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Periodontitis and the general-specific approach: a clinical case

The association between periodontitis and systemic diseases

The association between periodontitis and specific systemic diseases, some of which are prevalent in women, leads the medical community more and more towards the so-called “gender medicine”, which aims at providing a better and more holistic management of women’s health.

Periodontitis can be defined as the result of an inflammatory response by the organism to a bacterial infection that has generated in the periodontal tissues, or in other words those supporting the tooth. The progression of periodontitis and its seriousness depend on the balance between the aggressiveness of the subgingival bacteria and the immunitary response of the affected individual. To these, we must also add the genetic and epigenetic contexts and, of course, even environmental factors such as gender, age, smoking habits, and oral hygiene. At any rate, what seems to be clear is that the presence of pathogenic bacteria in periodontal lesions is correlated to several systemic disorders, such as:

  • Cancer
  • Diabetes mellitus
  • Rheumatoid arthritis
  • Cardiovascular disorders
  • Infertility
  • Deliveries with adverse outcomes


Periodontitis: women are more affected than men

On a statistical basis, and according to a recent study[1] carried out on about 3,000 patients, it emerges that periodontitis affects more women than men, with a ratio of 3:2. Moreover, medical literature supports the evidence that a correlation exists between periodontitis and female puberty, menstruation, pregnancy, menopause and the use of oral contraceptives.

To fully understand this association, it is important to remember the physiological changes of the female body linked with age, estrogen and progesterone levels, tissue distribution of the relative receptors, and hormonal metabolism. In particular, the cyclic reduction of sexual hormone levels, which induces an increase of vasodilation and of capillary permeability, makes women transiently more susceptible to periodontitis and increased levels of progesterone are associated with alterations of the bacterial flora, specifically with an increase of Gram negative anaerobic bacteria.

Gingival problems are also related to oral contraceptives, even if this varies subjectively. Finally, menopause and the consequent decrease in the levels of circulating progesterone and estrogen often determines the insurgence of oral problems, as well as of osteoporosis and relapses of periodontal disease (or worsening of a pre-existing condition).


The clinical case: aggressive periodontitis in a young breastfeeding woman

Let’s now analyze a clinical case of a young 26-year-old woman, primigravida, who breastfeeds, and is affected by an aggressive form of periodontitis that manifests itself with spontaneous bleeding, suppuration, and a generalized dental mobility.

Hereby, we find:

  • A DEXA, showing severe osteopenia at the femoral head and osteoporosis at the spinal column
  • The microbiological analysis during the preoperative stage and at 32 months
  • A comparison of the periodontal records at the preoperative stage and at 32 months
  • A comparative analysis of the three-dimensional X-ray images, showing the severe lesions to molars 17 and 27 and an inflammatory situation at the level of the maxillary sinus due to the penetration of periodontal pathogens in the antral cavity.

It is essential to note how, after 32 months, the resolution of the infection is accompanied by the reconstruction of the periodontal architecture of elements 17 and 27 as well as to a substantial disappearance of the images attributable to maxillary sinusitis.


In conclusion

Oral bacteria can favour the development of systemic diseases in two ways: the systemic spreading of oral sites towards the distal tissues and the promotion of local inflammatory phenomenons; and the systemic chronic inflammation induced by the bacteremia of the inflammatory cytokines produced in the periodontal lesions and which has spread into the organism’s circulation.

In particular, it is evermore important to consider the epidemiology and the progression of the diseases following a generic-specific approach. In many specific systemic disorders of women, he implication of the periodontal disease is an indicator of the need of a common effort by all medicine professionals for a more targeted and holistic management of women’s health.

[1] Martelli FS, Fanti E, Rosati C, et al. Long-term efficacy of microbiology-driven periodontal laser-assisted therapy. Eur J Clin Microbiol Infect Dis 2016;35(3):423- 431.

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