Department of Periodontology, School of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil.
Department of Periodontology, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Periodontol 2000. 2024 Oct;96(1):7-19. doi: 10.1111/prd.12616. Epub 2024 Nov 4.
For decades, periodontitis has been considered to be a local inflammatory disease of the periodontal tissues in the oral cavity. Initially, associations of periodontitis with a multitude of noncommunicable diseases were each studied separately, and relationships were shown. The associations of periodontitis with morbidities, such as cardiovascular diseases, rheumatoid arthritis, diabetes mellitus, respiratory diseases, have been demonstrated. As most such studies were cross-sectional in nature, questions about causality cannot be univocally answered. And periodontitis as an independent risk factor for one systemic disease, becomes even more difficult to assess since recently periodontitis has also been associated with multimorbidity. Periodontitis and many systemic diseases share environmental, lifestyle and genetic risk factors, and share immunopathology. Moreover, suffering from one common noncommunicable disease may increase the susceptibility for another such chronic disease; the systemic effects of one condition may be one of various risk factors for another such disease. The overarching effect of any systemic disease is it causing a pro-inflammatory state in the individual; this has also been shown for periodontitis. Moreover, in periodontitis a prothrombotic state and elevated immunological activity have been shown. As such, when we consider periodontal disease as another systemic disease, it can affect the susceptibility and progression of other systemic diseases, and importantly, vice versa. And with this, it is not surprising that periodontitis is associated with a variety of other noncommunicable diseases. The medical definition of a systemic disease includes diseases that affect different organs and systems. Thus, the aim of this opinion paper is to propose that periodontitis should be considered a systemic disease in its own right and that it affects the individual's systemic condition and wellbeing. The dental and medical profession and researchers alike, should adapt this paradigm shift, advancing periodontal disease out of its isolated anatomical location into the total of chronic noncommunicable diseases, being for some conditions a comorbid disease and, vice versa, comorbidities can affect initiation and progression of periodontal disease.
几十年来，牙周炎一直被认为是口腔牙周组织的局部炎症性疾病。最初，牙周炎与多种非传染性疾病的关联分别进行了研究，并显示出了相关性。牙周炎与心血管疾病、类风湿性关节炎、糖尿病、呼吸道疾病等多种疾病的关联已得到证实。由于大多数此类研究本质上是横断面研究，因此不能明确回答因果关系的问题。而且，由于牙周炎最近也与多种疾病相关，因此将牙周炎作为一种单一系统性疾病的独立危险因素来评估变得更加困难。牙周炎和许多系统性疾病具有相同的环境、生活方式和遗传危险因素，并且具有相同的免疫病理学。此外，患有一种常见的非传染性疾病可能会增加另一种此类慢性疾病的易感性；一种疾病的全身性影响可能是另一种疾病的各种危险因素之一。任何系统性疾病的总体影响都是使个体处于促炎状态；这也已在牙周炎中得到证实。此外，在牙周炎中，已经显示出了促血栓形成状态和免疫活性升高。因此，当我们将牙周疾病视为另一种系统性疾病时，它会影响其他系统性疾病的易感性和进展，反之亦然。因此，牙周炎与多种其他非传染性疾病相关也就不足为奇了。系统性疾病的医学定义包括影响不同器官和系统的疾病。因此，本意见论文的目的是提出牙周炎本身就是一种系统性疾病，它会影响个体的全身状况和健康。牙科和医疗专业人员以及研究人员都应该适应这一范式转变，将牙周病从孤立的解剖位置推进到慢性非传染性疾病的整体中，对于某些疾病来说是一种共病，反之亦然，共病也会影响牙周病的起始和进展。
