Editing Periodontal disease (section)

===Systemic implications===

Periodontal disease (PD) can be described as an inflammatory condition affecting the supporting structures of the teeth. Studies have shown that PD is associated with higher levels of systemic inflammatory markers such as Interleukin-6 (IL-6), C-Reactive Protein (CRP) and Tumor Necrosis Factor (TNF). To compare, elevated levels of these inflammatory markers are also associated with cardiovascular disease and cerebrovascular events such as ischemic strokes.<ref>{{Cite journal |last1=Gomes-Filho |first1=Isaac Suzart |last2=Freitas Coelho |first2=Julita Maria |last3=da Cruz |first3=Simone Seixas |last4=Passos |first4=Johelle Santana |last5=Teixeira de Freitas |first5=Camila Oliveira |last6=Aragão Farias |first6=Naiara Silva |last7=Amorim da Silva |first7=Ruany |last8=Silva Pereira |first8=Milena Novais |last9=Lima |first9=Thiago Lopes |last10=Barreto |first10=Maurício Lima |date=July 2011 |title=Chronic periodontitis and C-reactive protein levels |journal=Journal of Periodontology |volume=82 |issue=7 |pages=969–978 |doi=10.1902/jop.2010.100511 |issn=1943-3670 |pmid=21189085}}</ref>

The presence of a wide spectrum inflammatory oral diseases can increase the risk of an episode of stroke in an acute or chronic phase. Inflammatory markers, CRP, IL-6 are known risk factors of stroke. Both inflammatory markers are also biomarkers of PD and found to be an increased level after daily activities, such as mastication or toothbrushing, are performed. Bacteria from the periodontal pockets will enter the bloodstream during these activities and the current literature suggests that this may be a possible triggering of the aggravation of the stroke process.<ref>{{Cite journal |last=Loos |first=Bruno G. |date=November 2005 |title=Systemic markers of inflammation in periodontitis |journal=Journal of Periodontology |volume=76 |issue=11 Suppl |pages=2106–15 |doi=10.1902/jop.2005.76.11-S.2106 |issn=0022-3492 |pmid=16277583}}</ref>

Other mechanisms have been suggested, PD is a known chronic infection. It can aid in the promotion of atherosclerosis by the deposition of cholesterol, cholesterol esters and calcium within the subendothelial layer of vessel walls.<ref>{{Cite journal |last1=Libby |first1=Peter |last2=Ridker |first2=Paul M. |last3=Hansson |first3=Göran K. |last4=Leducq Transatlantic Network on Atherothrombosis |date=2009-12-01 |title=Inflammation in atherosclerosis: from pathophysiology to practice |journal=Journal of the American College of Cardiology |volume=54 |issue=23 |pages=2129–38 |doi=10.1016/j.jacc.2009.09.009 |issn=1558-3597 |pmc=2834169 |pmid=19942084}}</ref> Atherosclerotic plaque that is unstable may rupture and release debris and thrombi that may travel to different parts of the circulatory system causing embolization and therefore, an ischemic stroke. Therefore, PD has been suggested as an independent risk factor for stroke.

A variety of cardiovascular diseases can also be associated with periodontal disease. Patients with higher levels of inflammatory markers such as TNF, IL-1, IL-6 and IL-8 can lead to progression of atherosclerosis and the development and perpetuation of atrial fibrillation,<ref>{{Cite journal |last1=Harada |first1=Masahide |last2=Van Wagoner |first2=David R. |last3=Nattel |first3=Stanley |date=2015 |title=Role of Inflammation in Atrial Fibrillation Pathophysiology and Management |url=http://dx.doi.org/10.1253/circj.cj-15-0138 |journal=Circulation Journal |volume=79 |issue=3 |pages=495–502 |doi=10.1253/circj.cj-15-0138 |pmid=25746525 |pmc=4457364 |issn=1346-9843}}</ref> as it is associated with platelet and coagulation cascade activations, leading to thrombosis and thrombotic complications.

Experimental animal studies have shown a link between periodontal disease, oxidative stress and cardiac stress. Oxidative stress favours the development and progression of heart failure as it causes cellular dysfunction, oxidation of proteins and lipids, and damage to the deoxyribonucleic acid (DNA), stimulating fibroblast proliferation and metalloproteinases activation favouring cardiac remodelling.<ref>{{Cite journal |last1=Tsutsui |first1=Hiroyuki |last2=Kinugawa |first2=Shintaro |last3=Matsushima |first3=Shouji |date=December 2011 |title=Oxidative stress and heart failure |journal=American Journal of Physiology. Heart and Circulatory Physiology |volume=301 |issue=6 |pages=H2181–90 |doi=10.1152/ajpheart.00554.2011 |issn=1522-1539 |pmid=21949114|s2cid=25334639 }}</ref>

During SARS Covid 19 pandemic, Periodontitis was significantly associated with a higher risk of complications from COVID‐19, including ICU admission, need for assisted ventilation and death and increased blood levels of markers such as D‐dimer, WBC and CRP which are linked with worse disease outcome.<ref>{{cite journal |last1=Marouf |first1=Nadya |title=Association between periodontitis and severity of COVID-19 infection: A case–control study |journal=Journal of Clinical Periodontology |date=2021 |volume=48 |issue=4 |pages=483–491 |doi=10.1111/jcpe.13435 |pmid=33527378|pmc=8014679 }}</ref>