Periodontal inflammation indices in association to systemic diseases

Periodontitis is a multifactorial inflammatory disease that has been associated with several systemic inflammatory conditions. Periodontal inflammation indices are quantitative tools used to estimate the inflammatory burden of periodontitis and its potential systemic relevance. The aim of this review was to summarise and critically evaluate the current evidence on periodontal inflammation indices as connecting factors between periodontitis and systemic inflammatory diseases, and to assess their responsiveness to periodontal and systemic therapy.

This narrative review included intervention studies investigating patients with both periodontitis and systemic inflammatory diseases by monitoring the inflammatory status using a periodontal inflammation index. Relevant studies were identified through systematic searches across major electronic databases.

The available evidence is limited and methodologically heterogeneous. Most studies focused on periodontal-inflamed-surface-area (PISA). Intervention studies using PISA have been reported in relation to diabetes mellitus, cardiovascular disease, rheumatoid arthritis, and chronic kidney disease. Several studies indicate that reductions in periodontal inflammatory burden following periodontal or systemic therapy may be accompanied by improvements in selected systemic inflammatory or disease-related parameters. However, these findings are inconsistent and often limited by small sample sizes, short follow-up periods, and inadequate control of confounding factors.

While periodontal inflammation indices provide a biologically plausible framework for quantifying inflammatory burden, the bidirectional relationship between periodontal and systemic inflammation, as well as the long-term impact of therapeutic interventions, remains incompletely understood.

Periodontal inflammation indices may support the assessment of periodontitis as a contributor to systemic inflammatory burden. Although high-quality evidence is limited, periodontal therapy may represent a non-pharmacological adjunct in the management of certain systemic inflammatory diseases. Consequently, it may be worthwhile for various medical disciplines, researchers, and professional organisations to engage in comprehensive discourse and issue official statements concerning periodontal therapy as a primary and secondary prevention for systemic diseases.