Oral Inflammation and Systemic Diseases

Recent studies have suggested a relationship between oral infection; in particular periodontal disease and systemic diseases. Epidemiologic studies have implicated periodontal disease as a risk factor for the development of cardiovascular disease and stroke, and studies in diabetics have revealed that untreated periodontal disease can lead to diabetic complications and have a direct impact on glycemic control. It has become clear in recent years that periodontitis is an inflammatory disease that is linked to dysbiosis of the oral microbial biofilm. This distinction implies that it is the host response to the biofilm that destroys the periodontium in the pathogenesis of the disease. It is now clear that oxidative stress related to excess inflammation plays a role in the pathogenesis of periodontitis. However, there is limited data on the ability of antioxidants used therapeutically to significantly alter the course of local periodontitis or the associated systemic conditions. As our understanding of pathways of inflammation has matured, a better understanding of the molecular basis of resolution of inflammation, which is distinct from pharmacologic anti-inflammation, has emerged. Resolution of inflammation is an active, receptor agonist mediated well-orchestrated return of tissue homeostasis, not inhibition of proinflammatory pathways, that includes significant reductions in oxidative stress. The isolation and characterization of endogenous lipid mediators of resolution, called lipoxins and resolvins, has opened new doorways for the management of periodontitis and systemic inflammatory diseases. This presentation will review resolution of inflammation, and the role of inflammation and its control in the link between periodontal inflammation and inflammatory systemic diseases (including type 2 diabetes), cardiovascular disease and others.