Dr Nik Sisodia: “Periodontitis, inflammation, and respiratory diseases”
The study of periodontal pathogens has attracted significant attention in recent years due to their potential influence on the initiation and/or progression of several systemic conditions.
Researchers have already linked periodontal disease to diabetes and cardiovascular disease, but there is also a growing body of evidence associating periodontitis with respiratory disorders such as pneumonia and chronic obstructive pulmonary disease (COPD).
Understanding the ways in which periodontitis can influence the development of respiratory diseases is vital in order for dental teams to support patients in maintaining good oral health and hygiene. Several mechanisms have been proposed to explain the potential role of oral microbes in the pathogenesis of respiratory infections.
Dental plaque may act as a reservoir for periodontal pathogens that can be directly aspirated into the lungs to cause infection. Researchers also suggest that periodontal disease-associated enzymes may destroy the salivary film that protects against pathogenic bacteria.
Additionally, these enzymes may modify the mucosal surfaces of the respiratory tract, promoting the adhesion and colonisation of respiratory pathogens that can be aspirated into the lungs. Another theory is that cytokines originating from periodontal tissues can alter the respiratory epithelium and promote infection.
Oral colonisation by respiratory pathogens is common in institutionalised patients, especially those admitted to hospital intensive care units and elderly people who are debilitated, hospitalised or in a care home. It is also believed that ageing causes alterations to the immuno-inflammatory status of the periodontal tissue, which in turn contributes to increased susceptibility to periodontitis.
Given that the elderly population is more likely to have poor oral hygiene habits, and to use medications that can have side-effects on the mouth, periodontal disease is recognised as very prevalent amongst this demographic. As a result, the elderly are more vulnerable to respiratory disease.
This is of significant concern given that pneumonia and COPD are leading causes of death in the UK. However, COVID-19’s impact on the respiratory system provides even greater cause for alarm, especially as a recent study suggests oral bacteria can affect the function of the lungs, increasing the risk of pneumonia and potentially life-threatening, COVID-19-related pulmonary complications .
These findings underscore the importance of minimising inflammation in the body wherever possible, which is why dental professionals are encouraged to educate patients about reducing the burden of oral bacteria in the mouth through stringent at-home oral care, combined with regular screening and treatment for periodontal disease.
Once diagnosed, periodontal disease can be treated successfully in many cases. The first therapeutic goal is to alter or eliminate the origin of the periodontal pathogens as well as contributing risk factors (e.g., smoking), thereby preventing the progression of the disease and preserving the health of the periodontium.
Secondly, the recurrence of periodontitis must be prevented, particularly through the reinforcement of effective oral hygiene. This should involve interdental cleaning once a day and twice-daily toothbrushing for the recommended two minutes using a fluoride toothpaste and a soft-bristle toothbrush.
To promote maximum patient compliance with oral hygiene instructions, dental professionals may recommend the use of solutions that are ergonomically designed to further facilitate sufficient removal of plaque. Electric toothbrushes, for instance, have demonstrated greater efficacy over manual toothbrushes at reducing plaque and gingivitis.
It is vital that patients understand and appreciate their role in improving their oral health status. After all, the management of periodontal disease is a continuous process of re-assessment and treatment plans can change depending on patient motivation and response to treatment.
The first non-surgical step involves scaling and root planing involving hand instruments such as periodontal scalers and curettes, as well as sonic or ultrasonic equipment, although use of the latter may be limited under the COVID-19 working conditions in current practice.
Supplemental treatment may comprise of an antiseptic mouth rinse and medication, either to aid the healing process or further control the bacterial infection. In more severe cases of periodontitis, patients may respond more favourably to surgical therapy.
There’s no doubt that research regarding periodontal disease’s impact on the respiratory system is compelling, particularly more so under a health climate that focused on protecting elderly and immunocompromised individuals from COVID-19.
In an ideal world dental teams and allied healthcare professionals must adopt a collaborative and co-ordinated approach in the treatment of patients, especially if systemic diseases are present. The benefits of controlling periodontal disease are two-fold – the microbial burden in the mouth is reduced for improved oral health, therefore minimising the inflammation and exacerbation of respiratory conditions.
Dr Nikhil Sisodia graduated from Bristol University in 1995 and after spending a year as a Senior House Officer in Restorative Dentistry and several years in general practice in London, Nik went into partnership with Martin and together they created Ten Dental+Facial.
Alongside his implant practice, Nik is a mentor for the Association of Dental Implantology, a study club director for the International Team in Implantology and teaches on the Implant Restoration Course. He is also a key opinion leader for Dentsply Implants, assisting them in testing the viability and efficacy of their new products.
He adds: “For additional support in managing periodontally compromised patients, clinicians can always refer to Ten Dental+Facial. Our multi award-winning team includes periodontists with extensive experience in treating both simple and advanced cases. For more information visit www.tendental.com.”
1] Molayem, S. and Pontes, C. C. (2020) The Mouth-COVID Connection: Il-6 Levels in Periodontal Disease – Potential Role in COVID-19-Related Respiratory Complications. Journal of California Dental Association. 48(10): 1. DOI: 10.35481/jcda-48-10-01.