1. Periodontitis is an inflammatory disease and each individual produces a unique immune-inflammatory response profile to bacterial challenge. Inflammation is an essential homeostatic response but prolonged or excessive inflammation leads to tissue damage or disease.
2. Plaque drives the inflammatory process but there may be more to the story as plaque control doesn’t always limit the disease. Susceptibility may be independent of plaque.
3. The mouth should not be viewed in isolation from the rest of the body.
4. The association between dental and systemic health was suggested as early as the 1876.
5. Periodontitis has a significant impact on the life of an individual and may cause psychological disability, social disability, physical disability and a sense of regret (O’Dowd 2010).
6. Possible mechanisms linking periodontitis and cardiovascular disease – direct effect of oral bacteria affecting carotid arteries and other blood vessels, inflammatory response in the periodontal tissues resulting in systemic inflammatory responses, genetic susceptibility and shared risk factors.
7. Diabetes – adults with poorly controlled type 2 diabetes had a threefold increased risk of periodontitis compared with adults without diabetes (Tsai 2002). Successful periodontal treatment is associated with an approximate 0.4% reduction in HbA1C level – a clinical equivalent to adding a second drug to a pharmacological regime for diabetics (Simpson 2010).
8. Mechanisms by which periodontitis and diabetes may be related – entry of periodontal bacteria into the circulation, type 2 diabetes is preceded by systemic inflammation resulting in reduced beta cell function and insulin resistance, AGE-RAGE interactions and oxidative stress-mediated pathways provide plausible mechanistic links.
9. A study that interviewed physicians, diabetes specialists and diabetes nurses found that there is generally little/no knowledge about the links between periodontitis and diabetes. Some if the medical professionals expressed real surprise and some gave a defensive response when this was discussed (Bissett 2013). Patients welcome the opportunity to discuss general health in dental practice and dentists enjoyed giving this advice – the main barrier was time (Wright 2014).
10. There is a potential broader role for the dental team in wider healthcare management.

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Periodontology