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Role of oral foci in systemic diseases: An update

Ranjitkumar Patil, Shailesh M Gondivkar, Amol R Gadbail, Monal Yuwanati, Mugdha Mankar (Gadbail), Manoj Likhitkar, Sachin Sarode, Gargi Sarode, Shankargouda Patil


Background: A current research disagreement middles about a theorized connection between chronic oral infections and the progress of adverse systemic health conditions. However, the gap between general and dental medicine is quickly closing, due to significant findings supporting the association between dental infections and systemic conditions such as cardiovascular diseases, type 2 diabetes mellitus, respiratory diseases, stroke, adverse pregnancy outcomes, osteoporosis, renal diseases, and gastrointestinal diseases. Relentless efforts have brought light on numerous advances in illuminating their etiopathological links. However, the majority of data about possible role or interlink between the infection and systemic disease is available in the form of case report or summary. As case reports are not the acceptable to many indexed scientific magazines, many these findings undergo unnoticed to researchers. The currently minimal accessible data provide only an indication of the actuality. Aim: This article highlights the Role of oral foci in systemic diseases. Conclusion: There is need of sincere work efforts on genetic relatedness of organisms, rather than their phenotypes, sophisticated sampling, detection, and analytical techniques to create the associations. To give insight to recent apprises of different systemic diseases as a consequence of primary oral infections and the pathogenesis link. The odontogenic bacteremia is likely to cause systemic and end organ infections, but such infections can easily resist by body defenses. It is important that role of good oral health and the risks associated with poor oral health should told to the individuals. Clinical significance: Dentists and medical practitioners should work together to provide comprehensive health care, thereby reducing the morbidity and mortality associated with oral infections.


Adverse pregnancy outcomes; cardiovascular disease; diabetes mellitus; gastrointestinal disease; oral foci; osteoporosis; respiratory disease; renal disease; stroke

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Bobetsis YA, Barros SP, Offenbacher S. Exploring the relationship between periodontal disease and pregnancy complications. J Am Dent Assoc 2006;137 Suppl:7S-13.

Dasanayake AP, Gennaro S, Hendricks-Muñoz KD, Chhun N. Maternal periodontal disease, pregnancy, and neonatal outcomes. MCN Am J Matern Child Nurs 2008;33:45-9.

Kinane D, Bouchard P; Group E of European Workshop on Periodontology. Periodontal diseases and health: Consensus Report of the Sixth European Workshop on Periodontology. J Clin Periodontol 2008;35 8 Suppl:333-7.

Paju S, Scannapieco FA. Oral biofilms, periodontitis, and pulmonary infections. Oral Dis 2007;13:508-12.

Sivapathasundharam B. Spread of oral infection. In: Rajendran R, Sivapathasundharam B, editors. Textbook of Oral Pathology. 5th ed. New Delhi: Elsevier; 2005. p. 709.

de Lillo A, Ashley FP, Palmer RM, Munson MA, Kyriacou L, Weightman AJ, et al. Novel subgingival bacterial phylotypes detected using multiple universal polymerase chain reaction primer sets. Oral Microbiol Immunol 2006;21:61-8.

Aas JA, Paster BJ, Stokes LN, Olsen I, Dewhirst FE. Defining the normal bacterial flora of the oral cavity. J Clin Microbiol 2005;43:5721-32.

Samaranayake LP. Microbiology of periodontal disease. In: Essential Microbiology for Dentistry. 3rd ed. Philadelphia, PA: Elsevier; 2006. p. 275-285.

Gould FK, Elliott TS, Foweraker J, Fulford M, Perry JD, Roberts GJ, et al. Guidelines for the prevention of endocarditis: Report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 2006;57:1035-42.

Richey R, Wray D, Stokes T; Guideline Development Group. Prophylaxis against infective endocarditis: Summary of NICE guidance. BMJ 2008;336:770-1.

Forner L, Larsen T, Kilian M, Holmstrup P. Incidence of bacteremia after chewing, tooth brushing and scaling in individuals with periodontal inflammation. J Clin Periodontol 2006;33:401-7.

Hunter W. An address on the role of sepsis and antisepsis in medicine. Lancet 1911;1:79-86.

Michalowicz BS, Hodges JS, DiAngelis AJ, Lupo VR, Novak MJ, Ferguson JE, et al. Treatment of periodontal disease and the risk of preterm birth. N Engl J Med 2006;355:1885-94.

Packard RR, Libby P. Inflammation in atherosclerosis: From vascular biology to biomarker discovery and risk prediction. Clin Chem 2008;54:24-38.

Seymour RA. Is gum disease killing your patient? Br Dent J 2009;206:551-2.

Humphrey LL, Fu R, Buckley DI, Freeman M, Helfand M. Periodontal disease and coronary heart disease incidence: A systematic review and meta-analysis. J Gen Intern Med 2008;23:2079-86.

Cronin A. Periodontal disease is a risk marker for coronary heart disease? Evid Based Dent 2009;10:22.

de Oliveira C, Watt R, Hamer M. Toothbrushing, inflammation, and risk of cardiovascular disease: Results from Scottish Health Survey. BMJ 2010;340:c2451.

Williams RC, Barnett AH, Claffey N, Davis M, Gadsby R, Kellett M, et al. The potential impact of periodontal disease on general health: A consensus view. Curr Med Res Opin 2008;24:1635-43.

Oliveira FJ, Vieira RW, Coelho OR, Petrucci O, Oliveira PP, Antunes N, et al. Systemic inflammation caused by chronic periodontite in patients victims of acute ischemic heart attack. Rev Bras Cir Cardiovasc 2010;25:51-8.

Holmlund A, Holm G, Lind L. Number of teeth as a predictor of cardiovascular mortality in a cohort of 7,674 subjects followed for 12 years.J Periodontol 2010;81:870-6.

Kozarov E, Sweier D, Shelburne C, Progulske-Fox A, Lopatin D. Detection of bacterial DNA in atheromatous plaques by quantitative PCR. Microbes Infect 2006;8:687-93.

Chou HH, Yumoto H, Davey M, Takahashi Y, Miyamoto T, Gibson FC 3rd, et al. Porphyromonas gingivalis fimbria-dependent activation of inflammatory genes in human aortic endothelial cells. Infect Immun 2005;73:5367-78.

Roth GA, Moser B, Roth-Walter F, Giacona MB, Harja E, Papapanou PN, et al. Infection with a periodontal pathogen increases mononuclear cell adhesion to human aortic endothelial cells. Atherosclerosis 2007;190:271-81.

Yumoto H, Chou HH, Takahashi Y, Davey M, Gibson FC 3rd, Genco CA. Sensitization of human aortic endothelial cells to lipopolysaccharide via regulation of Toll-like receptor 4 by bacterial fimbria-dependent invasion. Infect Immun 2005;73:8050-9.

Argueta JG, Shiota S, Yamaguchi N, Masuhiro Y, Hanazawa S. Induction of Porphyromonas gingivalis GroEL signaling via binding to Toll-like receptors 2 and 4. Oral Microbiol Immunol 2006;21:245-51.

Ford PJ, Gemmell E, Timms P, Chan A, Preston FM, Seymour GJ. Anti-P. gingivalis response correlates with atherosclerosis. J Dent Res 2007;86:35-40.

Joshipura KJ, Wand HC, Merchant AT, Rimm EB. Periodontal disease and biomarkers related to cardiovascular disease. J Dent Res 2004;83:151-5.

Ridker PM, Silvertown JD. Inflammation, C-reactive protein, and atherothrombosis. J Periodontol 2008;79 8 Suppl:1544-51.

Elter JR, Hinderliter AL, Offenbacher S, Beck JD, Caughey M, Brodala N, et al. The effects of periodontal therapy on vascular endothelial function: A pilot trial. Am Heart J 2006;151:47.

Papapanagiotou D, Nicu EA, Bizzarro S, Gerdes VE, Meijers JC, Nieuwland R, et al. Periodontitis is associated with platelet activation. Atherosclerosis 2009;202:605-11.

Picchi A, Gao X, Belmadani S, Potter BJ, Focardi M, Chilian WM, et al. Tumor necrosis factor-alpha induces endothelial dysfunction in the prediabetic metabolic syndrome. Circ Res 2006;99:69-77.

Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005;352:1685-95.

Deo V, Bhongade ML, Ansari S, Chavan RS. Periodontitis as a potential risk factor for chronic obstructive pulmonary disease: A retrospective study. Indian J Dent Res 2009;20:466-70.

Sharma N, Shamsuddin H. Association between respiratory disease in hospitalized patients and periodontal disease: A cross-sectional study. J Periodontol 2011;82:1155-60.

Didilescu AC, Skaug N, Marica C, Didilescu C. Respiratory pathogens in dental plaque of hospitalized patients with chronic lung diseases. Clin Oral Investig 2005;9:141-7.

El Attar MM, Zaghloup MZ, Elmenoufr HS. Role of periodontitis in hospital-acquired pneumonia. East Mediterr Health J 2010;16:563-9.

Raghavendran K, Mylotte JM, Scannapieco FA. Nursing home-associated pneumonia, hospital-acquired pneumonia and ventilator-associated pneumonia: The contribution of dental biofilms and periodontal inflammation. Periodontol 2000 2007;44:164-77.

Sumi Y, Miura H, Michiwaki Y, Nagaosa S, Nagaya M. Colonization of dental plaque by respiratory pathogens in dependent elderly. Arch Gerontol Geriatr 2007;44:119-24.

Munro CL, Grap MJ, Elswick RK Jr, McKinney J, Sessler CN, Hummel RS 3rd. Oral health status and development of ventilator-associated pneumonia: A descriptive study. Am J Crit Care 2006;15:453-60.

Awano S, Ansai T, Takata Y, Soh I, Akifusa S, Hamasaki T, et al. Oral health and mortality risk from pneumonia in the elderly. J Dent Res 2008;87:334-9.

Azarpazhooh A, Leake JL. Systematic review of the association between respiratory diseases and oral health. J Periodontol 2006;77:1465-82.

Mealey BL, Oates TW; American Academy of Periodontology. Diabetes mellitus and periodontal diseases. J Periodontol 2006;77:1289-303.

Taylor GW, Borgnakke WS. Periodontal disease: Associations with diabetes, glycemic control and complications. Oral Dis 2008;14:191-203.

Salvi GE, Carollo-Bittel B, Lang NP. Effects of diabetes mellitus on periodontal and peri-implant conditions: Update on associations and risks. J Clin Periodontol 2008;35 8 Suppl:398-409.

Mealey BL, Rose LF. Diabetes mellitus and inflammatory periodontal diseases. Curr Opin Endocrinol Diabetes Obes 2008;15:135-41.

Shimazaki Y, Saito T, Yonemoto K, Kiyohara Y, Iida M, Yamashita Y. Relationship of metabolic syndrome to periodontal disease in Japanese women: The Hisayama Study. J Dent Res 2007;86:271-5.

Jansson H, Lindholm E, Lindh C, Groop L, Bratthall G. Type 2 diabetes and risk for periodontal disease: A role for dental health awareness. J Clin Periodontol 2006;33:408-14.

Soell M, Hassan M, Miliauskaite A, Haïkel Y, Selimovic D. The oral cavity of elderly patients in diabetes. Diabetes Metab 2007;33 Suppl 1:S10-8.

Lim LP, Tay FB, Sum CF, Thai AC. Relationship between markers of metabolic control and inflammation on severity of periodontal disease in patients with diabetes mellitus. J Clin Periodontol 2007;34:118-23.

Makiura N, Ojima M, Kou Y, Furuta N, Okahashi N, Shizukuishi S, et al. Relationship of Porphyromonas gingivalis with glycemic level in patients with type 2 diabetes following periodontal treatment. Oral Microbiol Immunol 2008;23:348-51.

King GL. The role of inflammatory cytokines in diabetes and its complications. J Periodontol 2008;79 8 Suppl:1527-34.

Giannoulis C, Zournatzi B, Giomisi A, Diza E, Tzafettas I. Toxoplasmosis during pregnancy: A case report and review of the literature. Hippokratia 2008;12:139-43.

Jauniaux E, Van Oppenraaij RH, Burton GJ. Obstetric outcome after early placental complications. Curr Opin Obstet Gynecol 2010;22:452-7.

Vrachnis N, Vitoratos N, Iliodromiti Z, Sifakis S, Deligeoroglou E, Creatsas G. Intrauterine inflammation and preterm delivery. Ann N Y Acad Sci 2010;1205:118-22.

Muglia LJ, Katz M. The enigma of spontaneous preterm birth. N Engl J Med 2010;362:529-35.

Beck S, Wojdyla D, Say L, Betran AP, Merialdi M, Requejo JH, et al. The worldwide incidence of preterm birth: A systematic review of maternal mortality and morbidity. Bull World Health Organ 2010;88:31-8.

Wimmer G, Pihlstrom BL. A critical assessment of adverse pregnancy outcome and periodontal disease. J Clin Periodontol 2008;35 8 Suppl:380-97.

Offenbacher S, Boggess KA, Murtha AP, Jared HL, Lieff S, McKaig RG, et al. Progressive periodontal disease and risk of very preterm delivery. Obstet Gynecol 2006;107:29-36.

López NJ, Da Silva I, Ipinza J, Gutiérrez J. Periodontal therapy reduces the rate of preterm low birth weight in women with pregnancy-associated gingivitis. J Periodontol 2005;76 11 Suppl:2144-53.

Pretorius C, Jagatt A, Lamont RF. The relationship between periodontal disease, bacterialvaginosis, and preterm birth. J Perinat Med 2007;35:93-9.

Rakoto-Alson S, Tenenbaum H, Davideau JL. Periodontal diseases, preterm births, and low birth weight: Findings from a homogeneous cohort of women in Madagascar. J Periodontol2010;81:205-13.

Gomes-Filho IS, Cruz SS, Rezende EJ, Dos Santos CA, Soledade KR, Magalhães MA, et al. Exposure measurement in the association between periodontal disease and prematurity/ low birth weight. J Clin Periodontol 2007;34:957-63.

Manau C, Echeverria A, Agueda A, Guerrero A, Echeverria JJ. Periodontal disease definition may determine the association between periodontitis and pregnancy outcomes. J Clin Periodontol 2008;35:385-97.

Seymour GJ, Ford PJ, Cullinan MP, Leishman S, Yamazaki K. Relationship between periodontal infections and systemic disease. Clin Microbiol Infect 2007;13 Suppl 4:3-10.

Gürsoy M, Könönen E, Gürsoy UK, Tervahartiala T, Pajukanta R, Sorsa T. Periodontal status and neutrophilic enzyme levels in gingival crevicular fluid during pregnancy and postpartum. J Periodontol 2010;81:1790-6.

Fardini Y, Chung P, Dumm R, Joshi N, Han YW. Transmission of diverse oral bacteria to murine placenta: Evidence for the oral microbiome as a potential source of intrauterine infection. Infect Immun 2010;78:1789-96.

Barak S, Oettinger-Barak O, Machtei EE, Sprecher H, Ohel G. Evidence of periopathogenic microorganisms in placentas of women with preeclampsia. J Periodontol 2007;78:670-6.

Kotz J, Chegini N, Shiverick KT, Lamont RJ. Localization of P. gingivalis in preterm delivery placenta. J Dent Res 2009;88:575-8.

Boggess KA. Pathophysiology of preterm birth: Emerging concepts of maternal infection. Clin Perinatol 2005;32:561-9.

Pradeep AR, Hadge P, Arjun Raju P, Shetty SR, Shareef K, Guruprasad CN. Periodontitis as a risk factor for cerebrovascular accident: A case-control study in the Indian population. J Periodontal Res 2010;45:223-8.

Kazanci E, Oguz KK, Gurgey A, Topçu M. Streptococcus oralis as a risk factor for middle cerebral artery thrombosis 2005;20:611-3.

Khouzam RN, El-Dokla AM, Menkes DL. Undiagnosed patent foramen ovale presenting as a cryptogenic brain abscess: Case report and review of the literature. Heart Lung 2006;35:108-11.

Kim HD, Sim SJ, Moon JY, Hong YC, Han DH. Association between periodontitis and hemorrhagic stroke among Koreans: A case-control study. J Periodontol 201;81(5):658-65.

Ramamurthy NS, Greenwald RA, Celiker MY, Shi EY. Experimental arthritis in rats induces biomarkers of periodontitis which are ameliorated by gene therapy with tissue inhibitor of matrix metalloproteinases. J Periodontol 2005;76:229-33.

Miossec P, Farge P, Gaudin P, Alexandre C, Mougin B, Miossec P. The association between periodontal disease and joint destruction in rheumatoid arthritis extends the link between the HLA-DR shared epitope and severity of bone destruction. Ann Rheum Dis 2006;65:905-9.

Moen K, Brun JG, Valen M, Skartveit L, Eribe EK, Olsen I, et al. Synovial inflammation in active rheumatoid arthritis and psoriatic arthritis facilitates trapping of a variety of oral bacterial DNAs. Clin Exp Rheumatol 2006;24:656-63.

Mikuls TR, Payne JB, Reinhardt RA, Thiele GM, Maziarz E, Cannella AC, et al. Antibody responses to Porphyromonas gingivalis (P. gingivalis) in subjects with rheumatoid arthritis and periodontitis. Int Immunopharmacol 2009;9:38-42.

Lacativa PG, Farias ML. Osteoporosis and inflammation. Arq Bras Endocrinol Metabol 2010;54:123-32.

Li X, Kolltveit KM, Tronstad L Olsen I. Systemic diseases caused by oral infection. Clin Microbiol Rev 2000;13:547-58.

Page RC. The pathobiology of periodontal diseases may affect systemic diseases: Inversion of a paradigm. Ann Periodontol 1998;3:108-20.

Górska R, Gregorek H, Kowalski J, Laskus-Perendyk A, Syczewska M, Madalinski K. Relationship between clinical parameters and cytokine profiles in inflamed gingival tissue and serum samples from patients with chronic periodontitis. J Clin Periodontol 2003;30:1046-52.

Tezal M, Wactawski-Wende J, Grossi SG, Ho AW, Dunford R, Genco RJ. The relationship between bone mineral density and periodontitis in postmenopausal women. J Periodontol 2000;71:1492-8.

Nagasawa Y, Iio K, Fukuda S, Date Y, Iwatani H, Yamamoto R, et al. Periodontal disease bacteria specific to tonsil in IgA nephropathy patients predicts the remission by the treatment. PLoS One 2014;9:e81636.

Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. Lancet 2005;366:1809-20.

Ardalan MR, Ghabili K, Pourabbas R, Shoja MM. A causative link between periodontal disease and glomerulonephritis: A preliminary study. Ther Clin Risk Manag 2011;7:93-8.

Anand PS, Nandakumar K, Shenoy KT. Are dental plaque, poor oral hygiene, and periodontal disease associated with Helicobacter pylori infection? J Periodontol 2006;77:692-8.

Gebara EC, Faria CM, Pannuti C, Chehter L, Mayer MP, Lima LA. Persistence of Helicobacter pylori in the oral cavity after systemic eradication therapy. J Clin Periodontol 2006;33:329-33.

Souto R, Colombo AP. Detection of Helicobacter pylori by polymerase chain reaction in the subgingival biofilm and saliva of non-dyspeptic periodontal patients. J Periodontol 2008;79:97-103.

Salmanian AH, Siavoshi F, Akbari F, Afshari A, Malekzadeh R. Yeast of the oral cavity is the reservoir of Heliobacter pylori. J Oral Pathol Med 2008;37:324-8.


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