Mouth and body

The mouth is not a separate area. With advanced periodontitis the inflamed inner surfaces of the periodontal pockets add up to a wound area roughly the size of the palm of a hand — permanently, over years. Across that area bacteria and inflammatory messengers pass into the bloodstream.

A field of research has grown out of this that deserves some caution: many connections are well observed, but observation is not proof. That two things occur together may be because one causes the other — or because both have the same causes. Smoking, excess weight, social status and diet act on both sides.

Diabetes

This is the best-studied relationship, and it runs in both directions. Poorly controlled blood sugar impairs the body's defences and wound healing — people with Diabetes have a markedly increased risk of periodontitis and of more severe courses. Conversely, untreated periodontitis makes blood sugar harder to control, because inflammatory substances dampen the action of insulin.

What is practical about this: the treatment has a measurable effect. After periodontal therapy, long-term blood sugar falls measurably on average in studies. This is one of the few cases in which a dental treatment improves an internal medicine value.

Heart and blood vessels

People with periodontitis statistically have arterial calcification, heart attacks and strokes more often. A biological pathway is plausible: bacteria from the mouth can be detected in arterial deposits, and chronic inflammation promotes arteriosclerosis.

What has not been shown so far is the decisive last step: that treating the gums lowers the number of heart attacks. Inflammatory markers and the function of the inner vessel wall improve measurably. Proof of hard endpoints is still outstanding. It is an additional reason to have periodontitis treated all the same.

Pregnancy

A connection with premature birth and low birth weight has been described for periodontitis. Whether treatment during Pregnancy lowers the risk has come out inconsistently in studies — probably because by then it comes too late. The sensible conclusion is to get the gums in order before a planned pregnancy.

Rheumatism

Rheumatoid arthritis and periodontitis occur together strikingly often. A shared mechanism is under discussion: a particular periodontitis bacterium alters the body's own proteins in such a way that the immune system attacks them — the same process that plays a part in rheumatoid arthritis. The connection is interesting and not conclusively clarified.

Lungs, kidneys, memory

In people needing care and confined to bed, the connection between oral hygiene and pneumonia is well established: bacteria from the mouth are inhaled. Careful oral care measurably lowers the number of cases of pneumonia in care homes — that is one of the practically most effective findings in this whole field.

For chronic kidney disease and for dementia there are observations that suggest a connection. They are to be taken seriously and are not sufficient to speak of a cause.

What follows from this

None of these connections should be used as a means of pressure, and none justifies promises. What can be said is more sober and nevertheless enough: treated periodontitis is better than untreated periodontitis, regardless of how much it achieves for the heart and the metabolism. And anyone with a chronic illness should have their gums examined regularly — because the inflammation there causes no complaints for a long time.