Periodontal disease is one of the most common diseases affecting humans and is one of the main causes of tooth loss in adults. More and more scientific research is proving the link between periodontal disease and systemic diseases such as cardiovascular disease, diabetes, strokes, adverse pregnancy outcomes and respiratory infections. The periodontal disease – systemic disease relationship is supported by over 20 years of research from across the globe.

According to Balakesavan  et al:

 the association of periodontal disease with several systemic conditions such as diabetes and atherosclerotic disease is reported to be related to the inflammatory response of periodontal disease. C-reactive protein is an important marker of the inflammatory response and is elevated in subjects with periodontal disease; its levels in peripheral blood are reduced when periodontal disease is treated. Another indication of the systemic inflammatory response associated with periodontal disease is the presence of cytokines, including tumor necrosis factor alpha and interleukins 1 and 6, often found in the circulation of patients with periodontal disease. There are other conditions that also contribute to a systemic inflammatory response including obesity, psoriasis and rheumatoid arthritis along with periodontal disease.  This two way relationship of periodontitis and chronic systemic diseases in turn increase the systemic inflammatory load.

What is Periodontal Disease?

Periodontal disease, also known as gum disease, is an infection of the tissues that surround and support your teeth. It’s primarily caused by poor oral hygiene that allows plaque — a sticky film of bacteria — to build up on the teeth, leading to inflammation in the gums. If left untreated, periodontal disease can cause serious damage to the soft tissue and bone that hold your teeth in place.

There are two main stages of periodontal disease:

1. Gingivitis: This is the earliest stage of gum disease, where the gums become inflamed and bleed easily, especially when brushing or flossing. Gingivitis is often caused by the accumulation of plaque on the teeth. It is usually reversible with proper oral hygiene and professional cleaning.
2. Periodontitis: If gingivitis progresses without treatment, it can develop into periodontitis. In this stage, the infection spreads deeper into the tissues and can lead to the breakdown of the bone and connective tissue that support the teeth. Periodontitis can result in tooth mobility or tooth loss if left untreated. Symptoms of periodontitis can include:
   1. Swollen, red, or bleeding gums.
   1. Bad breath (halitosis).
   1. Gum recession, where the gums pull away from the teeth.
   1. Loose teeth.
   1. Pus between the teeth and gums.
   1. A change in bite or the way teeth fit together.

Causes of Periodontal Disease

The primary cause of periodontal disease is poor oral hygiene, but other factors can contribute to the development of gum disease, including:

1. Smoking or chewing tobacco.
2. Poor nutrition, especially a lack of vitamins, such as vitamin C.
3. Diabetes or uncontrolled blood sugar levels.
4. Certain medications (such as phenytoin for epilepsy or drugs that reduce saliva flow).
5. Genetic factors (some people may be more susceptible to gum disease).
6. Hormonal changes (e.g., during pregnancy, menstruation, or menopause).
7. Medical conditions (such as cardiovascular disease or conditions that lower immunity).
8. Stress, which can make it harder for the body to fight off infection.