The Link Between Periodontal Disease and Upper Respiratory Diseases
By Donald S. Clem, DDS
A recent study by Sharma and Shamsuddin published in the January 2011 issue of the Journal of Periodontology suggests a possible link between upper respiratory diseases—including pneumonia, acute bronchitis, and chronic obstructive pulmonary disease (COPD)—and periodontal disease. Typically occurring when bacteria are inhaled into the lungs, the bacteria that cause periodontal disease also can be inhaled into the respiratory tract and increase the risk of infection.
The study examined 200 people, 100 who had been hospitalized with a respiratory infection and 100 who were healthy. The study results demonstrated that those who were part of the healthy group had better periodontal health, while the periodontal health of those with respiratory illnesses was worse.
Several studies have suggested a link between periodontal disease and other inflammatory diseases, such as cardiovascular disease and diabetes. However, there is not a lot known about how periodontal disease can impact respiratory health. Considering that respiratory infections, including chronic obstructive pulmonary disease (COPD) and pneumonia, can be severely debilitating and are a major cause of death in the United States, research into how periodontal health and respiratory health are potentially connected is imperative.
The significance of this research study is that it provides further evidence of the perio-systemic link by demonstrating that the incidence of pathogens in the periodontium may play a role in the progression of non-oral disease. These findings suggest that the presence of bacteria associated with periodontal disease, such as Porphyromonas gingivalis, may increase a patient’s risk of developing or exacerbating respiratory infections. The occurrence of these oral pathogens, and the resulting supragingival plaque accumulation, periodontal pockets, and—I would argue—the inflammatory response diminishes the host defense, thereby increasing subjects’ risk for developing a respiratory infection.
Poor periodontal health, therefore, may be viewed as a risk factor for respiratory disease. But as the researchers note, other factors may come into play as well. Additional research is needed in this area to better understand how periodontal disease and respiratory disease are related.
This study places a lot of emphasis on the role of bacterial pathogens in the progression of both periodontal disease and respiratory disease. While the presence of bacteria is a determinant of disease, it is often the inflammatory response to bacteria that is essential in the initiation and progression of disease states.
Individuals may be genetically predetermined to respond differently to a challenge, such as bacteria, and therefore their level of disease may be different. It seems that while an in-depth discussion of inflammation was missing in this study, there was speculation that periodontal pathogens not only are responsible for respiratory tract infection, but also that these pathogens may affect the local defense mechanisms of the region to increase these patients’ risk for respiratory disease.
Both periodontal disease and respiratory disease are often classified as inflammatory conditions, so it may be possible that inflammation may be a factor in the link between the two. Obviously, more research is required to illustrate this and better understand if and how the inflammatory response to periodontal bacteria leads to the development or aggravation of respiratory infections.
Periodontal disease is a chronic, inflammatory disease that can impact overall health, and therefore, we must treat our patients accordingly. This means conducting a comprehensive periodontal evaluation on an annual basis to ensure that periodontal disease is caught early and an appropriate treatment plan can be established. The dental team must work together to ensure that each patient receives a yearly comprehensive examination, including intraoral, extraoral, and occlusal evaluations; a thorough assessment of plaque, calculus, and gingival inflammation; probing of at least six sites per tooth; assessment and documentation of recession and attachment loss around teeth; radiographic evaluation of bone loss; and an assessment of patient-associated risk factors such as age, smoking, and the presence of other chronic, systemic conditions associated with systemic inflammatory burden.
Association Between Respiratory Disease in Hospitalized Patients and Periodontal Disease: A Cross-Sectional Study
Sharma N, Shamsuddin H.
Featured in Journal of Periodontology.
Background: Recent research indicated that periodontal infection may worsen systemic diseases, including pulmonary disease. Respiratory infections, such as pneumonia and the exacerbation of chronic obstructive pulmonary disease, involve the aspiration of bacteria from the oropharynx into the lower respiratory tract.
Methods: A group of 100 cases (hospitalized patients with respiratory disease) and a group of 100 age-, sex-, and race-matched outpatient controls (systemically healthy patients from the outpatient clinic, Department of Periodontics, Government Dental College and Hospital, Calicut, Kerala, India) were selected for the study. Standardized measures of oral health that were performed and compared included the gingival index (GI), plaque index (PI), and simplified oral hygiene index (OHI). Data regarding probing depths and clinical attachment levels (CALs) were recorded at four sites per tooth and compared statistically. The χ(2) and Student t tests were used for statistical analyses.
Results: The comparison of study-population demographics on the basis of age, sex, education, and income showed no significant differences between groups. Patients with respiratory disease had significantly greater poor periodontal health (OHI and PI), gingival inflammation (GI), deeper pockets, and CALs compared to controls. In the case group, patients with a low income were 4.4 times more prone to periodontal disease compared to high-income patients. Smokers had significantly higher CALs compared to non-smokers in the control group.
Conclusion: The findings of the present analysis support an association between respiratory and periodontal disease.
About the Author
Donald S. Clem, DDS
American Academy of Periodontology