IS PERIODONTAL DISEASE A COMORBIDITY…?Relationship Between Periodontal Disease and Respiratory Diseases

Periodontitis and Respiratory diseases

Periodontal disease has been reported as an independent risk factor for chronic obstructive pulmonary disease (COPD), with a 2-fold increased risk of COPD in individuals with periodontal disease, after controlling for common confounders, such as smoking.

Studies investigating a link between COPD and periodontitis remain preliminary and as such there is no clear evidence. Pneumonia, involving infection within the airways, may associate with periodontitis especially as many potential opportunistic pathogenic bacteria are found within the oral cavity. Improved oral hygiene has been shown in randomised controlled trials to have an important role in the prevention of pneumonia in a variety of at risk populations. However, there are few studies investigating the effects of established chronic periodontitis in relation to acquired lung infections.

Mechanisms of periodontal systemic connections. Periodontitis, a chronic inflammatory condition affecting tooth-supporting structures and resulting from altered host-biofilm interactions, generates periodontal pockets that harbor oral anaerobic bacteria and viruses. These can be released systemically through the highly vascularized pocket granulation tissue or through aspiration via the oropharynx in those at risk and during therapeutic interventions. Circulatory release of proinflammatory cytokines, bacteria, and their byproducts may be associated with bacteremia, circulating leukocyte priming, low-grade inflammation, and ectopic deposition in distant organs. Similarly, aspirated anaerobic bacteria can colonize the lungs and lead to aspiration pneumonia.

Aspiration pneumonia can occur due to infection with commensal oral bacteria, whereas nosocomial infection occurs due to the introduction of foreign bacteria into the oral cavity that can be integrated into plaque. Periodontitis and respiratory infections share common inflammatory pathogenesis and risk factors, one of which is smoking. Smoking increases the host’s susceptibility and risk of infection by inducing immune dysfunction and poor vascularization. Altogether, existing evidence supports the idea that inadequate oral hygiene and increased oral microbial loads may place patients at higher risk of pneumonia, and interventions should be put into place to control the accumulation of oral biofilm. CHX rinses could be considered to control dental biofilms, and aerosols should be minimized in dental procedures to decrease the risk of aspiration.

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