Dental clinicians intuitively weigh patient risks for developing disease and use that information for making treatment decisions and recommendations. Periodontitis, for instance, is one oral disease with documented risk factors including smoking, specific plaque bacteria and diabetes mellitus. While this link between systemic disease and periodontitis was thought to be unidirectional, mounting evidence in the last decade suggests that the relationship may be bi-directional. Cross sectional and case control studies indicate that periodontitis may confer two and seven-fold elevations in risk for cardiovascular disease and premature low birth weight respectively. While these early studies indicate potential associations between oral and systemic health, they support the central hypothesis that periodontitis triggers both local and systemic host inflammatory responses. Consequently, a new discipline, periodontal medicine, has emerged in dentistry which seeks to further define these interrelationships through scientific inquiry. Ultimately, this new knowledge may prove useful in intervention strategies to reduce patient risks and prevent systemic disease outcomes. This manuscript clarifies the concept of risk, traces the emergence of periodontal medicine and serves as a resource for the oral health professional in assessing and utilizing the current evidence on periodontal-systemic disease connections.
Evaluating risk: a primer for gastroenterologists. Am J Gastroenterol 1995;90:704-707.
Epidemiology in Medicine. Boston: Little, Brown and Company; 1987.
Periodontal diseases and tooth loss. Periodontol 2000 1993;2:117-127.
Current view of risk factors for periodontal diseases. J Periodontol 1996;67:1041-1049.
Influence of risk factors on the pathogenesis of periodontitis. Periodontol 2000 1997;14:173-201.
The interleukin-1 genotype as a severity factor in adult periodontal dis ease. J Clin Periodontol 1997;24:72-7.
Genetic factors in the pathogenesis of periodontitis. Periodontol 2000 1997;14:202-15.
Periodontal status in the United States, 1981-91. Prevalence, extent and demographic variations. J Dent Res 1996;75:672-683.
Periodontal diseases in the U.S. in 1981: Prevalence, severity, extent, and the role in tooth mortality. J Periodontol 1989;60:363-370.
Evaluating periodontal disease status of U.S. employed adults. J Am Dent Assoc 1990;121:226-232.
Periodontol 2000 1997;14:12-32.
Microbial complexes in subgingival plaque. J Clin Periodontol 1998;25:134-144.
Periodontal diseases: pathogenesis. Ann Periodontol 1996;1:821-878.
Advances in the pathogenesis of periodontitis: summary of developments, clinical implications and future directions. Periodontol 2000 1997;14:216-248.
The pathobiology of periodontal diseases may affect systemic diseases: inversion of a paradigm. Ann Periodontol 1998;3:108-120.
Microbial etiological agents of destructive periodontal diseases. Periodontol 2000 1994;5:78-111.
Incidence of bacteremias in patients with dental plaque. J Lab Clin Med 1941;26:801-802.
Experiment transient bacteremias in human subjects with varying degrees of plaque accumulation and gingival inflammation. J Clin Periodontol 1980;4:92-99.
Relationship of bacteremia to toothbrushing in patients with periodontitis. J Am Dent Assoc 1973;87:616-622.
Acute-phase inflammatory response to oral and systemic conditions. J Dent Res 1999;78:2192 (Abstract).
The human mouth as a focus of infection. Dental Cosmos 1891;33: 689-713.
Oral sepsis as a cause of disease. Br Med J 1900;1:215-216.
Chronic focal infections and their etiologic relations to arthritis and nephritis. Arch Inter Med 1912;9:484-498.
Focal infection of dental origin. Dental Cosmos 1922;64:1206-1208.
Focal infection. Am J Surg 1931;14:643-645.
Clinical and experimental observations on focal infection with an analysis of 200 cases of rheumatoid arthritis. Ann Intern Med 1938;12:577-584.
Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation 1994;90:583-612.
Periodontitis: a risk factor for coronary heart disease?. Ann Periodontol 1998;3:127-141.
Systemic diseases in elderly dental patients. Int Dent J 1993;43:213-218.
Prevalence of medical problems in periodontal patients obtained from three different populations. J Periodontol 1987;58:564-568.
Dental infections in association with cerebral infarction in young and middle-aged men. J Intern Med 1989;225:179-184.
Dental disease, fibrinogen and white cell count; links with myocardial infarction?. Scott Med J 1993;38:73-74.
Dental infections and coronary atherosclerosis. Atherosclerosis 1993;103:205-211.
Dental infection and the risk of new coronary events: prospective study of patients with documented coronary artery disease. Clin Inf Dis 1995;20:588-592.
Periodontal disease is a predictor of cardiovascular disease in a Native American population. J Dent Res 1997;76:3158 (Abstract).
Poor oral health and coronary heart disease. J Dent Res 1996;75:1631-1636.
Periodontal Status of cardiovascular disease subjects. J Dent Res 1999;78:2190 (Abstract).
Dental plaque, platelets, and cardiovascular diseases. Ann Periodontol 1998;3:151-160.
Herzberg MC. The Streptococcus sanguis platelet aggregation-associated protein. Identification and characterization of the minimal platelet-interactive domain. J Biol Chem 1993;268:1646-1649.
Periodontal microflora related to the risk for myocardial infarction. J Dent Res 1999;78:2811 (Abstract).
Identification of periodontal pathogens in atheromatous plaques. J Dent Res 1997;76:3159 (Abstract).
Public Health Aspect of Low Birth Weight. Geneva: Switzerland; WHO technical report series, no. 27, 1950.
Advance Report of Final Natality Statistics, 1991. Monthly vital statistics report, vol. 42, suppl. Hyattsville, MD: Public Health Service; 1993.
Health, United States, 1982. Washington, DC: U.S. Government Printing Office; DHHS publication (PHS) 83-1232, December 1982.
Preventing Low Birthweight. Washington, DC: National Academy Press; 1985.
Influence of maternal renal infection on the foetus and infant. Arch Dis Child 1967;42:208-213.
Risk factors for prematurity and premature rupture of membranes: a prospective study of the vaginal flora in pregnancy. Am J Obstet Gynecol 1984;150:965-972.
Vaginal infection and preterm labour. Br J Obstet Gynaecol 1991;98:427-435.
A case-control study of chorioamnionic infection and histologic chorioamnionitis in prematurity. N Eng J Med 1988;319:972-978.
A review of premature birth and subclinical infection. Am J Obstet Gynecol 1992;166:1515-1528.
Effects of a Porphyromonas gingivalis infection on inflammatory mediator response and pregnancy outcome in hamsters. Infect Immun 1994;62:4356-4361.
Animal chamber models for study of host-parasite interactions. Methods Enzymol 1994;235:120-140.