Factor In Periodontal Disease Research Articles

The Role of Interleukin 6 in Periodontitis and Its Complications.

Interleukin 6 (IL-6) is a pleomorphic pro-inflammatory cytokine that is strongly associated with local as well as systemic inflammatory processes. Its role in physiological and pathogenic processes throughout the human body has been the subject of numerous studies in recent years. Measurements of the IL-6 levels in gingival crevicular fluid (GFC), as well as in serum, can be important diagnostic and prognostic factors in periodontal diseases (PD) and in assessing their impact on a range of related inflammatory diseases. This narrative review explores the significant role of IL-6 in patients with periodontitis and its association with other widespread inflammatory pathologies.

Periodontal Disease and Its Genetic Link – A Review

This era of modern technology has opened up various routes for improvement and detection of the root cause of diseases. Many studies regarding periodontal disease and their relation with genetics have been conducted which clearly show that large number of genes play a predisposing and progressing factors in periodontal disease. Thus, this review article aim to enlight the genetic risk factors and their influence on periodontal disease.

Current status and factors of periodontal disease among Japanese high school students: a cross-sectional study

IntroductionThis study aimed to investigate the prevalence of periodontal disease and the factors of the disease among high school students.MethodThe participants were all students aged 15–18 years (n = 1202) at a high school in Japan. The data on oral health perceptions and behaviours were collected by a questionnaire survey. The prevalence of periodontal disease among them was investigated with the partial community periodontal index (PCPI). A logistic regression analysis was used to identify the factors associated with the PCPI.ResultsA total of 1069 students (88.9%) participated in this study. The prevalence of gingival bleeding, calculus, pocket depth of 4–5 mm, and pocket depth of 6 mm or more were 44.2%, 42.2%, 11.4%, and 1.6%, respectively. Approximately one-third of the students had a fear of dental treatment, and only 28.4% used dental floss. The results of logistic regression analysis, adjusted for sex and school year, showed that not visiting dentists regularly, not using dental floss, brushing teeth for less than 5 min, fear of dental treatment, and drinking sports drinks frequently were positively associated with periodontal conditions.ConclusionThis study identified a high prevalence of periodontal disease among Japanese high school students aged 15–18 years and its risk factors, such as poor oral health behaviours and fear of dental treatment.

Microbial β-glucuronidases drive human periodontal disease etiology.

Periodontitis is a chronic inflammatory disease associated with persistent oral microbial dysbiosis. The human β-glucuronidase (GUS) degrades constituents of the periodontium and is used as a biomarker for periodontitis severity. However, the human microbiome also encodes GUS enzymes, and the role of these factors in periodontal disease is poorly understood. Here, we define the 53 unique GUSs in the human oral microbiome and examine diverse GUS orthologs from periodontitis-associated pathogens. Oral bacterial GUS enzymes are more efficient polysaccharide degraders and processers of biomarker substrates than the human enzyme, particularly at pHs associated with disease progression. Using a microbial GUS-selective inhibitor, we show that GUS activity is reduced in clinical samples obtained from individuals with untreated periodontitis and that the degree of inhibition correlates with disease severity. Together, these results establish oral GUS activity as a biomarker that captures both host and microbial contributions to periodontitis, facilitating more efficient clinical monitoring and treatment paradigms for this common inflammatory disease.

Expression Pattern and Value of Brain-Derived Neurotrophic Factor in Periodontitis

BackgroundPeriodontitis is a common human disease with an increasing incidence. Brain-derived neurotrophic factor (BDNF) is known to play a crucial role in the regeneration of periodontal tissue; however, the expression, methylation level, molecular function, and clinical value of BDNF in periodontitis require further investigation. This study aimed to investigate the expression and potential functions of BDNF in periodontitis. MethodsRNA expression and methylation data were obtained from the Gene Expression Omnibus (GEO) database, and the expression and methylation levels of BDNF were compared between periodontitis and normal tissues. In addition, bioinformatics analysis was performed to investigate the downstream molecular functions of BDNF. Finally, Reverse transcription Quantitative real-time polymerase chain reaction was performed to determine the level of BDNF expression in periodontitis and normal tissues. ResultsGEO database analysis revealed that BDNF was hypermethylated in periodontitis tissues and that its expression was downregulated. Reverse transcription Quantitative real-time polymerase chain reaction confirmed that BDNF expression was downregulated in periodontitis tissues. Several genes that interact with BDNF were determined using a protein–protein interaction network. Functional analysis of BDNF revealed that it was enriched in the Gene Ontology terms cytoplasmic dynein complex, glutathione transferase activity, and glycoside metabolic process. Kyoto Encyclopedia of Genes and Genomes analysis suggested that BDNF was associated with the mechanistic target of rapamycin signaling pathway, fatty acid metabolism, the Janus kinase-signal transducer and activator of transcription signaling pathway, glutathione metabolism, and others. Furthermore, the level of BDNF expression was correlated with the immune infiltration degree of B cells and CD4+ T cells. ConclusionsThis study shown that BDNF was hypermethylated and downregulated in periodontitis tissues, which could be a biomarker and treatment target of periodontitis.

Combined use of antimicrobial medication and physical therapeutic factors in periodontitis

Metronidazole-based preparations are widespread in periodontal practice among those with antibacterial action. However, recently, reports are increasing about the resistance of pathogenic microorganisms to metronidazole. The treatment of this problem is facilitated by the combined effect of metronidazole and physical therapeutic factors, which can ensure the delivery of the antimicrobial agent to periodontal tissues and its deposition. The efficacy of Metrogil Dent gel ultraphonophoresis with low-frequency ultrasound and Metrogil electrophoresis in the treatment of periodontitis has been proven. However, no information is available in the literature about the comparative effectiveness of ultraphonophoresis and electrophoresis of metronidazole-based preparations in the complex treatment of periodontitis, which is of scientific and practical interest.

Risk Characteristics of Peri-Implant Infections: A Retrospective Evaluation in a University Consultation Setting

Peri-implantitis is a common biological complication in dentistry. The aim of the present study was to retrospectively analyze risk characteristics in a group of patients referred to a university-based consultation for peri-implantitis. In all, 190 initial cases from 2010 to 2019 were evaluated and descriptively summarized. The evaluation included various parameters such as periodontitis, smoking and oral hygiene status, implant position, type of prosthetic restoration and retention, mucosal quality, and further anamnestic and clinical findings related to the potential risk of developing peri-implantitis. Peri-implantitis was diagnosed in 83% of the cases, with peri-implant mucositis alone in 16% of cases; furthermore, 38% of the patients were diagnosed with active/instable periodontitis, while 14% had stable periodontitis. Residual cement was considered as a potential co-factor of peri-implant inflammation in 43% of cases. Suboptimal implant positioning was found in 19% of patients. Peri-implantitis or peri-implant mucositis was present in about one-third of patients in the absence of smoking and periodontitis factors. Of note, 6% showed no identifiable risk factors. Factors related to an increased risk of peri-implantitis should be taken into consideration when planning implant treatment. Adequate prosthetic implant position, restoration, and cleanability remain important for long-term success.

Detection of gingipain activity using solid state nanopore sensors

Accurate, robust, and rapid diagnostics is the basis for all well-functioning healthcare. There is a large need in point-of-care biosensors to facilitate diagnosis and reduce the need for cumbersome laboratory equipment. Proteases are key virulence factors in periodontitis. Periodontal disease is very common and characterized by inflammation and infection in the tooth-supporting structures and is linked to many systemic diseases such as cardiovascular disease, diabetes, and Alzheimer’s disease. Proteases present in periodontal disease, gingipains, are highly responsible for the disease onset and progression and are therefore a promising biomarker. Here we show a novel nanopore-based biosensor strategy for protease activity monitoring. Solid-state nanopores were modified with a proteolytic substrate, restricting the ionic current through the apertures of the nanopores. Protease can digest the proteolytic substrate thus enlarge the aperture and the ionic current. Trypsin was used as an initial model protease to investigate the performance of the sensor. We show that the solid-state nanopore-biosensor can detect trypsin with a limit of detection (LOD) of 0.005 ng/mL (0.2 pM). The detection system developed for the model enzyme was then applied to the detection of gingipains. The LOD for detection of gingipains was 1 ng/mL (0.02 nM), with a 27% recovery of the signal at 0.1 µg/mL, indicating that the sensitivity and dynamic range are relevant for the clinical diagnosis of periodontitis. The generic detection of protease activity and high sensitivity make this a promising sensor technology for both diagnosis of periodontal disease and monitoring of other disease-related proteases.

Prevalence and correlates of periodontitis among Kenyan women planning to conceive

BackgroundPeriodontitis has been associated with adverse pregnancy outcomes. Little is known about the burden and risk factors for periodontitis among reproductive age women in sub-Saharan Africa. This analysis aimed to determine the prevalence and correlates of periodontitis among Kenyan women planning to conceive.MethodsHIV-seronegative, reproductive-age women who were planning to conceive were enrolled and underwent a periodontal examination. Following the US Centers for Disease Control and Prevention clinical case definitions, the presence and severity of periodontitis was determined by establishing the level of clinical periodontal attachment loss and graded in three categories: no/mild, moderate, and severe. Secondary outcomes included the scores on the Gingival Index and Decayed, Missing, and Filled Teeth (DMFT) Index. Correlates of periodontitis were examined using univariable and multivariable logistic regression.ResultsOf the 647 women in the study, 84% (n = 541) had no/mild periodontitis, 15% (n = 97) had moderate periodontitis, and 1% (n = 9) had severe periodontitis. Mild gingivitis was present in 61% (n = 396) of women, while 27% (n = 176) had moderate gingivitis, and 1% (n = 9) had severe gingivitis. The majority (75%, n = 487) of women had a DMFT index in the very low range (score < 5). Periodontitis was observed in 12% (12/101) of nulliparous women compared to 13% (36/286) of women with one prior delivery (prevalence ratio [PR] 1.03, 95% confidence interval [95% CI] 0.57–1.96), 21% (36/170) of women with two prior deliveries (PR 1.78, 95% CI 0.97–3.26), and 24% (22/90) of women with 3 or more prior deliveries (PR 2.06, 95% CI 1.08–3.92).ConclusionThis study demonstrated a substantial prevalence of moderate-severe periodontitis among women planning to conceive in Kenya. These results highlight the need to address the oral care needs of reproductive age women, particularly those with multiple prior pregnancies.

Індексна оцінка стану тканин пародонта у хворих з атеросклерозом

The purpose of the study was to assess the condition of periodontal tissues using periodontal indices in patients with generalized periodontitis on the background of atherosclerosis. Materials and methods. In the course of the dental study, we examined 232 patients (202 – patients with generalized periodontitis on the background of atherosclerosis (main group), and 30 patients with generalized periodontitis without somatic diseases (control group), aged 45-65 years, with a percentage ratio of men to women 65.5% and 34.5%, respectively. To establish the diagnosis (generalized periodontitis) the classification of periodontal tissue diseases edited by Danilevsky M. F. was used. Index assessment of periodontal tissue was determined using: papillary-marginal-alveolar index (Massler M., 1949, modified by Parma), periodontal index (Russel A. L., 1956), gingiva bleeding index (Muhlemann H. R., Mazor A. S., 1958, Cowell I., 1975). The loss of epithelial attachment was measured with a graduated probe and expressed in millimetres: the condition of the furcation of multi-rooted teeth was assessed in the horizontal direction by the method of Hemp, in the vertical – by the method of Tarnow-Fletcher. To study the degree and nature of resorption of the interalveolar septa of the bone of the alveolar processes, X-ray examination was performed using panoramic radiography and evaluated according to the Fuch X-ray index (Rtg). Results and discussion. Analysis of data from the modern literature shows that cardiovascular pathology can be considered as a risk factor for periodontal disease. On the other hand, there is convincing evidence that periodontal disease, in particular, its etiological factor – periodontal pathogens, directly affects the occurrence of changes in the cardiovascular system. This relationship is also evidenced by some epidemiological studies. According to Tonetti M. S., the connection between atherosclerosis and periodontal pathology is confirmed by the presence of common risk factors, in particular, generalized periodontitis induces systemic inflammation, which leads to the development of endothelial dysfunction, which is considered the basis of the pathogenesis of atherosclerosis. It was found that in patients with generalized periodontitis on the background of atherosclerosis, the average value of the papillary-marginal-alveolar index was 53.23±2.87%, p &lt;0.05, and the Muellemann-Cowell index (gingiva bleeding index) was 2.53±0.25 points, p &gt;0.05, which was by 1.2 times higher than the values in patients with generalized periodontitis without somatic diseases (44.27±2.57% and 2.10±0.29 points, respectively). In the main group, the values of periodontal indices and loss of epithelial attachment were by 1.3 times higher than the values in the comparison group (2.78±0.13 points, and 3.48±0.22 mm, against 2.06±0.09 points, 2.09±0.12 and 2.69±0.19 mm, p &lt;0.05). In this case, the average value of Rtg – recession index of the gums in patients with atherosclerosis did not differ from those in persons without somatic diseases of the comparison group (1.36±0.12 points and 1.43±0.12 points, respectively, p &gt;0.05). Conclusion. Thus, our results indicate a progressive course of generalized periodontitis in patients with atherosclerosis

Periodontitis in First Degree-Relatives of Individuals With Rheumatoid Arthritis: A Short Narrative Review.

Periodontal disease (PD) and rheumatoid arthritis (RA) are chronic inflammatory diseases with a bi-directional relationship. Both share common genetic and environmental risk factors and result in the progressive destruction of bone and connective tissue. First degree relatives of patients with RA (FDR-RA) are one of the at-risk populations for RA. The etiopathogenic mechanisms of their susceptibility are currently being explored, focusing mostly on the role of anti–cyclic citrullinated protein/ peptide antibodies (ACPA) in triggering RA. Oral microbiota and their relation with oral health has been suggested as a factor influencing the risk of the FDR-RA developing RA. In particular, compromised periodontal status often correlates with ACPA seropositivity in FDR-RA. The presence of periodontal pathogens such as Porphyromonas gingivalis, in oral microbiota has been proposed to increase the risk of developing RA through its uniquely expressed peptidyl arginine deiminase (PPAD), capable of citrullinating both host and bacterial peptides. Aggregatibacter actinomycetemcomitans and its leukotoxin A (LtxA), also induces hypercitrullination in host neutrophils. Common risk factors of periodontitis and RA such as genetic predisposition, smoking, higher local and systemic inflammatory burden, are discussed in the literature. Based on those mechanisms periodontal disease seems to be presented as one of the factors triggering RA in FDR-RA. Larger studies evaluating all the potential mechanisms linking RA and periodontitis are needed in FDR-RA to confirm that periodontal disease should be considered in the screening of FDR-RA.

Anti-Inflammatory and Anti-Bacterial Potential of Mulberry Leaf Extract on Oral Microorganisms.

Mulberry leaves extract (Morus alba extracts; MAE) is known to have therapeutic potentials for numerous human diseases, including diabetes, neurological disorders, cardiovascular diseases, and cancers. However, there has not been sufficient research proving therapeutic effects on oral disease and its related oral risk factors. Thus, we investigated whether MAE has any anti-inflammatory and anti-bacterial effects on risk factors causing oral infectious diseases. To examine the anti-inflammatory response and bacterial inhibition of MAE, we measured intracellular reactive oxygen species (ROS) generation, production of pro-inflammatory cytokines, and the bacterial growth rate. Our study showed that MAE has anti-inflammatory activities, which inhibit the ROS generation and suppressed the production of pro-inflammatory cytokines (TNF-α and IL-6) in human monocyte THP-1 cells by stimulating lipopolysaccharide (LPS) and/or F. nucleatum, which are the virulent factors in periodontal diseases. Furthermore, MAE inhibited the bacterial growth on oral microorganisms (F. nucleatum and S. mutans) infected THP-1 cells. These findings suggested that MAE could be a potential natural source for therapeutic drugs in oral infectious disease.

Effect of smoking and dental fluorosis as environmental risk factors in periodontal disease — An observational study

To assess the periodontal status of smokers and non-smokers in dental fluorosis subjects from endemic water fluoride areas of Davangere district, Karnataka. A stratified random sample study (n=338) was performed to obtain an equal number of subjects in tobacco and non-tobacco users. Participants had similar perceived oral health status (including self-reports of bleeding gums, loose teeth, and receding gums) low to medium socioeconomic status, and education. The sample for the present study on the tobacco effect consisted of 338 subjects aged 15-74 years. The periodontal status was assessed by clinical parameters Oral Hygiene Index — Simplified (OHI-S), Jackson’s Fluorosis Index (JFI), Community Periodontal Index Treatment Needs (CPITN). Overall, periodontitis is significantly higher among smokers as compared to non-smokers. Although dental fluorosis is a risk factor compared in relation to age, sex was statistically not significant. OHI-S, JFI, and CPITN show statistical significance among smokers and tobacco chewers. The risk determinants such as age, sex followed by risk factors such as smoking and oral hygiene status for periodontal disease would make no difference from high to low fluoride areas but the current study concept on tobacco use in dental fluorosis subjects is thought-provoking and has to be considered in further studies.

What’s new for the clinician– summaries of recently published papers

Type 2 diabetes mellitus (T2DM) is the most common chronic disease in the Western world and developing countries have also shown an explosion in the incidence and prevalence of this disease. Exercise therapy is essential for the management of diabetes. The American College of Sports Medicine and the American Diabetes Association have recommended at least 150 min/week of moderate (50%-70% of an individual’s maximum heart rate) to vigorous (&gt; 70% of an individual’s maximum heart rate) physical activity for patients with type 2 diabetes (T2DM). Studies including lifestyle and health interventions have shown that they have a positive health effect on patients with T2DM. For example, physical activity has been shown to improve the metabolic condition of T2DM patients, reduce HbA1c levels and cardiovascular mortality, and improve the quality of life, lipid levels, and blood pressure. Diabetes has been identified as an important risk factor for periodontitis. The risk of developing periodontitis and peri-implantitis is significantly increased in patients with diabetes compared to healthy control groups. Wernicke and colleagues (2021)1 reported on a trial that sought to test the hypothesis that physical activity is a health-promoting measure with significant positive effects on periodontal health and HbA1c concentrations.

Comparison of Salivary pH in patients with Prevalence of Periodontitis with and without type 2 diabetes

Background: Diabetes type 2 and periodontitis has bi-directional relationship not only diabetes is a risk factor for periodontitis but periodontitis could have negative effect on glycemic control. Poor glycemic control is associated with reduced salivary pH. Aim: To compare the difference in salivary PH in patients with Periodontitis with or without Diabetes mellitus (Type 2). Method: A total of 348 consenting subjects were recruited for this investigation. There were 116 with diabetes mellitus and periodontitis, 116 with periodontitis but not diabetes and 116 patients with no periodontitis and diabetes. Salivary PH strips were used to determine the PH levels in each participant and recorded. Results: Participants with periodontitis and diabetes had decreased salivary PH of 6.16 ± 0.03 when compared with individuals with periodontitis who were not diabetic who had PH of 6.62 ± 0.04. The mean salivary PH was compared between the three groups (Control, Periodontitis and DM) where a statistically significant relationship was determined (P&lt;0.05). Conclusion: Our study concluded that the salivary PH of patients with DM and periodontitis is lower than that of the control group. The difference in mean PH value between group 1, group 2 and group3 was statistically significant (P&lt;0.05). Keywords: Periodontitis, Diabetes mellitus, salivary PH

Assessment of Vitamin C Levels in Periodontal Patients: A Cross-Sectional Study in Palestine.

Background:Vitamin C is an essential nutrient for the health of gingival and periodontal tissues due to its antioxidant potential.Aim:To assess the levels of vitamin C in different stages and grades of periodontitis.Materials and Methods:The present study follows a cross-sectional study design and was conducted in a private dental clinic in Palestine. The present study involves the collection of serum to assess the vitamin C deficiency in patients with existing periodontal diseases. Mann–Whitney U test was used to compare the difference in the vitamin C levels in various stages and grades of periodontitis. P value <0.05 was considered significant.Results:There was a significantly lower vitamin C level in patients with Stage IV periodontitis as compared to the early stages of periodontitis. However, there was no difference between the other stages of periodontitis.Conclusion:Vitamin C deficiency might be considered as one of the risk factors in periodontitis.

Diabetes Mellitus and Periodontitis: Bidirectional Relationship

Type 2 diabetes mellitus and chronic periodontitis hold a close relationship that has been the focus of many researches. Periodontitis is a common chronic inflammatory disease characterised by destruction of the supporting structures of the teeth. Evidences stated that diabetes is a major risk factor for periodontitis; susceptibility to periodontitis is increased by approximately threefold in people with diabetes. There is a clear relationship between degree of hyperglycaemia and severity of periodontitis. The mechanisms that underpin the links between these two conditions are not completely understood, but involve aspects of immune functioning, neutrophil activity, and cytokine biology. There is emerging evidence to support the existence of a two-way relationship between diabetes and periodontitis, with diabetes increasing the risk for periodontitis, and periodontal inflammation negatively affecting glycaemic control. Oral and periodontal health should be promoted as integral components of diabetes management.

Assessment of Interleukin-1β in Saliva of Smoker and Non-smoker Patients with Chronic Periodontitis.

Background and objectives: Smoking is considered a significant risk factor in periodontitis. The pathogenesis of periodontal disease may be affected by alterations of the inflammatory response by smoke. Interleukin-1 (IL-1β), an effective pro-inflammatory cytokine have been associated with the immunopathology of periodontitis. The aim of this study was to assess the levels of IL-1β in saliva from smokers and non-smokers with chronic periodontitis and periodontally healthy controls. Materials and methods: Gingival index, Plaque index, probing pocket depth, clinical attachment level, bleeding on probing were assessed in 84 subjects who were equally divided in to three groups. group I periodontally healthy non-smoking subjects ; group II non-smokers with chronic periodontitis; group III smokers with chronic periodontitis; Enzyme Linked Immunosorbent Assay (ELISA) test was used for quantification of Interleukin (IL)- 1β in the saliva samples. Statistical analysis were performed with SPSS version 22.0. Results: Interleukin-1β level in saliva was significantly higher in smoker than in nonsmokers with chronic periodontitis and the controls (P˂ 0.001). In subjects with chronic periodontitis, a significant correlation existed between CAL and IL-β (r= 0.313, p= 0.052) among non-smokers; there was also a highly significant positive correlation between, CAL and IL-β (r= 0.310, p= 0.051), BOP and IL-β (r= 0.333, p= 0.05) among smokers. Conclusion: Salivary IL-1β level were significantly elevated in periodontitis patients. Smokers with chronic periodontitis exhibited a highly significant increase in salivary IL-1β levels. Hence, this reflects the impact of smoking on immune response and its role in the pathogenesis of periodontal disease.

Features of local etiological factors of periodontal disease in residents of high latitudes

Aim. The purpose of the article is to determine specific regional risk factors for periodontal diseases in residents of the North-East of Russia on a complex clinical and physiological research.Materials and methods. A clinical study of the biophysical properties and composition of oral fluid (salivation rate, pH, viscosity, microcrystallization type, lysozyme activity) in the adult population with inflammatory periodontal diseases were done at dental clinic of the Medical Institute of M.K.Ammosov North-Eastern Federal University, dental clinic "Valeon" and clinical and diagnostic laboratory "Scientific and Practical Center of Phthisiatry" (Yakutsk). A total of 1012 individuals aged 15-19 years old (n = 248) and 35-44 years old (n = 764) were examined. Oral hygiene in the age groups was assessed by the Oral Hygiene Index according to J.C. Green and J.R. Vermillion (1964). In addition, social and hygienic status was assessed according Yu. V.Chizhov's method (2005). Statistical processing was carried out using the SPSS software package, version 22. The research was performed in accordance with the principles and rules of evidence-based medicine.Results. The obtained results determine quantitative and qualitative changes in oral fluid properties. The presence of biological risk factors associated with changes in the composition and properties of the oral fluid, as well as a low sanitary level, which are associated with viscosity increase, salivation rate decrease, a predominance of II and III types of microcrystallization, acidic pH level, a decrease in the level of lysozyme activity, were revealed. The identified risk factors have an impact on the prevalence of periodontal disease in the people of the North and mostly determine their clinical course.Conclusion. The revealed biophysical features of oral fluid in the examined adolescents and adult population of the North-East of Russia are specific regional local risk factors for the development of periodontitis, which must be taken into account when improving the therapeutic and preventive measures of pathological processes of periodontal tissues.

Periodontal Disease: The Good, The Bad, and The Unknown.

Periodontal disease is classically characterized by progressive destruction of the soft and hard tissues of the periodontal complex, mediated by an interplay between dysbiotic microbial communities and aberrant immune responses within gingival and periodontal tissues. Putative periodontal pathogens are enriched as the resident oral microbiota becomes dysbiotic and inflammatory responses evoke tissue destruction, thus inducing an unremitting positive feedback loop of proteolysis, inflammation, and enrichment for periodontal pathogens. Keystone microbial pathogens and sustained gingival inflammation are critical to periodontal disease progression. However, recent studies have revealed the importance of previously unidentified microbes involved in disease progression, including various viruses, phages and bacterial species. Moreover, newly identified immunological and genetic mechanisms, as well as environmental host factors, including diet and lifestyle, have been discerned in recent years as further contributory factors in periodontitis. These factors have collectively expanded the established narrative of periodontal disease progression. In line with this, new ideologies related to maintaining periodontal health and treating existing disease have been explored, such as the application of oral probiotics, to limit and attenuate disease progression. The role of systemic host pathologies, such as autoimmune disorders and diabetes, in periodontal disease pathogenesis has been well noted. Recent studies have additionally identified the reciprocated importance of periodontal disease in potentiating systemic disease states at distal sites, such as in Alzheimer’s disease, inflammatory bowel diseases, and oral cancer, further highlighting the importance of the oral cavity in systemic health. Here we review long-standing knowledge of periodontal disease progression while integrating novel research concepts that have broadened our understanding of periodontal health and disease. Further, we delve into innovative hypotheses that may evolve to address significant gaps in the foundational knowledge of periodontal disease.