REVIEW - Dentistry and internal medicine: from the focal infection theory to the periodontal medicine concept.

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Eur J Intern Med. 2010 Dec;21(6):496-502.

Dentistry and internal medicine: from the focal infection theory to

the periodontal medicine concept.

Pizzo G, Guiglia R, Lo Russo L, Campisi G.

Section of Oral Sciences, University of Palermo, Via del Vespro 129,

90127 Palermo, Italy.

Abstract

During past decades the relationship between dentistry and internal

medicine and especially the concept of the so-called focal infection

theory have long been a matter of debate. The pathogenesis of focal

diseases has been classically attributed to dental pulp pathologies

and periapical infections. Nonetheless, in recent years, their role is

being dismissed while increasing interest is being devoted to the

possible associations between periodontal infection and systemic

diseases. In fact, periodontal pathogens and their products, as well

as inflammatory mediators produced in periodontal tissues, might enter

the bloodstream, causing systemic effects and/or contributing to

systemic diseases. On the basis of this mechanism, chronic

periodontitis has been suggested as a risk factor for cardiovascular

diseases associated with atherosclerosis, bacterial endocarditis,

diabetes mellitus, respiratory disease, preterm delivery, rheumatoid

arthritis, and, recently, osteoporosis, pancreatic cancer, metabolic

syndrome, renal diseases and neurodegenerative diseases such as

Alzheimer's disease. Various hypotheses, including common

susceptibility, systemic inflammation, direct bacterial infection and

cross-reactivity, or molecular mimicry, between bacterial antigens and

self-antigens, have been postulated to explain these relationships. In

this scenario, the association of periodontal disease with systemic

diseases has set the stage for introducing the concept of periodontal

medicine. This narrative review summarizes the evolution of focal

infection theory up to the current pathophysiology of periodontal

disease, and presents an update on the relationships between chronic

periodontitis and systemic diseases.

PMID: 21111933

http://www.ncbi.nlm.nih.gov/pubmed/21111933

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