Periodontitis and Systemic Diseases

Clinical Evidence and Biological Plausibility

Josefine Hirschfeld, Iain L. C. Chapple, Josefine Hirschfeld, Iain L. C. Chapple

• Publisher: Quintessenz Verlag
• Year: 2021
• ISBN:
  9783868675573
• Edition: 1
• Topic: Medicine
• Subtopic: Dentistry

The association between periodontitis and systemic diseases has become a hot topic in recent years. This comprehensive book reviews the clinical evidence and biological plausibility of the many systemic diseases that have been linked to periodontitis. Edited by Dr Josefine Hirschfeld and Prof Iain L.C. Chapple, experts in each field discuss the mechanisms at work, citing the available key literature and clearly summarising current knowledge and understanding of the associations between periodontitis and diabetes mellitus, cardiovascular diseases, chronic kidney disease, inflammatory bowel diseases, rheumatoid arthritis, respiratory diseases, pregnancy and fertility, malignancy, neurodegenerative diseases, stress and depression, and autoimmunity. Each chapter critically appraises the existing evidence, providing comprehensive, contemporary and well-considered insights into the clinical evidence and biological plausibility of each condition, as well as the limitations of existing studies and how these can be overcome in the future. Periodontitis and Systemic Diseases: Clinical Evidence and Biological Plausibility is an indispensable reference for both clinicians and researchers.

Chapter 1

Periodontitis, obesity and diabetes mellitus

Bruno S. Herrera and Filippo Graziani

1.1 Introduction

In the last two decades, researchers have looked more deeply into the association of periodontitis and common major systemic chronic pathologies such as atherosclerosis1, diabetes2, obesity3, and preterm labour4 with adverse pregnancy outcomes5. The rationale of the periodontal-systemic link likely involves two important mechanisms: systemic inflammation and bacteraemia. One of the most important systemic diseases in this field is diabetes mellitus (DM). DM is a group of metabolic diseases characterised by hyperglycaemia due to decrease in insulin secretion, insulin response or both. The chronic hyperglycaemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels6. The vast majority of cases of diabetes fall into two broad aetiopathogenetic categories: type 1 (T1DM) and 2 (T2DM). T1DM is the absolute deficiency of insulin secretion due to autoimmune beta-cell destruction in the pancreas. T2DM develops when there is an abnormally increased resistance to the action of insulin and the body cannot produce enough insulin to overcome the resistance6^,7.

1.1.1 Obesity

Overweight and obesity involve abnormal or excessive fat accumulation that may impair health and are considered major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases and also periodontitis8. Childhood obesity results in the same conditions, with premature onset, or with greater likelihood of developing these diseases as adults. Thus, the economic and psychosocial costs of obesity alone, as well as when coupled with these comorbidities are striking9. According to the World Health Organization (WHO)8, in 2016, more than 1.9 billion adults were overweight and, of these, over 650 million were obese. Worldwide obesity has nearly tripled since 1975 and most of the world’s population live in countries where overweight and obesity kills more people than underweight. This epidemic is far from its resolution, since 41 million children under the age of 5 and over 340 million children and adolescents aged 5 to 19 were overweight or obese in 20168.

Body mass index (BMI, calculated as weight in kg/height in metres²) provides the most useful population-level measure of overweight and obesity. However, it should be considered a rough guide because it may not correspond to the same degree of fatness in different individuals. For adults, the WHO defines overweight as a BMI greater than or equal to 25; and obesity a BMI greater than or equal to 308. Another way to assess this information is to use Z-scores (also known as standard deviation scores). It is obtained by dividing the median weight of the reference person or population by the standard deviation height or age of the reference population. Z-scores are sex-independent, thus permitting the evaluation of children’s growth status by combining sex and age groups (Table 1-1). There are several factors that increase obesity risk, such as parental diet and/or obesity, a sedentary lifestyle, famine exposure, smoking, and alcohol binge drinking and regular high consumption, especially in women9^,13. In addition, to date, over 60 relatively common genetic markers have been implicated in elevated susceptibility to obesity9.

Table 1-1 Common classifications of body weight in adults and children9

Age group		Age	Indicator	Normal weight	Overweight	Obese
Adults		≥ 20 y	BMI (kg/m^2)	18.5–24.99	25.00 to 29.99	≥ 30.00
						Class 1: ≤ 34.99
						Class 2: ≤ 39.99
						Class 3: ≥ 40.00
Children	WHO Multicentre Growth Reference Study Group10	0–60 mo	BMI Z or WH Z	> −2 to ≤ 2 SD. At risk of overweight: > 1 to ≤ 2 SD	> 2 to ≤ 3 SD	> 3 SD
	de Onis et al11 (WHO)	5–19 y	BMI Z	> −2 to ≤ 1 SD	1 to ≤ 2 SD	> 2 SD
	Kuczmarski et al12 (CDC)	2–19 y	BMI percentile	≥ 5th to < 85th	≥ 85th to < 95th	≥ 95th

MI = body mass index; CDC = Centers for Disease Control and Prevention; SD = standard deviation of the optimum weight-for-height; WH = weight-for-height; WHO = World Health Organization; Z = Z-score.

In the USA, a 2005 estimation indicated that obese men are thought to incur an additional US $1152 annually per person in medical spending, while obese women incur over double that. The authors estimate that around US $190 billion per year, approximately 21% of US health care expenditure, is due to treating obesity and obesity-related conditions14. In Europe, a 2008 review of 13 studies in 10 western European countries estimated the obesity-­related health care burden had a relatively conservative upper limit of €10.4 billion annually15^,16.

1.1.2 Diabetes mellitus

Diabetes was first described in the Ebers Papyrus in 1500 BC, when it was called ‘too great emptying of the urine’. At the time, physicians from India observed that the urine from people with diabetes attracted ants and flies, calling it ‘honey urine’. In 1776, the British physiologist Matthew Dobson first described that the sweet-tasting substance in the urine was sugar. However, it was only in the nineteenth century that glycosuria became an accepted diagnostic criterion for diabetes, after Michel Eugène Chevreul observed in 1815 that the sugar found in urine was glucose and after Hermann Von Fehling developed a quantitative test for glucose in urine in 184817. Between 1893 and 1909, several researchers, including Paul Langerhans, observed that insulin deficiency was the factor responsible for the development of diabetes. Prior to its isolation and clinical use in 1922 by Frederick Banting and Charles Best, the only known treatment for diabetes was starvation diets, with not uncommonly death from starvation in some patients with diabetes T2DM17. Regarding oral hypoglycaemic agents, in 1918, C. K. Watanabe observed that guanidine caused hypoglycaemia17. Ten years later, biguanidine, a guanidine-modified molecule, was introduced for treatment of diabetes in Europe17. In 1949, Becton, Dickinson and Company began the production of a standardised insulin syringe designed and approved by the American Diabetes Association (ADA). The standardised syringe reduced dosing ­errors and the associated episodes of hyperglycaemia and hypoglycaemia.

Diabetes impacts more than 415 million people worldwide and two thirds of people with diabetes die of heart disease and stroke18. In addition, the risk for cardiovascular disease mortality is two to four times higher in people with diabetes than in people who do not have diabetes7. Diabetes is a disease that rarely occurs alone. When it is combined with abdominal obesity, high cholesterol and/or high blood pressure, it becomes a cluster of the highest risk factors of heart attack. The combination of these diseases is termed metabolic syndrome (MS), also known as insulin-resistance syndrome or cardiometabolic syndrome. According to the most recent guidelines issued in 2009 by the International Diabetes Federation (IDF), American He...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Preface
• Acknowledgements
• List of authors
• Contents
• Introduction
• 1 Periodontitis, obesity and diabetes mellitus
• 2 Periodontitis and atherosclerotic cardiovascular disease
• 3 Periodontitis and chronic kidney disease
• 4 Periodontitis and inflammatory bowel disease
• 5 Periodontitis and rheumatoid arthritis
• 6 Periodontitis and respiratory diseases
• 7 Periodontitis, pregnancy and fertility
• 8 Periodontitis and malignancy
• 9 Periodontitis and neurodegenerative diseases
• 10 Periodontitis, stress and depression
• 11 Periodontitis and autoimmunity
• Figure source directory
• Backcover