Periodontitis and systemic diseases

A record of discussions of working group 4 of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases

Gerry J. Linden, Mark C. Herzberg, Mark Bartold, Michael Glick, Mark Harzberg, Francis Hughes, Palle Holmstrup, Angelo Mariotti, Marc Quirynen, Frank Scannapieco, Arie Jan Van Winkelhoff

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: There has been an explosion in research into possible associations between periodontitis and various systemic diseases and conditions. Aim: To review the evidence for associations between periodontitis and various systemic diseases and conditions, including chronic obstructive pulmonary disease (COPD), pneumonia, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome and cancer, and to document headline discussions of the state of each field. Periodontal associations with diabetes, cardiovascular disease and adverse pregnancy outcomes were not discussed by working group 4. Results: Working group 4 recognized that the studies performed to date were largely cross-sectional or case-control with few prospective cohort studies and no randomized clinical trials. The best current evidence suggests that periodontitis is characterized by both infection and pro-inflammatory events, which variously manifest within the systemic diseases and disorders discussed. Diseases with at least minimal evidence of an association with periodontitis include COPD, pneumonia, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome and cancer. The working group agreed that there is insufficient evidence to date to infer causal relationships with the exception that organisms originating in the oral microbiome can cause lung infections. Conclusions: The group was unanimous in their opinion that the reported associations do not imply causality, and establishment of causality will require new studies that fulfil the Bradford Hill or equivalent criteria. Precise and community-agreed case definitions of periodontal disease states must be implemented systematically to enable consistent and clearer interpretations of studies of the relationship to systemic diseases. The members of the working group were unanimous in their opinion that to develop data that best inform clinicians, investigators and the public, studies should focus on robust disease outcomes and avoid surrogate endpoints. It was concluded that because of the relative immaturity of the body of evidence for each of the purported relationships, the field is wide open and the gaps in knowledge are large.

Original languageEnglish (US)
Pages (from-to)S20-S23
JournalJournal of periodontology
Volume84
Issue number4
DOIs
StatePublished - Apr 1 2013

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Periodontitis
Joints
Education
Chronic Renal Insufficiency
Causality
Chronic Obstructive Pulmonary Disease
Rheumatoid Arthritis
Pneumonia
Obesity
Explosions
Microbiota
Periodontal Diseases
Pregnancy Outcome
Infection
antiarrhythmic peptide
Neoplasms
Cohort Studies
Cardiovascular Diseases
Randomized Controlled Trials
Biomarkers

Keywords

  • Cancer
  • Chronic kidney disease
  • Cognitive impairment
  • Epidemiology
  • Metabolic syndrome
  • Obesity
  • Periodontal diseases
  • Periodontitis
  • Pneumonia
  • Respiratory disease
  • Rheumatoid arthritis

Cite this

Periodontitis and systemic diseases : A record of discussions of working group 4 of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. / Linden, Gerry J.; Herzberg, Mark C.; Bartold, Mark; Glick, Michael; Harzberg, Mark; Hughes, Francis; Holmstrup, Palle; Mariotti, Angelo; Quirynen, Marc; Scannapieco, Frank; Jan Van Winkelhoff, Arie.

In: Journal of periodontology, Vol. 84, No. 4, 01.04.2013, p. S20-S23.

Research output: Contribution to journalArticle

Linden, GJ, Herzberg, MC, Bartold, M, Glick, M, Harzberg, M, Hughes, F, Holmstrup, P, Mariotti, A, Quirynen, M, Scannapieco, F & Jan Van Winkelhoff, A 2013, 'Periodontitis and systemic diseases: A record of discussions of working group 4 of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases', Journal of periodontology, vol. 84, no. 4, pp. S20-S23. https://doi.org/10.1902/jop.2013.1340020
Linden, Gerry J. ; Herzberg, Mark C. ; Bartold, Mark ; Glick, Michael ; Harzberg, Mark ; Hughes, Francis ; Holmstrup, Palle ; Mariotti, Angelo ; Quirynen, Marc ; Scannapieco, Frank ; Jan Van Winkelhoff, Arie. / Periodontitis and systemic diseases : A record of discussions of working group 4 of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. In: Journal of periodontology. 2013 ; Vol. 84, No. 4. pp. S20-S23.
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