Periodontitis and Systemic Diseases

Josefine Hirschfeld / Iain L. C. Chapple

Periodontitis and Systemic Diseases

Clinical Evidence and Biological Plausibility

A CIP record for this book is available from the British Library.

ISBN (ebook): 978-3-86867-557-3

ISBN (print): 978-1-78698-100-4

© 2021 Quintessenz Verlags-GmbH, Berlin

All rights reserved. This book or any part thereof may not be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, or otherwise, without prior written permission of the publisher.

Editing: Elizabeth Ducker Publishing, UK

Preface

The training of dental and medical students has diverged in recent decades along distinct pathways. Medical courses devote a trivial amount of time to the study of the oral cavity, presuming it to be the sole responsibility of oral health care professionals. Similarly, dental programmes cover the entirety of human diseases and the underpinning biological and pharmacological sciences as relatively minor components of a long programme of study, presuming it to be the unique responsibility of medical professionals. Hence, the mouth has become figuratively separated from the rest of the body. However, the mouth represents one of the most complex organs of the human holobiont, as well as one of the most vulnerable points of entry for microbial pathogens into the internal systems and structures of the body. Teeth naturally breach the ectodermal barrier of the oral mucosa (gingiva), and form a non-shedding surface that is colonised by the second most complex human microbiome. Nature has therefore created a unique anatomical and physiological barrier to isolate mesodermal and ectodermal tissues, which is composed of the junctional epithelium, immunological surveillance processes, and the gingival crevicular fluid. The vulnerability of this complex results in micro-ulcers that form following dental plaque biofilm accumulation, and a portal of entry for the microbiome into the internalised body systems develops. The downstream consequences are both significant and under-appreciated. It is therefore unsurprising that in recent decades, periodontitis has become recognised as a significant and independent risk factor for premature mortality, and multiple chronic non-communicable diseases associated with ageing. This book attempts to provide a contemporary evidence base for periodontal-systemic disease relationships, from epidemiology, to the biological plausibility of associations, to considerations of causal pathways and therapeutic challenges. It aims to put the mouth back inside the body for both dental and medical professionals, and in doing so, makes a compelling case for a reunion of these two professions. From such a reunion, collaborative care pathways can be developed that embrace both personalised and precision medicine, and place the individual at the centre of holistic care. It is time to break down the artificial barriers that have emerged from 20th century educational theory and practice.

Iain L. C. Chapple & Josefine Hirschfeld

Acknowledgements

Dr Hirschfeld would like to dedicate this book to her loving, supportive and encouraging family. She also wishes to acknowledge the role of her past and current teachers and mentors in Würzburg, Boston, Bonn and Birmingham, in developing and inspiring her academically and scientifically.

Prof Chapple wishes to dedicate this text to his late mother Beryl Chapple and his father Arthur Chapple for their devoted care and guidance. He wishes to thank his wife Liz and daughters Jess and Tasha for their unconditional support, love and patience.

Both editors are extremely grateful to the chapter authors for their dedication, expertise and friendship in creating this book and for their commitment to our discipline, our patients and the public at large. They also wish to dedicate this book to two giants of this area of study, Robert Genco (1938–2019) and Stephen Offenbacher (1950–2018) – thank you Bob and Steve for your science, mentorship and friendship – this is your legacy.

List of authors

Editors: Dr Josefine Hirschfeld and Prof Iain Chapple

Contents

Preface

Acknowledgements

List of authors

Introduction

1 Periodontitis, obesity and diabetes mellitus

1.1 Introduction

1.2 Clinical evidence

1.3 Cellular and molecular mechanisms

1.4 Guidelines for prevention and treatment of patients with diabetes

1.5 Conclusion

1.6 References

2 Periodontitis and atherosclerotic cardiovascular disease

2.1 Introduction

2.2 Clinical evidence

2.3 Cellular and molecular mechanisms

2.4 Conclusion

2.5 References

3 Periodontitis and chronic kidney disease

3.1 Introduction

3.2 Clinical evidence

3.3 Cellular and molecular mechanisms

3.4 Conclusion

3.5 Acknowledgement

3.6 References

4 Periodontitis and inflammatory bowel disease

4.1 Introduction

4.2 Clinical evidence