Periodontitis is a global public health problem. That is the conclusion of a large review of all the scientific literature on the association between periodontitis and mortality, recently published in the United States.
The association between periodontal disease and the development of fatal chronic diseases has been investigated for many years. A few months ago, the Journal of Dental Research published the results of a major study that systematically reviewed the findings of every scientific paper published on the subject.
The aim of this systematic review was to establish whether people with periodontitis or edentulism (the loss of one or more teeth) face a higher risk of mortality than people without periodontitis or edentulism. To this end, 57 studies were examined and 155 meta-analyses were carried out, involving more than 5.7 million people.
The results show that periodontitis and its permanent consequences (the loss of one or more teeth, or edentulism) are associated with an increased risk of mortality from the major non-communicable chronic diseases that most often cause death worldwide (cardiovascular, cerebrovascular and coronary disease, cancer and pneumonia).
In a previous article, we discussed the risks the recent COVID-19 pandemic poses for people with periodontitis: in the event of infection, the high bacterial load in the mouth and chronic systemic inflammation can make the course of the disease much more severe and, in a number of cases, even fatal.
It is fair to say that if you want to live a long and healthy life, you should never neglect the health of your gums!
Source: Periodontitis, Edentulism, and Risk of Mortality: A Systematic Review with Meta-analyses, M. Romandini, G. Baima, G. Antonoglou, J. Bueno, E. Figuero, M. Sanz.
References:
Awano, S, Ansai, T, Takata, Y, Soh, I, Akifusa, S, Hamasaki, T, Yoshida, A, Sonoki, K, Fujisawa, K, Takehara, T. 2008. Oral health and mortality risk from pneumonia in the elderly.
LaMonte, MJ, Genco, RJ, Hovey, KM, Wallace, RB, Freudenheim, JL, Michaud, DS, Mai, X, Tinker, LF, Salazar, CR, Andrews, CA, et al. 2017. History of periodontitis diagnosis and edentulism as predictors of cardiovascular disease, stroke, and mortality in postmenopausal women.
Bernabe, E, Marcenes, W, Hernandez, CR, Bailey, J, Abreu, LG, Alipour, V, Amini, S, Arabloo, J, Arefi, Z, Arora, A, et al.; Global, regional, and national levels and trends in burden of oral conditions from 1990 to 2017: a systematic analysis for the global burden of disease 2017 study.
Caton, JG, Armitage, G, Berglundh, T, Chapple, ILC, Jepsen, S, Kornman, KS, Mealey, BL, Papapanou, PN, Sanz, M, Tonetti, MS. 2018. A new classification scheme for periodontal and peri-implant diseases and conditions: introduction and key changes from the 1999 classification.
Chapple, IL, Genco, R; Working Group 2 of the Joint EFPAAP Workshop . 2013. Diabetes and periodontal diseases: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases.
Czesnikiewicz-Guzik, M, Osmenda, G, Siedlinski, M, Nosalski, R, Pelka, P, Nowakowski, D, Wilk, G, Mikolajczyk, TP, Schramm-Luc, A, Furtak, A, et al. 2019. Causal association between periodontitis and hypertension: evidence from mendelian randomization and a randomized controlled trial of non-surgical periodontal therapy.
D’Aiuto, F, Gkranias, N, Bhowruth, D, Khan, T, Orlandi, M, Suvan, J, Masi, S, Tsakos, G, Hurel, S, Hingorani, AD, et al. 2018. Systemic effects of periodontitis treatment in patients with type 2 diabetes: a 12 month, single-centre, investigator-masked, randomised trial.
D’Aiuto, F, Nibali, L, Parkar, M, Suvan, J, Tonetti, MS. 2005. Short-term effects of intensive periodontal therapy on serum inflammatory markers and cholesterol.
DerSimonian, R, Kacker, R. 2007. Random-effects model for meta-analysis of clinical trials: an update.
Eke, PI, Borgnakke, WS, Genco, RJ. 2020. Recent epidemiologic trends in periodontitis in the USA.
Eke, PI, Dye, BA, Wei, L, Thornton-Evans, GO, Genco, RJ. 2012. Prevalence of periodontitis in adults in the United States: 2009 and 2010.
Eke, PI, Wei, L, Thornton-Evans, GO, Borrell, LN, Borgnakke, WS, Dye, B, Genco, RJ. 2016. Risk indicators for periodontitis in US adults: NHANES 2009 to 2012.
Genco, RJ, Sanz, M. 2020. Clinical and public health implications of periodontal and systemic diseases: an overview.
Gomes-Filho, IS, Cruz, SSD, Trindade, SC, Passos-Soares, JS, Carvalho-Filho, PC, Figueiredo, ACMG, Lyrio, AO, Hintz, AM, Pereira, MG, Scannapieco, F. 2020. Periodontitis and respiratory diseases: a systematic review with meta-analysis.
Hajishengallis, G, Korostoff, JM. 2017. Revisiting the Page & Schroeder model: the good, the bad and the unknowns in the periodontal host response 40 years later.
Higgins, JP, Soares-Weiser, K, López-López, JA, Kakourou, A, Chaplin, K, Christensen, H, Martin, NK, Sterne, JA, Reingold, AL. 2016. Association of BCG, DTP, and measles containing vaccines with childhood mortality: systematic review.
Higgins, JP, Thompson, SG, Deeks, JJ, Altman, DG. 2003. Measuring inconsistency in meta-analyses.
Hirschfeld, L, Wasserman, B. 1978. A long-term survey of tooth loss in 600 treated periodontal patients.
Hobbins, S, Chapple, IL, Sapey, E, Stockley, RA. 2017. Is periodontitis a comorbidity of copd or can associations be explained by shared risk factors/behaviors?
Hujoel, PP, Drangsholt, M, Spiekerman, C, DeRouen, TA. 2002. Periodontitis-systemic disease associations in the presence of smoking: causal or coincidental?
Jha, P, Ramasundarahettige, C, Landsman, V, Rostron, B, Thun, M, Anderson, RN, McAfee, T, Peto, R. 2013. 21st-Century hazards of smoking and benefits of cessation in the United States.
Loos, BG. 2005. Systemic markers of inflammation in periodontitis.
Lund Håheim, L, Rønningen, KS, Enersen, M, Olsen, I. 2017. The predictive role of tooth extractions, oral infections, and hs-c-reactive protein for mortality in individuals with and without diabetes: a prospective cohort study of a 12 1/2-year follow-up.
Mattila, KJ, Nieminen, MS, Valtonen, VV, Rasi, VP, Kesaniemi, YA, Syrjala, SL, Jungell, PS, Isoluoma, M, Hietaniemi, K, Jokinen, MJ. 1989. Association between dental health and acute myocardial infarction.
Michaud, DS, Lu, J, Peacock-Villada, AY, Barber, JR, Joshu, CE, Prizment, AE, Beck, JD, Offenbacher, S, Platz, EA. 2018. Periodontal disease assessed using clinical dental measurements and cancer risk in the ARIC study.
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG; PRISMA Group. 2009. Preferred Reporting Items for Systematic Reviews and Meta-analyses: the PRISMA statement.
Muñoz Aguilera, E, Suvan, J, Buti, J, Czesnikiewicz-Guzik, M, Barbosa Ribeiro, A, Orlandi, M, Guzik, TJ, Hingorani, AD, Nart, J, D’Aiuto, F. 2020. Periodontitis is associated with hypertension: a systematic review and meta-analysis.
Nesse, W, Abbas, F, van der Ploeg, I, Spiijkervet, FKL, Dijkstra, PU, Vissink, A. 2008. Periodontal inflamed surface area: quantifying inflammatory burden.
Nwizu, N, Wactawski-Wende, J, Genco, RJ. 2020. Periodontal disease and cancer: epidemiologic studies and possible mechanisms.
Papapanou, PN, Sanz, M, Buduneli, N, Dietrich, T, Feres, M, Fine, DH, Flemmig, TF, Garcia, R, Giannobile, WV, Graziani, F, et al. 2018. Periodontitis: consensus report of Workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions.
Peres, MA, Macpherson, LMD, Weyant, RJ, Daly, B, Venturelli, R, Mathur, MR, Listl, S, Celeste, RK, Guarnizo-Herreño, CC, Kearns, C, et al. 2019. Oral diseases: a global public health challenge.
Romandini, M, Laforí, A, Romandini, P, Baima, G, Cordaro, M. 2018. Periodontitis and platelet count: a new potential link with cardiovascular and other systemic inflammatory diseases.
Sanz, M, Ceriello, A, Buysschaert, M, Chapple, I, Demmer, RT, Graziani, F, Herrera, D, Jepsen, S, Lione, L, Madianos, P, et al. 2018. Scientific evidence on the links between periodontal diseases and diabetes: consensus report and guidelines of the Joint Workshop on Periodontal Diseases and Diabetes by the International Diabetes Federation and the European Federation of Periodontology.
Sanz, M, Marco Del Castillo, A, Jepsen, S, Gonzalez-Juanatey, JR, D’Aiuto, F, Bouchard, P, Chapple, I, Dietrich, T, Gotsman, I, Graziani, F, et al. 2020. Periodontitis and cardiovascular diseases: consensus report.
Sharma, P, Dietrich, T, Ferro, CJ, Cockwell, P, Chapple, IL. 2016. Association between periodontitis and mortality in stages 3-5 chronic kidney disease: NHANES III and linked mortality study.
Stroup, DF, Berlin, JA, Morton, SC, Olkin, I, Williamson, GD, Rennie, D, Moher, D, Becker, BJ, Sipe, TA, Thacker, SB; MOOSE Group (Meta-analysis of Observational Studies in Epidemiology) . 2000. Meta-analysis of observational studies in epidemiology: a proposal for reporting.
Suvan, JE, Petrie, A, Nibali, L, Darbar, U, Rakmanee, T, Donos, N, D’Aiuto, F. 2015. Association between overweight/obesity and increased risk of periodontitis.
Teeuw, WJ, Slot, DE, Susanto, H, Gerdes, VE, Abbas, F, D’Aiuto, F, Kastelein, JJ, Loos, BG. 2014. Treatment of periodontitis improves the atherosclerotic profile: a systematic review and meta-analysis.
Tonetti, MS, Claffey, N; European Workshop in Periodontology Group C . 2005. Advances in the progression of periodontitis and proposal of definitions of a periodontitis case and disease progression for use in risk factor research: Group C consensus report of the 5th European Workshop in Periodontology.
Tonetti, MS, D’Aiuto, F, Nibali, L, Donald, A, Storry, C, Parkar, M, Suvan, J, Hingorani, AD, Vallance, P, Deanfield, J. 2007. Treatment of periodontitis and endothelial function.
Tonetti, MS, Jepsen, S, Jin, L, Otomo-Corgel, J. 2017. Impact of the global burden of periodontal diseases on health, nutrition and wellbeing of mankind: a call for global action.
Tonetti, MS, Van Dyke, TE; Working Group 1 of the Joint EFP/AAP Workshop . 2013. Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases.
Watt, RG, Daly, B, Allison, P, Macpherson, LMD, Venturelli, R, Listl, S, Weyant, RJ, Mathur, MR, Guarnizo-Herreño, CC, Celeste, RK, et al. 2019. Ending the neglect of global oral health: time for radical action.
Wells, G, Shea, B, O’Connell, D, Peterson, J, Welch, V, Losos, M, Tugwell, P. 2000. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.
World Health Organization. 2020. WHO Mortality Database [accessed 2020 Apr 8]
Credits: Photo by Hybrid on Unsplash
