Clinical Literature Evaluation Supports Correlation Between Oral Health And Systemic Diseases

Abstract

Objective A systematic review of research literature to identify specific pro-inflammatory biomarkers that are elevated and correlate with poor oral health, provide a target for rapid diagnostic testing (RDT) that can help to improve the patient's overall health. Background A wealth of clinical research literature supports the premise that a patient's overall health is related to their oral health. Poor oral hygiene can lead to gum disease, i.e., periodontal disease (PD). There are several systemic and/or chronic diseases (SIDs) that produce elevated levels of inflammatory biomarkers. The hypothesis of this research project is the presence of specific bacterial pathogens and/or elevated biomarkers in the oral cavity are related to one or more SIDs; and early detection via testing of the oral cavity can lead to early detection of such SIDs. Detection of elevated inflammatory biomarkers in body tissues and fluids (e.g., plasma) of patients with PD could lead to development of a clinical point-of-care (POC) testing and earlier preventative treatment. To-date, there has been no systematic evaluation of outcomes from these numerous studies to identify which biomarker(s) should be targeted for a POC testing. Methods Electronic databases (e.g. PubMed, Elsevier, Google scholar) were searched for research articles containing the keywords: periodontal disease, salivary diagnostics, POC testing, systemic inflammatory diseases, and various biomarkers {e.g., IL-6, IL-1, TNF-alpha (TNF-α), and C-reactive protein (CRP)}. The data was collected and analyzed to identify relationships between bacterial pathogens and specific biomarkers present in both PD and SIDs. Results: The positive association between PD and SIDs is evident from bacterial pathogens and biomarkers that are found in biological tissues and body fluids (e.g., saliva, endothelium, brain tissue, bronchoalveolar fluid, and atherosclerotic plaques, and plasma) in inflammatory-related disease states. These diseases include cardiovascular disease, diabetes, rheumatoid arthritis, Alzheimer's disease, and pulmonary disease. The most virulent pathogens present in periodontal disease and various SIDs include: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythensis, and Treponema denticola. Biomarkers found to be elevated in both PD and SIDs include IL-6, IL-1, TNF-α, and CRP. There have been 86 articles evaluated demonstrating the positive relationships between periodontal disease and the following: systemic inflammatory diseases (37/86), bacterial pathogens (14/86), biomarkers (29/86), and salivary diagnostics (6/86). Conclusion This study provides the foundational information to support targeted clinical studies testing this hypothesis in pharmacies, health-fairs, as well as physicians or dentist offices. There is a need for a chair-side point of care (POC) or rapid diagnostic testing (RDT) methodology to be developed for healthcare providers to take the next step towards providing the patient early intervention. The end goal is identifying the best pathogen and/or biomarker for development of a POC in order to narrow the therapeutic gap for many patients with chronic diseases by early detection and preventative care.