Editing Periodontal disease (section)

===Associated conditions===
Periodontitis has been linked to increased [[inflammation]] in the body, such as indicated by raised levels of [[C-reactive protein]] and [[interleukin-6]].<ref>{{cite journal | vauthors = D'Aiuto F, Parkar M, Andreou G, Suvan J, Brett PM, Ready D, Tonetti MS | title = Periodontitis and systemic inflammation: control of the local infection is associated with a reduction in serum inflammatory markers | journal = Journal of Dental Research | volume = 83 | issue = 2 | pages = 156–60 | date = February 2004 | pmid = 14742655 | doi = 10.1177/154405910408300214 | s2cid = 34329326 }}</ref><ref>{{cite journal | vauthors = Nibali L, D'Aiuto F, Griffiths G, Patel K, Suvan J, Tonetti MS | title = Severe periodontitis is associated with systemic inflammation and a dysmetabolic status: a case-control study | journal = Journal of Clinical Periodontology | volume = 34 | issue = 11 | pages = 931–7 | date = November 2007 | pmid = 17877746 | doi = 10.1111/j.1600-051X.2007.01133.x }}</ref><ref>{{cite journal | vauthors = Paraskevas S, Huizinga JD, Loos BG | title = A systematic review and meta-analyses on C-reactive protein in relation to periodontitis | journal = Journal of Clinical Periodontology | volume = 35 | issue = 4 | pages = 277–90 | date = April 2008 | pmid = 18294231 | doi = 10.1111/j.1600-051X.2007.01173.x }}</ref><ref>{{cite journal | vauthors = D'Aiuto F, Ready D, Tonetti MS | title = Periodontal disease and C-reactive protein-associated cardiovascular risk | journal = Journal of Periodontal Research | volume = 39 | issue = 4 | pages = 236–41 | date = August 2004 | pmid = 15206916 | doi = 10.1111/j.1600-0765.2004.00731.x }}</ref> It is associated with an increased risk of stroke,<ref>{{cite journal | vauthors = Pussinen PJ, Alfthan G, Jousilahti P, Paju S, Tuomilehto J | title = Systemic exposure to Porphyromonas gingivalis predicts incident stroke | journal = Atherosclerosis | volume = 193 | issue = 1 | pages = 222–8 | date = July 2007 | pmid = 16872615 | doi = 10.1016/j.atherosclerosis.2006.06.027 }}</ref><ref>{{cite journal | vauthors = Pussinen PJ, Alfthan G, Rissanen H, Reunanen A, Asikainen S, Knekt P | title = Antibodies to periodontal pathogens and stroke risk | journal = Stroke | volume = 35 | issue = 9 | pages = 2020–3 | date = September 2004 | pmid = 15232116 | doi = 10.1161/01.STR.0000136148.29490.fe | doi-access = free }}</ref> [[myocardial infarction]],<ref>{{cite journal | vauthors = Pussinen PJ, Alfthan G, Tuomilehto J, Asikainen S, Jousilahti P | title = High serum antibody levels to Porphyromonas gingivalis predict myocardial infarction | journal = European Journal of Cardiovascular Prevention and Rehabilitation | volume = 11 | issue = 5 | pages = 408–11 | date = October 2004 | pmid = 15616414 | doi = 10.1097/01.hjr.0000129745.38217.39 | s2cid = 34400631 }}</ref> [[atherosclerosis]]<ref>{{cite journal | vauthors = Ford PJ, Gemmell E, Timms P, Chan A, Preston FM, Seymour GJ | title = Anti-P. gingivalis response correlates with atherosclerosis | journal = Journal of Dental Research | volume = 86 | issue = 1 | pages = 35–40 | date = January 2007 | pmid = 17189460 | doi = 10.1177/154405910708600105 | s2cid = 5567995 }}</ref><ref>{{cite journal | vauthors = Beck JD, Eke P, Heiss G, Madianos P, Couper D, Lin D, Moss K, Elter J, Offenbacher S | title = Periodontal disease and coronary heart disease: a reappraisal of the exposure | journal = Circulation | volume = 112 | issue = 1 | pages = 19–24 | date = July 2005 | pmid = 15983248 | doi = 10.1161/CIRCULATIONAHA.104.511998 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Scannapieco FA, Bush RB, Paju S | title = Associations between periodontal disease and risk for atherosclerosis, cardiovascular disease, and stroke. A systematic review | journal = Annals of Periodontology | volume = 8 | issue = 1 | pages = 38–53 | date = December 2003 | pmid = 14971247 | doi = 10.1902/annals.2003.8.1.38 }}</ref><ref>{{cite journal | vauthors = Wu T, Trevisan M, Genco RJ, Dorn JP, Falkner KL, Sempos CT | title = Periodontal disease and risk of cerebrovascular disease: the first national health and nutrition examination survey and its follow-up study | journal = Archives of Internal Medicine | volume = 160 | issue = 18 | pages = 2749–55 | date = October 2000 | pmid = 11025784 | doi = 10.1001/archinte.160.18.2749 }}</ref><ref>{{cite journal | vauthors = Beck JD, Elter JR, Heiss G, Couper D, Mauriello SM, Offenbacher S | title = Relationship of periodontal disease to carotid artery intima-media wall thickness: the atherosclerosis risk in communities (ARIC) study | journal = Arteriosclerosis, Thrombosis, and Vascular Biology | volume = 21 | issue = 11 | pages = 1816–22 | date = November 2001 | pmid = 11701471 | doi = 10.1161/hq1101.097803 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Elter JR, Champagne CM, Offenbacher S, Beck JD | title = Relationship of periodontal disease and tooth loss to prevalence of coronary heart disease | journal = Journal of Periodontology | volume = 75 | issue = 6 | pages = 782–90 | date = June 2004 | pmid = 15295942 | doi = 10.1902/jop.2004.75.6.782 }}</ref><ref>{{cite journal | vauthors = Humphrey LL, Fu R, Buckley DI, Freeman M, Helfand M | title = Periodontal disease and coronary heart disease incidence: a systematic review and meta-analysis | journal = Journal of General Internal Medicine | volume = 23 | issue = 12 | pages = 2079–86 | date = December 2008 | pmid = 18807098 | pmc = 2596495 | doi = 10.1007/s11606-008-0787-6 }}</ref> and [[hypertension]].<ref>{{cite journal | vauthors = Martin-Cabezas R, Seelam N, Petit C, Agossa K, Gaertner S, Tenenbaum H, Davideau JL, Huck O | title = Association between periodontitis and arterial hypertension: A systematic review and meta-analysis | journal = American Heart Journal | volume = 180 | pages = 98–112 | date = October 2016 | pmid = 27659888 | doi = 10.1016/j.ahj.2016.07.018 }}</ref> It is also linked in those over 60 years of age to impairments in delayed memory and calculation abilities.<ref>{{cite journal | vauthors = Noble JM, Borrell LN, Papapanou PN, Elkind MS, Scarmeas N, Wright CB | title = Periodontitis is associated with cognitive impairment among older adults: analysis of NHANES-III | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 80 | issue = 11 | pages = 1206–11 | date = November 2009 | pmid = 19419981 | pmc = 3073380 | doi = 10.1136/jnnp.2009.174029 }}</ref><ref>{{cite journal | vauthors = Kaye EK, Valencia A, Baba N, Spiro A, Dietrich T, Garcia RI | title = Tooth loss and periodontal disease predict poor cognitive function in older men | journal = Journal of the American Geriatrics Society | volume = 58 | issue = 4 | pages = 713–8 | date = April 2010 | pmid = 20398152 | pmc = 3649065 | doi = 10.1111/j.1532-5415.2010.02788.x }}</ref> Individuals with [[impaired fasting glucose]] and [[diabetes mellitus]] have a higher degrees of periodontal inflammation and often have difficulties with balancing their blood [[glucose]] level, owing to the constant systemic inflammatory state caused by the periodontal inflammation.<ref name="glucose">{{cite journal | vauthors = Zadik Y, Bechor R, Galor S, Levin L | title = Periodontal disease might be associated even with impaired fasting glucose | journal = British Dental Journal | volume = 208 | issue = 10 | pages = E20 | date = May 2010 | pmid = 20339371 | doi = 10.1038/sj.bdj.2010.291 | doi-access = free }}</ref><ref name="DM">{{cite journal | vauthors = Soskolne WA, Klinger A | title = The relationship between periodontal diseases and diabetes: an overview | journal = Annals of Periodontology | volume = 6 | issue = 1 | pages = 91–8 | date = December 2001 | pmid = 11887477 | doi = 10.1902/annals.2001.6.1.91 }}</ref> Although no causal association was proven, there is an association between chronic periodontitis and [[erectile dysfunction]],<ref name="ED">{{cite journal | vauthors = Zadik Y, Bechor R, Galor S, Justo D, Heruti RJ | title = Erectile dysfunction might be associated with chronic periodontal disease: two ends of the cardiovascular spectrum | journal = The Journal of Sexual Medicine | volume = 6 | issue = 4 | pages = 1111–6 | date = April 2009 | pmid = 19170861 | doi = 10.1111/j.1743-6109.2008.01141.x | s2cid = 3421903 }}</ref> [[inflammatory bowel disease]],<ref>{{Cite journal|last1=Poyato-Borrego|first1=M.|last2=Segura-Egea|first2=J.-J.|last3=Martín-González|first3=J.|last4=Jiménez-Sánchez|first4=M.-C.|last5=Cabanillas-Balsera|first5=D.|last6=Areal-Quecuty|first6=V.|last7=Segura-Sampedro|first7=J.-J.|date=27 August 2020|title=Prevalence of endodontic infection in patients with Crohn´s disease and ulcerative colitis|journal=Medicina Oral, Patologia Oral y Cirugia Bucal|volume=26|issue=2|pages=e208–e215|doi=10.4317/medoral.24135 |pmid=32851982|pmc=7980298|doi-access=free}}</ref> and heart disease.<ref>{{cite journal |last1=Perk |first1=J. |last2=De Backer |first2=G. |last3=Gohlke |first3=H. |last4=Graham |first4=I. |last5=Reiner |first5=Z. |last6=Verschuren |first6=M. |title=European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR) |journal=European Heart Journal |date=3 May 2012 |volume=33 |issue=13 |pages=1635–1701 |doi=10.1093/eurheartj/ehs092 |pmid=22555213 |doi-access=free }}</ref>
==== Diabetes and periodontal disease ====
A positive correlation between raised levels of glucose within the blood and the onset or progression of periodontal disease has been shown in the current literature.

Data has also shown that there is a significant increase in the incidence or progression of periodontitis in patients with uncontrolled diabetes compared to those who do not have diabetes or have well-controlled diabetes. In uncontrolled diabetes, the formation of [[reactive oxygen species]] can damage cells such as those in the connective tissue of the periodontal ligament, resulting in cell [[necrosis]] or [[apoptosis]]. Furthermore, individuals with uncontrolled diabetes mellitus who have frequent exposure to periodontal pathogens have a greater immune response to these bacteria. This can subsequently cause and/or accelerate periodontal tissue destruction leading to periodontal disease.<ref>{{Cite journal |last1=Nascimento |first1=Gustavo G. |last2=Leite |first2=Fábio R. M. |last3=Vestergaard |first3=Peter |last4=Scheutz |first4=Flemming |last5=López |first5=Rodrigo |date=July 2018 |title=Does diabetes increase the risk of periodontitis? A systematic review and meta-regression analysis of longitudinal prospective studies |journal=Acta Diabetologica |volume=55 |issue=7 |pages=653–667 |doi=10.1007/s00592-018-1120-4 |issn=1432-5233 |pmid=29502214|s2cid=3689420 }}</ref>