review underscores the clinical significance of oral-systemic interactions.

Paquette, D. W., Bell, K. P., Phillips, C., Offenbacher, S., & Wilder, R. S. (2015). Dentists’ Knowledge and Opinions of Oral-Systemic Disease Relationships: Relevance to Patient Care and Education. Journal of Dental Education, 79(6), 662–670. doi:10.1002/j.0022-0337.2015.79.6.tb05934.x.
Surveying 667 dentists, the study found strong awareness of the link between periodontal disease and systemic conditions like cardiovascular disease and diabetes, with widespread support for interprofessional collaboration to improve patient care.

Natto, Z. S., & Hameedaldain, A. (2019). Methodological Quality Assessment of Meta-analyses and Systematic Reviews of the Relationship Between Periodontal and Systemic Diseases. Journal of Evidence-Based Dental Practice, 19(2), 90–101. doi:10.1016/j.jebdp.2018.12.003.
A review of 42 systematic reviews/meta-analyses confirms methodological variability in studies linking periodontal disease to systemic conditions. High-quality evidence is essential for clinicians to reliably inform patients about oral-systemic health risks.

Nocini, R., Favaloro, E. J., Sanchis-Gomar, F., Lippi, G. Periodontitis, coronary heart disease and myocardial infarction: Treat one, benefit all. Blood Coagulation and Fibrinolysis 31, 339–345 (2020). doi:10.1097/MBC.0000000000000928.
Periodontal disease, an inflammatory condition affecting the gums and periodontium, is increasingly prevalent worldwide. Epidemiological and biological evidence supports a strong association between periodontitis and coronary heart disease (CHD), with patients showing higher rates of hypertension, dyslipidemia, endothelial dysfunction, platelet hyper-reactivity, and a prothrombotic state. Translocation of periodontal microorganisms into atherosclerotic plaques may exacerbate plaque instability. Statins may also offer periodontal benefits, highlighting the interconnection between CHD and periodontitis.

Deshpande, N., Amrutiya, M. Obesity and oral health - Is there a link? An observational study. Journal of Indian Society of Periodontology 21, 212–218 (2017). doi:10.4103/jisp.jisp_305_16.
Obese participants (BMI >30) demonstrated significantly higher prevalence of periodontitis than non-obese participants, as measured by gingival index (GI), pocket probing depth (PPD), and clinical attachment level (CAL). The study indicates a strong correlation between obesity and periodontal disease, suggesting that obesity may predispose individuals to periodontal tissue destruction.

Marchetti, E., Monaco, A., Procaccini, L., et al. Periodontal disease: The influence of metabolic syndrome. Nutrition and Metabolism 9, 88 (2012). doi:10.1186/1743-7075-9-88.
Metabolic syndrome (MetS) induces oxidative stress and a proinflammatory state that can exacerbate periodontitis. Hyperglycemia and advanced glycation end-products contribute to periodontal tissue damage, while adipocytokines influence oxidant/antioxidant balance. The study highlights the systemic and local consequences of MetS, linking cardiovascular disease, diabetes, and periodontal destruction.

Raspini, M., Cavalcanti, R., Clementini, M., et al. Periodontitis and Italians (2016–2020): Need for clinical guidelines to perform effective therapy. Dental Cadmos 89, 312–320 (2021). doi:10.19256/d.cadmos.05.2021.05.
Surveys in Italy reveal high prevalence of periodontitis and low rates of diagnosis and treatment. The study emphasizes the socio-economic and psychological burden of untreated disease and calls for evidence-based clinical guidelines to improve patient outcomes and reduce public health costs.

Zemedikun, D. T., Chandan, J. S., Raindi, D., et al. Burden of chronic diseases associated with periodontal diseases: A retrospective cohort study using UK primary care data. BMJ Open 11, e048296 (2021). doi:10.1136/bmjopen-2020-048296.
Periodontal diseases were associated with increased baseline and incident risk of cardiovascular, cardiometabolic, autoimmune diseases, and mental ill-health. The findings suggest that the widespread prevalence of periodontal disease contributes significantly to the overall chronic disease burden.

Ryan, M. E. Nonsurgical approaches for the treatment of periodontal diseases. Dental Clinics of North America 49, 637–664 (2005). doi:10.1016/j.cden.2005.03.010.
Emphasizes the integration of therapies addressing bacterial pathogens and host responses, including MMPs and cytokines. Effective periodontal management may reduce risks for systemic conditions such as cardiovascular disease, diabetes, stroke, respiratory disease, and adverse pregnancy outcomes.

Taylor, G. W., Borgnakke, W. S. Self-Reported Periodontal Disease: Validation in an Epidemiological Survey. Journal of Periodontology 78, 1406–1413 (2007). doi:10.1902/jop.2007.060481.
Self-reporting can be a valid tool for assessing periodontal disease prevalence in large populations. Logistic models using age, gender, smoking, and self-reported oral health measures achieved high sensitivity and specificity in predicting moderate and severe periodontitis.

Chun, Y. H. P., Chun, K. R. J., Olguin, D., Wang, H. L. Biological foundation for periodontitis as a potential risk factor for atherosclerosis. Journal of Periodontal Research 40, 87–98 (2005). doi:10.1111/j.1600-0765.2004.00771.x.
Reviews molecular interactions linking periodontitis to atherosclerosis. Porphyromonas gingivalis has pathogenic roles contributing to inflammation and immune dysregulation. The study explores mechanistic plausibility for cardiovascular risk stemming from periodontal pathogens.

Chiu, S. Y., Chang, C. H., Fu, C. H., Chen, M. Y. Factors Associated With Oral Health Status and Oral Hygiene Behavior in Patients With Stroke. Hu li za zhi The Journal of Nursing 67, 77–85 (2020). doi:10.6224/JN.202010_67(5).07.
Stroke patients showed inadequate oral hygiene behaviors and poor oral health, with age, health-promoting behaviors, and tooth brushing as key predictors. Findings support early interventions to improve oral care in vulnerable populations.

Martelli, F. S., Fanti, E., Rosati, C., et al. Long-term efficacy of microbiology-driven periodontal laser-assisted therapy. European Journal of Clinical Microbiology and Infectious Diseases 35, 431–441 (2016). doi:10.1007/s10096-015-2555-y.
A retrospective study of 2,683 patients shows that combining microbiome profiling with Nd:YAG laser-assisted therapy significantly improves clinical and bacteriological outcomes in periodontitis, demonstrating long-term efficacy even in aggressive cases.

Choi, S. E., Sima, C., Pandya, A. Impact of treating oral disease on preventing vascular diseases: A model-based cost-effectiveness analysis of periodontal treatment among patients with type 2 diabetes. Diabetes Care 43, 613–621 (2020). doi:10.2337/dc19-1201.
Nonsurgical periodontal treatment in type 2 diabetes patients reduced tooth loss and microvascular complications, yielding net cost savings and quality-adjusted life year gains, highlighting the systemic benefits of oral health management.

Dubar, M., Delatre, V., Moutier, C., et al. Awareness and practices of general practitioners towards the oral-systemic disease relationship: A regionwide survey in France. Journal of Evaluation in Clinical Practice 26, 1556–1567 (2020). doi:10.1111/jep.13343.
Surveyed GPs showed partial awareness of the oral-systemic disease link, particularly for diabetes and cardiovascular conditions, and underscored the need for improved collaboration and continuing education to integrate oral health into general medical practice.

Fine, N., Chadwick, J. W., Sun, C., et al. Periodontal Inflammation Primes the Systemic Innate Immune Response. Journal of Dental Research 100, 272–281 (2021). doi:10.1177/0022034520963710.
Ligature-induced periodontitis in mice enhanced systemic polymorphonuclear neutrophil (PMN) responses, a phenomenon mirrored in humans with gingivitis. Findings demonstrate systemic hyperinflammatory priming by periodontal inflammation, suggesting broader implications for inflammatory comorbidities.

Doan, B., Buduneli, E., Emingil, G., et al. Characteristics of Periodontal Microflora in Acute Myocardial Infarction. Journal of Periodontology 76, 740–748 (2005). doi:10.1902/jop.2005.76.5.740.
Patients with generalized chronic periodontitis and acute myocardial infarction showed elevated total bacterial counts and specific shifts in subgingival microflora, supporting a potential link between periodontal microbial burden and systemic cardiovascular risk.

Quijano, A., Shah, A. J., Schwarcz, A. I., Lalla, E., & Ostfeld, R. J. (2010). Knowledge and Orientations of Internal Medicine Trainees Toward Periodontal Disease. Journal of Periodontology, 81(3), doi:10.1902/jop.2009.090475.
Incoming internal medicine trainees demonstrated limited knowledge regarding periodontal disease, with 82% never asking patients about periodontal diagnoses and 69% feeling uncomfortable performing basic periodontal examinations. These findings underscore the need for enhanced oral health training in both medical school and postgraduate education to bridge the gap between oral and systemic health awareness.

Pessolano, L. G., Kramer, C. D., Simas, A., Weinberg, E. O., Genco, C. A., & Schreiber, B. M. (2020). Periodontal Disease and Birth Outcomes: Are We Missing Something? Current Oral Health Reports, 7(1), doi:10.1007/s40496-020-00255-5.
This review highlights the potential contribution of periodontal disease to adverse pregnancy outcomes, including preterm birth, fetal growth restriction, and gestational diabetes. Mechanisms include systemic inflammation and microbial translocation. The authors emphasize the need for standardized definitions and consideration of genetic, epigenetic, and environmental confounders in future studies.

Pizzo, G., Guiglia, R., & Campisi, G. (2011). Periodontal disease and systemic diseases: Interrelationships and interactions. In Periodontal Disease: Symptoms, Treatment and Prevention.
Chronic periodontitis can drive systemic inflammation through bacteremia and inflammatory mediators. Links with cardiovascular disease, diabetes mellitus, adverse pregnancy outcomes, and neurodegenerative diseases highlight the field of “periodontal medicine,” stressing that oral health interventions may benefit overall systemic health.

Thompson, D. (2023). Integrative oral medicine: Dentistry's role in improving health outcomes. Journal of Esthetic and Restorative Dentistry, 35(5), doi:10.1111/jerd.13083.
Emphasizing integrative oral medicine, this article demonstrates that managing periodontal disease, caries, and periapical infections reduces systemic inflammatory burden, potentially lowering cardiovascular risks and improving overall patient health outcomes.

Lamster, I. B. (2016). Geriatric periodontology: how the need to care for the aging population can influence the future of the dental profession. Periodontology 2000, 72(1), doi:10.1111/prd.12157.
With an aging population retaining more teeth and presenting complex systemic conditions, geriatric periodontology will require interprofessional care. Recognizing links between periodontitis and chronic diseases like diabetes and cardiovascular conditions is essential for optimizing oral and systemic health.

Carra, M. C., Schmitt, A., Thomas, F., Danchin, N., Pannier, B., & Bouchard, P. (2017). Sleep disorders and oral health: a cross-sectional study. Clinical Oral Investigations, 21(4), doi:10.1007/s00784-016-1851-y.
Individuals with sleep disorders had higher prevalence of gingival inflammation, and the coexistence of sleep disorders and periodontitis correlated with elevated cardiovascular risk, supporting a systemic link between oral and sleep health.

Yu, Y. H., Steffensen, B., Chasman, D. I., & Buring, J. E. (2024). Self-reported oral health is associated with systemic health outcomes and all-cause mortality. Journal of the American Dental Association, 155(3), doi:10.1016/j.adaj.2023.11.006.
Self-reported poor oral health mirrored clinical periodontal disease in predicting cardiovascular disease, diabetes, osteoporosis, and increased all-cause mortality, validating the use of oral health questionnaires in epidemiological surveillance.

Cho, H. J., Shin, M. S., Song, Y., Park, S. K., Park, S. M., & Kim, H. D. (2021). Severe Periodontal Disease Increases Acute Myocardial Infarction and Stroke: A 10-Year Retrospective Follow-up Study. Journal of Dental Research, 100(7), doi:10.1177/0022034520986097.
Severe periodontal disease was causally linked to higher incidence of acute myocardial infarction, stroke, and major adverse cardiovascular events in a large Korean cohort, highlighting its role as an independent cardiovascular risk factor.

Taylor, H. L., Rahurkar, S., Treat, T. J., Thyvalikakath, T. P., & Schleyer, T. K. (2021). Does Nonsurgical Periodontal Treatment Improve Systemic Health? Journal of Dental Research, 100(3), doi:10.1177/0022034520965958.
Systematic review evidence is limited and methodologically weak regarding nonsurgical periodontal treatment improving systemic outcomes. The authors call for rigorous studies and use of integrated medical-dental databases to assess true systemic benefits.

Niswade, G., Niswade, A., Gattani, D., & Bhutada, G. (2019). Study of common carotid and brachial artery hemodynamic variations in periodontal disease in Central India-a clinical study. Clinical Epidemiology and Global Health, 7(3), doi:10.1016/j.cegh.2019.03.005.
Patients with periodontitis exhibited higher carotid intima-media thickness and arterial diameter compared to controls, suggesting endothelial dysfunction and elevated cardiovascular risk linked to periodontal inflammation.

Moutsopoulos, N. M., & Madianos, P. N. (2006). Low-grade inflammation in chronic infectious diseases: Paradigm of periodontal infections. Annals of the New York Academy of Sciences, 1088, doi:10.1196/annals.1366.032.
Chronic periodontitis induces systemic low-grade inflammation, increasing risk for cardiovascular disease, diabetes, and adverse pregnancy outcomes. Pilot studies show periodontal therapy may reduce surrogate cardiovascular risks and preterm birth rates.

Schwarz, C., Hajdu, A. I., et al. (2023). Link between Oral Health, Periodontal Disease, Smoking, and Systemic Diseases in Romanian Patients. Healthcare (Switzerland), 11(16), doi:10.3390/healthcare11162354.
The severity of periodontitis correlated positively with systemic disease prevalence and quality-of-life impairment. Non-smokers had significantly lower diagnostic severity, highlighting modifiable risk factors in systemic comorbidity prevention.

Boitor, O., Stoica, F., Mihăilă, R., et al. (2023). Automated Machine Learning to Develop Predictive Models of Metabolic Syndrome in Patients with Periodontal Disease. Diagnostics, 13(24), doi:10.3390/diagnostics13243631.
Machine learning analysis identified periodontal disease severity, cardiovascular risk, and low EQ-5D-5L scores as primary predictors of metabolic syndrome, supporting the bidirectional relationship between oral and systemic metabolic health.

Shrestha, D., Choi, Y.-H., Zhang, J., et al. (2015). Relationship Between Serologic Markers of Periodontal Bacteria and Metabolic Syndrome and Its Components. Journal of Periodontology, 86(3), doi:10.1902/jop.2014.140408.
Specific antibody clusters against periodontal bacteria (Orange-Red and Orange-Blue) were associated with altered fasting glucose levels, revealing nuanced connections between periodontal microbiology and metabolic health.

Walther, C., Wenzel, J. P., et al. (2022). Association between periodontitis and heart failure in the general population. ESC Heart Failure, 9(6), doi:10.1002/ehf2.14150.
Severe periodontitis was significantly associated with heart failure with mildly reduced ejection fraction, even after adjusting for traditional cardiovascular risk factors, suggesting periodontal inflammation may contribute to cardiac dysfunction.

Jamieson, L., Hedges, J., Dodd, Z., Larkins, P., Zbierski, C., Nath, S., Kapellas, K., Ju, X. Provision of Dental Care to Indigenous South Australians and Impacts on Improved General Health: Study Protocol. Int J Environ Res Public Health 20, 2955 (2023). doi:10.3390/ijerph20042955.
This mixed-methods study protocol explores culturally safe dental care for Indigenous South Australians, aiming to improve both oral and systemic health outcomes. The intervention involves baseline and 12-month follow-up oral examinations with point-of-care testing to assess diabetes (HbA1c), cardiovascular (CRP), and kidney disease (ACR). The study will provide insight into culturally appropriate care and its impact on chronic disease prognosis.

Emery, D. C., Cerajewska, T. L., Seong, J., Davies, M., Paterson, A., Allen-Birt, S. J., West, N. X. Comparison of Blood Bacterial Communities in Periodontal Health and Periodontal Disease. Front Cell Infect Microbiol 10, 577485 (2021). doi:10.3389/fcimb.2020.577485.
This study examined intact bacterial cells in the blood of subjects with severe periodontitis and healthy controls. Findings show 43–52% of blood bacteria are oral in origin, predominantly Firmicutes. Proteobacteria, often linked to gut origin, were relatively low. The study highlights distinct phylogenetic differences in blood bacterial communities between health and disease.

Otomo-Corgel, J., Pucher, J. J., Rethman, M. P., Reynolds, M. A. State of the science: Chronic periodontitis and systemic health. J Evid Based Dent Pract 12, 3 Suppl, 20–32 (2012). doi:10.1016/S1532-3382(12)70006-4.
This review summarizes associations between chronic periodontitis and systemic conditions, including diabetes, cardiovascular disease, osteoporosis, pregnancy complications, respiratory diseases, and rheumatoid arthritis. While biological plausibility exists, cause-and-effect relationships remain unclear. Treatment of periodontal infections is emphasized to reduce local and systemic inflammation.

Teufer, B., Sommer, I., Nussbaumer-Streit, B., Titscher, V., Bruckmann, C., Klerings, I., Gartlehner, G. Screening for periodontal diseases by non-dental health professionals: A protocol for a systematic review and overview of reviews. Syst Rev 8, 1 (2019). doi:10.1186/s13643-019-0977-9.
This systematic review protocol aims to assess the effectiveness and risks of screening for periodontal diseases by non-dental professionals. The study will synthesize evidence on early detection during routine health exams and evaluate treatment approaches, emphasizing outcomes like tooth loss, gingival inflammation, and lifestyle modifications.

Kaye, E. K., Chen, N., Cabral, H. J., Vokonas, P., Garcia, R. I. Metabolic Syndrome and Periodontal Disease Progression in Men. J Dent Res 95, 7, 823–830 (2016). doi:10.1177/0022034516641053.
A 33-year longitudinal study shows that metabolic syndrome increases risk of tooth loss, periodontal pocket depth, attachment loss, alveolar bone loss, and tooth mobility. The results suggest that systemic metabolic disturbances may contribute to periodontitis development and progression.

Holtfreter, B., Empen, K., Gläser, S., Lorbeer, R., Völzke, H., Ewert, R., Kocher, T., Dörr, M. Periodontitis is associated with endothelial dysfunction in a general population: A cross-sectional study. PLoS ONE 8, 12, e84603 (2013). doi:10.1371/journal.pone.0084603.
This population-based study found high levels of periodontal disease associated with increased flow-mediated dilation (FMD), suggesting a complex relationship between periodontitis and endothelial function, independent of systemic inflammation markers.

Jamieson, L., Skilton, M., Maple-Brown, L., Kapellas, K., Askie, L., et al. Periodontal disease and chronic kidney disease among Aboriginal adults; An RCT. BMC Nephrol 16, 1, 169 (2015). doi:10.1186/s12882-015-0169-3.
This RCT evaluates whether intensive periodontal treatment can improve cardiovascular health and slow CKD progression in Aboriginal adults. The study uses a 24-month follow-up and emphasizes the potential for oral health interventions to reduce systemic disease burden in vulnerable populations.

Sindelar, D. Virulent Porphyromonas gingivalis as the root cause of chronic inflammation – a Chronic Oral Health Perspective. Alzheimer’s Dement 19, S12, 1–12 (2023). doi:10.1002/alz.079331.
This review highlights the systemic impact of P. gingivalis, linking it to cardiovascular, autoimmune, neurodegenerative diseases, cancers, and metabolic disorders. Emphasizes the role of dental professionals in early detection and intervention to mitigate systemic inflammation and chronic disease onset.

Orlandi, M., Guinto, J., Bakshi, J., Cotton, A., Wilton, J., et al. Prevalence of periodontitis in patients with rheumatoid arthritis and systemic lupus erythematosus. Rheumatology 57, suppl_3, key075.340 (2018). doi:10.1093/rheumatology/key075.340.
Cross-sectional survey reveals ~45% prevalence of periodontitis in RA and SLE patients. Periodontitis is linked with elevated inflammatory markers (CRP, ESR), highlighting the need for targeted oral health assessment in patients with autoimmune conditions.

Del Pinto, R., Pietropaoli, D., Monaco, A., D’aiuto, F., et al. Gingival bleeding: A possible indicator of high blood pressure? J Hypertens 39, Suppl 1, e1–e10 (2021). doi:10.1097/01.hjh.0000747768.30823.cb.
Using NHANES III data, this study shows gingival bleeding is independently associated with higher systolic blood pressure and increased odds of uncontrolled hypertension, suggesting periodontal status may serve as an indicator of cardiovascular risk.

Wang, J., Yang, X., Zou, X., Zhang, Y., et al. Relationship between periodontal disease and lung cancer: A systematic review and meta-analysis. J Periodontol Res 55, 5, 705–717 (2020). doi:10.1111/jre.12772.
Meta-analysis finds periodontal disease and edentulism significantly associated with increased lung cancer risk. Highlights the need for standardized periodontal assessments in future observational studies to clarify causal links.

Kuraji, R., Sekino, S., Kapila, Y., Numabe, Y. Periodontal disease–related nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: An emerging concept of oral-liver axis. Periodontol 2000 87, 1, 197–214 (2021). doi:10.1111/prd.12387.
This review proposes the oral-liver axis concept, linking periodontal disease to nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) via systemic exposure to oral pathogens and gut dysbiosis. Highlights potential for diagnostic and therapeutic strategies targeting oral health to mitigate liver disease progression.

Marković, D., Blazić, L., Durić, M., Vucinić, P., et al. Current trends in dental practice. Med Pregl 60, 11–12, 457–464 (2007).
This review outlines advancements in dental procedures, including microsurgery, light-activated restorative materials, and computer-aided diagnostics. Discusses associations between periodontal disease and systemic conditions, emphasizing the need for integration of oral and general health care.

Kothiwale, S. V., Kothiwale, V. A., Kumar, A., Bhargava, P. V. Comparative evaluation of the periodontal status and plaque microbial flora in gestational diabetic and non-diabetic pregnant women: A clinicomicrobiological study. Diabetologia 55, 1234–1240 (2012).
Case-control study shows significant differences in periodontal status and microbial plaque composition between gestational diabetic and healthy pregnant women. Highlights periodontal disease as a potential contributor to gestational diabetes mellitus and its associated maternal-infant complications.

Ramseier, C. A., Kinney, J. S., Herr, A. E., et al. Identification of pathogen and host-response markers correlated with periodontal disease. J Periodontol 80, 3, 436–446 (2009). doi:10.1902/jop.2009.080480.
This study identifies salivary and biofilm biomarkers, including MMP-8, MMP-9, and red-complex pathogens, that correlate with periodontal disease severity. Highlights potential for point-of-care diagnostics for early detection of oral and systemic disease.

Mark, K., Rusinol, J. Clinical literature evaluation supports correlation between oral health and systemic diseases. FASEB J 35, S1, 3904 (2021). doi:10.1096/fasebj.2021.35.s1.03904.
Systematic evaluation of 86 studies confirms correlations between periodontal pathogens, elevated biomarkers (IL-6, IL-1, TNF-α, CRP), and systemic inflammatory diseases. Supports development of rapid diagnostic testing for early intervention and prevention of chronic diseases.

Nazir, M. A., Alghamdi, L., Alkadi, M., Albeajan, N., Alrashoudi, L., & Alhussan, M. The burden of diabetes, its oral complications and their prevention and management. Open Access Maced. J. Med. Sci. 6, 1409–1417 (2018). doi:10.3889/oamjms.2018.294.
This review details the global prevalence of diabetes mellitus (DM) and its associated economic and health burdens. Over 90% of diabetic patients exhibit oral manifestations, including periodontal disease, caries, xerostomia, and candidiasis. The article emphasizes the bidirectional relationship between DM and periodontal disease and highlights the importance of regular dental check-ups, scaling, and root planing for glycemic control.

Kinane, D. F., & Marshall, G. J. Periodontal manifestations of systemic disease. Aust. Dent. J. 46, 2–12 (2001). doi:10.1111/j.1834-7819.2001.tb00267.x.
This review discusses how systemic diseases, medications, and lifestyle factors affect periodontitis. Diabetes, immunosuppression, smoking, and genetic polymorphisms are shown to increase susceptibility and severity of periodontal disease. The paper also examines the potential causal links between periodontal and cardiovascular diseases, emphasizing the need for well-controlled longitudinal studies.

Sakanaka, A., Kuboniwa, M., Katakami, N., et al. Saliva and plasma reflect metabolism altered by diabetes and periodontitis. Front. Mol. Biosci. 8, 742002 (2021). doi:10.3389/fmolb.2021.742002.
Using untargeted metabolomics of plasma and saliva in type 2 diabetes patients, this study identifies metabolites associated with periodontal inflamed surface area (PISA) and cardiometabolic risk. Salivary metabolites, including threonate and cadaverine, reflect systemic metabolic changes, demonstrating saliva’s potential as a non-invasive marker for metabolic and periodontal health.

Tachalov, V. V., Orekhova, L. Y., Kudryavtseva, T. V., et al. Making a complex dental care tailored to the person: population health in focus of predictive, preventive and personalised (3P) medical approach. EPMA J. 12, 153–171 (2021). doi:10.1007/s13167-021-00240-7.
This paper emphasizes a person-centered approach to dental care, integrating socio-economic, lifestyle, and behavioral factors. Poor oral hygiene, periodontal disease, and comorbidities such as diabetes and cardiovascular disease are linked to worse outcomes, including COVID-19 severity. Innovative screening and personalized treatment are recommended to improve population oral health.

NCT05178563. Mechanisms of Acute Inflammation Following Periodontal Treatment. ClinicalTrials.gov (2021). https://clinicaltrials.gov/show/NCT05178563.
This clinical trial investigates the acute inflammatory response and endothelial dysfunction following non-surgical periodontal therapy (NSPT). Photodynamic therapy (PDT) is evaluated as a method to reduce systemic inflammation and cardiovascular risk by targeting oral pathogens prior to NSPT.

Kapila, Y. L. Oral health’s inextricable connection to systemic health: Special populations bring to bear multimodal relationships and factors connecting periodontal disease to systemic diseases and conditions. Periodontol. 2000 87, 48–79 (2021). doi:10.1111/prd.12398.
This review highlights bidirectional links between periodontal disease and systemic conditions including diabetes, cardiovascular disease, obesity, liver disease, and pregnancy outcomes. Mechanisms involve microbial dysbiosis, immune dysregulation, and genetic and environmental factors, emphasizing the importance of personalized oral-systemic health management.

Ashenfelter, B. The Oral Systemic Link between Periodontal Disease and Systemic Disease. Dental Assist. 90, 12–20 (2021).
This article details how periodontal disease triggers systemic inflammation, contributing to conditions such as diabetes, cardiovascular disease, lupus, and breast cancer. Prevention and treatment involve dentists, hygienists, and primary care providers, highlighting the American Dental Association’s initiatives to improve oral-systemic health.

Iheozor-Ejiofor, Z., Middleton, P., Esposito, M., & Glenny, A. M. Treating periodontal disease for preventing adverse birth outcomes in pregnant women. Cochrane Database Syst. Rev. 2017, CD005297 (2017). doi:10.1002/14651858.CD005297.pub3.
This Cochrane review evaluates the effect of periodontal treatment during pregnancy on maternal and perinatal outcomes. Evidence suggests periodontal therapy may reduce low birth weight (<2500 g), but its impact on preterm birth and perinatal mortality remains uncertain. The review highlights the need for future studies integrating both periodontal and obstetric outcomes.

NCT02633462. Non-surgical Periodontal Therapy and Myo-inositol in Polycystic Ovary Syndrome Women Having Chronic Periodontitis. Clin. Trials. https://clinicaltrials.gov/show/NCT02633462 (2015).
This study investigates the effect of non-surgical periodontal therapy combined with myo-inositol supplementation on systemic inflammation, insulin resistance, and periodontal health in women with PCOS and chronic periodontitis. Anthropometric (BMI, waist circumference), metabolic (fasting glucose, serum testosterone, FSH/LH, hsCRP, HOMA-IR), and periodontal parameters (plaque index, gingival index, bleeding on probing, pocket depth, clinical attachment level) were monitored over 6 months. The trial highlights the interplay between periodontal inflammation and metabolic dysregulation in PCOS patients and evaluates whether periodontal therapy can improve systemic and reproductive health outcomes.

NCT06074861. Fasting-mimicking Diet and Periodontitis (FMD). Clin. Trials. https://clinicaltrials.gov/ct2/show/NCT06074861 (2023).
This randomized clinical study evaluates whether a fasting-mimicking diet (FMD) influences systemic and periodontal responses following non-surgical periodontal therapy. The plant-based FMD provides reduced calories for 4–7 days per month and is designed to mimic fasting effects while minimizing adverse effects. Outcomes include periodontal parameters, systemic inflammatory markers (CRP), and metabolic profiles. The study explores the potential of dietary interventions to modulate inflammation, enhance periodontal healing, and improve systemic health.