Periodontal Disease and Overall Health: A Clinician's Guide

52 Periodontal Disease and Overall Health: A Clinician's Guidehigh-risk groups because, according toWilliams 45 and colleagues, these groupscan provide more immediate answers thanstudies with a more heterogeneous diabeticpopulation.Respiratory InfectionsScannapieco 56 describes four possiblemechanisms of the presence of oral bacteriain the pathogenesis of respiratory infections:1. The oral cavity might be a reservoirfor micro-organisms that contaminatesaliva and is then aspirated into thelungs.2. Periodontal disease-associated enzymesin saliva may facilitate theadherence of respiratory pathogensin the mucosal surfaces.3. Periodontal disease-associated enzymesmay destroy protective salivarypellicles, resulting in fewernonspecific host defense mechanismsin high-risk patients.4. Cytokines and other molecules originatingfrom untreated periodontaltissues are continuously released insaliva. Aspiration of these may alterrespiratory epithelium and promoterespiratory pathogen colonization.A systematic review published in 2006by Azarpazhooh and Leake investigated evidencefor a possible etiological associationbetween oral health and pneumonia or otherrespiratory diseases. 57 They concluded thatthere is fair evidence of an association ofpneumonia with oral health, and poor evidenceof an association of chronic obstructivepulmonary disease with oral health.Additionally, there is good evidence thatimplementation of high-quality and frequentoral healthcare decreases the occurrence andprogression of respiratory diseases amongelderly hospitalized or institutionalizedindividuals. 57There is a need for large-scale prospectiveintervention studies targeting high-riskpeople of the community, nursing homes,and intensive care units.OsteoporosisOver the last decade, it has been specu -lated that by decreasing the patient’s alveolarbone mass, osteoporosis makes teeth moresusceptible to resorption by the periodontalinflammatory reaction. Human studies haveaddressed this relationship, and several largescalestudies showed there is an associationbetween osteoporosis and reduced alveolarcrestal height in postmenopausal women. 58In another study, osteoporosis and perio -dontal infection were found to be independentrisk factors for oral bone loss. 59 Otherstudies, especially longitudinal studies, arenecessary to determine the temporal natureof this relationship and to further evaluate it.Some studies investigated the effect ofhormone replacement therapy or vitamin Dintake on tooth loss. 60 In almost all studies,there was a positive correlation between thenumber of teeth retained and medical treatment,but it must be kept in mind that confoundingfactors such as age, smoking, socio -economic status, and many others may haveaffected the results. 40There is a need for large-scale pro s-pec tive studies with as many confoundingfactors as possible to be factored into theseinvestigations.CONCLUSIONSThere is a long-standing and wellacceptedprinciple that good oral health is anintegral component of good general health.In recent years, there has been an attempt totie oral conditions to systemic diseases in acausal relationship, but existing data supportonly an association. Evidence for this relationshipis growing, and a scientifically basedunderstanding of how oral health may posea risk for certain systemic diseases is developing.Certain linkages are stronger thanothers, but until there are a number of well-