Periodontitis as a manifestation of systemic disease

Periodontitis as a manifestation of systemic diseases is one of the seven categories of periodontitis as defined by the American Academy of Periodontology 1999 classification system.^[1][2] At least 16 systemic diseases have been linked to periodontitis. These systemic diseases are associated with periodontal disease because they generally contribute to either a decreased host resistance to infections or dysfunction in the connective tissue of the gums, increasing patient susceptibility to inflammation-induced destruction.^[1]
These secondary periodontal inflammations should not be confused by other conditions in which an epidemiological association with periodontitis was revealed, but no causative connection was proved yet. Such conditions are coronary heart diseases,^[3] cerebrovascular diseases^[4] and erectile dysfunction.^[5]

Conditions associated with periodontitis

• Diabetes mellitus
  • Recent evidence suggests that, similar to diabetes mellitus, individuals with impaired fasting glucose have higher degree of periodontal inflammation.^[6]
• Associated with hematologic disorders:
  • Acquired neutropenia
  • Leukemia

For those patients with periodontitis as a manifestation of hematologic disorders, coordination with the patient's physician is instrumental in planning periodontal treatment. Therapy should be avoided during periods of exacerbation of the malignancy or during active phases of chemotherapy, and antimicrobial therapy might be considered when urgent treatment must be performed when granulocyte counts are low.^[7]

• Associated with genetic disorders
  • Familial and cyclic neutropenia
  • Down syndrome
  • Leukocyte adhesion deficiency disorder
  • Papillon-Lefèvre syndrome
  • Chediak-Higashi syndrome
  • Langerhans cell disease (histiocytosis syndromes)
  • Glycogen storage disease
  • Chronic granulomatous disease
  • Infantile genetic agranulocytosis
  • Cohen syndrome
  • Ehlers-Danlos syndrome (Types IV and VIII)
  • Hypophosphatasia
  • Crohn's disease (inflammatory bowel disease)
  • Marfan syndrome
  • Klinefelter syndrome

References

1. Armitage GC (2004). "Periodontal diagnoses and classification of periodontal diseases". Periodontol. 2000. 34: 9–21. doi:10.1046/j.0906-6713.2002.003421.x. PMID 14717852.
2. Armitage GC (December 1999). "Development of a classification system for periodontal diseases and conditions". Ann. Periodontol. 4 (1): 1–6. doi:10.1902/annals.1999.4.1.1. PMID 10863370.
3. Friedewald VE, Kornman KS, Beck JD, et al. (July 2009). "The American Journal of Cardiology and Journal of Periodontology Editors' Consensus: periodontitis and atherosclerotic cardiovascular disease". Am J Cardiol. 104 (1): 59–68. doi:10.1016/j.amjcard.2009.05.002. PMID 19576322.
4. Khader YS, Albashaireh ZS, Alomari MA (August 2004). "Periodontal diseases and the risk of coronary heart and cerebrovascular diseases: a meta-analysis.". J Periodontol. 75 (8): 1046–53. doi:10.1902/jop.2004.75.8.1046. PMID 15455730.
5. Zadik Y, Bechor R, Galor S, Justo D, Heruti RJ (April 2009). "Erectile dysfunction might be associated with chronic periodontal disease: two ends of the cardiovascular spectrum". J Sex Med. 6 (4): 1111–6. doi:10.1111/j.1743-6109.2008.01141.x. PMID 19170861.
6. Zadik Y, Bechor R, Galor S, Levin L (May 2010). "Periodontal disease might be associated even with impaired fasting glucose". Br Dent J. 208 (10): e20. doi:10.1038/sj.bdj.2010.291. PMID 20339371.
7. American Academy of Periodontology (May 2000). "Parameter on periodontitis associated with systemic conditions. American Academy of Periodontology". J. Periodontol. 71 (5 Suppl): 876–9. doi:10.1902/jop.2000.71.5-S.876. PMID 10875698. as PDF