A Clinician s Guide to Systemic Effects of Periodontal Diseases. Ronald G. Craig Angela R. Kamer Editors

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1 A Clinician s Guide to Systemic Effects of Periodontal Diseases Ronald G. Craig Angela R. Kamer Editors 123

2 A Clinician s Guide to Systemic Effects of Periodontal Diseases

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4 Ronald G. Craig Angela R. Kamer Editors A Clinician s Guide to Systemic Effects of Periodontal Diseases

5 Editors Ronald G. Craig Basic Sciences and Craniofacial Biology New York University College of Dentistry New York, NY USA Angela R. Kamer Department of Periodontology and Implant Dentistry New York University College of Dentistry New York, NY USA ISBN ISBN (ebook) DOI / Library of Congress Control Number: Springer-Verlag Berlin Heidelberg 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer-Verlag GmbH Berlin Heidelberg

6 Contents 1 Introduction and Overview of the Systemic Effects of Periodontal Diseases Ronald G. Craig and Angela R. Kamer 2 Pathogenesis of Periodontal Diseases Ronald G. Craig 3 Periodontitis and Diabetes Mellitus: A Complex Relationship Maria Emanuel Ryan, Veena S. Raja, and Sherry K. Sussman 4 Atherosclerotic Vascular Disease and Periodontal Disease Harmony R. Reynolds and Ronald G. Craig 5 Interactions Between Periodontal Disease and Chronic Kidney Diseases Ronald G. Craig and Peter Kotanko 6 The Association Between Periodontitis and Preterm Labor (PTL) Ananda P. Dasanayake and Frederick Naftolin 7 Oral Health and Pneumonia Frank A. Scannapieco and Keith Webb Harris 8 Peripheral Inflammation and Alzheimer s Disease: Periodontal Disease Angela R. Kamer, Ronald G. Craig, and Mony J. de Leon 9 Periodontal Infections and Rheumatoid Arthritis Walter A. Bretz, Jose U. Scher, and Steven B. Abramson 10 Summary and Possible Future Directions Angela R. Kamer and Ronald G. Craig Index v

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8 Contributors Steven B. Abramson, MD Department of Medicine, New York University School of Medicine, New York, NY, USA Walter A. Bretz, DDS, PhD Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY, USA Ronald G. Craig, DMD, PhD Department of Basic Sciences and Craniofacial Biology, New York University College of Dentistry, New York, NY, USA Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, NY, USA Ananda P. Dasanayake, BDS, MPH, PhD, FACE Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, NY, USA Keith Webb Harris, DO Pulmonology, John T. Mather Memorial Hospital, Port Jefferson, NY, USA Angela R. Kamer, DMD, MS, PhD Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, NY, USA Peter Kotanko, MD Private Corporation, Renal Research Institute, New York, NY, USA Mony J. de Leon, EdD, Professor Department of Psychiatry, Director Center for Brain Health, New York University Langone Medical Center, New York, NY, USA Frederick Naftolin, MD, PhD, FACOG, FRCOG Division of Reproductive Biology Research, New York University School of Medicine, New York, NY, USA Veena S. Raja, BDS, MS Graduate Program in Department of Oral Biology and Pathology, The Graduate School, Stony Brook University, Stony Brook, NY, USA Harmony R. Reynolds, MD Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA Maria Emanuel Ryan, DDS, PhD Department of Oral Biology and Pathology, School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA vii

9 viii Contributors Frank A. Scannapieco, DMD, PhD Department of Oral Biology, State University of New York at Buffalo, Buffalo, NY, USA Jose U. Scher, MD Division of Rheumatology, New York University School of Medicine, New York, NY, USA New York University Langone Hospital for Joint Diseases, New York, NY, USA Sherry K. Sussman, MD, FACE, ECNU Department of Medicine, Division of Endocrinology, School of Medicine, Stony Brook University, Stony Brook, NY, USA

10 Introduction and Overview of the Systemic Effects of Periodontal Diseases 1 Ronald G. Craig and Angela R. Kamer There has been an exponential increase in the number of papers published within the past decade on the association between periodontal diseases and a range of seemingly non-related systemic diseases and conditions. These associations include but are not limited to: diabetes mellitus, atherosclerosis, preterm low birth weight infants, rheumatoid arthritis, chronic kidney disease, pneumonia, Alzheimer s disease (all covered in this volume), some forms of cancer [ 1 4 ], and even erectile dysfunction [ 5 ]. When confronted with this wide array of diseases and conditions associated with periodontitis, one might ask if periodontitis contributes to the cause and progression of these conditions or whether these conditions contribute to periodontitis? Is the association due to a common underlying mechanism or mechanisms, or is the association merely due to the presence of confounding factors? And most importantly, can periodontal therapy decrease the risk or progression of these systemic diseases and conditions? Surprisingly, the answer to all five questions could be yes depending upon the disease or condition. Clearly what is needed by the practicing healthcare professional to remain abreast of this rapidly advancing and sometimes confusing field is a concise source that summarizes the current research on the association between periodontitis and systemic disease. R.G. Craig, DMD, PhD (*) Department of Basic Sciences and Craniofacial Biology, New York University College of Dentistry, New York, NY, USA Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, NY, USA ron.craig@nyu.edu A.R. Kamer, DMD, MS, PhD Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, NY, USA angela.kamer@nyu.edu Springer-Verlag Berlin Heidelberg 2016 R.G. Craig, A.R. Kamer (eds.), A Clinician s Guide to Systemic Effects of Periodontal Diseases, DOI / _1 1

11 2 R.G. Craig and A.R. Kamer To meet this need, A Clinician s Guide to Systemic Effects of Periodontal Diseases is intended to be a quick reference for the healthcare professional that will in one convenient volume: 1. Summarize the current research on the effects of periodontal diseases on systemic health and disease. 2. Relate how the results of recent research in this area may impact clinical practice, both now and in the future. 3. Assist in making evidence-based responses to questions posed by patients, colleagues, and the media in this ever-expanding area. The volume is not meant to be an exhaustive discussion on the systemic effects of periodontal diseases but to provide a quick overview of the research findings in this rapidly expanding field with an emphasis placed upon clinical applications. Additional information on each topic may be accessed using the reference section found in the conclusion of each chapter. The book has been designed to present each topic as a collaborative narrative between a dental investigator and medical colleague(s) active in the field of interest in an attempt to highlight the clinical relevance of the topic from both the dental and medical perspectives. We felt this design was important since effective management of several of the diseases presented in this volume require interdisciplinary efforts between medical and dental practitioners. Chapter 2 presents a discussion of the pathogenesis of periodontal diseases with a focus on adult chronic periodontitis, the periodontal disease most often associated with systemic effects. Our understanding of the pathogenesis of periodontitis has extensively deepened over the past several decades, providing insight into possible mechanisms through which a common oral disease such as periodontitis can have diverse and often significant systemic effects. Along with type 2 diabetes mellitus, atherosclerosis, Alzheimer s disease, and rheumatoid arthritis, periodontitis is considered to be a complex disease that begins with a mild clinical presentation that advances in severity with age. In addition, complex diseases exhibit multiple risk factors both modifiable and innate (genetic), although in the case of periodontitis, the genes involved and the roles they play in disease susceptibility and progression have not yet been characterized. Periodontitis is also a polymicrobial disease. Disease progression is associated with a predictable succession of microbial species that climax in disease-susceptible individuals with the appearance of Gram-negative anaerobic assacharolytic bacterial species. Several Gram-negative anaerobic species associated with periodontitis have been shown to invade periodontal tissues and gain access to the circulation to seed distant non-oral sites such as atheromas. The presence of Gram-negative anaerobic species in moderate to severe periodontitis has also been shown to elevate pro-inflammatory cytokines and initiate an acute phase response which includes elevation in blood glucose levels, dyslipidemia, and increase in systemic markers of inflammation. These and other systemic effects of periodontopathic bacteria further detailed in this volume have been proposed as mechanisms to link periodontitis with the systemic diseases and conditions described in this volume.

12 1 Introduction and Overview of the Systemic Effects of Periodontal Diseases 3 The following Chaps. 3, 4, 5, 6, 7, 8, and 9 discuss the association of periodontal diseases with diabetes mellitus, atherosclerosis, chronic kidney diseases, preterm labor, pneumonia, Alzheimer s disease, and rheumatoid arthritis. Each chapter begins with a discussion of the prevalence, presentation, pathogenesis, and medical management of the systemic disease/condition. Each chapter then discusses the association with periodontal diseases, comments on possible mechanisms involved, and concludes with a discussion of management concerns from both medical and dental perspectives. The final chapter discusses factors that are common among the systemic effects of periodontal diseases with respect to underlying mechanisms. The chapter also discusses some of the difficulties encountered when designing periodontal intervention trials and possible reasons for the inconclusive results reported for intervention trials to date. The chapter also discusses several clinical implications for disease management and suggestions for further studies. With the aging of the populations in industrialized nations and the advances made in the prevention and treatment of oral diseases, more individuals will retain teeth into old age and therefore be at risk for periodontal disease and its associated systemic effects. An understanding of the mechanisms linking periodontal diseases with systemic disease underscores the need for prevention and early intervention for this manageable common oral disease. Acknowledgments This work was supported by NIH DE , Alzheimer s Association NIRG References 1. Tezal M, Sullivan MA, Hyland A, Marshall JR, Stoler D, Reid ME, Loree TR, Rigual NR, Merzianu M, Hauck L, Lillis C, Wactawski-Wende J, Scannapieco FA. Chronic periodontitis and the incidence of head and neck squamous cell carcinoma. Cancer Epidemiol Biomarkers Prev. 2009;18: Ahn J, Segers S, Hayes RB. Periodontal disease, porphyromonas gingivalis serum antibody levels and orodigestive cancer mortality. Carcinogenesis. 2012;33: Salazar CR, Francois F, Li Y, Corby P, Hays R, Leung C, Bedi S, Segers S, Queiroz E, Sun J, Wang B, Ho H, Craig RG, Cruz G, Blaser MJ, Perez-Perez G, Hayes RB, Dasanayake A, Pei Z, Chen Y. Association between oral health and gastric precancerous lesions. Carcinogenesis. 2012;33: Wen B-W, Tsai C-S, Lin C-L, Chang Y-J, Lee C-F, Hsu C-H, Kao C-H. Cancer risk among gingivitis and periodontitis patients: a nationwide cohort study. Q J Med. 2014;107: Keller JJ, Chung S-D, Lin H-C. A nationwide population-based study on the association between chronic periodontitis and erectile dysfunction. J Clin Periodontol. 2012;39: