Exploring the links

Although the role of oral health in systemic disease has been recognised for over a millennium, the bacteria of the complex microbial biofilm that forms dental plaque and which are the cause of periodontal disease and gingivitis, have only recently been implicated in specific conditions such as coronary heart disease and stroke, or higher risk of preterm low birth-weight babies, and as a risk compounding factor in those with chronic disease such as diabetes, respiratory disorders and osteoporosis.

The aetiological and pathological mechanisms behind these associations remain unknown, although hypotheses such as common susceptibility, systemic inflammation with increased circulating cytokines and mediators, direct infection and cross-reactivity or molecular mimicry between bacterial antigens and self-antigens have all been suggested.

The implication, that control of oral disease is essential in the prevention and risk reduction of systemic conditions, is increasingly recognised and may prove an essential tool in the management of many chronic diseases. Also, many of these associations are two-way, that is, the disease itself is affected by periodontal disease and can in turn affect the oral environment, bacterial populations and oral health.However, further research is core to