Periodontal disease and systemic illness: will the evidence ever be enough?
Version of Record online: 11 APR 2013
© 2013 John Wiley & Sons A/S
Volume 62, Issue 1, pages 271–286, June 2013
How to Cite
Cullinan, M. P. and Seymour, G. J. (2013), Periodontal disease and systemic illness: will the evidence ever be enough?. Periodontology 2000, 62: 271–286. doi: 10.1111/prd.12007
- Issue online: 11 APR 2013
- Version of Record online: 11 APR 2013
The concept of focal infection or systemic disease arising from infection of the teeth was generally accepted until the mid-20th century when it was dismissed because of lack of evidence. Subsequently, a largely silo approach was taken by the dental and medical professions. Over the past 20 years, however, a plethora of epidemiological, mechanistic and treatment studies have highlighted that this silo approach to oral and systemic diseases can no longer be sustained. While a number of systemic diseases have been linked to oral diseases, the weight of evidence from numerous studies conducted over this period, together with several systematic reviews and meta-analyses, supports an association between periodontitis and cardiovascular disease, and between periodontitis and diabetes. The association has also been supported by a number of biologically plausible mechanisms, including direct infection, systemic inflammation and molecular mimicry. Treatment studies have shown that periodontal treatment may have a small, but significant, systemic effect both on endothelial function and on glycemic control. Despite this, however, there is no direct evidence that periodontal treatment affects either cardiovascular or diabetic events. Nevertheless, over the past 20 years we have learnt that the mouth is an integral part of the body and that the medical and dental professions need to work more closely together in the provision of overall health care for all patients.