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1.
Introduction
Periodontal diseases, which include gingivitis (where the inflammation is confined to the gingiva and is reversible with dental care) and periodontitis (where the inflammation spreads, and results in tissue destruction and alveolar bone resorption), are the most common types of disease in humans worldwide (1). Tissue destruction, such as the breakdown of the collagen fibres of the periodontal ligament (PDL) and the loss of gingival tissue and alveolar bone, are characteristic of periodontitis, resulting in gradual weakening of the tooth-supporting tissues, which eventually leads to tooth loss. The condition is widespread. Severe periodontitis that threatens tooth retention affects 10–15% of adults in the majority of populations investigated and ranged from 1%, among 20- to 29-year-old, to 39%, among individuals >65-year-old while moderate periodontitis affects 40–60% of adults in all populations (2). Therefore, periodontitis is a highly prevalent, chronic inflammatory disease, which has negative and profound impacts on many aspects of daily life (3).
2.Associations between systemic diseases and periodontitis
Periodontitis has been a controversial point of interest due to the identification of correlations between it and metabolic syndrome (MS). MS is a condition, which constitutes a group of risk factors that occur together and increase the risk for coronary artery disease, stroke and type 2 diabetes mellitus (DM) (4).
Important investigations into the underlying mechanisms linking periodontitis to systemic disorders have ensued, resulting in the development of a novel branch of periodontics termed ‘periodontal medicine’ (5). Since the first report of the association between periodontitis and systematic diseases, there have been constant novel discoveries. Along with five other complications (diabetic cardio-cerebrovascular disease, diabetic nephropathy, diabetic eye disease, diabetic neuropathy and diabetic sexual dysfunction) periodontal disease has been labeled as the sixth complication of diabetes (6). Thus, periodontitis and diabetes appear to interact. Clinical evidence provides strong support to the statement that periodontal infection contributes to the worsening of glycaemic control in individuals with diabetes (7). Respiratory disease and chronic obstructive pulmonary disease are other systemic disorders ranking the third and sixth most common causes of mortality worldwide in 1990, causing 4.3 and 2.2 million mortalities, respectively (8) and a cross-sectional study suggested that chronic obstructive pulmonary disease may be associated with severe periodontitis (2). The teeth and periodontium may serve as a...