The role of dental plaque biofilm in oral health

Access,  Sept-Oct, 2007  by JoAnn R. Gurenlian

• E-mail
• Print
• Link

Since atherosclerosis is inflammatory by nature, identifying inflammatory markers that correlate with disease state is important. One recognized and consistent marker of systemic inflammation and poor cardiovascular prognosis is the acute-phase protein C-reactive protein (CRP), the level of which rises with systemic inflammation. (62,63) Animal model studies of the relationship between cardiovascular disease and periodontal disease demonstrate that clinically induced oral infection with P gingivalis will increase atheroma size and elevate CRP levels in the blood. (30) Conversely, some studies have shown that treatment of periodontitis decreases CRP blood levels, (64) though this has not been a consistent finding.

[FIGURE 4 OMITTED]

Diabetes Mellitus. Diabetes mellitus is another chronic systemic disease associated with periodontitis. In fact, periodontitis has been identified as one of the major complications of diabetes. (65) Although diabetes increases the susceptibility to periodontal disease, (38,39,65) periodontitis may also increase the difficulty of maintaining satisfactory glycemic control in people with diabetes as compared with those with diabetes without periodontitis. (40) One biological mechanism proposed to explain the increased incidence and severity of periodontal disease in individuals with diabetes is the finding of elevated levels of inflammatory mediators in the gingival crevicular fluid from periodontal pockets of patients with diabetes with poor glycemic control as compared with those with diabetes who are well controlled or those without diabetes. Those with poor glycemic control had considerable periodontal destruction with an equivalent bacterial challenge. (39,66) Of note, the proinflammatory cytokine TNF-[alpha] plays a significant role in this process. TNF-[alpha] has a major role in insulin resistance, the primary cause of type 2 diabetes, and is produced in large quantities by fat cells. Periodontitis also has been associated with increased levels of TNF-[alpha]. Elevated levels of TNF-[alpha] may lead to greater bone loss by killing cells that repair damaged connective tissue or bone. Elevated TNF-[alpha] levels also may exacerbate insulin resistance and worsen glycemic control. (44,66,67)

Adverse Pregnancy Outcomes. Studies also demonstrate that periodontal diseases are associated with the risk of adverse pregnancy outcomes, especially preterm low-birth-weight infants. (50-52) Chronic infection, such as that found with chronic periodontitis, can stimulate the inflammatory process throughout the body. In the placenta, this may lead to elevated amniotic levels of prostaglandins, TNF-[alpha], and IL-1 and IL-6, stimulating premature rupture of membranes, preterm labor, and the birth of low-birth-weight infants. Intervention studies are currently under way to investigate a cause and effect relationship between advanced periodontitis and adverse pregnancy outcomes.

Strategies for Managing Dental Biofilm to Promote Health